Health officials are concerned that resources to detect and deal with bird flu
are inadequate after Cambodia confirmed its first human death caused by the
A fresh outbreak of bird flu in chickens was also
recorded February 7 near the town of Takhmao in Kandal province, 10 kilometers
from Phnom Penh.
Ly Sovann, chief of the Disease Surveillance Bureau of
the Ministry of Health, said attempts to make people aware of the warning signs
of bird flu have fallen short.
"We are trying to get information out to
the villagers via radio, newspaper, any means possible, but we are still not
confident that all people know," said Sovann.
However, the Ministry of
Health insisted the situation was under control and the funding package it
received in February last year was enough for education and surveillance of
Yves Froehlich, of the Food and Agriculture Organization, said
the $1 million provided by international donors a year ago to cope with bird flu
was almost gone.
Donors said they were waiting on an official request
from the government for more funding.
The concerns came days after a
Cambodian woman, Tit Sokhan, 25, was confirmed as the country's first human
victim of avian influenza earlier this month.
Her 14-year-old brother,
Tit Chiang, died from respiratory failure on January 24 but was cremated before
authorities could test him for the virus.
None of the birds tested around
Sokhan's home in Kampot showed positive results for the disease and the dead
woman had little contact with poultry, causing speculation that she contracted
the disease from her brother.
Sokhan died on January 30 in a Vietnamese
Before going to Vietnam, Sokhan's family had become
increasingly worried about her condition and sought help at the Kampong Trach
district health center.
A doctor was unable to identify her illness and
sent her home, suggesting she may have angered the spirits of her grandparents.
Health workers advised her to perform a ceremony to appease the spirits.
When Sokhan failed to recover, she sought treatment in Vietnam, but the
highly pathogenic strain of avian influenza A/H5N1 had spread to her lungs and
she died soon after.
Sokhan is survived by her husband and two young
children. Their mother, Tim Ran, 42, said she did not know about the bird flu
until after her children had died. Ran said she was shocked to learn bird flu
could affect humans.
A week after the death in Kampot, Cambodia's 14th
confirmed outbreak of avian influenza was reported in Prek Russei village,
Ouch You, 58, who owned the infected chickens, reported
the death of 70 birds to the village chief in late January. He thought they had
died from Newcastle disease, a poultry disease that occurs at this time of year
and resembles the symptoms of bird flu.
Ouch You said he didn't know
anything about bird flu until the animal health department officials arrived to
take samples from his remaining chickens. Two tested positive.
two or three dead chickens every morning. I buried them and took the healthy
looking ones to the markets," he said.
He said he now knows more about
the human symptoms, "a bad cough", but he is not completely sure.
Ton, village chief of Prek Russei, said he had been informed about bird flu by
leaflets distributed by the government one month ago. He distributed the
leaflets to villagers, but there were not enough for everyone. Ton said he hoped
word-of-mouth would do the rest.
The World Health Organization and other
international organizations are watching the bird flu situation in Southeast
WHO reports that all available evidence points to an increased
risk of human-to-human transmission of the disease when outbreaks of H5N1
influenza are widespread in poultry, and such an event could mark the start of
an influenza pandemic (see related story, page13).
To date, 29 people
have died in Vietnam, 12 in Thailand, and one in Cambodia from the H5N1 strain
of avian flu since January 2004. Three of these cases, including the death of
Tit Sokhan and her younger brother, are particularly alarming to health experts
as family members appear to have contracted the disease from a relative, not
contact with infected poultry.
There is no vaccine available for the H5N1
Hitoshi Oshitani, head of the WHO for the western pacific based
in Manila, said they have developed a seed virus for vaccine production, which
was distributed to vaccine manufacturers.
Once a vaccine is developed,
clinical trials could take up to two years. An influenza vaccine would need to
be administered to people at least 14 days prior to infection to be effective.
"Even if vaccines are developed, the supply of vaccines is expected to
be very limited, and countries like Cambodia where there is no vaccine
production capacity may not be able to obtain vaccines," Oshitani
Tamilflu (also known by its pharmaceutical name oselta-mivir) is
the primary treatment for bird flu infection, with one dose administered within
48 hours of symptoms.
Ly Sovann said Cambodia has between 300 and 400
doses of Tamilflu in the country.
"There is one dose for one person per
province. The rest is stored in Phnom Penh because there is a shortage and there
is not enough to waste," he said. "Some provinces will get more if there is
suspected human bird flu, for example in Kampot."
Cambodia needs increased funding, surveillance and education if it is to combat
bird flu outbreaks.
"Cambodia doesn't have any experience with human H5N1
infections because they did not have any human cases last year. They still need
some support from WHO and other international organizations," he said.
Sorn San, Head of the National Animal Health and Production
Investigation Centre (NAHPIC) said they did a very good job last year in
educating and training provincial animal health staff.
Productivity Improvement Project trained 5,000 villagers in detection and
identification of bird flu.
San said that each village has one unpaid
animal health worker that villagers can alert.
In response to a bird flu
report, San said each province dispatches three taskforce teams: one to
investigate and take samples, another to collect information and communicate to
back to the government, and one more to disinfect the area and control movement
of poultry between farms and markets.
He said staff was very busy with
"We only have three people in NAHPIC, not enough people to
keep up with [testing] the chickens coming in."