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On 8 January 2014, the Public Health Agency of Canada reported a confirmed fatal case of avian influenza A (H5N1) in a traveller returning from Beijing, China. The patient had not been outside of Beijing during the trip and had not visited live bird markets or farms. This is the first case to be reported in North America.
The case first exhibited symptoms of fever, headache and malaise aboard a flight from Beijing to Vancouver on 27 December 2013, before boarding a connecting flight from Vancouver to Edmonton, Alberta. The patient was admitted to hospital in Edmonton on 1 January as symptoms worsened and died there on 3 January 2013.
The clinical presentation; fever, malaise and headache, was consistent with meningo-encephalitis and did not involve the respiratory system which is unusual for A (H5N1) infection. Laboratory tests confirmed influenza A (H5N1) infection on 7 January 2013.
The Public Health Agency of Canada is following up two family contacts who travelled together with the patient, who remain well.
The risk to travellers remains low.
Avian influenza A (H5N1) is primarily a disease of birds, and is currently circulating in wild waterfowl, and domestically farmed poultry. Human infection is rare and usually requires close contact with infected birds, and there is no evidence of sustained human-to-human transmission. However, the fatality rate amongst human cases is high (approximately 60%).
Travellers to China and South-East Asia should avoid live poultry markets and any contact with chickens, ducks, wild birds, and their droppings. This reduces the risk of exposure not only to A (H5N1) but also to A (H7N9). Poultry meat and eggs should be well cooked.
WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions.
