India reported its first death from bird flu on July 12, 2021. An eleven-year-old boy from Haryana was diagnosed with avian influenza and succumbed to multi-organ failure. Although the transmission of avian influenza virus (H5Nx) from birds to humans is very rare, its mortality rate is found to be very high.
This is the first recorded avian influenza human death in India this year, and globally over 16 countries have reported cases in humans to the World Health Organisation. India had reported outbreaks of the disease in close to 14 states in the beginning of this year.
The Haryana boy was first diagnosed with acute myeloid leukemia- a type of blood cancer which showed an increase in his white blood cells in June 2021. He was admitted to All India Institute of Medical Sciences (AIIMS), Delhi on July 2, 2021. At the hospital, his disease progressed to be identified as Acute Respiratory Distress Syndrome (ARDS) after he showed signs of pneumonia, shock and febrile neutropenia (fever-induced shocks).
He tested positive for both Influenza A as well as Influenza B but was negative for COVID-19 and other respiratory illnesses. The confirmations only came four days after the boy's death. AIIMS sent his samples to the National Institute of Virology for testing and identifying the virus. The virus strains belonged to the H5 subtype and Type B Victoria lineage.
Haryana's Integrated District Surveillance Programme (IDSP) team is going to conduct an epidemiological survey to ensure that this is an isolated case and not an outbreak in the boy's community or family. Since July 16, 2021, all the doctors, nurses, and support staff that were attending to this child have been kept under observation. None of them have showed any symptoms of influenza so far, shared the Ministry.
What Is Bird Flu?
India reported an outbreak of bird flu in poultry as well as crows in January 2021. The influenza A virus that causes bird flu is categorised as avian because wild birds are natural hosts of this sub-type.
Classified on the basis of the protein on its surface, Influenza A has 18 HA subtypes and 11 NA subtypes. In the case of the boy from Haryana, the NIV could isolate and identify the HA subtype to be of the fifth protein but not the NA protein. Hence, it was shared that the boy was diagnosed with the H5Nx influenza virus. H5N1 is the most rampant Avian Influenza virus.
So far, only H1N1- swine flu and H3N2- which was also first found in pigs, are the Influenza A sub-types known to adversely affect humans.
H5N1 was first recorded in China in 1996 in geese but its first human transmission was reported in 1997 at a outbreak in Hong Kong. While 50 countries have reported poultry being infected by this virus, India along with Bangladesh, China, Egypt, Indonesia, and Vietnam are said to be endemic for the virus.
Considered to be highly pathogenic among birds, the virus is deadly even for birds. Since December 2003, this H5N1 virus has resulted in high mortality in poultry and wild birds in Asia, the Middle East, Europe, and Africa. H5N1 has also been reported in pigs, cats, dogs, tigers, and leopards according to the US Centres of Disease Control and Prevention.
Bird Flu In Humans
As shared earlier, only close to 700 human cases of bird flu have been recorded, yet. However, the mortality rate of human bird flu infections is very high. It is believed that humans who are diagnosed with the H5N1 virus are infected after they have been in prolonged contact of a severely infected or dead bird.
Although human to human transmission is rare, there have been a few cases of outbreaks across Asia and Africa but they have been contained and the communities have recovered. Dr. Randeep Guleria, Director, AIIMS, has asked people to not panic because of the news and emphasised that transmission is rare.
Children between the ages of 10-19 are the ones most at risk of being infected and their mortality rate due to bird flu is higher than the other age groups. Individuals under the age of 40 working with poultry and not taking precautions are susceptible to the virus.
Some signs and symptoms include atypical presentations of fever and diarrhoea before pneumonia, multi-organ failure, encephalitis, and septic shock.
The only way to reduce exposure of the virus to humans is through precautionary measures. People working on poultry farms should wear Personal Protective Equipment (PPE) kits while tackling with infected poultry.
The Food Safety and Standards Authority of India had also released a series of guidelines that should be followed by people consuming poultry when the outbreak was reported in the country.
