Fatal H5N1 Encephalitis In Edmonton Canada ex-Beijing

Wednesday, January 8, 2014
By Paul Martin

January 8, 2014

Dr. James Talbot, chief medical officer for Alberta, said the person was admitted to hospital on Jan. 1 with high fever and “decreasing CNS consciousness” (meaning extreme lethargy). There was no cough or other signs of respiratory illness, which is usually the case with influenza, but not always with H5N1. Dr. Talbot said the patient died of meningoencephalitis, or swelling of the brain.

The above comments describe the clinical presentation of the first confirmed H5N1 case in the Americas. The patient (female?) developed symptoms on an Air Canada 030 flight from Beijing on December 27. The case is reported export of H5N1 via commercial airline.

The export signals a high level of H5N1 in humans in northern China. However, human avian influenza in China has been dominated by reports of H7N9, including cases reported today in northern China (Ninjing, Jiangsu – see map), southern China (Foshan, Guangdong – see map), and Hong Kong (see map).

Enhanced surveillance in mainland China as well as Taiwan has led to the identification of H6N1, H10N8, H9N2 cases in 2013, but there have been no reports of human cases of H5N1.

The unusual clinical presentation raises concerns that high levels of H5N1 in cases in China are being missed due to a focus on cases with more traditional bird flu symptoms including breathing difficulties and pneumonia.

Aggressive testing of encephalitis cases in Beijing and Toronto would be useful, as would release of complete H5N1 sequences from this case.

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