H5N1 Bird Flu Kills 11 Year Old Girl In Cambodia, Father Infected

From a bird’s eye view, the H5N1 avian influenza situation has been very worrying for over a year. And now it’s rather worrying from a human’s eye view as well as a mink’s eye view, an otter’s eye view, a fox’s eye view. The Cambodian Health Ministry has found not just one but two humans infected with the H5N1 bird flu virus with one of the cases ending up in death. These reported human cases along with the continuing spread of this virus among birds around the world and the detection of the virus in minks, otters, and foxes has led a World Health Organization (WHO) official to call the whole situation “worrying.”

You never want to hear a WHO official say the word “worrying” unless it’s something like, “We’re worrying that you have too many different types of cake to choose from on the menu.” Now, in the case of H5N1, “worrying” doesn’t mean “time to panic and hoard toilet paper.” This virus hasn’t yet demonstrated the ability to jump from one human to another human. Such human-to-human transmission would be needed for this virus to potentially cause a pandemic among those who don’t have feathers and regularly wear clothes. This virus, which already has infected over 40 million birds worldwide since October 2021, has been a primarily a threat to those with wings, meaning those who have wings as body parts and not those who have simply ordered wings from a restaurant. Nevertheless, it’s important for humans to keep a close eye on what’s been happening in Cambodia.

These two new cases in Cambodia have become the first reported H5N1 bird flu cases in the country since 2014. The first of these two cases was an 11-year old girl from Cambodia’s rural Prey Veng province, who was diagnosed on Wednesday after a week of high fevers, a cough, and a sore throat. She unfortunately died that same day as tweeted by the Cambodian Government on February 22:

Then, less than two days later, on February 24, the Cambodian Health Ministry reported the second case, the girl’s father:

It’s not yet clear whether transmission between the girl and her father had actually occurred or whether this was a bird-in-hand situation with both of them catching the virus from birds. Four of the 12 humans who have been in close contact with the girl have had flu-like symptoms, based on a report from Fresh News Asia. However, aside from the father, none of them have tested positive for the H5N1 avian virus so far. Authorities in Cambodia have been testing birds in the area too and warning people to avoid touching either dead or sick birds. Of course, there probably aren’t too many situations where authorities will say, “Go ahead and touch dead birds all that you want.”

These two cases from Cambodia mean that there have now been nine human cases of the 2.3.4.4b clade of H5N1 avian influenza that’s been circulating amongst birds. Before the current Cambodia situation, the last reported human infection occurred about a month-and-half ago in the Bolívar province of Ecuador when nine-year-old girl was hospitalized with a severe infection. According to a January 18 WHO report, this girl had been in contact with backyard poultry and started having symptoms on December 25, 2022. Five days later she entered the hospital and was transferred on January 3, 2023, to a pediatric hospital in critical condition. She developed septic shock and required mechanical ventilation due to pneumonia. Other human cases since 2021 have appeared in other China, India, Spain, the U.K., and the U.S.

To date, public health experts have considered the threat of the H5N1 avian influenza virus to humans as low. It’s been more of a fine feathered mess since the virus hasn’t yet demonstrated the ability to consistently bind to and enter cells in the human respiratory tract. Nonetheless, flu viruses have shown over and over again that they can mutate in various ways. The right mutations (or the wrong ones, depending on your perspective) could make the H5N1 avian influenza virus become more of a threat to humans.

There has been a “furry” of H5N1 bird flu cases in some of our fine furred friends such as minks, otters, and foxes. For example, a Rapid Communication published in the journal Eurosurveillance on January 19, 2023, described an outbreak of highly pathogenic avian influenza (HPAI) A(H5N1) on a mink farm in the Galicia region in Spain in October 2022. A significant increase in mink deaths was the first clue to farm workers that something was amiss. While such mammals may seem closer to humans than birds, if you haven’t noticed, minks aren’t exactly the same as humans. They don’t wear Spanx and some of their cells do have some similarities to bird cells. However, samples from the mink outbreak did show the virus to have a mutation in its PB2 gene that was present in the avian-like PB2 gene of the H1N1 flu virus that caused the 2009 pandemic. This mutation could potentially help the virus connect with cells in the airways of humans.

WHO has been worried about what’s been happening with the H5N1 avian influenza virus globally? The answer is apparently yes. A February 24 article in The Guardian by Nicola Davis and agencies, quoted Sylvie Briand, MD, MPH, PhD, Director of the Global Infectious Hazard Preparedness Department at the WHO, as saying, “The global H5N1 situation is worrying given the wide spread of the virus in birds around the world and the increasing reports of cases in mammals including humans.” The quote continued with, “WHO takes the risk from this virus seriously and urges heightened vigilance from all countries.”

Heightened vigilance will be important since you never know when the next pandemic might emerge. After all, the world did get caught with its collective pants down in 2020 with the Covid-19 coronavirus. Now, heightened vigilance doesn’t mean donning a trench coat and sunglasses, peering around the corners of buildings, and looking at every bird suspiciously. It does mean, though, that countries should install and maintain ways of detecting and quickly investigating any unusual cases of the flu. It also means keeping close track of what’s happening among different bird populations such as poultry farms and trying to control the spread of the virus as much as possible. No one wants 2023 to give everyone the bird, the bird flu, that is.