R 130218Z DEC 08
FM AMEMBASSY PHNOM PENH
TO SECSTATE WASHDC 0201
INFO ASEAN REGIONAL FORUM COLLECTIVE
ASEAN PACIFIC ECONOMIC COOPERATION
DEPT OF HHS WASHINGTON DC
CDC ATLANTA GA
USDA FAS WASHDC
DIRAFMIC FT DETRICK MD//MA-1//

UNCLAS PHNOM PENH 000990 
 
 
STATE FOR CA/OCS/ACS, EAP/EX, EAP/MLS, MED 
STATE ALSO FOR OES/PDAS/PCI ASTEWART AND OES/IHA DSINGER 
HHS FOR OGHA STEIGER AND ELVANDER 
CDC FOR NCID COX 
USAID FOR ANE/AA KUNDER, GH/HIDN CARROLL, OFDA LEVY 
BEIJING FOR ESTH - SELIGSOHN AND SHAPIRO 
BANGKOK FOR CDC MALISON AND WETTRICH, USAID FOR BRADSHAW 
JAKARTA FOR NAMRU JONES, USAID KRAMER 
HANOI FOR USAID ZVINAKIS, HHS IADEMARCO AND DENNIS 
VIENTIANE FOR BAUER AND CORWIN 
RANGOON FOR TIDWELL 
 
E.O. 12958: N/A 
TAGS: TBIO KFLU ECON PREL SOCI CASC CB
 
SUBJECT: CAMBODIA - NEW CASE OF AVIAN INFLUENZA 
 
¶1.  Summary: On December 12, 2008, the Cambodian Ministry of Health 
(MOH) reported a new case of laboratory-confirmed H5N1 avian 
influenza (AI) in a 19-year-old male from Kandal Province who also 
worked in Kampong Speu Province. The patient is currently 
hospitalized in Phnom Penh but is clinically stable and improving. 
This patient represents the first evidence of H5N1 disease activity 
in either humans or animals in Cambodia since April 2007. The MOH 
has rapidly assembled an outbreak investigation and response team 
composed of individuals from MOH's Cambodian Communicable Disease 
Control division (CCDC), World Health Organization (WHO), Institut 
Pasteur in Cambodia (IPC), US Naval Medical Research Unit 2 
(NAMRU-2), US Centers for Disease Control and Prevention (CDC), the 
National Veterinary Research Institute (NaVRI), and Food and 
Agriculture Organization (FAO). Human and veterinary Rapid Response 
Teams (RRTs) under CCDC and NaVRI, respectively, have been 
dispatched to the affected provinces to perform contact tracing, 
active surveillance, sample collections, and immediate control 
measures. Interviews of the patient are also ongoing to obtain more 
detailed clinical and epidemiological information. End Summary. 
 
¶2.  On December 2, 2008, the patient presented to a hospital clinic 
in Kandal Province with a 4-day history of fever, cough, sore 
throat, headache, muscle aches, and malaise. On presentation, his 
measured temperature was 39.00C, and he was enrolled in a febrile 
illness study conducted on-site by NAMRU-2. On December 10, 2008, 
respiratory samples collected from the patient tested positive for 
H5 influenza by real time polymerase chain reaction (rt-PCR) at the 
NAMRU-2 laboratory. On December 11, 2008, a sample aliquot was sent 
to the IPC laboratory, and rt-PCR results later that day confirmed 
H5N1 infection. 
 
¶3.  Retrospectively, it was determined that on December 3, 2008, the 
patient was evaluated at Chantrea Clinic in Phnom Penh after his 
clinical condition worsened. He was diagnosed as having possible 
tuberculosis and was subsequently admitted to CENAT Hospital on the 
same day for further evaluation and treatment. On December 11, 2008, 
he was transferred to Calmette Hospital in Phnom Penh, a national AI 
referral hospital, after the diagnosis of H5N1 infection was made. 
 
¶4.  Eleven days prior to his illness onset, the patient had a 
history of defeathering and/or consuming chickens found dead in his 
village. Eight days prior to onset, he traveled to Kampong Speu 
Province to help relatives harvest rice. He remained in Kampong Speu 
Province up until the time of onset, and reported defeathering 
chickens during this interval. It is unclear whether poultry that he 
was exposed to had any signs of illness. H5N1 infection has not yet 
been laboratory-confirmed in animals from or nearby his villages in 
Kandal or Kampong Speu Provinces. No other laboratory-confirmed 
human infections have been reported. Animal and human field 
investigations are ongoing. 
 
RODLEY