On March 24, 2019, a 21-year-old male was admitted in hospital with symptoms of fever and cough. Throat swab sample was sent to National Public Health Laboratory (NPHL) – the National Influenza Center (NIC) of Nepal - to confirm suspected Influenza infection on March 25, 2019, and antiviral medication (Oseltamivir) was started from the same day, provided from Epidemiology and Disease Control Division (EDCD). The patient died in hospital following respiratory complications while undergoing treatment on March 29, 2019.

NPHL confirmed influenza A infection. For identification of the specific subtype, the sample had to be sent to the NIC of Japan which is a WHO Collaborating Center for Influenza. Information on the confirmation regarding Influenza A (H5N1) infection in the patient by the laboratory in Japan was received by EDCD – the national focal point for IHR in Nepal - on April 30, 2019. This is the first reported human case of Influenza A (H5N1) in Nepal. No additional case of infection with this virus has been reported by NPHL since then.

Influenza A (H5N1) virus usually infects birds leading to death. Very rarely this virus spreads from birds to humans. According to World Health Organization (WHO), a total of 860 human cases have been reported since 2003 with more than 50% mortality rate following infection with this virus. Human to human spread of this viral infection has not been substantiated till date.

Follow-up actions by the Ministry of Health & Population (MoHP), Government of Nepal:

1. Information on this event, in line with International Health Regulations (IHR) 2005 needs to be shared by Nepal to other member states through WHO. Hence, the National Focal Point IHR for Nepal has formally reported this event to WHO.

2. MoHP, along with the WHE Teams of the WHO Country Office for Nepal and WHO South East Asia Regional Office, has initiated a detailed case investigation. In collaboration, the Ministry of Agriculture and Livestock Development, WHO, concerned stakeholders (INGO/ NGO), and MoHP will strengthen surveillance, comprehensive epidemiological investigation, and risk assessment for containment of Influenza.

3. Risk communication messages on preventive measures are being disseminated.

Preventive measures

The following preventive measures would reduce the risk of Influenza A (H5N1) Infection:

? Wash hands frequently and properly,

? Take due care of personal hygiene,

? Maintain cleanliness of surroundings,

? Use gloves and masks while handling domestic poultry and other birds,

? Avoid preparing or eating raw or undercooked poultry products,

? Handle raw poultry hygienically and cook all poultry and poultry products (including eggs) thoroughly before eating,

? Keep children away from the dead or sick birds,

? Avoid contact with domestic birds (poultry) that appear ill or have died,

? Avoid contact with high-risk environments such as live/wet poultry/animal markets and poultry farms, and any free-ranging or caged poultry,

? Avoid contact with surfaces that appear to be contaminated with feces from wild or domestic birds,

? Avoid close contact with people with respiratory symptoms (cough, sneezing & cold),

? Travelers returning from areas affected by avian flu outbreak in domestic/wild birds should report to local health services if respiratory symptoms (cough, sneezing & cold) suspecting Avian Influenza.

Do´s & Don’ts for persons experiencing flu like symptoms (fever, cough, malaise, muscle pain, diarrhea):

? Wash hands regularly with proper drying of the hands,

? Cover mouth and nose when coughing or sneezing. If using tissues, dispose of them correctly,

? Self-isolate early if feeling unwell, feverish, and having other symptoms,

? Visit hospital or Contact to doctors immediately, if you experience any flu like symptoms,

? People with direct contact with sick poultry to be vigilant to notice the occurrence of the illness early and seek treatment early,

? Do not take medicines without doctor’s prescriptions,

? Always use masks, goggles, gloves, gown, and cap when near infected patients and always wash hands with soap and water or use hand sanitizer.