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H5N1 avian influenza, Kampot Province, Cambodia.


To the Editor: As a resident in pediatrics with an interest in infectious diseases infectious diseases: see communicable diseases. , I was fascinated by the range and scope of conditions I saw in May and June of 2005 in local children in Kampot Province, a mainly rural area in southeastern Cambodia. This province, near the Vietnamese border, is the epicenter of H5N1 avian influenza avian influenza: see influenza.  in Cambodia, with all 4 known human cases of the disease. All of these documented human cases have been fatal.

While the World Health Organization and the Cambodian Ministry of Health have engaged in public education, the village-level response to a pathogen of potential global importance is evolving. As part of my work in Cambodia, I made numerous information-gathering visits to villages in Kampot Province. Though village elders and health workers had often heard of the "bird flu bird flu: see influenza.
bird flu
 or avian influenza

viral respiratory disease, mainly of birds including poultry and waterbirds but also transmissible to humans.
," most of the villagers I spoke to had not. Many persons did not know whom to contact should their chickens or other birds die. Those who knew about H5N1 influenza told me that, without adequate compensation for culling culling

removal of inferior animals from a group of breeding stock. The removal is premature, i.e. before completion of its life span, disposal of an animal from a herd or other group.
 flocks, little incentive would exist to report bird deaths. In a typical village, chickens, ducks, and pigs intermingled with each other and with humans underneath or around homes on stilts This article is about the poles. For the type of bird, see stilt. For other uses, see Stilts (disambiguation).

Stilts are poles, posts or pillars used to allow a person or structure to stand at a certain distance above the ground.
. General knowledge of infection control practices among villagers was minimal.

The dissemination of information into a rural, agricultural society such as that in the southeast of Cambodia is a difficult task. Many rural inhabitants
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 do not have televisions or radios and may infrequently travel to larger towns. Health workers from international groups, nongovernmental organizations, and the government are often required to travel on foot or motorbike through fields and forests to reach and educate the population. Government health workers lack the personnel and resources to adequately identify and investigate potential cases, and Cambodia has substantially fewer microbiology laboratories than do neighboring Thailand and Vietnam.

Should a pandemic pandemic /pan·dem·ic/ (pan-dem´ik)
1. a widespread epidemic of a disease.

2. widely epidemic.


pan·dem·ic
adj.
Epidemic over a wide geographic area.

n.
 of avian influenza occur, it will almost certainly originate in Southeast Asia. Cambodian and international health organizations have recognized the country's potential key role in propagation of an impending im·pend  
intr.v. im·pend·ed, im·pend·ing, im·pends
1. To be about to occur: Her retirement is impending.

2.
 pandemic agent. However, because of its history and current economic state, Cambodia is less able to respond to the avian influenza threat than its neighbors. In recognition of this fact, the World Health Organization and the Cambodian Ministry of Health have stated that the prevention, control, and identification of avian influenza are national priorities. Additionally, international funds have been flowing into Cambodia to assist with avian H5N1 influenza surveillance and case investigation. Much work remains to be done; we hope that by combining international resources and policy with domestic expertise and effort, Cambodia will mount a successful response against this emerging threat.

Shaun K. Morris, University of Toronto Research at the University of Toronto has been responsible for the world's first electronic heart pacemaker, artificial larynx, single-lung transplant, nerve transplant, artificial pancreas, chemical laser, G-suit, the first practical electron microscope, the first cloning of T-cells, , Toronto, Ontario, Canada

Address for correspondence: Shaun K. Morris, Department of Pediatrics, The Hospital for Sick Children, The University of Toronto, 555 University Ave, Toronto, Ontario M5G1X8, Canada; email: shaun.morris@utoronto.ca
COPYRIGHT 2006 U.S. National Center for Infectious Diseases
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2006, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:LETTERS
Author:Morris, Shaun K.
Publication:Emerging Infectious Diseases
Geographic Code:9CAMB
Date:Jan 1, 2006
Words:481
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