Vet dies from pneumonia in avian flu caseBMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7396.952/h (Published 03 May 2003) Cite this as: BMJ 2003;326:952
The Dutch government has ordered an independent investigation into the rare death of a veterinary surgeon from pneumonia after infection with avian flu virus. Until now the worst effect that this virus has had in infected people has been conjunctivitis.
The National Influenza Centre, part of Rotterdam's Erasmus Medical Centre, has already confirmed that the strain of virus was identical to avian flu virus and not a mutant strain such as the strain that caused deaths during the 1997 outbreak of avian flu in Hong Kong.
The 57 year old vet became ill within days of visiting a poultry farm hit by the current avian flu outbreak that is affecting the Netherlands and Belgium. The same avian flu virus, A/H7N7, that has infected poultry in the region was identified in his lungs. He had no other illness, so avian flu is the likely cause of death.
The outbreak management team has advised everyone who was in close contact with the vet—including doctors and nurses who treated him, pathology staff, and his immediate family—to take the antiviral drug oseltamivir (Tamiflu). The vet himself had not taken any antiviral treatment.
Guidelines issued last month advised people in direct contact with infected poultry—such as farm workers involved in culling or people who live, work, or visit infected farms for long periods—to wear protective clothing and take antiviral treatment. Such people are also being vaccinated against the human flu virus H3, to avoid coinfection.
The Healthcare Inspectorate has now written to all general practitioners repeating the guidelines and advising that oseltamivir can be prescribed up to seven days after the last contact with infected poultry. The National Coordination Centre for Communicable Disease Control is alerting doctors to flu-like symptoms, and agricultural workers have been recruited throughout the Netherlands to deal with the outbreak.
Data from the National Institute of Public Health and the Environment show that since 4 March 332 people have had health problems associated with the outbreak. Of these people 266 had conjunctivitis and 78 tested positive for A/H7N7. Many infected people are believed to be poultry workers who failed to protect themselves adequately.
Albert Osterhaus, professor of virology at the Erasmus Medical Centre, said: “The most important message is that the virus should be regarded as a human pathogen which we have to take seriously. That is why we have implemented a whole package of measures to preventively treat everyone involved in the cull.”
Though deaths from avian flu are rare, Professor Osterhaus warned: “We just do not know how serious the H7N7 virus is, so we have to be very cautious.”