The IDSP State Surveillance Unit of Haryana has initiated an epidemiological investigation into the first documented human case of bird flu in India, an 11-year-old boy who succumbed to the infection at AIIMS recently, the Union Health Ministry said on July 21. The Animal Husbandry Department has not found any suspected cases of bird flu in the area and has enhanced surveillance in a 10 km zone as a precautionary measure.

Further, the epidemiological investigation by the National Centre for Disease Control (NCDC), involving the Animal Husbandry Department and state government surveillance unit, is underway and appropriate public health measures have been instituted. The boy was diagnosed with acute myeloid leukemia (AML) in the Paediatrics Department of AIIMS, Delhi in June. He developed symptoms of fever, cough, coryza, and breathing difficulty, soon after induction therapy for AML. He was diagnosed as AML with febrile neutropenia with pneumonia and shock that progressed to ARDS. He was admitted to AIIMS, New Delhi on July 2. The boy suffered from multi-organ dysfunction and died on July 12, the ministry said in a statement.

The Department of Microbiology, AIIMS received the bronchoalveolar lavage (BAL) for respiratory panel testing on July 7 and July 11. The sample has tested positive for both Influenza A and Influenza B. It was negative for SARS COV-2 and other respiratory viruses. Subtyping for Influenza A remained inconclusive with available reagents for H1N1 and H3N2 at AIIMS. So, the samples were sent to NIV on July 13.

"At NIV, both the samples were tested for Influenza A and Influenza B along with Influenza A seasonal (H1N1, H1N1 pdm09 and H3N2), non-seasonal avian subtypes (H5, H7, H9 and H10) by real-time PCR. The result showed that the sample is positive for A/H5 and Type B Victoria lineage. Whole genome sequencing and virus isolation is in process," the statement said.

The NCDC, Delhi received information on July 16 from AIIMS, Delhi along with a lab report from NIV, Pune. "The information was communicated to the IDSP State Surveillance Unit (SSU), Haryana to initiate an epidemiological investigation into the case. The matter was also reported to the Animal Husbandry Department," the statement said.

A team from NCDC comprising epidemiologists and microbiologists was set up and it immediately visited AIIMS, New Delhi and Gurgaon for undertaking an epidemiological assessment. Officials of the state Health Department and the Animal Husbandry Department are also involved in the investigation, it said.

Based on the available information, the team of doctors and nurses treating the patient are being monitored since July 16 for development of any influenza-like illness. However, no one reported symptomatic till date. Contact tracing has been undertaken, and family members, close contacts and healthcare workers are under close surveillance. None of the close contacts have any symptoms. Contact tracing, an active search for any symptomatic case, has been carried out in the hospital and area where the patient resided. IEC activities were carried out for the public with advice to report any symptomatic case to the health authorities.

There are no symptomatic individuals in the area at present. "The Animal Husbandry Department has not found any suspected cases of bird flu in the area and has enhanced surveillance in a 10 km zone as a precautionary measure. Further, epidemiological investigation by the NCDC, involving Animal Husbandry Department and state government surveillance unit, is underway and appropriate public health measures have been instituted," the statement said.