A two-year-old girl from Andhra Pradesh has died after contracting H5N1 bird flu, marking what appears to be the first human infection and fatality from the disease in the country since at least 2021.
The case comes amid growing international concern about H5N1 and its potential for wider transmission. While human cases remain exceedingly rare, the virus’s high mortality rate — approximately 50% in documented cases— has kept the disease on the radar of scientists around the world.
State health officials said the child, who resided in Baliah Nagar in Narasaopet town, Palnadu district, died on March 16 while receiving treatment at AIIMS-Mangalagiri. The Pune-based National Institute of Virology (NIV) confirmed on March 24 that she had contracted bird flu, with additional confirmation from the Indian Council of Medical Research in Delhi.
Health officials investigating the case discovered that the child had consumed a small piece of raw chicken on February 26, which they believe was the likely source of infection. Family members reported that the girl occasionally ate raw chicken, a practice that significantly increases transmission risk.
“The girl developed fever and other symptoms on February 28 and was initially admitted to a local hospital,” a health department official said. “On March 4, she was transferred to AIIMS Mangalagiri after her condition worsened with acute fever, breathing difficulties and diarrhoea.”
The child’s parents have tested negative for the virus, as have all other family members, indicating the pathogen involved in this case did not jump to or from another human being – a scenario that would have otherwise been worrying. To be sure, there have been no recorded cases of human to human transmission of bird flu.
Dr T Damodar Naidu, Director of the Animal Husbandry Department, stated that extensive surveillance has revealed no other cases of bird flu in Palnadu or neighbouring districts.
“We conducted physical surveillance of all poultry farms in the region and found no symptoms of bird flu among poultry,” Dr Naidu said. He emphasised that thorough cooking is crucial for prevention, noting that “the bird flu virus does not survive in temperatures above 60-70 degrees Celsius.”
The health department has deployed rapid response teams to conduct fever surveys in and around the locality where the girl lived, with no abnormal cases identified thus far. Surveillance will continue for the next two weeks, with testing organised for any suspected cases.
The Union ministry of health and family welfare has deployed a National Joint Outbreak Response Team to Andhra Pradesh to investigate and assist the state following the child’s death.
Officials from the ministry said they are closely watching the situation and believe the state is equipped to manage it.
“Human to human transmission of H5N1 virus is uncommon and the risk of any other epidemiologically-linked case being reported is assessed to be low. But, due to abundance of caution, the following public health measures have been initiated: Union health ministry has reviewed the status; the centre has deployed the National Joint Outbreak Response Team to undertake an epidemiological investigation and to assist the State,” said a senior health ministry official.
The official noted that according to data from the Integrated Disease Surveillance Programme (IDSP), there has been no unusual surge in Influenza-like illness or severe acute respiratory illness cases in the district over the past few weeks.
“AIIMS, Mangalagiri is an ICMR VRDL (Virus Research and Diagnostic Laboratory) that has sufficient quantities of kits and reagents for testing suspected influenza patients. Union health ministry through Integrated Disease Surveillance Programme, National Centre for Disease Control, is closely monitoring the situation,” the official added.
Evolution growing concern
A highly pathogenic subtype of H5N1 was first detected in birds in China in 1996, with the first human cases appearing shortly thereafter, with most infections originating in contact with infected bords. Since then, nearly 1,000 human infections have been documented worldwide.
The statement from the Andhra Pradesh government noted that only four other cases of human avian influenza (H5N1 and H9N2) have been reported in India over the past five years: one each from Maharashtra in June 2019 and Haryana in July 2021, and two from West Bengal in April and May 2024.
In the case of H5N1, the July 2021 case was the last known infection and fatality. It involved an 11-year-old boy from Gurugram in the National Capital Region who was being treated for acute myeloid leukemia at the All India Institute of Medical Sciences (AIIMS) in New Delhi. The child died on July 12, 2021 after developing multiorgan dysfunction.
In that case, family interviews revealed that the child frequently visited a family-owned poultry business, suggesting possible exposure to birds with undetected infection, although no infected domestic or wild avian sources had been reported in the area at that time.
In recent days, experts have said they are tracking the virus closely. “In 2022, a new subtype of H5N1 clade 2.3.4.4b emerged in North America and spread to domestic poultry and many wild mammal species. Over the past year, this subtype has also been spreading in dairy cows,” professor Jeremy Luban of UMass Chan Medical School said during the Massachusetts Consortium on Pathogen Readiness (MassCPR) in March.
“The virus diversified as it replicated in birds, and migratory bird species spread multiple subtypes around the planet,” Luban noted.
This expansion into new species—particularly the jump to dairy cattle—is at the heart of the concerns since they signal the virus’s adaptive capabilities. While most recent human cases have been mild and there has been no confirmed human-to-human transmission, experts have pointed to documented human-to-cat spread, suggesting humans can transmit the virus under certain conditions. No cat-to-human transmission, however, has been recorded.
Health officials continue to advise the public to cook poultry and eggs thoroughly, avoid direct contact with sick or dead birds, and practise good hand hygiene, especially after handling raw poultry products.
The Andhra Pradesh health department has urged residents to report unusual bird deaths and to seek immediate medical attention if they develop flu-like symptoms after contact with birds or poultry.
