The route of transmission is usually from birds to humans. There is usually a history of exposure to dead or sick poultry/wild birds, their secretions or excretions during the week prior to illness. Activities involving close contact such as defeathering, preparing poultry for cooking, holding or playing with sick poultry, handling fi ghting cocks and eating raw or undercooked poultry products have been implicated [4] [5] [6] [7] .