Two Cambodians have already died from bird flu in 2013, making a worrying start to the year.
Now a two-year-old Cambodian girl is in a serious condition in Phnom Penh after being hospitalized with the H5N1 virus, also known as avian, or bird, flu.
Sonny Inbaraj Krishnan, the communications officer for the World Health Organization in Phnom Penh, says the development has health professionals concerned. "This is the fourth case this month of human influenza H5N1," Krishnan said. "Last year we had three cases, so within one month in the new year we've got four cases, and we're quite concerned about that."
H5N1, which can spread from infected poultry to people, was first detected in humans in 1997 in Hong Kong. It is potent: to date it has killed some 360 people worldwide, more than half of those confirmed as infected.
The latest victims were a 15-year-old girl, who died a week ago, and a 35-year-old man, who died last Wednesday. A baby who fell ill earlier in the month has recovered. Over the weekend officials culled and burned more than 4,000 chickens and ducks in the village that was home to the 15-year-old victim.
However, other diseases such as dengue and malaria kill many more people than H5N1, so Krishnan was asked what is the concern with avian flu?
"Well our specific worry is that this H5N1 virus could undergo what we call a recombination and then re-assortment with another influenza virus," he explained, "and that could give rise to a new virus that is transmittable between humans -- so that's our main concern."
Cambodia is a predominantly agricultural nation, and every village has its chickens and ducks. Health ministry staff are monitoring those who came into contact with the patients who were infected, and teams from the agriculture ministry are testing poultry in the affected villages and destroying sick birds.
On Friday Health Minister Mam Bunheng called on parents to ensure their children wash their hands regularly, and stay away from sick and dead poultry. He also advised that children who develop breathing difficulties should be taken directly to the nearest health clinic.
Krishnan says TV and radio are being used to spread that message. "So from this week onwards we're going to increase the number of radio and TV spots -- telling them how to protect themselves and their families from avian influenza," he explained. "Especially to watch out for children playing with chickens - and also a very important message is to wash your hands."
Cambodia reported its first cases of H5N1 in 2005 when four people died. To date the worst year was 2011 when eight people were infected. All eight died.
The country's weak health sector is a hindrance and likely goes some way to explaining why Cambodia's avian flu fatality rate of nearly 90 percent - 21 dead from a total of 24 infected -- is so much higher than the global average of around 60 percent.
The WHO's Krishnan cautions against drawing too many conclusions from that, pointing out that the sample size is small. But, he says, there are local factors that compound the problem. When people fall ill, the first place their relatives take them is typically the local pharmacy or a private clinic. H5N1 can kill in little more than a week after infection, so losing a few days in failed treatments and misdiagnoses can be fatal.
"So as the cases get worse and when the local clinics or the pharmacies can no longer prescribe any medicine, that's when they're told to bring the kid or the patient to the hospital, and when they reach the hospital the chances are slim that they would survive," Krishnan said.
One looming complication is Chinese New Year, which starts on February 10. It is a time when large numbers of poultry are transported to markets, and that raises the risk that infected birds could spread the disease. Health professionals are hoping the information efforts underway now will pay off.