The recent resurgence of H5N1 in Egypt (see Egyptian MOH Update: 21st H5N1 Case Of 2014) is a reminder that as we try to deal with Ebola, MERS-CoV, and new emerging avian viruses, that the venerable H5N1 virus has not gone away.
While there are no signs of increased transmissibility of the virus among humans, anytime we see a surge in human infections, the situation bears watching.
With 17 cases reported over roughly the past 6 weeks, the level of activity in Egypt is unusual – particularly for this time of the year. Yesterday the ECDC released a Rapid Risk Assessment on these Egyptian cases, along with some excellent background on the virus’s transmission in Egypt. First their summary, then some excepts from the report:
23 Dec 2014
Avian influenza A(H5N1) has been circulating in Egypt since its introduction in 2006 and has been the source of sporadic human infections. The number of cases reported in Egypt for 2014 (12) is higher than last year but at similar levels as 2012. Given this increase, and that eight cases by date of onset were reported in November, ECDC has assessed the potential changes in the risk to public health in the EU/EEA and to European citizens in a new rapid risk assessment.
The current risk status of this epidemic remains unchanged. In addition, considering the circulation of the virus is in areas which are not very popular as tourist destinations, the risk of EU citizens in Egypt being infected is extremely low.
The total number of human cases due to A(H5N1) is decreasing; 2014 had the lowest number of cases reported since the first cases in 2003 . The most affected countries cumulatively are Indonesia and Egypt, and Egypt and Cambodia reported most cases in 2014.
Human infections remain rare and these influenza A(H5N1) viruses do not currently appear to transmit easily among people.
ECDC threat assessment for the EU
• Human infections remain rare, and influenza A(H5N1) viruses do not currently appear to transmit easily among people. As such, the risk of community-level spread of these viruses remains low, and the assessment of the last updated ECDC Rapid Risk Assessment published on 26 February 2014 remains valid .
• A higher number of human cases due to A(H5N1) was reported from Egypt in November 2014. The detection of A(H5N1) in backyard poultry with a high number of outbreaks in 2014 might be the cause for the increase in human cases, as all cases reported exposure to infected poultry prior to the onset of symptoms.
• No indication is given of human clusters or human-to-human transmission.
• Considering the circulation of the virus in non-touristic areas, the risk of EU citizens being infected is extremely low. No cases of A(H5N1) among travellers to Egypt have ever been notified.
The recently reported increase of human cases of A(H5N1) infection from Egypt in November 2014 might be due to an increase in the circulation of A(H5N1) in backyard poultry and exposure to infected poultry across Egypt.
Identification of such sporadic cases or small clusters are not unexpected as avian influenza A(H5N1) viruses are known to be circulating in poultry in the country. Strict control measures of infected poultry are essential to prevent zoonotic transmission and human cases. Epidemiological investigations should be performed and results communicated to the global public health community.
Human cases and outbreaks were only reported from non-touristic areas in Egypt. Travellers visiting affected areas should avoid contact to sick or dead poultry and birds.