Sunday, December 14, 2014

Egypt: Sunday Morning Bird Flu Roundup




# 9438


It isn’t possible to say with very much confidence exactly what the H5N1 situation is in Egypt right now, as the Ministry of Health’s website doesn’t seem in any rush to post updates, and most of what we know now comes from scattered, variable, and sometimes hard to decipher Arabic media reports. 


The only H5N1 update I can find on the Egyptian MOH site refers to 180 total cases (link), a milestone that was passed several weeks, and roughly 10 media reported cases  ago.


While the exact case count is up for debate, and may have to wait for a WHO announcement to sort out, what is apparent from the various media reports is that new suspect H5N1 cases continue to be isolated, and some infections continue to be confirmed.  Several Governorates have reportedly declared a `state of emergency’, antivirals are being distributed to hospitals, and there is a massive public education campaign under ways.


Apparent also is a growing discord between the Ministry of Health and the Ministry of Agriculture over who is responsible.


Today I’m finding media reports suggesting two new H5N1 cases;  a 12 year old  from Sohag and a 35 year-old man in Luxor.  It is not entirely clear whether both of these cases are lab-confirmed.  In addition, there are reports of a massive poultry vaccination campaign about to start in Qena Governorate..


Here there is a round up of some of this morning’s Arabic media reports (machine translated).   As always, Caveat Lector.


First stop, the report of a 35 year-old with H5N1 in Luxor.

Discovery of the first infected bird flu case Luxor International Hospital

14 ديسمبر 2014 | 3:36 مساء

Dr. Mohammed Dahi director Luxor International Hospital, a positive first case of bird flu in the governorate.

Dahi said that the situation of a man of Nakada Center Qena at the age of 35 years, referring to the delay in his case, because of the delay in going to the hospital.

Luxor International Hospital director Ali stressed that the hospital was prepared to cope with the disease processing of medical isolation room


Next, the report on the 12 year old in Sohag.

Sohag recorded the fifth case of bird flu

Sunday 14/Dec/2014-01: 32 pm

Cases of bird flu to 5 cases rose, after the central hospital reception in Dar es Salaam in Sohag , infected with the disease was a kid, and was transferred to a hospital diets in Sohag . The central hospital Balblina, has received the first on Friday, fourth-infected case of a student named Ahmed.

M. W, 12 years old, resides district Amarna Department Belina center, signed a medical examination found his suspicions of infection with avian influenza and show it clearly signs of infection, and was transferred to a hospital fevers Sohag to the work of analysis and testing.

It is noteworthy that the incidence of bird flu in Sohag, had risen to 5 cases, and the Crescent Hospital for health insurance in Sohag, you may have seen last Thursday the death of the first case of them, to evaluate the school Balblina.

And this on plans to vaccinate 1 million birds across Qena.


Veterinary Medicine Qena: targeting million birds vaccinated against bird flu

14 ديسمبر 2014 | 1:38 مساء  Dr. Ayman Abdella Director Directorate of Veterinary Medicine in Qena, said that the Directorate targeted campaign against bird flu, vaccination million birds on the villages and hamlets the province, in addition to the vaccination of poultry farms which are subject under the supervision of the Directorate, free of charge.

He said Abdellah, a week ago that he did not show foci of viral suspected to be infected with the disease, stressing that all the outposts have been vaccinated, which is suspected human bird flu cases were negative samples


Egypt has tried for years to discourage the keeping of home poultry, and live-market bird sales, in an attempt to reduce the threat of avian flu, but has always run into stiff resistance from the public.  Like China and many other bird-flu endemic nations, Egypt has come to rely heavily on poultry vaccines to control the avian flu virus, particularly in commercial poultry operations. 


But in rural areas of Egypt it has been estimated that as many as 90% of households still raise poultry, and it is generally from these small holdings that human infections arise.


For years the OIE (World Organization For Animal Health) has warned that vaccination of poultry cannot be considered a long-term solution to combating the avian flu virus, and in recent years we’ve seen increasing evidence that – over time – these vaccines can lose their effectiveness – particularly if they are not updated to match viral changes.

Mismatched poultry vaccines can often mask symptoms of illness in birds, but may not stop the spread of the virus. 


In 2012, in Egypt: A Paltry Poultry Vaccine, we looked at a study – conducted by the Virology department at St. Jude Children’s Research Hospital -  appearing in the journal Poultry Science, that looks at the effectiveness of six commercially available H5 poultry vaccines currently deployed in Egypt.


Of the 6 vaccines tested, only one (based on a locally acquired H5N1 seed virus) actually appeared to offer protection.


Poult Sci. 2013 Jan;92(1):114-8. doi: 10.3382/ps.2012-02637.

Do commercial avian influenza H5 vaccines induce cross-reactive antibodies against contemporary H5N1 viruses in Egypt?

Kayali G, Kandeil A, El-Shesheny R, Kayed AS, Gomaa MR, Kutkat MA, Debeauchamp J, McKenzie PP, Webster RG, Webby RJ, Ali MA.


More recently, in EID Journal: Subclinical HPAI In Vaccinated Poultry – China, we saw a similar situation in Asia that was allowing for the creation of `vaccine-escape’ variant strains, helping to hasten the evolution of the virus.


While culling is a preferred method of avian flu control – particularly in wealthier nations -  as we discussed in Food Insecurity, Economics, And The Control Of H7N9, it can be an impractical option in many low resource regions where millions of people depend on their backyard flocks as a source of income, food security, and accrued wealth.


The ability of any mass vaccination campaign to bring a halt to Egypt’s recent surge in H5N1 activity will ultimately depend on how well matched the vaccine is to the currently circulating strain and just how much penetration the campaign will have at the household and small village level.

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