The ability to track H5N1 cases in Egypt seems to vary from day to day. Sometimes we’ll get timely updates on the Egyptian Ministry of Health’s website, but often we’ll go days, or even weeks, with only Arabic media reports to go on. While the `official’ number of Egyptian cases in 2014 was reported as 29 (with 11 deaths), the real number is anyone’s guess.
Reporting and surveillance in Egypt is spotty at best, but even here in the United States public health officials can’t give you an exact number of how many `novel’ influenza infections occur each year.
In 2013, in , in CID Journal: Estimates Of Human Infection From H3N2v (Jul 2011-Apr 2012), we saw a study that estimated that in 2011 – a year where there were only 12 human cases of swine variant H3N2v reported in the United States – the real number of cases was probably in excess of 2000.
Likewise in 2013, during the first wave of H7N9, just over 130 cases were recorded by Chinese health officials, but Hong Kong researchers estimated the number between was probably between 1500 and 27,000 symptomatic infections.
After more than 10 years of study, we still don’t have a good feel for how many H5N1 cases experience mild or moderate flu symptoms, never seek medical care, and therefore never get tested. Likewise, we don’t know how many people succumbed to the virus, while their deaths were attributed to some other cause.
From 2003 through 4 December 2014, 676 laboratory-confirmed human cases of avian influenza A(H5N1) virus infection have been officially reported to WHO from 16 countries. Of these cases, 398 have died.
Privately, scientists debate (despite a paucity of hard data) whether we should add one, two, three or perhaps even four zeros to those numbers (see The Great CFR Divide). If the number of infections turns out to be several orders of magnitude higher than we currently believe, the oft quoted 60% mortality rate for H5N1 would drop considerably.
Of course, that’s a big `if’, and assumes facts not in evidence.
Part of the problem is there is nothing immediately obvious about an H5N1 infection that stands out as something other than severe influenza (or any other viral respiratory infection). While some hospitals in Egypt appear to be aggressive in their H5N1 testing, in other cases we’ve seen patients diagnosed only after their conditions deteriorate, often several days following admission.
The point being that the numbers being reported by any country on any disease must always be taken with a large boulder of salt, as they probably only reflect the tip of the iceberg.
All of which serves as prelude to the latest media report out of Egypt, where El Asher City (aka Tenth of Ramadan) in Sharqia governorate appears to have recorded their second H5N1 case in two days (see Friday’s report Egyptian Media Reports New H5N1 Case).
Dr. Khaled Fawzi, director general of the eastern region of Preventive Medicine, said that hospitals in the province imposed a state of emergency after noon the second case of infection with bird flu.
He explained «Fawzi» in remarks «Egyptian today», the second case, which had been infected with bird flu to a woman called the conscience of Yusuf Muhammad, 44 years old, and a resident of the Tenth of Ramadan City, semi-stable condition, samples were taken for them, and sent to the central laboratories of the Ministry of Health, Sunday, to make sure of a positive situation.
It is noteworthy that the Tenth of Ramadan City has witnessed the first case of the disease to the child Hanan Mohammed herding 0.4 years, on Friday, and was transported to the hospital for a fever
Meanwhile, Dr. Amr Kandil, with the Egyptian Ministry of health is quoted as warning:
Dr. Amr Kandil, head of Preventive Medicine, Ministry of Health Sector, said that there was a case died yesterday due to bird flu, and that there are 12 cases died from the disease in 2014, in addition to heal 16 others, and that there is one condition is stable now for a child Sharqia, expected to increase infection rate until next April.
He called Qandil in a phone call program «Good evening», provided by Media Muhammad Ali Best, via satellite «CBC Tu», citizens' awareness and adequate preventative measures of tennis, warning treated anyone with infected birds, saying: «anyone catch the flu and dealing with the bird within 24 hours, he go to hospitals. »
Although the accuracy of the avian flu numbers we get out of Egypt and China may be subject to debate, there are regions of the world from which we get little or no reporting at all. Large swaths of Asia, Africa, the Middle East, and even South America remain surveillance black holes, either due to a lack of resources, repressive governments, or civil strife.
And as was illustrated during the opening months (Dec 2013 – March 2014) of the Ebola outbreak in Western Africa last year, during which time no international alarm was raised:
No news isn’t necessarily good news.