With the caveat that if you add up the cases (and deaths) reported by individual Governorates, you come up with an even higher number than is currently acknowledged by the Egyptian Ministry of Health, we have new media reports this morning indicating Egypt’s 8th death, and 25th H5N1 case of 2015.
The Ministry of health and population, Friday, wounding case بڤيروس «bird flu», an old lady, a 60-year-old from Western Province of Kafr El-Zayat, are still under treatment in a hospital of Tanta, in addition to the death of a 5-year-old from Asyut province.
The Ministry said that the total number of cases of bird flu during the 2015 date 25 «8 cases of healing, and 9 cases under treatment, and 8 deaths).
The Ministry calls citizens who handle poultry to go immediately to the nearest hospital to receive health service if they have flu symptoms, the patients received the drug "Tamiflu" during the first 24 hours of the onset of symptoms increases the cure rates of disease and reduces the rates of death, also advises people who deal with poultry to be careful and prudent when dealing with birds, especially those showing symptoms of the disease, and the need to take preventive action to prevent infection, such as covering the mouth and nose when handling poultry, wash Hands with SOAP and water after handling birds, not accompany children to places of breeding birds, slaughter, and the need to separate the bird for the living quarters.
This current streak of H5N1 cases in Egypt is unusual not only for the high number of cases reported (54 identified since mid-November), but also for the number of pediatric deaths (4) reported since early December.
Unlike the pattern in Asia – where children are often the most severely affected - Egypt has enjoyed a much lower mortality rate among children with H5N1, with many youngsters presenting with only mild symptoms.
While the reasons aren’t well understood, the clade of H5N1 circulating in Egypt (2.2.1) is different from the clades circulating in Indonesia (18.104.22.168) or Cambodia & Vietnam (1.1.2) - which might account for these epidemiological differences - as could societal factors, such as seeking medical treatment much earlier in Egypt.
As to why this winter is so much more severe than previous years? We don’t have any good answers.
Earlier this month in CIDRAP: FAO Reports Mutations In H5N1 Virus From Egyptian Poultry, we looked at an FAO report that had found some signs suggestive of `mammalian adaptations’ in viruses collected from poultry, but that were not present in two human samples tested.
Although all influenza viruses evolve over time, preliminary laboratory investigation has not detected major genetic changes in the viruses isolated from the patients or animals compared to previously circulating isolates. The increase in reported human cases is likely a consequence of several factors. These includes increased circulation of influenza A(H5N1) viruses in poultry, lower public health awareness of risks in middle and upper Egypt and seasonal factors such as closer proximity to poultry and longer survival of the viruses in the environment because of cold.
The good news is that the Egyptian government seems to be taking this surge very seriously, and has reportedly invited our NAMRU-3 laboratory in Cairo to assist, which should be able to identify any major genetic changes should they turn up in this virus.