Although you’d hardly know it by recent public announcements from the Egyptian Ministry of Health, or reports in Egypt’s highly controlled media, their H5N1 tally continues to climb at a steady rate. The Egyptian MOH stopped reporting publicly on a regular basis two months ago (see The Silence Of The Egyptian MOH), and the media’s coverage since then has been both sparse and confused.
Luckily, Egypt continues to notify the WHO of new cases under the terms of the IHR, and so according to a recently published EMRO news statement - as of March 17th, Egypt has reported 116 cases (36 deaths) for 2015.
When you add in the 26 cases that occurred in November and December of 2014, and ongoing media reports of new cases, this current outbreak must be approaching 145 cases.
The two pieces of good news in all of this is:
- We’ve seen no signs suggestive of improved human-to-human transmission of the virus. Direct contact with infected poultry appears to be the primary risk factor for infection.
- The Case Fatality Ratio (CFR) remains about half of the global average, running between 30%-35%.
While it is not entirely clear what is behind this sudden increase in H5N1 cases, Egypt has reported heavy rates of poultry infections this winter – even among vaccinated flocks (see Egypt H5N1: Poultry Losses Climbing, Prices Up 25% - which calls into question the effectiveness of the vaccines currently being used.
Previously, in 2012’s Do commercial avian influenza H5 vaccines induce cross-reactive antibodies against contemporary H5N1 viruses in Egypt?, we saw researchers test six commercial poultry vaccines in use in Egypt, and find that only one appeared protective.
While even poorly matched vaccines can often protect poultry against illness - with increasingly diverse and rapidly evolving avian flu viruses - they cannot always prevent subclinical infection. The end result is that healthy looking chickens can harbor undetected infections, that viruses continue to circulate, and new variants or reassortants continue to emerge.
And without the traditional warning signs of sick or dying chickens, people who handle them are not aware of the the danger they pose.
This update from WHO’s EMRO.
21 March 2015 | The Ministry of Health and Population of Egypt has notified the World Health Organization (WHO) of an additional 17 human cases of avian influenza A(H5N1).
With these new cases, the total number of avian influenza A (H5N1) cases in Egypt stands at 116, including 36 deaths for the period of 1 January to 17 March 2015. Since it was first reported in March 2006, a total of 318 human cases of avian influenza A(H5N1), including 112 related deaths (case–fatality rate = 35.2%) have been reported in Egypt.
Among these newly reported human cases of avian influenza A (H5N1), 11 cases were female and six cases were male. These human cases are reported from the governorates of Sharkia, Behera, Giza, Qaluobia, Menia, Qena, Dakahlia and Kafr Alshekh.
From 8 to 12 March 2015, a joint high-level mission was conducted in Egypt comprising of representatives of WHO, the Food and Agriculture Organization of the United Nations, World Organisation for Animal Health, US Naval Medical Unit-3 and UNICEF on the current H5N1 situation in Egypt and understand the current and future risks of transmission of the currently circulating avian influenza viruses. The mission reviewed the effectiveness of the recent and ongoing disease control measures implemented by both the human and animal health sectors, as well as assessed gaps in disease control policies and strategies. Recommendations were presented to the Ministry of Health and Population following conclusion of the mission.
FluTracker’s conservatively curated Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List has added a couple of cases since the reporting cutoff of today’s report, putting the number at roughly 118 cases for the year.