Tuesday, March 10, 2015

WHO H5N1 Update - Egypt

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The World Health Organization has published their latest Influenza at the human-animal interface (dated March 3rd) which shows roughly * 88 cases, and 24 deaths in Egypt from the H5N1 virus since the first of the year.  

 

This matches very closely to FluTrackers independently curated  2015 Egypt H5N1 Case List, which showed (as of this morning) 82 cases and 23 deaths for the year. 

 

As recently as last Saturday Egyptian media sources were reporting a highly fanciful 38 cases, and just 13 deaths for 2015 (see Egypt: The Operation Was A Success, But . . . .   and   Egypt’s bird flu death toll rises to 13 in 2015: Health Ministry).

 

 

Summary and assessment as of 3 March 2015

Human infection with avian influenza A(H5) viruses

From 2003 through 3 March 2015, 784 laboratory-confirmed human cases of avian influenza A(H5N1) virus infection have been officially reported to WHO from 16 countries. Of these cases, 429 have died.


Since the last WHO Influenza update on 26 January 2015, 66 new laboratory-confirmed human cases of avian influenza A(H5N1) virus infection, including 13 fatal cases, were reported to WHO from Egypt (65) and China (one).


Of the 65 human cases of influenza A(H5N1) virus infection reported from Egypt, 29 had onset of disease in January and the rest had onset of disease in February. The cases were reported from 18 different governorates of Egypt (see table 1 in the annex). The age range of the 65 cases is from one to 75 years, with a median of 26 years, and 23% of the cases are under 10 years of age. All cases had exposure to poultry or poultry markets, were hospitalized and all but one reportedly received treatment with antiviral medication.

Of the newly-reported cases, there was one cluster which included two confirmed cases in a mother and daughter from Fayoum governorate. The mother had an onset of illness two days prior to the daughter’s onset of illness and both had exposure to backyard poultry.


Currently, there are reports of an increased number of outbreaks and detections of influenza A(H5N1) viruses in poultry in Egypt compared to previous months and compared to this month in previous years. The number of laboratory-confirmed human cases of avian influenza A(H5N1) virus infection in Egypt with onsets of illness in the months of December 2014, January and February 2015 are the highest numbers reported by any country in a single month. 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 , but further in depth analysis is ongoing.

A new candidate vaccine virus was proposed to better protect against the current circulating H5 clade 2.2.1. viruses (a group which all the recent influenza A( H5N1) virus isolates from Egypt belong to). 1 The increase in the number of human cases is likely attributed to a mixture of factors, including 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 because of cold weather and possible longer survival of the viruses in the environment. A high-level joint WHO/FAO/OIE mission to Egypt to assess the risks associated with the influenza A(H5N1) viruses and to recommend control measures is planned for early March 2015.

China reported a human infection with an avian influenza A(H5N1) virus in a 37-year-old woman from Jiangsu province. She developed symptoms on 14 January 2015, was admitted to hospital on 20 January.


The patient had a history of exposure to poultry. No further cases among contacts were reported. China reported a human infection with an avian influenza A(H5N6) virus in a 44-year-old man from Yunnan province. He developed symptoms on 27 January 2015, was admitted to hospital on 3 February, and passed away on 6 February. The patient had a history of exposure to dead wild birds. No further cases among contacts were reported. This is the third human case of influenza A(H5N6) reported from China.


Various influenza A(H5) subtypes, such as influenza A(H5N1), A(H5N2), A(H5N3), A(H5N6) and A(H5N8), have recently been detected in birds in Europe, North America, and Asia, according to reports received by OIE. Although these influenza A(H5) viruses might have the potential to cause disease in humans, so far no human cases of infection have been reported, with exception of the human infections with influenza A(H5N1) viruses and the three human infections with influenza A(H5N6) virus detected in China since 2014.

Overall public health risk assessment for avian influenza A(H5) viruses: Whenever avian influenza viruses are circulating in poultry, sporadic infections and small clusters of human cases are possible in people exposed to infected poultry or contaminated environments. Although an increased number of animal-to-human infections have been reported by Egypt over the past few months, these influenza A(H5) viruses do not currently appear to transmit easily among people.

As such, the risk of community level spread of these viruses remains to be low

Note: there is a 1 case discrepancy between the Updated WHO chart of January 26th, and the last summary update, hence the `roughly’  qualifier.    When the new case count chart if posted, that will hopefully clarify matters.

 

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