Saturday, August 22, 2015

Revisiting Egypt’s Murky H5N1 Battle




We’ve some interesting numbers, released today from Egypt’s Central Agency for Public Mobilization and Statistics  on their growing avian influenza problem, but first some background and catch-up.


Since late January, getting credible information out of Egypt on their AI (Avian Influenza) problem has become increasingly difficult.  During the first three weeks of the year – when human H5N1 cases were climbing rapidly – we saw daily status reports issued. 


But after January 22nd, that practice abruptly stopped (see Egypt’s MOH Confirms 21st H5N1 Case).


Since then, as I’ve noted before (see The Silence Of The Egyptian MOH Media: WHO H5N1 Mission To Egypt), the Egyptian MOH has ceased to report most cases on their website and the YTD numbers attributed to MOH spokesmen in the Egyptian media have been `fanciful at best.


Although I wouldn’t wager anything I’d care to lose on its accuracy (it is, after all, based on Egypt’s self reporting), the World Health Organization  reports 134 human H5N1 cases (and 37 deaths) in Egypt during the first half of the year. 


To put this into perspective, prior to 2015, all of the world’s countries combined had never reported more than 115 cases in a single year.


More than five months ago World Health Organization, along with the FAO, OIE,  NAMRU-3, CDC & UNICEF were invited to Egypt as a joint mission to investigate and to make recommendations on containing that outbreak. In early May we aw the  WHO Statement On Joint H5N1 Mission To Egypt,  with specific recommendations for addressing the crisis.


The 7-page executive summary, warns:

` . . .  the presence of H5N1 viruses in Egypt with the ability to jump more readily from birds to humans than viruses in other enzootic countries is of concern and requires a high level of vigilance from the Ministries of Health and Agriculture.’


You can read the full details in my May 15th blog, WHO Statement On Joint H5N1 Mission To Egypt.  The status of the 2-year action plan’ - outlined in the executive summary and supposedly due by now – remains uncertain.


Although human infections are of the greatest concern, equally murky have been the number and severity of HPAI outbreaks in Egypt’s poultry population.  


Since 2008, H5N1 has been considered endemic in Egyptian poultry, and regular reporting to the OIE ceased (see 07/07/08 Final report (endemic)), . That final report stated, `No more follow-up reports will be made, but instead, information about this disease will be included in the future six-monthly reports.’


Although hard numbers have been difficult to obtain, between Arabic media reports, and sporadic reporting to the OIE and FAO, it has been no secret that HPAI continues to ravage Egyptian poultry. 

Like China, Egypt depends heavily upon HPAI poultry vaccines to control their AI problem, and is in fact the world’s second largest consumer of these vaccines (after China). But as we’ve seen elsewhere in the world, the longer they have been in use, the less effective they have become (see A Paltry Poultry Vaccine). 


While Egypt’s AI problems never went away, it did seem on the decline after 2010. In mid-2014 we began to see signs that the number of poultry outbreaks was increasing, and in the fall of 2014 Egypt began the largest, and longest running, outbreak of human H5N1 in history. 

The likely explanation for this spike in human cases was that more poultry were falling ill and therefore more human exposures were occurring.


In February of this year, in Egypt H5N1: Poultry Losses Climbing, Prices Up 25%, we saw reports of vaccinated poultry flocks succumbing to the H5N1 virus, and and growing panic in the poultry industry.  And in April, a report in the ECDC’s Eurosurveillance journal appeared to shed additional light on this change in AI activity.


In Eurosurveillance: Emergence Of A Novel Cluster of H5N1 Clade, we learned that the predominant H5N1 virus in Egypt had changed in mid-2014, just months before the human and poultry outbreaks began to rise.  From the Abstract:


A distinct cluster of highly pathogenic avian influenza viruses of subtype A(H5N1) has been found to emerge within clade in poultry in Egypt since summer 2014 and appears to have quickly become predominant. Viruses of this cluster may be associated with increased incidence of human influenza A(H5N1) infections in Egypt over the last months.


As AI outbreaks always decline during the heat of the summer,  we’re seeing very little in the way of H5N1 reports right now.  In the meantime, we have a very brief report today that sheds some light on last year’s abrupt increase in poultry outbreaks in Egypt.

Note, this is a comparison of poultry outbreaks reported in 2014 vs. 2013, and they attribute the increase to a `mutation of the virus’ .  We don’t have official numbers for the current year.


281.6% increase in the incidence of bird flu

Saturday, August 22, 2015 11:46

Cairo - Gate delegation

Central Agency for Public Mobilization and Statistics, revealed that the total incidence of bird flu epicenter was 374 in 2014 compared to 98 the focus in 2013, an increase of 281.6%.

He attributed this surge device for the mutation of the virus that causes the disease which led to the ineffectiveness of fortifications used and thus increase the number of casualties.

The device, in its annual report on animal diseases in Egypt, that the Minya governorate registered the highest percentage of injury where the number of spots reached 47 focus, by 12.6%, followed by Giza province, where the number of foci of 38 focus by 10.2%, followed by Sohag 36 focus by 9.6 % of the total number of outposts


These are, of course, only officially reported (and recorded) outbreaks.  As with any type of disease reporting, 100% accuracy and year-to-year consistency in surveillance and reporting is impossible to achieve. 


Sill, a nearly 3-fold increase in outbreaks over 2013 is a pretty telling statistic.

The big concern this year is that it won’t just be Egypt and China dealing with the bulk of avian flu this winter.   HPAI H5 is expected to return to plague North America’s poultry industry,  Europe may well find HPAI H5 and H7 making inroads again, Southeast Asia remains vulnerable to H5N6 and H7N9, and Africa continues to report a major surge in bird flu reports.


Stay tuned . . . and fasten your seatbelts . . . it’s likely to be a bumpy ride.


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