Between November of 2014 and late spring of this year Egypt saw an unprecedented surge in human H5N1 cases. Previously, Egypt had never reported more than 39 cases during a single calendar year (both 2009 & 2011), yet over that five-month period they reported 165 cases, and 51 deaths.
You’ll can find details on this outbreak in Revisiting Egypt’s Murky H5N1 Battle and EID Dispatch: Increased Number Of Human H5N1 Infection – Egypt, 2014-15.
Last March the 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.’
After a quiet summer, cooler fall temperatures are expected to once again spark H5N1 outbreaks in Egyptian poultry, and the risk of another large spillover event looms large. In May the Egyptian MOH and MOA promised to deliver a `2 year action plan’ against H5N1 within `90 days’.
While I’ve not seen an official document published to that effect, overnight the Egyptian press has been filled with dozens of stories outlining the Egyptian government’s plans to deal with the return of bird flu this winter.
Most of the press reports are emphasizing the stockpiling (and deployment to hospitals and clinics) of hundreds of thousands of doses of Tamiflu. A far more detailed (translated) report, is presented below.
«Health» preparations against bird flu. Activate surveillance for the disease in hospitals. Follow the genetic mutation. The availability stock «tamflo». Coordination with «agriculture» for reporting suspicions. And raise awareness among citizens
Wednesday, October 21, 2015-4:11 am
Preparations «health» Reham Saeed
The Ministry of health has developed a package of security measures to prevent human infections of bird flu in conjunction with winter season, where the national plan to combat the disease, and distributed to all health facilities carries all the information about the disease.
Coordination with veterinary services
The plan includes coordination with the veterinary services of the Ministry of agriculture to take necessary actions against infected birds and report her contacts move medical teams to take samples from them have also been allocated rooms to isolate viruses and chest hospitals in all governorates to isolate any suspicious situations, and follow-up of contacts of confirmed cases, sampling necessary.
The High Commission is following
In the same context the Supreme Committee to combat bird flu, and the problem of date by decision of the Prime Minister of agriculture and the membership of the Ministers of health and local development environment for control of infectious diseases through early detection, including bird flu and eliminate opportunities for endemic in Egypt.
Raise citizens ' awareness
The Ministry of health in providing preventive and curative care in hospitals with the full commitment of doctors in hospitals and primary care units the definition of avian influenza and the need for suspicion in any case definition applies, in addition to raising awareness among citizens about the disease and how to prevent and handle any suspected case.
Measures to prevent proliferation
The Ministry has taken a number of measures, including surveillance of influenza and activation of pneumonia in all hospitals of the Republic daily to assess the epidemiological situation and follow up continuously for viruses, in addition to follow-up the global situation and the recommendations of the World Health Organization in this respect, as well as genetic mutation at the global, regional, and follow-up of contacts of positive spots that appear in the bird's injuries, and training and print case definition.
Stocks of "Tamiflu"
Dr. Khaled Mujahed, spokesman of the Ministry of health in a statement for "Vito", the Department has a strategic stockpile of Tamiflu used to treat bird flu and necessary to deal with the disease also has been supporting the central laboratories of the Ministry and regional laboratories for screening influenza viruses, balkwashf supplies needed to examine cases, in addition to training their employees on ways to drag, save, and transfer the necessary samples, as well as sharing samples with who reference laboratories and national research center of the Ministry of scientific research.
The plan includes immediate reporting for veterinary medicine for all cases in humans in the case of suspicion, in the framework of coordination between the Ministry of health and Ministry of agriculture to address avian influenza
The role of the Ministry of agriculture
This includes the role of the Ministry of agriculture, the Commission is applying bio-security measures and monitor the application of infection control during a get rid of birds in infected areas, in addition to the development and activation of plans dealing with positive poultry infection foci of the disease and will be implemented in these hot spots in the surrounding areas.
The role of the Ministry of State for Environmental Affairs of the Committee is to develop and implement a plan for safe disposal of dead birds is the Ministry of State for local development is to develop and implement the plan at all levels for the safe disposal of dead birds in addition to coordination with the Ministry of agriculture in controlling the disease and preventing its spread from infected areas.
The plan includes coordination with the radio and television Union and the SIS and the media is to raise citizens ' awareness on bird flu and how to prevent it.
The Egyptian press is also carrying reports of scattered H5N1 outbreaks (in poultry) and of plans to dispense AI vaccines to affected areas. 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 these vaccines have been in use, the less effective they have become (see A Paltry Poultry Vaccine).
In February of this year, in Egypt H5N1: Poultry Losses Climbing, Prices Up 25%, we saw reports that vaccinated poultry flocks were succumbing to the H5N1 virus. In April, a report in the ECDC’s Eurosurveillance journal appeared to shed additional light on this change in AI activity (see Eurosurveillance: Emergence Of A Novel Cluster of H5N1 Clade 220.127.116.11).
A distinct cluster of highly pathogenic avian influenza viruses of subtype A(H5N1) has been found to emerge within clade 18.104.22.168 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.
Genetic changes in Egypt’s H5N1 virus last year are suspected to have helped it evade the vaccines in use, and may have increased its ability to jump from poultry to humans. So far, there is no evidence to suggest it has increased its ability to transmit from human-to-human.
But influenza viruses are constantly changing and are highly unpredictable, and that makes Egypt one of the main bird flu battlegrounds that we’ll be watching closely again this winter.