Compared to winter and spring of 2014-2015, when Egypt reported more than 160 human H5N1 infections (see WHO EMRO: Updating H5N1 IN Egypt), Egypt has had a pretty mild 2016, with just 4 cases reported back in March.
There have been scattered media reports of other `suspected' cases, but none have been officially confirmed by the MOH, or the WHO.
Yesterday afternoon Gert van der Hoek on FluTrackers picked up an Arabic media report of a human avian flu infection in Dakahlia Governorate, which was followed last night by additional reports posted by Sharon Sanders.
In a bit of a surprise (since they rarely acknowledge cases, even when confirmed by WHO), the Egyptian MOH has posted a confirmation. It does not specify the subtype, but it is likely H5N1.
Health: A man injured bird flu Dakahlia Governorate
Alent the Ministry of Health and Population confirmed cases of bird flu case , a man at the age of fifty years of Dakahlia and still under hospital treatment issued Mansoura. Therefore calls upon the Ministry of Health and Population citizens who deal with poultry immediately go to the nearest hospital for medical service in the event of the appearance of symptoms of influenza them where to receive the injured bird flu drug Tamiflu within the first 24 hours of the onset of symptoms increases Alchweemn rates of disease and reduces the rates of death and advises
The Ministry of Health of citizens who deal with poultry to exercise caution and prudence when dealing with birds , especially that shows the symptoms and the need to take precautions to prevent infection such as covering the mouth and nose when dealing with poultry and Gslaloada with soap and water after handling birds and not to take children to places of birds breeding or slaughter as well as the need to separate the birds from the living quarters. source Media Center
While this is only Egypt's 5th case reported in 2016, and they have reported just over 350 cases over the last decade - both are likely undercounts - as only those sick enough to be hospitalized, and lucky enough to be tested, are ever confirmed. It is likely that some number of infections were only mildly ill, were misdiagnosed, or otherwise missed by surveillance.
So the expectation is many - perhaps even most - human avian flu infections go undetected.
A sentiment we saw reinforced last January in EID Journal: H5N1 In Egypt, where the authors reported on an (admittedly small) seroprevalence study that found antibodies for H5 in roughly 2% of the people tested, suggesting thousands of cases may have gone uncounted in Egypt.
The rapid evolution of H5N1 viruses in Egypt appears to be the result of poorly matched and inconsistently applied poultry vaccines (see A Paltry Poultry Vaccine), along with the co-circulation of H9N2 in Egyptian poultry (see Virology Journal: Evolution of H5N1 Clade 2.2.1 In Egypt).
While Egypt's bird flu woes have been pushed out of the headlines by Zika in the Americas, it remains one of the most active bird flu hot spots in the world, and requires watching.