Monday, October 10, 2016

WHO EMRO:H5N1 Update In Egypt - September 2016

# 11,809

The WHO Eastern Mediterranean Region Office (EMRO) has published a brief update on H5N1 in Egypt which includes the infographic above. Unfortunately at this time only a 12kb thumbnail image is linked on the page, making it all but impossible to read.

Hopefully someone will notice and link a higher resolution graphic. 

Although no specifics are provided, from text of the report we learn that two additional H5N1 cases have been reported since the last update in July, bringing the number of cases reported by the Egyptian MOH to 10 for the year.

This represents a major reduction in the number of reported cases over the previous year, which saw roughly 160 cases reported between November of 2014 and May of 2015.

First the report, then I'll return with a bit more.

Avian influenza A(H5N1) situation update, Egypt, September 2016

Avian influenza update infographic, September 2016

Avian influenza A(H5N1) situation update, Egypt, September 2016

356 human cases of avian influenza A(H5N1) were reported in Egypt between 9 March 2006 and 30 September 2016. Of these cases, 121 were fatal (case–fatality rate: 34%). The country has been reporting sporadic cases since the beginning of 2016. A total of 10 cases were reported during the period from 1 January 2016 to 30 September 2016, including 4 deaths (case–fatality rate: 40%).  The last case was reported on 28 July 2016. 

Among the reported cases in 2014 up until 30 September 2016 (n=183), the majority of cases were female (60%). The death rate was almost similar among both male and female cases. Children in the under-5 year age group (30%) and those in the age group of 30 to 45 years (31%) were most at risk of acquiring the infection. The case–fatality rate was observed to have increased with age. 

Children in the under-5 year age group had the lowest case–fatality rate (12%), while it was the highest among those in the age group of more than 45 years. 

There is significant variation in the death rate between those who received antiviral treatment within 48 hours of onset of symptoms compared to those who received antiviral treatment after 48 hours (17% versus 34%).
The doubled survival rate among those who received antiviral treatment early is similar to other reports we've seen with treating H5N1 (see ECDC: Expert Opinion On Effectiveness of NAI Antivirals For Influenza).

Although Egypt leads the world with 356 H5N1 cases, that number must be taken with a sizable grain of salt, as only the `sickest of the sick' are ever hospitalized and tested for the virus.

We know that H5N1 can sometimes present with mild or moderate symptoms, and so the assumption is some unknown number of cases go uncounted.  

Last January in EID Journal: H5N1 In Egypt, we saw a report on a  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 authors wrote:

If this seroprevalence were to be extrapolated to the entire poultry-exposed population in Egypt, the true number of infections would amount to several hundred thousand. These figures are even more striking when it comes to human infection with H9N2 viruses. The seroprevalence of H9N2 antibodies detected in the same cohort study (19) ranged from 5.6% to 7.5%, whereas just 1 case of H9N2 infection was reported.

Although only 10 cases reported this year is heartening - between a largely silent MOH, a government clamp down on reporting by the Arabic press, and limited surveillance and testing - the true scope of Egypt's avian flu problem remains largely unknown.


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