FAO: Egypt Reports Third H9N2 Case Of 2015

 

# 10,079

 

Since we only rarely hear of it infecting humans, and it tends to produce mild to moderate illness when it does, the H9N2 avian influenza virus doesn’t get as much attention as it probably deserves. Despite its relatively benign reputation, H9N2 is a major driver of avian influenza evolution, and reassorts readily (and often) with other viruses.

 

Look at the internal genes of some of the most worrisome avian influenza viruses – H5N1, H7N9, H10N8, etc. – and you’ll find that H9N2 that has lent a good deal of its backbone – it’s internal genes – to the creation of these emerging threats. 

 

Earlier this year, the WHO warned:

 

The emergence of so many novel viruses has created a diverse virus gene pool made especially volatile by the propensity of H5 and H9N2 viruses to exchange genes with other viruses. The consequences for animal and human health are unpredictable yet potentially ominous.

 

Early last year, The Lancet carried a report entitled Poultry carrying H9N2 act as incubators for novel human avian influenza viruses by Chinese researchers Di Liu a, Weifeng Shi b & George F Gao that warned:

 

Several subtypes of avian influenza viruses in poultry are capable of infecting human beings, and the next avian influenza virus that could cause mass infections is not known. Therefore, slaughter of poultry carrying H9N2—the incubators for wild-bird-origin influenza viruses—would be an effective strategy to prevent human beings from becoming infected with avian influenza.

We call for either a shutdown of live poultry markets or periodic thorough disinfections of these markets in China and any other regions with live poultry markets.

   

And just last  January (see PNAS: Evolution Of H9N2 And It’s Effect On The Genesis Of H7N9) we looked at a study that found a new, better adapted genotype  (G57) of the H9N2 virus had emerged  – one that evades the poultry vaccines currently in use – and that it has become widespread among vaccinated Chinese poultry since 2010.

 

Globally, we’ve seen seen a fairly limited number of human infections, including a handful in China between 1998 & 1999, Hong Kong in 1999 (2 cases), 2003 (1 case), and 2007 (1 case), and December of 2013 (see Hong Kong: Isolation & Treatment Of An H9N2 Patient).   In late 2014, two mild cases were reported out of China.

 

As this virus is most common in areas where testing and surveillance are less than optimal, we really don’t know how many people end up infected by it. 

 

Although reporting out of Egypt has been inconsistent, last February (see An H9N2 Infection In Egypt & Updated H5N1 Count – FAO/EMPRES) we learned of Egypt’s first H9N2 infection. Late yesterday ProMed Mail carried the following report – gleaned from an FAO report – detailing Egypt’s third H9N2 infection.

 

Published Date: 2015-05-22 13:44:27

Subject: PRO/AH/EDR> Avian influenza, human (108): Egypt, H9N2, influenza B

Archive Number: 20150522.3378923

AVIAN INFLUENZA, HUMAN (108): EGYPT, H9N2 AND INFLUENZA B
*********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the International Society for Infectious Diseases
http://www.isid.org

Date: Thu 14 May 2015

Source: FAO EMPRES-Animal Health, Global Early Warning System (GLEWS) [edited]
Animal Disease Threats Update

(Disease Events monitored by FAO AGAH/GLEWS between 10 May 2015 and 14 May 2015)
Egypt, confirmed additional infection with H9 LPAI in a human;

• on 29 Apr 2015, a 7-year-old male with high fever and cough tested positive for H9 on 7 May 2015;
• the sample tested positive for RNP gene, flu A, avian H9 and flu B and was negative for all other respiratory viruses;
• the investigation revealed a history of exposure to live bird market poultry. The case was cured and discharged. [MoH and FAO field officer, 12 May 2015]

Note: This is the 3rd case of H9N2 LPAI reported in humans in Egypt since January 2015. The other 2 cases were detected in 2015 in Aswan and Cairo Governorate. The latest case is the 1st recorded human case of co-infection with H9 and flu B in Egypt.

(Continue . .. )

 

While the direct threat to human health from H9N2 is currently small, its promiscuity and history of reassorting with other avian viruses makes it a serious threat, and one very much worth keeping track of.

 

Returning briefly to the World Health Organization’s blunt pandemic warning of last February:

 

Warning: be prepared for surprises

Though the world is better prepared for the next pandemic than ever before, it remains highly vulnerable, especially to a pandemic that causes severe disease. Nothing about influenza is predictable, including where the next pandemic might emerge and which virus might be responsible. The world was fortunate that the 2009 pandemic was relatively mild, but such good fortune is no precedent.

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WHO: H5N1 Update & Risk Assessment

 

 

# 10,065

 

The World Health Organization has posted their latest Influenza at the Human-Animal Interface, monthly risk assessment summary – current through May 1st – which adds 13 additional H5N1 cases from Egypt during the month of April, and 1 from China.

 

 

Influenza at the human-animal interface

Summary and assessment as of 1 May 2015

Human infection with avian influenza A(H5) viruses

From 2003 through 1 May 2015, 840 laboratory-confirmed human cases of avian influenza A(H5N1) virus infection have been officially reported to WHO from 16 countries. Of these cases, 447 have died. 1 Since the last WHO Influenza update on 31 March 2015, 14 new laboratory-confirmed human cases of avian influenza A(H5N1) virus infection, including one fatal case, were reported to WHO from Egypt (13) and China (one).

Of the 13 human cases of influenza A(H5N1) virus infection reported from Egypt, nine had onset of disease in March and the rest had onset of disease in April. The cases were reported from eight different governorates of Egypt (see table 1 in the annex). The age range of the 13 cases is from three to 58 years, with a median of 31 years and 23% of the cases are under 10 years of age. Slightly more females than males were affected. Only one fatal case was reported and the rest have recovered and been discharged from hospital. All cases had exposure to poultry or poultry, all cases were hospitalized and all reportedly received treatment with antiviral medication.

Although all influenza viruses evolve over time, preliminary laboratory investigation has not detected major genetic changes in the limited number of viruses isolated from the patients and animals in Egypt compared to previously circulating isolates thus far, but further in depth analysis is ongoing.

Compared to the previous five months, there has been a decrease in the number of laboratory confirmed human cases of avian influenza A(H5N1) virus infection reported by Egypt since the last risk assessment. The decrease in the number of human cases over the past month is presently unclear. It is likely attributed to a mixture of factors, including fewer outbreaks in poultry, heightened public health awareness of risks and seasonal factors. The proportion of fatal cases has been consistently lower in Egypt than in other countries, especially in children.

China reported one human case of infection with an avian influenza A(H5N1) virus from Yunnan province, where two cases were detected last month. The case has recovered from his illness and was not reported to have had known exposure to poultry before illness.

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 west Africa, Asia, Europe, and North America, according to reports received by OIE. Although these influenza A(H5) viruses might have the potential to cause disease in humans, so far with the exception of human infections with influenza A(H5N1) and A(H5N6) viruses, no other subtypes of A(H5) virus infection in humans has been reported.

Overall public health risk assessment for avian influenza A(H5) viruses: The human cases reported appear to be sporadic and the virus is known to be endemic in poultry in these countries. 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. Therefore additional human cases would not be unexpected.

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 and the risk assessment remains unchanged.

Further studies are needed to understand the risk factors for human infections and the potential role of mild cases if they are occurring. More analyses on the viruses from both animals and humans need to be undertaken to better understand if any subtle changes in the transmissibility of the virus from animals to humans may be playing a role in the current situation.

A statement on the joint high-level mission to Egypt in March 2015, as well as the executive summary of the mission report, can be found at this link:

http://www.emro.who.int/egy/egypt-news/upsurge-h5n1-human-poultry-cases-may-2015.html

With the rapid spread and magnitude of avian influenza A(H5) outbreaks, notably in areas that had not experienced this disease in animals until recently, there is an increasing need for vigilance in the public health sector. Surveillance should be enhanced to detect, at the earliest stage, human infections if they occur and changes in viruses of transmissibility and pathogenicity that could have significant public health implications.

(Continue . . . )

WHO Statement On Joint H5N1 Mission To Egypt

 

# 10,054

 

 

We’ve been following an unprecedented surge in human H5N1 infection in Egypt since late last fall, and while the Egyptian MOH has been less than forthcoming in their public statements regarding the outbreak, between the WHO, the FAO, and the efforts of independent news gatherers like FluTrackers’ Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List we’ve managed to keep reasonable track of its progress.

 

Two 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.   We’ve been expecting a report on what they found for some time.

 

As I mentioned earlier this week, a summary report was briefly posted on the WHO EMRO  website on May 3rd, but was taken down almost immediately without explanation. 

 

Today the WHO has posted a similar - but more abbreviated - summary of their findings along with a link to an executive summary.  Changes from the May 3rd release include updated case counts to the end of April (165 cases, 48 deaths), and the removal of a section with specific recommendations for addressing the crisis, which are now to be found in the executive summary.

 

 

Egypt: upsurge in H5N1 human and poultry cases but no change in transmission pattern of infection

 

15 May 2015 – The recent increase in the number of people affected by the avian influenza virus H5N1 in Egypt is not related to virus mutations but rather to more people becoming exposed to infected poultry, according to a recent mission of six organizations assessing the H5N1 situation in the country.

Since November 2014 to 30 April 2015, the period analysed by the international mission, a total of  165 cases, including 48 deaths were reported. This is by far the highest number of human cases ever reported by a country over a similar period. There are indications that H5N1 is circulating in all sectors of poultry production and in all parts of Egypt.

The mission stressed that the way the influenza H5N1 virus is transmitted in Egypt appears to have remained stable despite the recent upsurge in numbers of human and poultry infections. While the risk for the current situation to escalate into an H5N1 pandemic does not appear to have been changed appreciably, the situation remains a cause for considerable concern.

“Based on all the evidence we have, we believe the upsurge is not explained by changes in the virus itself,” said Dr Keiji Fukuda, WHO Assistant Director-General for Health Security and head of the H5N1 investigation team in Egypt. “The most likely reason for the increase in cases is that more poultry in Egypt are infected by H5N1 and so more people are exposed to this virus. Coupled with insufficient awareness, behavioural patterns and inadequate precautions taken by humans when interacting with poultry this explains what we are seeing.”

For successful reduction of the negative impact on human health and associated economic and food security consequences, it will be essential to strengthen animal and human disease surveillance, biosecurity and disease control programmes, in a context of a strengthened and close collaboration between human health and animal health departments. This includes appropriate animal vaccination programmes through joint efforts by the public and private sector in charge of animal health.

The report found that: 

• although  human-to-human transmission cannot be excluded, the key epidemiological and demographic features of the recent human cases did not significantly change compared to those reported before the recent increase;  
• there was no evidence for transmission from patients to health care workers during the upsurge; 
• the vast majority of recent human cases – approximately 70% – had known exposure to infected backyard poultry; 
• analysis of the genetic sequence data did not identify changes suggesting more efficient human-to-human transmission.

Although some of the apparent upsurge in cases might be a result of increased testing for H5N1 in humans, this cannot explain the whole picture. The upsurge of infections in poultry and the cases in people has likely been caused by changes in the economy and the poultry industry.

Many small farmers have turned to raising poultry for food and income in an unmonitored and uncontrolled farming sector. The implementation of a proper veterinary control strategy will require strengthening the response capacity, public–private partnerships, vaccination strategies and biosecurity in most poultry production sectors. Ensuring compliance with intergovernmental standards on animal health and regulatory statutes at national level, both in poultry production enterprises or households will be critical for limiting the spread of the H5N1 virus.

The report also notes that Egypt has already recognized the key features leading to the increase in disease, and has recently proposed important structures, sound policies and strategies. However, for them to be effective will require better implementation and concerted commitments at national, governorate and local level. The report recommended that Egypt should make long-term investments in agriculture, veterinary services, health and rural communities to combat H5N1. Policies should be developed to engage the large number of unlicensed commercial and semi-commercial poultry farms in developing new means of implementing and assuring effective disease prevention and control.

 

 

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 reviewing their findings, and listing their recommendations, the report concludes:

 

The way forward

A successful approach to addressing H5N1 requires long-term, sustainable investments in agriculture, health and communities. In particular, close collaboration between sectors is required in communications, policy development, surveillance and response, and the production and sharing of information. Accurate, regular assessment of the impact of control measures is required to evaluate progress.

The government should undertake one or more pilot projects at the district level to determine which changes in policies and practices are most effective in reducing spread of infection among poultry and to humans and sustainable on a medium- to long-term basis. Addressing H5N1 nationally will require long-term changes in policies, practices, culture, awareness and community engagement.

Within three months, a two-year action plan that encompasses these recommendations and includes clear outcomes and indicators for monitoring will be developed by the ministries of health, agriculture and local development. FAO, WHO and OIE will support development of the plan, which will be presented to the NSC.

 

Hopefully we’ll soon see another Influenza at the Human-Animal Interface report from the WHO updating us on the progress and the epidemiology of this outbreak.

Egypt’s H5N1 Outbreak: No News is . . . ?

Credit EMRO 

 

# 10,038

 

We are coming up on six weeks since the last World Health Organization update on Egypt (see WHO H5N1 Update For Egypt – Thru March 31st), more than 3 weeks since the last FAO interim report (see FAO Reports 6 More Egyptian H5N1 Cases), and Egypt’s MOH site has provided little information now for more than 3 months.

Although the Egyptian press remains filled with with avian flu stories – they are, ironically, all focused on America’s bird outbreak – not their own.  

 

Doing her best to keep track of all of this is Sharon Sanders at FluTrackers, who curates their Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List. Based on the information currently available, Sharon conservatively shows 143 cases in Egypt since the 1st of January.  But that number is roughly 3 weeks old.

How many cases there really are – and how many have been recorded (but not yet publicly acknowledged) over the past 6 weeks – well, that’s anyone’s guess.  

 

In Mid-March a joint mission of the WHO, FAO, NAMRU, CDC, and others were invited to Egypt to observe the situation on the ground and make recommendations. A report was produced and provided to the Egyptian government, but I haven’t found it published anywhere.  

 

A summary report was briefly posted on the EMRO website on May 3rd, but was removed without explanation within hours.  Why?  I have no idea.  

 

With warmer temperatures now well entrenched across the Middle East, it is possible the number of human infections has dropped appreciably over the past 6 weeks and the outbreak is on the wane. We normally expect to see fewer outbreaks in poultry, and human infections, during the summer months. 

 

But without timely and credible reporting from the Egyptian MOH, that’s an assumption that is difficult to make.

 

I fully expect we’ll see an update from the FAO or the WHO in the coming days, and that should give us some kind of clue as to how the H5N1 outbreak is trending in Egypt.  Assuming, of course, the Egyptian MOH is being completely forthright with their reporting to these international agencies.

It is a worrisome trend – one we’re seeing both in China with H7N9 and Egypt with H5N1 (and no doubt, other nations as well) – where nations strategically `manage’ the release of disease outbreak information, likely for political, societal, or economic reasons.  

As we discussed in The New Normal: The Age Of Emerging Disease Threats, the reality of life in this second decade of the 21st century is that disease threats that once were local, can now spread globally in a matter of hours or days.  Vast oceans, and extended travel times no longer offer the protections they once did.

A disease threat anywhere can quickly become a health threat everywhere.  

 

Making the full and timely disclosure of infectious disease outbreak information a global responsibility for every nation. 

WHO H5N1 Update For Egypt – Thru March 31st

 

# 9919

 

We’ve an update today from the World Health Organization’s EMRO division, which is current through March 31st, 2015, that shows 159 H5N1 cases and 49 deaths since this outbreak began in early November of 2014.   

 

In the first 3 months of the year there have been  125 cases and 33 deaths reported, which is more than triple Egypt’s previous highest one-year total. 

 

Since March 31st we’ve been made aware of at least 7 additional cases via the FAO (see Catching Up With Egypt’s H5N1 Case Count).

 

Avian influenza A(H5N1) in Egypt, 9 April 2015

 

This infographic provides an overview of the H5N1 situation in Egypt as of 9 April 2015. Click here to view.

08 April 2015 - The Ministry of Health and Population of Egypt has notified WHO of additional laboratory-confirmed human cases of avian influenza A(H5N1) during the last few weeks. With this additional number, the total number of cases reported during the month of March 2015 now stands at 30 cases, including 4 deaths. This increase in reported human cases has been observed since the beginning of November last year.

Since its introduction in Egypt in 2006, avian influenza A(H5N1) virus has been circulating in domestic poultry in the country and has been the source of sporadic human infections. Almost all cases of H5N1 infection reported in humans in recent times have been associated with close contact with infected live or dead birds, or H5N1-contaminated environments. Though the number of cases reported is higher compared to last year, the increase in the number of cases does not change current risk status of avian influenza A(H5N1) virus that is currently circulating at the animal-human interface in the country.

Since it was first reported in March 2006, a total of 336 cases of avian influenza A(H5N1) infections in humans have been reported, including 114 related deaths (case-fatality rate =34%)

 

 

Last week, in Eurosurveillance: Emergence Of A Novel Cluster of H5N1 Clade 2.2.1.2, we looked at a study that found a new strain of H5N1 has emerged in Egypt and has rapidly become the predominant strain in poultry, and that suggested that genetic changes in this strain may be making it more easily transmitted from birds to humans.

Whether due to genetic changes to the virus, or simply due to a greater prevalence in Egyptian poultry, this outbreak has reached historic, and unprecedented levels. 

 

And when you add in the recent emergence of H5N8, H5N6, H5N3 in Asia and novel reassortants of H5N2 and H5N1 in North America, it is easy to understand why the  World Health Organization recently released a pointed warning that H5 Is Currently The Most Obvious Avian Flu Threat.

Eurosurveillance: Emergence Of A Novel Cluster of H5N1 Clade 2.2.1.2

Credit Eurosurveillance 

 

# 9899

 

Over the past 5 months in Egypt we’ve witnessed the largest, and most sustained, outbreak of H5N1 among humans since the virus first emerged in China in 1996.  While numbers are murky, we are somewhere in the vicinity of 160 confirmed cases since November 1st, and roughly 50 deaths. 

 

Or roughly 50% higher than the greatest previous one year combined total (for 9 countries) of 115 cases set back in 2006.

Although we’ve seen a few small family clusters where H-2-H transmission may have occurred, we’ve seen no signs of increased human-to-human transmissibility of the H5N1 virus.

 

But obviously something has changed in Egypt. 

 

Last January in a CIDRAP report (see FAO Reports Mutations In H5N1 Virus From Egyptian Poultry) we learned that genetic characterizations of H5N1 viruses sampled from Egyptian poultry recently showed signs of several troubling `mammalian adaptations’, and we’ve seen repeated reports of large numbers of poultry outbreaks – even among previously vaccinated poultry (see Egypt H5N1: Poultry Losses Climbing, Prices Up 25%).

Yesterday the journal Eurosurveillance published a Rapid Communications characterizing the genetic changes in a rapidly spreading strain of H5N1 that  appears to have emerged in early 2014, and is quickly supplanting other strains of the virus in that region.

 

Eurosurveillance, Volume 20, Issue 13, 02 April 2015

Rapid communications

Emergence of a novel cluster of influenza A(H5N1) virus clade 2.2.1.2 with putative human health impact in Egypt, 2014/15

A S Arafa^1,2, M M Naguib^1,2,3, C Luttermann³, A A Selim¹, W H Kilany¹, N Hagag¹, A Samy¹, A Abdelhalim¹, M K Hassan¹, E M Abdelwhab¹, Y Makonnen⁴, G Dauphin⁵, J Lubroth⁵, T C Mettenleiter³, M Beer³, C Grund³, T C Harder ()³

---

A distinct cluster of highly pathogenic avian influenza viruses of subtype A(H5N1) has been found to emerge within clade 2.2.1.2 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.

---

In Egypt, highly pathogenic avian influenza (HPAI) influenza A(H5N1) viruses of clade 2.2.1 and their descendants have been circulating in poultry populations since 2006, causing sporadic human infections [1]. Human influenza A(H5N1) infections in Egypt have been reported since the introduction of the virus in 2006 with 204 cases occurring until end of 2014 and a fatality rate of 35,8% in laboratory-confirmed cases reported to the World Health Organization (WHO). However, since January 2015, the incidence of human H5N1 cases in Egypt has increased dramatically: as of 21 March 2015, 116 human cases including 36 deaths have been reported to WHO [2]. This study was initiated to analyse molecular properties of H5N1 viruses that have caused outbreaks in poultry in Egypt since summer 2014 and to compare them with published sequences from H5N1 viruses obtained from recent human cases.

<SNIP>

Discussion

(Excerpt)

Our data confirm the emergence of an additional virus cluster within the Egyptian 2.2.1.2 clade of H5N1 HPAI viruses. Since November 2014, viruses of this new cluster appear to have become dominant over the previously described clade 2.2.1.2 phylotypes circulating in various poultry species. The only two publicly available sequences of viruses isolated from recent human H5N1 cases in Egypt show similar mutation patterns and fall into the same phylogenetic group. The molecular determinants that may improve the evolutionary fitness of these viruses need to be further clarified. The emergence of new clusters of H5N1 HPAI viruses in Egypt is not without precedence: In late 2007, a subclade of antigenic drift variants, later designated 2.2.1.1, emerged and expanded (clade 2.2.1.1a) in commercial poultry in Egypt but disappeared until end of 2010 [14] and, contrary to the current situation, did not replace 2.2.1 viruses. Viruses of clade 2.2.1.1 that emerged in 2007 hardly caused any human cases: according to the OpenFlu database [15]: only one of 100 H5N1 isolates from humans in Egypt belonged to clade 2.2.1.1; all others belonged to clade 2.2.1 and 2.2.1.2. In contrast, the emerging cluster identified in this study seems to be predominant across all poultry production sectors and has already caused a third of all human infections reported in Egypt since 2006 in only three months of 2015.

Given the endemic status of influenza H5N1 in poultry and the limitations of the reporting system of H5N1 HPAI virus outbreaks in poultry in Egypt, it is difficult to assess whether the altered epidemiological pattern of the emerging phylotype is due to altered biological properties in poultry or whether the increased incidence of infections in poultry merely reflects an increased viral burden across all poultry sectors in Egypt. In any case, the observed recent rise in outbreaks in poultry probably resulted in increased exposure risks for humans in contact with poultry, which may have caused an increased incidence in human cases. However, it can at this point not be excluded with certainty that the emerging phylotype of viruses may have increased zoonotic potential and may be transmitted more efficiently to humans, although this assumption cannot be drawn from the molecular evidence described here. Further studies of the pathogenicity and transmissibility of these viruses in humans, e.g. in the ferret model, are required. Concerted efforts of both veterinary and public health authorities are urgently needed to interrupt virus circulation in poultry in Egypt efficiently. This will help decrease the risk of human exposure to the virus.

(Continue . . .)

 

While the exact impact of these changes on the transmissibility of H5N1 to humans isn’t certain, its rapid spread among Egyptian poultry has – at the very least – increased the odds of human exposure. 

While the future course of the H5N1 virus is uncertain, the more opportunities it gets to infect humans, the more chances it will have to adapt to our physiology.  

 

Add in the recent emergence of H5N8, H5N6, H5N3 in Asia and novel reassortants of H5N2 and H5N1 in North America, and it is hardly surprising that the World Health Organization recently released a pointed warning that H5 Is Currently The Most Obvious Avian Flu Threat.

FAO: Egypt’s H5N1 Case Count Continues To Climb

 

 

# 9883

 

Although the Egyptian MOH remains largely silent on their H5N1 outbreak, and the Egyptian media continues to publish numbers from some alternate reality (this report today cites only 13 deaths for the year), we’re able to keep some semblance of track via updates from the World Health Organization, releases from the FAO EMPRES website, and the hard work of Sharon Sanders who curates the Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List.

Our last update from the FAO came two weeks ago (see Egypt’s H5N1 Bird Flu Beat Goes On . . . .),  which was followed up a few days later by a WHO EMRO Update On Egypt’s H5N1 Outbreak, which pegged the number of H5N1 cases in Egypt for the year at 116, with 36 deaths (as of March 17th).

While we’ve seen scattered reports in the media of additional cases over the past two weeks, we rarely see a confirmation by Egyptian authorities.  Luckily, they still continue to report to International agencies like the WHO and FAO under the rules established under the IHR (International Health Regulations).

 

Today the FAO has announced 11 more H5N1 cases, the links you’ll find below:

 

1. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Assiut, for human
2. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Port Said, for human
3. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Fayoum, for human
4. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Shrkia, for human
5. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Shrkia, for human
6. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Menoufia, for human
7. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Dakahlia, for human
8. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Suhag, for human
9. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Shrkia, for human
10. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Behera, for human
11. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Shrkia, for human

Based on this report, previous reports, and FluTrackers’ 2015 Egypt H5N1 Case List , Egypt is up to 128 cases for the year. Deaths are often reported late (or sometimes not at all), but the WHO’s last tally was 36, and several more appear to have died since then.

While it is not entirely clear what is behind this sudden increase in H5N1 cases, Egypt has reported heavy rates of poultry infections this winter – even among vaccinated flocks (see Egypt H5N1: Poultry Losses Climbing, Prices Up 25% - which calls into question the effectiveness of the vaccines currently being used.

 

Poorly matched vaccines can often protect poultry against illness – but with increasingly diverse and rapidly evolving avian flu viruses - they cannot always prevent infection. The end result is that healthy looking chickens can harbor undetected infections, that viruses continue to circulate, and new variants or reassortants continue to emerge.

 

And without the traditional warning signs of sick or dying chickens, people who handle them are not aware of the the danger they pose.

 

While we’ve not seen any evidence of increased or efficient human-to-human transmission of the H5N1 virus in Egypt, it is worrisome that this outbreak has now gone on for five full months, and that in excess of 150 people have been infected. 

 

Twice as many human cases as has ever been reported by one country in a single year.  And each human infection provides the virus with another opportunity to better adapt to human physiology.

 

Although the future threat from H5N1 is unknown, these outbreaks in  Egypt and the rapid emergence and spread of new HPAI H5 reassortants around the globe over the past year recently prompted the World Health Organization to issue a pointed warning (see WHO: H5 Currently The Most Obvious Avian Flu Threat).

Egypt’s H5N1 Bird Flu Beat Goes On . . . .

Credit WHO

 

# 9835

 

Despite the fact that Egypt is more than 4 months into the worst H5N1 outbreak since the virus emerged in the mid-1990s, with at last count – 115 human cases since November 1st – we get very little day-to-day information about the crisis.  

 

Unfortunately, no news doesn’t always equal good news.

 

The Egyptian Ministry of Health stopped reporting publicly on a regular basis in late January (see The Silence Of The Egyptian MOH), and the media’s coverage has been both sparse and confused.

The last `official’ number we received was from the World Health Organization’s March 3rd update, which showed 88 cases and 26 deaths for the year (see below), based on reports provided to them by the Egyptian MOH. 

Excerpted from WHO Case Count Table – March 3rd

Exactly how current Egypt’s last notification to the WHO was, and how many cases have been detected since this update, are open questions. Based on media reports, new cases continue to emerge, but details are often absent and the YTD totals remain murky at best.

Sharon Sanders, whose conservatively curated 2015 Egypt H5N1 Case List had  94 cases and 26 deaths as of this morning, but also has several `probable's’ in waiting. 

 

Today, however, the FAO published notifications of 17 recent human H5N1 cases from Egypt (see below), that appear to be recent enough not to have been included in the last WHO update.  Some of these, Sharon believes she’s already captured on her list, but others appear to be `new’.

As these FAO updates lack identifying details, like age and gender, accurately matching them up to the FluTracker’s list isn’t possible at this time, but it is a pretty good indication that Egypt’s bird flu outbreak continues to steamroll along.

 

Sharon estimates that perhaps 9 of these cases will end up added to her list, once the WHO publishes a usable line listing. 

 

All of which puts Egypt’s probable YTD case count something north of 100, and growing.  Shattering Vietnam’s record year (2005) which saw 61 cases and 19 deaths, and Indonesia’s 2006 total of 55 cases and 45 deaths.

 

The `good news’, as far as we can tell from FAO, WHO, and Egyptian statements is that these human infections appear to be caused by direct contact with infected birds. 

 

A couple of small `family clusters’ have been mentioned in recent months, but there’s been nothing at this point to indicate the virus is transmitting easily, or efficiently, from person-to-person.

 

Below you’ll find a listing of today’s FAO notifications:

 

1. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Kafr-el-sheikh, for human
2. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Al Jizah (giza), for human
3. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Al Daqahliyah (dakahlia), for human
4. 16/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Ash Sharqiyah (sharkia), for human
5. 16/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Al Buhayrah (behera), for human
6. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Al Buhayrah (behera), for human
7. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Ash Sharqiyah (sharkia), for human
8. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Al Minya (menia), for human
9. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Qina, for human
10. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Qina, for human
11. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Al Buhayrah (behera), for human
12. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Al Minya (menia), for human
13. 16/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Al Qalyubiyah (kalyoubia), for human
14. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Al Qahirah (cairo), for human
15. 16/03/2015: Egypt - Influenza – Avian Confirmed Influenza - Avian in Al Jizah (giza), for human
16. 16/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Al Buhayrah (behera), for human
17. 16/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Ash Sharqiyah (sharkia), for human

ECDC Rapid Risk Assessment On H5N1 In Egypt

Credit ECDC

 

# 9824

 

Egypt is currently experiencing the largest outbreak of human H5N1 infections since the virus re-emerged in 2003, with roughly 115 cases reported over the past 17 weeks (see WHO H5N1 Update – Egypt).  

 

While transmission still appears to be bird-to-human, and the virus remains difficult to spread from person-to-person, this uptick is nonetheless a worrisome development.

 

Today the ECDC has released one of their detailed Rapid Risk Assessments on Egypt’s recent H5N1 outbreak.  First the summary, and then a link to, and excerpts from the document.

 

 

Rapid risk assessment: Human infection with avian influenza A(H5N1) virus, Egypt, first update

•  13 Mar 2015

Available as PDF in the following languages

EN

This document is free of charge.

Abstract

Human cases and fatalities due to influenza A(H5N1) virus continue to increase in Egypt, with cases from the country now accounting for the highest number of human cases reported worldwide.

Continuous increase of virus circulation in backyard poultry and exposure to infected poultry are most probably contributing to the increase in human cases. Whenever avian influenza viruses circulate in poultry, sporadic infections and small clusters of human cases are possible in people exposed to infected poultry or contaminated environments.

Although Egypt has reported an increased number of animal-to-human infections over the past few months, the influenza A(H5) viruses do not appear to transmit easily among people, and no sustained human-to-human transmission has been observed. As such, the risk of these viruses spreading in the community remains low.

Increased human infectivity of the circulating virus and the protection conferred by the poultry vaccines currently in use should be further investigated.

The current assessment remains that there is no risk for the general public in the EU. Travellers from the EU should avoid direct contact with poultry or poultry products when travelling to Egypt.

There is a low but ongoing and continuous risk of the virus being introduced and cases being imported into Europe and therefore both veterinary and public health authorities should maintain preparedness.

 

 

 

 

RAPID RISK ASSESSMENT Human infection with avian influenza A(H5N1) virus, Egypt

First update, 13 March 2015

 

ECDC threat assessment for the EU

Egypt has reported a dramatic increase in human cases and deaths due to A(H5N1) in recent months. During the  same period, a large increase in outbreaks among poultry has been reported, mainly related to backyard farming. A(H5N1) affects all sectors of poultry production, is detected in different bird species and circulates in all geographical areas.

The reason for the current increase in human infections is believed to be the spread of the virus within the backyard poultry population and the intensive virus circulation. There has also been speculation that increased co circulation of A(H9N2) might have contributed to the intensified spread of A(H5N1) in poultry and associated human cases in Egypt. The current joint WHO/CDC/FAO/OIE mission to Egypt will hopefully provide more information on the reason for the sharp increase in human cases. A strategy needs to be established to prevent further geographical spread.

Although the risk of an introduction of A(H5N1) into Europe via migratory birds seems to be very low, the increase in the number of outbreaks and the higher level of virus circulation in the poultry population in Egypt might increase the likelihood for A(H5N1) infections of migratory birds. In particular, migratory waterfowl are known to be potential vectors for the introduction of A(H5N1) to free areas as they undertake movements at certain times of the year. Therefore in Europe there is a theoretical risk that the virus may spread to poultry and the veterinary sector should maintain vigilance, using well-established surveillance systems for early detection, should new introductions occur.

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 has been reported by Egypt over the past few months, these influenza A(H5) viruses do not appear to transmit easily among people at present. As such, the risk of these viruses spreading in the community remains low.

Human infections are related to exposure to infected poultry, with the increase in outbreaks among backyard poultry most probably contributing to the increase in human cases. Increased human infectivity of the circulating virus and protection conferred by the poultry vaccines currently in use should be further investigated. No indications of human–to-human transmission have been reported from Egypt. As such, the risk of these viruses spreading in the community remains low, and the assessment of the last ECDC Rapid Risk Assessment published on 23 December 2014 remains valid.

Although the areas where there has been transmission in poultry are mostly rural, the importation of a sporadic travel-related human A(H5N1) case into the EU is possible and public health authorities should be prepared. The risk of EU citizens being infected in Egypt is extremely low. No cases of A(H5N1) among travellers to Egypt have ever been notified. Travellers should be advised to avoid direct contact with poultry or poultry products.

WHO: Updated H5N1 Cumulative Case Count Table

Excerpted from WHO Case Count Table – March 3rd

 

# 9808

 

In yesterday’s WHO H5N1 Update – Egypt I mentioned that the latest cumulative H5N1 human case count table had not yet been uploaded, although based on the summary narrative it appeared that we’ve had `roughly * 88 cases, and 24 deaths’  reported in Egypt since the first of the year.

Overnight a new chart has been published, and in it we find a slight adjustment to the 2014 numbers (10 deaths reduced from 11 in the last report), and a YTD total of 88 cases, and 26 deaths.

 

Since this outbreak began in November, Egypt has reported 115 cases and 36 fatalities, making this the largest single nation run of cases since the virus began is main assault in 2003.

 

Based on the reporting cut-off of March 3rd, delays in the Egyptian MOH forwarding reports to the WHO, and the sporadic reporting of new (suspected & confirmed) cases in the media, it is safe to assume these numbers continue to expand.

 

Unknown, too, are how many mild or moderate infections there might be that are never counted.  

 

While the assumption is that some number of H5N1 cases go undiagnosed (or are misdiagnosed), and only the `sickest of the sick’ seek medical treatment and are counted, so far the evidence for there being a lot of missed  `mild’ cases is fairly limited. 

 

In PLoS One: Seroprevalence Of H5N1 Among Bangladeshi Poultry Workers, we looked at the paucity of evidence for missed cases, and ongoing debate over the actual burden of the disease, and the resultant CFR (Case Fatality Rate). 

 

Currently the WHO, FAO, NAMRU-3 and other International agencies are in Egypt reviewing the situation and offering advice to the Egyptian government on controlling this outbreak. 

 

We hope to get some sense of their findings in the next couple of days.

Stay tuned.

WHO H5N1 Update - Egypt

# 9806

 

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.

 

An Egyptian H5N1 Roundup

 

# 9783

 

Although details are often absent from official statements and media reports, we continue to see signs that Egypt’s bird flu crisis continues to worsen, both in poultry and in humans. 

 

New emergency committees are formed seemingly on a weekly basis, new cases (suspected and confirmed) are announced daily in the media, and repeated warnings go out to the public to seek medical care if they suspect avian flu infection.

 

Since the MOH has become increasingly uncommunicative on the subject over the past six weeks, we are left with gleaning what we can from local media reports.   Today I’ve included a few examples:

 

First, the formation of yet another high level committee to address the crisis (see Egypt: Government Statements On H5N1 Response & Latest Fatality & Egypt MOH: Three H5N1 Statements & Confirmation Of 17th Case for other committee announcements).

 

A supreme committee to combat the "bird flu" in Fayoum

Thursday 05 / March / 2015 - 10:19

Print Issued adviser Wael Makram, the governor of Fayoum, a decision No. 100 for the year 2015 to form a higher committee under his chairmanship to combat bird flu in Fayoum. committee shall take all necessary measures to combat bird flu and prevention measures, as well as follow-up to provide the necessary vaccinations to citizens and birds, and patient follow-up cases and the work of inventory Comprehensive their numbers, as well as assigning competent hospitals to lift the state of emergency for the reception of these cases.

The Commission in its membership, secretary general of the province , Assistant General Secretary, and Chairman of the Central Department for the governor's office as a member of the National Committee of crises and disasters, and the agents and the Ministries of Health and Agriculture and Veterinary Medicine in Fayoum, and general manager IDSC, and Director of Crisis Management, and Director of Environmental Affairs, and President of the bodies of water police, and the heads of local units of cities and centers.

 

Next, a report on the setting up of roadblocks to interdict the illegal transporting of poultry in and out of Menofia:

Menofia facing bird flu ambushes # Police

Monofia announced the face of bird flu tighten ambushes on the roads to monitor the tanker cars for birds and stop the transfer of birds to and from the provinces.

 (continue . . . )

 

And this report, which indicates that 359 outbreaks of avian flu have been detected in Egypt since the first of the year, and that also concedes that  Egypt is only capable of producing roughly 10% of the vaccine that would be required to fully immunize their nation’s poultry. .  

 

Ministry of Agriculture: the arrival of the hotbeds of infection with bird flu to focus 359

Latest update: Wednesday, March 4, 2015 - 12:48

Lightning News - Egypt, announced the report, issued by the Central Department of Preventive Medicine, attached to the Veterinary Services, Ministry of Agriculture, the arrival of the foci of infection with bird flu, observed from the fact teams disease, to 359 focus, from the first of January, until last Monday.

The report, that one of the outposts 0.236 of highly pathogenic type, and 123 weak virulence, and that the total bosses of poultry in rural education, arrived at the 6 million birds, just last month in the nursery education and wards of Education municipal birds such as chickens, ducks, ranging from ages between 15 days to 45 days.

(Continue . . . )

 

While greater vaccination coverage is often cited as a major component of their bird flu response, a couple of weeks ago in Egypt H5N1: Poultry Losses Climbing, Prices Up 25%, we looked at the impact that H5N1 has had on their poultry industry, and reports that a growing number of outbreaks are occurring among vaccinated poultry.

 

For a discussion on the limitations of poultry vaccination, you may wish to revisit yesterday’s blog Study: Recombinant H5N2 Avian Influenza Virus Strains In Vaccinated Chickens or 2012’s Egypt: A Paltry Poultry Vaccine.

 

Today, the creation of an emergency hotline to report suspected bird flu outbreaks was also announced.

 

Activate the service hotline for reporting bird flu and queens

Thursday 05 / March / 2015 - 13:52

General Authority for Veterinary Services, announced the Ministry of Agriculture and land reclamation for the activation of the hotline 19561 service, to report any emergency to the pathogenesis of animal and poultry bird flu. For its part .. said Dr. Amal Abdel-Fattah, Director General of Veterinary Medicine, and queens, he was the service support a team of doctors and Aladrain for two morning starting at nine in the morning until two o'clock pm, and the evening Tbdomn o'clock pm and finished seventh pm.

 

And of course we continue to see a steady parade of media reports on suspected or confirmed human cases, which may or may not be eventually confirmed by the MOH.  Some examples from the last 24 hours include:

 

Egypt announces the death of a woman infected with bird flu

Injury to a child by «bird flu» lake

High injured bird flu Sharqia for 13 cases

 

While we are hampered by the Egyptian MOH’s reluctance to discuss or divulge case information (except, presumably to the WHO per the IHR), we know from the FAO, media, and World Health Organization reports that over the past four months Egypt has seen the largest outbreak of H5N1 in humans since the virus emerged nearly 20 years ago.

The MOH (and by extension, the Egyptian press) stopped updating case counts in January, and so we get dubious headlines and reportage like this week’s Two die from bird flu bringing Egypt's 2015 death toll to 10, which doesn’t even come close to reflecting reality.

 

FluTracker’s conservatively curated Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List puts the number at nearly 80 cases, and at least 21 deaths since the start of the year (note: deaths are harder to quantify because follow up reports are less likely to be printed in the media).

 

Numbers which tally pretty well with recent FAO and WHO dispatches.

 

The most recent FAO/EMPRES Animal Influenza Update # 637 contains the following update on Egypt.

EGYPT
 
12, 17, 22 & 23/02/2015 - H5N1 infections in humans, Behera, Cairo, Giza, Dakahlia, Fayoum, Iskandariyah, Menia, Menoufia,Qina, Sharkia, Sohag and Sharkia Governorates

Source: National Authorities

According to the Ministry of Health, between 9 January and 2 February 2015, 22 new human cases of H5N1 infection were detected in 13 out of Egypt’s 27 governorates namely: Asyiut (1), Behera (3), Cairo (6), Damietta (1), Fayoum (4), Giza (1), Menia (4), Menoufia (2), Qalyubia (3) and Sharkia (4), of which 8 have died. Patients affected are aged between 0.8 and 42 years old, 13 of them are less than 6 years old, and 29 cases had contacts with backyard or market poultry few days prior to illness. Of the 285 confirmed human cases in Egypt since 2006, 102 were fatal.

 

Since the WHO case count sat at 177 cases and 63 deaths last October, these numbers reflect a net gain of 108 cases and 39 deaths since November 1st, 2014.  Of those (based on the WHO report of January 26th), roughly 27 cases and 9 deaths reportedly occurred between November 1st and Dec 31st, 2014.

All of which leaves us in the ballpark of 80+ cases, and approximately 30 deaths in Egypt since the start of the year.  

 

These numbers are as of a couple of weeks ago, and as we continue to see (unconfirmed) media reports of new suspected and `confirmed’ cases on a daily basis,  today’s total is no doubt even higher.

 

The World Health Organization and the FAO are reportedly scheduled to arrive in Egypt later this month to assist the government in their bird flu response this month (see Media: WHO H5N1 Mission To Egypt). 

 

Hopefully their after-mission reports will provide us with a better understanding of the scope of Egypt’s H5N1 outbreak.