Bird Flu Center

Egypt’s 38th human case of avian influenza infection was confirmed this week as a woman aged 25. The infection is believed to be the result of contact with dead poultry in the woman’s household. She resides in the Nile Delta province of Damietta, northern Egypt. Bird flu cases in Egypt are rare during the summer months, however the woman developed high fever and was subsequently treated with Tamiflu.

15 Egyptians have so far succumbed to the disease since the first cases were discovered in the country last year. It is the single most affected country outside Asia at the moment. Millions of household across Egypt depend on poultry as their main source of food as well as income. This is making efforts to eradicate the disease very difficult.

Egypt’s human bird flu victims number has reached 13, with a 5 year old boy living in the region of the Nile Delta succumbing to the disease. He was the 22nd Egyptian person to fall victim to the disease. Another case has now surfaced in the Sharqiya governate, some 40 miles north of the country’s capital, Cairo. Egypt is now fighting a massive outbreak of the disease, as the virus has now been confirmed in 20 of its 26 governorates.

As an Egyptian woman died following a bird flu infection, a five year old boy was confirmed as the country’s 22nd human case. World Health Organization experts are saying that delayed reports in the cases discovered lead to a late reporting of the bird flu cases in the last weeks in Egypt. The last person to succumb to the disease is a 37 year year old woman who had been reported as being in a stable and improving condition following her transfer to a major hospital in Cairo. The 5 year old boy is being treated with Tamiflu, as he tested positive for avian influenza earlier this week. Most of the people becoming infected with bird flu in Egypt had been in close contact with poultry at their residences.

The Egyptian Health Ministry has confirmed that the two bird flu cases recorded in the last month have shown resistance to Tamiflu, the drug thought to best treat the disease among humans. In-depth genetic study done on the viruses, in the case of persons who succumbed to the disease, have shown the that virus is resistant to Tamiflu. Just days ago, World Health Organization officials announced that the Egyptian cases recorded last month showed a mutation from the regular known form of the pathogenic agent.

A woman living in Egypt became the country’s 7th bird flu victim on Monday, as she passed away after being infected with the avian influenza virus. The announcement was made by a health ministry spokesperson, who also gave the information that the infection occurred during slaughtering of domestic birds by the woman. She was presented to the hospital with high fever on October 4th but the disease could not be fought off. Egypt recorded its first case of the highly pathogenic bird flu virus in February and is now the hardest hit country outside Asia.

An Egyptian woman hospitalized almost a week ago with symptoms of bird flu has been confirmed to carry the highly pathogenic H5N1 virus, after thorough laboratory testing. The 39 year old woman is the country’s first case in almost five months. She has received treatment with Tamiflu and her condition is now reported to be stable. Egypt is the country that has been affected the most by the disease, excluding Asian countries, as numerous cases of human infections have been reported until earlier this year. This is now Egypt’s 15th case.

Birds tested in Egypt’s southern province of Sohag and the Mediterranean coastal province of Damietta have been found to be infected with the avian influenza virus. A health ministry made the announcement on Tuesday, saying that all birds in the area will be culled. This is the country’s first case of bird flu in months, raising concerns of a possible recurrence of the virus with the beginning of the migration season for birds. Egypt first recorded an outbreaks in march and six people eventually succumbed to the disease. World wide, more than 140 people have been killed, with most human deaths being traced back to human contact with sick birds.

Critics say Egypt is not prepared to handle a major outbreak 

Egypt, the Arab world’s most populous country, has gone on high alert after a warning from the UN  that the deadly H5N1 bird flu strain could hit North Africa and the Middle East.

Officials from the United Nations’ Food and Agriculture Organisation (FAO) said they were worried about the potential spread of avian influenza along the pathways of migratory birds to northern and eastern Africa.

On Saturday, Egyptian President Hosni Mubarak held a ministerial meeting to discuss measures in the event bird flu cases are detected.

A national committee comprising various government bodies which has been set up to monitor the avian flu situation held an emergency meeting on Friday attended by representatives from the ministries of defence, agriculture and health, in addition to the World Health Organisation (WHO), according to the official Middle East News Agency.

The Egyptian authorities had already banned poultry imports and bird hunting more than two weeks ago.

On 17 October, WHO issued a bulletin warning that daily dynamic interaction with other countries could easily result in the introduction of avian influenza into the Eastern Mediterranean region (EMR).

The bulletin listed the return of expatriate workers, trade, and tourism, in addition to migratory birds, as likely risk factors.

“The EMR is the nearest region to the current focus of unprecedented outbreaks of avian influenza than any other WHO region outside of Asia,” the bulletin added.

Not prepared

With the discovery of the virus in Turkey and Romania, Egyptian officials have been working to assure the public that the country has been safe so far and all safety measures have been taken.

But the measures appear limited to precautionary actions and no national pandemic preparedness plan has been announced.

Ahmad Tawfiq, head of the government-run Authority of Veterinary Services (AVS), said his organisation had increased the monitoring of Egypt’s border areas, especially in North Sinai’s coastal area and Fayum, 100km south of Cairo.

Both areas are frequented by migratory birds.

The ban on imported poultry is expected to raise prices .The authorities have also tightened airport quarantine controls.

Environmental Affairs Minister Maged George said his ministry had taken more than 500 blood samples from migratory birds flying across Egypt to make sure they were not carrying the disease. None had tested positive.

The AVS banned the import of poultry products, including eggs and feathers, from flu-infected countries. A bulletin was sent to veterinary units across the country on how and when to report poultry deaths.

Markets affected

The quail market has been severely affected as customers snubbed the bird, an autumn delicacy, which migrates to Egypt at this time of the year.

Meanwhile, the ban on imported poultry and its by-products is expected to raise the price of already expensive white meat products.

Before flying to Canada in an avian flu-related mission, Health Minster Awad Tag al-Din said Egypt was different from other countries which reported cases of the disease because there had been no infections so far.

“The flu is being monitored closely and is under control,” he said.

Public scepticism

But some suspect the authorities will not announce avian flu cases if any are detected.

This fear stems from a much criticised state policy that maintains “everything is under control” in situations such as this. Such stances are often met with scepticism by Egyptians.

Fahmy Howeidy, a respected Egyptian columnist, launched an attack on the government’s policy in a recent article published in the London-based Al-Sharq Al-Awsat newspaper.

He demanded that officials should adopt a transparent and honest stand with avian flu developments.

“The real fear is if the avian influenza becomes pandemic. If that happens in a developing country like Egypt, it will be a catastrophe”

Rauf Hamid, National Institute for Pharmaceutical Research
Rauf Hamid, a professor of pharmaceutical sciences and toxicology in the National Institute for Pharmaceutical Research, told Aljazeera.net: “The real fear is if the avian influenza becomes pandemic. If that happens in a developing country like Egypt, it will be a catastrophe.

“I think the minister of health flew to Canada to do his avian flu homework. I doubt they have a preparedness plan,” he said.

Although Egypt has a reputable national vaccine institute, Vaccera, its efficiency in handling avian flu has yet to be tested.

When rating developing countries, Egypt’s Vaccera comes third after Cuba and Iran, Hamid said.

“But in recent years, it has been responding to market demands and focused on profit rather than specialising and expanding in vaccines and antivirals.

“So this is a problem in Egypt as we face the avian flu threat.”

Officials at Vaccera and the Ministry of Health were not available for comment.

Tamiflu unavailable

There is no vaccine for avian flu, but there are anti-influenza drugs such as Tamiflu made by Swiss pharmaceutical company Roche, which does not cure the flu but can lessen symptoms if taken shortly after they appear.

Tamiflu cannot be found even in
Cairo’s larger pharmacies
It is one of a class of treatments recommended by WHO for use in the event of a flu pandemic.

Although it is authorised by the Ministry of Health, Tamiflu cannot be found in Cairo pharmacies.

“Don’t try to look for it anywhere, it’s not in Egypt,” a pharmacist in the top El-Ezabi chemists told Aljazeera.net.

“Antivirals are very expensive and manufactured abroad,” said Hamid. “In the case of a pandemic, the developed countries and rich people will find treatment. But what will a country like Egypt do?”

Counting on luck?

Usama Raslan, head of Ain Shams University’s Medical Microbiology and Infection Control Department, however, argues that the issue is not limited to Egypt’s preparedness.

“On the other hand we might be lucky … Egypt is a warm country and migratory birds do not stop here for long”

Usama Raslan, head of Ain Shams University’s Medical Microbiology and Infection Control Department
“If there is no international cooperation in infection control measures between the UN, WHO and governments, there will be a problem everywhere,” he told Aljazeera.net.

“I don’t think the situation is as grave as it appears to be and I don’t think any government, here or elsewhere, will stop short of taking the needed precautionary methods.

“On the other hand we might be lucky,” said Raslan. “Egypt is a warm country and migratory birds do not stop here for long.”

A new human case of avian influenza was announced on 2 May, bringing the total number of reported human infections in Egypt to 13.

A 27-year-old woman was diagnosed with the disease on 1 May when she visited a Cairo hospital after showing symptoms associated with the avian flu, including high fever and breathing difficulties, according to a Ministry of Health press statement. “An X-ray revealed both her lungs were inflamed,” the statement read.

The infection is the first human case of the potentially fatal virus to have been reported within the capital, Cairo. However, according to the health ministry, the woman contracted the disease in her home village in the Menoufiya governorate, some 80 km north of the capital, while handling sick domestic birds. “She was exposed to infected domestic birds in her village,” read the ministry statement.

After being tested positive, she was immediately administered with Tamiflu capsules in an effort to blunt the efficacy of the virus. “Her condition at present is stable,” the statement noted. Members of her family, meanwhile, have all tested negative for the illness.

The discovery comes only three days after a joint announcement by the health ministry and World Health Organization (WHO) that there were no longer any human cases in Egypt. Both organisations emphasised, however, on the continued possibility of new infections. “The threat posed by bird flu has by no means passed,” said Sayyid al-Abbasi, a media official at the health ministry, prior to the latest discovery.

Egypt’s first human case was reported in mid-March. Since then, four people have died from the disease, while another eight have fully recovered. “Compared with other countries where H5N1 infections among humans have been found, the recovery rate in Egypt has been very good,” said Mona Yassin, WHO technical assistant for media and communications.

On the whole, the survival rate for bird flu patients the world over has been approximately 50 percent, according to health ministry spokesman Abdel Rahman Shahine.