Human H5N1 avian influenza cases surge in Egypt

A major rise in the number of human cases of H5N1 avian influenza was recorded in Egypt between November 2014 and February 2015. The number of cases found over the period exceeded the number of human cases ever found in any country since the disease’s re-emergence in 2004.
This increase and the fact that the H5N1 virus is now present throughout the Egyptian poultry flock were among the findings of a joint World Health Organization (WHO) high level mission to 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 the virus. Coupled with insufficient awareness, behavioral patterns and inadequate precautions taken by humans when interacting with poultry this explains what we are seeing,” said Dr Keiji Fukuda, WHO assistant director-general for health security and head of the H5N1 investigation team in Egypt. “


Country-wide infection
H5N1 Avian influenza is circulating in all sectors of the Egypt’s poultry sector and in all geographical areas. Between December 1, 2014 and February 28, 2015, 333 outbreaks were observed in Egypt’s poultry industry, while over the same period in 2013-2014 there were only 44 reported outbreaks.
The way that poultry is produced in Egypt, and the manner in which disease prevention and controls are applied, are thought to be contributing to the increase in human and bird cases.
Changes in the country’s economy and the poultry industry since 2011 have had a negative impact on the capacity of the Ministry of Agriculture and Land Reclamation to prevent and respond to disease outbreaks. For example, many small farms have turned to rearing poultry for food and income and are completely unmonitored. Evidence suggests that the H5N1 virus is deeply entrenched on such farms and in household flocks.


Weak avian influenza controls
Disease control strategies in the country are hampered by weak response capacity, weak public-private partnerships, sub-optimal avian influenza vaccination strategies and poor biosecurity in some sectors, while national disease control laboratories are not used as effectively as they could be for diagnosis, rapid response, monitoring and vaccine use.
Although the country has a national HPAI Integrated National Plan for Avian and Human Influenza, developed with support from the FAO, it has not been implemented.
The  increase in the number of human cases detected each month in unprecedented, and most likely results from increases exposure of people to infected poultry. Most recent human cases (approximately 70 percent) had exposure to backyard poultry. While the Ministry of Health and Population has strengthened disease surveillance systems to monitor seasonal influenza cases and H5N1, this improved monitoring is not thought to be behind the higher number of reported cases.
Structures and strategies have been developed in Egypt for both animal and public health but they need to be implemented more fully, WHO says. Similarly, communication efforts have failed to modify risk behaviors.
Egypt needs to make long term investments to fight H5N1, review its current strategies and concentrate on preventing virus spread within poultry populations. Surveillance and reporting needs to be improved and trade in infected chickens stopped. Infected birds need to be disposed safely, and particular attention needs to be paid to the country’s unlicensed commercial and semi-commercial farms.