CIDRAP: Egypt reports four new H5N1 infections

Lisa Schnirring Staff Writer

Jan 28, 2010 (CIDRAP News) – Egypt's health ministry has confirmed four new H5N1 avian influenza cases, which aren't related although all had contact with sick and dead poultry and are recovering in stable condition, the World Health Organization (WHO) reported today.

News of the four cases comes the same day researchers detailed the epidemiologic patterns of Egypt's H5N1 cases in Eurosurveillance. The report suggests that children have been disproportionately affected as well as women, a group that is more likely to die from H5N1 infection. The new report also shows a connection between early treatment and recovery.

The new cases include:

• A 20-year-old woman from Beni Suef governorate who got sick on Jan 6 and was hospitalized and started on oseltamivir (Tamiflu) on Jan 11; this case appears to be the same one reported on Jan 13 by Strengthening Avian Influenza Detection and Response (SAIDR), an Egypt-based project funded by the US Agency for International Development
• A 1-year-old boy from Dakahalya governorate who got sick on Jan 7 and was hospitalized and treated with oseltamivir on Jan 12
• A 3-year-old boy from Assuit governorate who became ill on Jan 19 and was hospitalized and treated on Jan 12
• A 45-year-old man from Sharkia governorate who started experiencing symptoms on Jan 12 and was hospitalized and treated on Jan 19

The four H5N1 cases bring Egypt's total to 94, of which 27 have been fatal. They are the first cases to be reported in 2010. Last year Egypt reported 39 avian flu cases, up dramatically from 8 in 2008. However, the number of deaths for both years was the same, at 4. The new cases raise the world's H5N1 count to 471 cases, including 282 deaths.

New reports of human infections appear to mirror a recent spike in poultry infections in Egypt. On Jan 19 animal health authorities announced that they had recently detected 17 household outbreaks across 8 governorates as the result of increased passive surveillance in veterinary clinics.

In today's Eurosurveillance report, researchers from the National Veterinary Research Institute in Nigeria analyzed the first 3 years of H5N1 infections in Egypt, from March 2006 through August 2009, which includes 85 cases and 27 deaths.

In 2009 the disease seemed to take a growing toll on children. At the same time, Egypt's H5N1 patients seemed increasingly more likely to survive their infections. Officials have suspected that earlier medical treatment has led to the drop in case-fatality rates, but some public health officials have wondered if other factors such as genetic changes in the virus have contributed to the different clinical outcomes in Egypt, where the virus is endemic in poultry.

Females were more likely to be infected than males, though infected children were more likely to be male. Women aged 20 to 39 were more likely to die of their infections, and researchers speculated that they may have had more exposure to the virus, because Egyptian women do the bulk of culling, slaughtering, and defeathering.

The investigators linked early hospitalization to an increased chance of recovery, and they noted that Egyptian children are hospitalized more quickly than adults, which could contribute to the lower deaths rates in children.

Rising numbers of H5N1 infections in Egypt, plus continuing human infections in Vietnam and China despite intensive H5N1 control efforts in poultry, serve as a reminder of the virus's pandemic potential, the researchers noted. They also said that cocirculation of H5N1 and pandemic H1N1 viruses in Egypt, where novel flu infections recently peaked, raises the possibility of coinfections and emergence of reassortant viruses.

They noted that studies are needed to document levels of viral exposure in Egyptians who frequently handle poultry and explore levels of asymptomatic and unreported infections in African populations.

Researchers also echoed concerns of global health experts that more efforts are needed in Egypt to change agricultural practices and people's perceptions. They point out that studies in other African countries show farmers believe they are at little risk from poultry-handling activities such as slaughtering.

Egyptians frequently keep poultry on rooftops and near living quarters, and the government doesn't compensate for culled birds, making it less likely that bird owners will report outbreaks, the authors noted.