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Avian influenza – situation in Egypt – update
19.03.2012

The Ministry of Health and Population of Egypt has notified WHO of a new cases of human infection with avian influenza A (H5N1) virus.

The case is a 40 year-old female from Dakahlia Governorate. She developed symptoms on 6 March 2012, was hospitalised on 12 March 2012. She was in critical condition and received oseltamivir upon admission. She died on 15 March 2012. The case was laboratory confirmed by the Central Public Health Laboratories(NIC). Investigations into the source of infection indicate that the case had exposure to sick backyard poultry.

Of the 164 cases confirmed to date in Egypt, 58 have been fatal.

Gruß
Birgitt

Avian influenza – situation in Egypt – update
02.04.2012 - WHO

The Ministry of Health and Population of Egypt has notified WHO of two new cases of human infection with avian influenza A (H5N1) virus.

The first case is a 2 year-old female from Demiatta Governorate. She developed symptoms on 19 March 2012 and was admitted to a hospital on 20 March 2012 where she received oseltamivir. She is still under treatment and in good medical condition. The case was laboratory confirmed by the Central Public Health Laboratories (NIC) on 22 of March 2012. Epidemiological investigations into the source of infection indicate that the case had exposure to dead backyard poultry.

The second case is a 15 year-old female from Giza Governorate. She developed symptoms on 25 March 2012 and was admitted to a hospital in critical condition on 29 March 2012. She received oseltamivir on admission. She died on 31 March 2012. The case was laboratory confirmed by the Central Public Health Laboratories (NIC) on 31 March 2012. Epidemiological investigations into the source of infection is ongoing.

Of the 166 cases confirmed to date in Egypt, 59 have been fatal.

Gruß
Birgitt

Avian influenza – situation in Egypt – update
12.04.2012

The Ministry of Health and Population of Egypt has notified WHO of a new case of human infection with avian influenza A (H5N1) virus.

The case is a 36 year-old female from Giza governorate. She developed symptoms on 1 April 2012 and was admitted to a hospital on 7 April 2012 and died on the same day. The case was confirmed by the Central Public Health Laboratories; a National Influenza Center of the WHO Global Influenza Surveillance Network. Epidemiological investigations into the source of infection indicate that the case had exposure to backyard poultry.

Of the 167 cases confirmed to date in Egypt, 60 have been fatal.

Gruß
Birgitt

Avian influenza – situation in Egypt – update
07.06.2012

The Ministry of Health and Population of Egypt has notified WHO of a new case of human infection with avian influenza A(H5N1) virus.

The case is a four year-old female from Kfr -Elsheikh governorate. She developed symptoms on 25 April 2012, was admitted to a hospital on 26 April 2012 and received oseltamivir treatment upon admission. She was discharged from the hospital on 7 May 2012. Investigations into the source of infection indicated that the case had exposure to backyard poultry. The case was confirmed by the Central Public Health Laboratories and the Naval Medical Research Unit 3 (NAMRU-3), a WHO reference laboratory.

To date, a total of 168 cases have been confirmed in Egypt, of which 60 have been fatal.

Gruß
Birgitt

AVIAN INFLUENZA, HUMAN (62): EGYPT, ANTIGENIC DRIFT
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Date: Fri 14 Dec 2012
Source: CIDRAP News [edited]
http://wwwnc.cdc.gov/eid/article/19/1/1 ... rticle.htm


Analysis shows antigenic drift in H5N1 viruses in Egypt
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An analysis of H5N1 avian flu strains isolated from Egyptian patients from 2007 through 2011 found little evidence of reassortment but substantial antigenic drift, according to a report yesterday in Emerging Infectious Diseases [see comment below]. US and Egyptian investigators sequenced the complete genomes of 59 A/H5N1 influenza virus isolates and 13 hemagglutinin (HA) genes sequenced directly from clinical specimens of 72 patients.

"We found minimal evidence of reassortment and no exotic introductions," they wrote. "The hemagglutinin genes of the viruses from 2011 formed a monophyletic group within clade 2.2.1 that also included human viruses from 2009 and 2010 and contemporary viruses from poultry; this finding is consistent with zoonotic transmission."

While they found little evidence of reassortment, they observed "substantial antigenic drift" when they performed HA inhibition tests using ferret antisera and compared results against a panel of H5N1 viruses. Egypt confirmed 158 human H5N1 cases during the study period.

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[The preceding report summarises the following publication: Younan M, Poh MK, Elassal E, Davis T, Rivailler P, Balish AL, et al. Microevolution of highly pathogenic avian influenza A(H5N1) viruses isolated from humans, Egypt, 2007-2011. Emerg Infect Dis [Internet]. 2013 Jan [date cited]. http://dx.doi.org/10.3201/eid1901.121080.

Abstract
--------
We analyzed highly pathogenic avian influenza A(H5N1) viruses isolated from humans infected in Egypt during the period 2007-2011. All analyzed viruses evolved from the lineage of subtype H5N1 viruses introduced into Egypt in 2006; we found minimal evidence of reassortment and no exotic introductions.

The hemagglutinin genes of the viruses from 2011 formed a monophyletic group within clade 2.2.1 that also included human viruses from 2009 and 2010 and contemporary viruses from poultry; this finding is consistent with zoonotic transmission.

Although molecular markers suggestive of decreased susceptibility to antiviral drugs were detected sporadically in the neuraminidase and matrix 2 proteins, functional neuraminidase inhibition assays did not identify resistant viruses. No other mutations suggesting a change in the threat to public health were detected in the viral proteomes.

However, a comparison of representative subtype H5N1 viruses from 2011 with older subtype H5N1 viruses from Egypt revealed substantial antigenic drift. Outbreaks of highly pathogenic avian influenza (HPAI) A(H5N1) virus infection among poultry in parts of Africa, the Middle East, and Asia have caused sporadic human infections with high case-fatality ratios and a few instances of possible human-to-human transmission.

In Egypt, HPAI (H5N1) virus was 1st detected in poultry in February 2006, and in March 2006, the first human infection was detected. Surveillance in wild and domestic birds and phylogenetic analyses of viruses from the region indicated that subtype H5N1 virus was probably transported to Egypt by wild birds migrating from the Qinghai Lake region of the People's Republic of China in the fall of 2005. Analyses of the evolution of subtype H5N1 viruses in Egypt in the following years showed the exclusive circulation of clade 2.2 viruses in poultry, indicating no other subtype H5N1 viruses had been introduced.

Subsequent genetic divergence of the clade 2.2 hemagglutinin (HA) genes in Egypt, however, resulted in a distinct phylogenetic group designated clade 2.2.1, which is enzootic in peridomestic poultry, and a more recently classified sister group known as clade 2.2.1.1, which is mostly found in commercial chicken flocks.

In 2011, a total of 39 human cases of subtype H5N1 infection and 15 related deaths were reported in Egypt; a total of 158 cases and 55 deaths were reported during 2006-2011, making Egypt the country with the 2nd highest number of human cases after Indonesia. Increases in the annual number of human infections and accompanying decreases in case-fatality ratios in Egypt during 2009-2011, compared with those in 2006-2008, led to the hypothesis that the circulating viruses may have acquired distinct virologic properties. To address this issue, we studied the genetic and antigenic diversity of subtype H5N1 viruses isolated from humans in Egypt during 2007-2011. Analysis of 90 complete viral genomes was conducted to determine 1) the predominant genotype of subtype H5N1 viruses infecting humans and 2) other molecular changes that would suggest altered phenotypic properties, susceptibility to antiviral drugs, or the need for development of new candidate vaccine viruses.

Summarised conclusions
----------------------
In summary, these findings indicate that the recent subtype H5N1 viruses isolated from human infections originated from poultry. These viruses evolved from a single genotype introduced into Egypt in 2005/2006; there is no evidence of subsequent reassortment with new subtype H5N1 virus genes introduced into Egypt or resident LPAI (low pathogenic avian influenza).

The viruses have been observed in all subtype H5N1 infections in humans since 2009 and belong to a subgroup, termed 2.2.1-C, with unique genetic signatures that may contribute to their persistence in poultry. A rationale for linking the observed amino acid changes to the decline in case-fatality ratios since 2009 could not be identified.

Systematic analysis of subtype H5N1 viruses in Egypt is critical to better understand the genetic and phenotypic evolution of subtype H5N1 viruses in Egypt and to inform public health programs to reduce the risk for zoonotic infections and prevent or mitigate a potential pandemic.

Contrary to some past predictions the outbreak of avian A?(H5N1) influenza in the human and animal populations of Egypt appear to be self-contained and the progressive change in properties of the virus in Egypt do not appear to involve reassortment of genome subunits from extraneous influenza viruses. - Mod.CP ]

AVIAN INFLUENZA, HUMAN (63), EGYPT, INDONESIA, WHO
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Date: Mon 17 Dec 2012
Source: WHO, Influenza at the human-animal interface [edited]
http://www.who.int/influenza/human_anim ... 7Dec12.pdf


[NB: The WHO reports confirming A/H5N1 human infections are now being reported in the following format. The fatal case in Indonesia recorded below was reported in ProMED-mail posting Avian influenza, human (61): Indonesia (WJ) fatal, child 20121214.1452311, whereas the Egyptian case is a new case not previously reported. - Mod.CP]

Human infection with avian influenza A(H5N1) viruses; associated animal health events
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From 2003 through 17 Dec 2012, 610 laboratory-confirmed human cases with avian influenza A(H5N1) virus infection have been officially reported to WHO from 15 countries, of whom 360 have died.

Since January 2012, 32 human cases of influenza A(H5N1) virus infection have been reported to WHO.

Since the last update on 5 Nov 2012, 2 new laboratory-confirmed human cases with influenza A(H5N1) virus infection were reported to WHO, one from Egypt and the other a fatal case from Indonesia.

Table: Laboratory-confirmed human cases with avian influenza A(H5N1) virus infection reported between 5 Nov and 17 Dec 2012

Country / Province / Age(y) / Sex / Onset* / Hospitalisation* / Death* / Exposure

Egypt / Demietta governorate / 2 / F / 3 Dec 2012 / 1 Dec 2012 / surviving / backyard poultry (chicken and ducks)

Indonesia / West Java / 4 / M / 30 Nov 2012 / 5 Dec 2012 / 6 Dec 2012 / poultry (duck) in neighbourhood)

* dates thereof

Comment: based on previous years' observations, an increase in reported H5N1 influenza events in poultry is expected for this time of year. Sporadic human cases reported this month [December 2012] in countries with known influenza A(H5N1) virus activity in poultry are within the expected range. No onward sustained human to human transmission was reported.

Public health risk assessment of avian influenza A(H5N1) viruses: the public health risk remains unchanged.

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[The following figures can be displayed by accessing the original text via the source URL above. The 1st figure provides an overview of the entire epidemic since 2003 up to the present. The 2nd figure displays the geographic localisation of the A/H5N1 virus outbreak to South and East Asia and Egypt.

Figure 1: Epidemiological curve of avian influenza H5N1 cases in humans by country and month of onset
Figure 2: Map of avian influenza H5N1 cases in humans for 2012

Other relevant links
WHO human-animal interface web page:
http://www.who.int/influenza/human_animal_interface/en/
Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO:
http://www.who.int/influenza/human_anim ... 1cases.pdf
H5N1 avian influenza: timeline of major events:
http://www.who.int/influenza/human_anim ... update.pdf
WHO archive: avian influenza situation updates:
http://www.who.int/influenza/human_anim ... index.html
World Organisation for Animal Health (OIE) web page: web portal on avian influenza:
http://www.oie.int/animal-health-in-the ... influenza/. - Mod.CP]

AVIAN INFLUENZA, HUMAN (13): (EGYPT)
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Date: Mon 25 Mar 2013
Source: CIDRAP News [edited]
http://www.cidrap.umn.edu/cidrap/conten ... scan1.html


H5N1 sickens Egyptian woman
---------------------------
A 40-year-old Egyptian woman from Menofia governorate who became ill after contact with sick poultry tested positive for H5N1 avian influenza, according to a Thu 21 Mar 2013 report from the United Nations Food and Agriculture Organization (FAO). She got sick on 3 Mar 2013 a few days after close contact with sick and dead backyard ducks and chickens. If the World Health Organization (WHO) confirms the case, the woman's illness will be counted as Egypt's 171st case, of whom 61 have been fatal.

The tests were conducted at Egypt's Central Public Health Laboratories. News of her illness appeared in the FAO's monthly Emergency Center for Transboundary Animal Diseases (ECTAD) highly pathogenic avian flu situation update. Egypt has had only one other H5N1 case this year, a fatal one.

--
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[So far in 2013 (as of 12 Mar 2013) there have been 12 confirmed human cases of avian A/(H5N1) virus infection, 11 of which have had fatal outcome. 9 of the cases were recorded in Cambodia, 2 in China, and one in Egypt prior to the current case. Globally, since the 1st case in 2003, there have been 622 confirmed human cases of avian influenza A/(H5N1) virus infection with 371 fatalities (for a breakdown, see: http://www.who.int/influenza/human_anim ... 1cases.pdf). - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1zkM.]

AVIAN INFLUENZA, HUMAN (49): EGYPT (DAKAHLIA) H5N1, FATAL
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Date: Tue 16 Apr 2013
Source: Shanghai Daily, Xinhua News Agency report [edited]
http://www.shanghaidaily.com/article/ar ... ?id=137157


An Egyptian young man died Tuesday [16 Apr 2013] of bird flu [avian influenza A/(H5N1) virus infection], raising the death toll of the disease in Egypt to 3 since the beginning of the year [2013], a Health Ministry spokesman told Xinhua. "A 26-year-old man from the governorate of Daqahliya [Dakahlia], north of Cairo, died in hospital after showing symptoms of the avian flu," Yahya Moussa said.

The ministry strongly recommends citizens to consult physicians in case of any suspicion of the disease. Earlier reports from the Agriculture Ministry said Egypt has been implementing a 5-year national strategy since 2010 to eradicate the H5N1 virus.

Last September [2012], an official report said 60 infected people died of bird flu out of 168 cases that appeared in Egypt since 2006.

--
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ProMED-mail Rapporteur Kunihiko Iizuka

[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/6n7f.]

AVIAN INFLUENZA, HUMAN (65): H5N1
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Date: Sun 28 Apr 2013
Source: The Global Dispatch, Outbreak News [edited]
http://www.theglobaldispatch.com/who-re ... eks-60184/


WHO reports 6 human H5N1 avian influenza cases during past 6 weeks
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According to a World Health Organization (WHO) summary and assessment on Friday [26 Apr 2013], from 12 Mar to 26 Apr 2013, there were a total of 6 new laboratory confirmed human cases with avian influenza A(H5N1) virus infection. The cases were from the following countries: Bangladesh (1), Cambodia (1), Egypt (2), and Viet Nam (2). The UN agency says that after investigation, the 6 cases are considered sporadic.

So far this year [2013], Cambodia has reported 10 cases of the lethal virus in humans, resulting in 8 fatalities. Health authorities say cases do not seem to be linked directly, and most had contact with sick poultry in their villages. Since 2003, there have been 628 laboratory confirmed human cases of avian influenza A(H5N1) virus infection officially reported to WHO from 15 countries, of which 374 died (about 60 per cent).

According to WHO, the H5N1 virus subtype (different from the H7N9 strain circulating in the current China outbreak) is a highly pathogenic AI virus, which first infected humans in 1997 during a poultry outbreak in Hong Kong SAR, China. Since its widespread re-emergence in 2003 and 2004, this avian virus has spread from Asia to Europe and Africa and has become entrenched in poultry in some countries, resulting in millions of poultry infections, several hundred human cases, and many human deaths.

The case fatality rate for H5N1 virus infections in people is much higher than that of seasonal influenza infections. Clinically, in many patients, the disease caused by the H5N1 virus follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Like most emerging disease, H5N1 influenza in humans is poorly understood.

The incubation period for H5N1 avian influenza may be longer than that for normal seasonal influenza, which is around 2 to 3 days. Current data for H5N1 infection indicate an incubation period ranging from 2 to 8 days and possibly as long as 17 days. WHO currently recommends that an incubation period of 7 days be used for field investigations and the monitoring of patient contacts. Initial symptoms include a high fever, usually with a temperature higher than 38 deg C [100.4 deg F], and other influenza-like symptoms. Diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients.

One feature seen in many patients is the development of lower respiratory tract early in the illness. On present evidence, difficulty in breathing develops around 5 days following the 1st symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody.

[byline: Robert Herriman]

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[All these recent human cases of avian A/(H5N1) influenza virus infection have been recorded in detail in ProMED-mail during the past few weeks. Robert Herriman's review serves to remind us, however, that the H7N9 avian influenza virus is not the only avian influenza virus threatening the human population. These 2 avian viruses interact differently with the human population and their control will necessitate different strategies. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1yvE, http://healthmap.org/r/1iGB, http://healthmap.org/r/1zkM, http://healthmap.org/r/1jtz.]

AVIAN INFLUENZA (75): EGYPT, H5N1, POULTRY, UPDATE
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Date: Mon 24 Jun 2013
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]
http://www.cidrap.umn.edu/cidrap/conten ... 3scan.html


H5N1 prevalence may surpass 10 percent in Egyptian backyard, market poultry
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An Egyptian surveillance study found that while H5N1 avian flu viruses were uncommon on commercial poultry farms, more than 10 percent of backyard and live-market birds harbored the virus, according to a report in the Journal of Virology [see comment]. Throughout 2009 Egyptian and German scientists took tracheal and cloacal swabs from 22 024 farm poultry, of which 23 birds (0.1 percent) were positive by polymerase chain reaction for the H5N1 virus. In comparison, 151 (10.5 percent) of 1435 birds in backyard flocks and 108 (11.4 percent) of 944 birds in live-bird markets were infected. Incidence was highest in spring and summer, particularly in backyard birds. The team also sampled 1297 wild birds of 28 different species in 2009 and 2010 and detected no H5N1. They conclude that backyard flocks may play a key role in maintaining H5N1 in Egyptian poultry, especially in live-bird markets.

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[The report above was derived from the abstract of the following paper:
Elham F El-Zoghby, Mona M Aly, Soad A Nasef , Mohamed K Hassan et al: Surveillance on A/H5N1 virus in domestic poultry and wild birds in Egypt. Virology Journal 2013; 10: 203 doi:10.1186/1743-422X-10-203 (http://www.virologyj.com/content/pdf/17 ... 10-203.pdf).

The following 2 chapters are copied from the paper's original abstract:

"Results
--------
In this surveillance, A/H5N1 was detected from 0.1 percent (n=23) of examined commercial poultry farms, 10.5 percent (n=151) of backyard birds and 11.4 percent (n=108) of LBMs [live bird markets] but no wild bird tested positive for A/H5N1. The virus was detected from domestic poultry year-round with higher incidence in the warmer months of summer and spring particularly in backyard birds. Outbreaks were recorded mostly in Lower Egypt where 95.7 percent (n=22), 68.9 percent (n=104) and 52.8 percent (n=57) of positive commercial farms, backyards and LBMs were detected, respectively. Higher prevalence (56 percent, n=85) was reported in backyards that had mixed chickens and waterfowl together in the same vicinity and LBMs that had waterfowl (76 percent, n=82).

Conclusion
----------
Our findings indicated broad circulation of the endemic A/H5N1 among poultry in 2009 in Egypt. In addition, the epidemiology of A/H5N1 has changed over time with outbreaks occurring in the warmer months of the year. Backyard waterfowl may play a role as a reservoir and/or source of A/H5N1 particularly in LBMs. The virus has been established in poultry in the Nile Delta where major metropolitan areas, dense human population and poultry stocks are concentrated. Continuous surveillance, tracing the source of live birds in the markets and integration of multifaceted strategies and global collaboration are needed to control the spread of the virus in Egypt."

Since 2006 and as of June 2013, Egypt has reported 173 human cases of HPAI H5N1, of which 63 died.

In its annual OIE report for 2012, Egypt reported 12 HPAI H5N1 outbreaks in domestic poultry. Mass routine vaccination of poultry was, reportedly, applied. For further statistical data, please refer to the full report at http://tinyurl.com/nsjfxsf.

Confirmed human cases/deaths have, so far, been reported during 2013 from the following 5 countries:
Bangladesh (1/1); Cambodia (11/8); China (2/2); Egypt (4/3); Vietnam (2/1). Though the disease is also considered to be endemic in Indonesia (since 2005 there have been 192 confirmed human cases, of which 160 died), no human cases have been reported there yet during 2013; in 2012, Indonesia reported 9 cases (all died). - Mod.AS

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1zkM.]

AVIAN INFLUENZA, HUMAN (107): EGYPT (GIZA), H5N1, INFANT
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Date: Tue 30 Sep 2014
Source: Outbreak News Today [edited]
http://outbreaknewstoday.com/egypt-repo ... ant-58305/


The Egyptian Minister of Health and Population, Dr. Adel Adawi, announced a human case of H5N1 avian influenza (AI) in a 3-month-old girl from the Giza governorate. According to the Minister, the date of onset of the illness was Monday, 22 Sep 2014; she was presenting symptoms of fever, sore throat, cough and vomiting.

The girl's parents took her to the Hospital of the Abbasid, and she was released 3 days later. They said the child had exposure to dead birds. A throat sample was taken and analyzed and confirmed positive for avian influenza virus (A/H5N1). The child was treated with Tamiflu and is reportedly in stable condition.

According to the Health Ministry, this is the 4th human H5N1 AI case of 2014. However, the people at FluTrackers point out that this is the 5th case of the bird flu, writing on their site: "We have a record of 4 previous cases. 3 were announced by the Ministry of Health of Egypt, and one was announced by the Ministry of Health of Beheira governorate:

No. 14 Egypt - Female, 56, hospitalized in critical condition,
No. 15 Egypt - Child, 4, mild condition,
No. 16 Egypt - Female, 86, hospitalized in serious condition and
No. 19 Egypt - Male, 34, hospitalized on ventilator, Death."

See: http://www.flutrackers.com/forum/sho...d.php?t=217148.

[Byline: Robert Herriman]

--
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Nati Elkin
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[Avian influenza or "bird flu" is an infectious disease of animals (usually birds, and less commonly pigs) caused by type A strains of the influenza virus. Transmission to humans is rare, but there is recent cause for concern. In mid-2003, the largest and most severe avian flu outbreak in history began in South-east Asia, caused by a sub-type of the virus called H5N1 and resulting in widespread transmission to poultry and some documented transmission to humans. Transmission of H5N1 to humans is of particular concern because it mutates rapidly and may therefore change into a form that is highly infectious for humans and more easily spread. In addition, unlike normal seasonal influenza, H5N1 can cause severe disease in humans.

The cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO, 2003-2014, can be found at http://www.who.int/influenza/human_anim ... s.pdf?ua=1. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/55.]

Seit längerer Zeit wurde der Vogelgrippe keine Aufmerksamkeit mehr geschenkt. In Ägypten starben in der letzten Wochen wieder einige Menschen, was die Anzahl der Toten mit dem gestrigen Fall auf 11 erhöht.

Auch in Japan und Deutschland wurden in Geflügelbetriebe die Vogelgrippe festgestellt und einige 10.000 Tiere getötet.
Ich frage mich, ob man hier mit der Sense arbeitet, oder ob es Sinn machen würde, die Tiere zuerst zu testen bevor man sie tötet und einen signifikanten wirtschaftlichen Schaden anrichtet.

Grüsse
Alexander