Commentary - December in Egypt - A/H1N1 and A/H5N1 Quandary

[sharon sanders]

Commentary - December in Egypt - A/H1N1 and A/H5N1 Quandary

by The FluTrackers Team
December 19, 2010
1:29am

In December the influenza situation has intensified. There have been reports of confirmed and suspected cases of both A/H5N1 and A/H1N1 in humans. In addition, it appears that many poultry continue to be infected with A/H5N1 and this is a direct threat to humans who are in the vicinity.

In December we believe that there are 4 total H5N1 cases confirmed by the central government and/or governorate authorities:

#113 - 30 year old female, onset date November 28, 2010 - hospitalized December 1, 2010 - Gharbia governorate - Death

Governorate confirmed case- 30 year old male, onset date unknown, death reported on December 7, 2010 - Dakahlia governorate - Death

#114 - 25 year old female, onset date unknown at this time - Behiera governorate

#115 - 44 year old male, onset date unknown at this time - Dakahlia governorate Death


The case designated as "Governorate confirmed case" was confirmed by Dakahlia public health officials but has not been confirmed by the Egypt Ministry of Health (MOH) or by the World Health Organization. Confusing this situation further, the Egyptian MOH fired the director of a hospital on December 16 for not reporting an H5N1 case. We do not know which case this is in reference to. It might be this case or an entirely new case that we have no information about. In addition, an unnamed "medical source" reported 3 "confirmed" H5N1 cases in Sharqia Governorate yesterday but these cases have not been ratified by either the govenorate or Egyptian MOH. Tests are also pending for 2 suspected cases in Fayoum govenorate.

The case that we have tentatively numbered as #115 was reported yesterday by a reputable news organization quoting local public health officials. At this time we do not know if the Egyptian MOH will ratify this case, or not. For instance, last week, on December 10, a news conference was held in Fayoum governorate by the Health Department and Fayoum Hospital about "dozens of children" in that governorate "newly infected with viral-like symptoms in colds". 3 reputable news organizations covered this conference: youm7, masrawy.com, and fayoumwindow.net. Later the Egyptian MOH denied that many children were sick and, in fact, said that the story was "fabricated". Another article followed stating that some children had colds but it was not a "viral" disease.

At this time we believe there are many suspected H5N1 cases but Egypt has routinely screened thousands of people per year for H5N1 so this is not an unusual situation. So far they have screened 11,877. This is approximately 2969 per year, or approximately 247 per month.

With H5N1 continuing to be endemic in Egypt's poultry it is no surprise that humans continue to be screened at such a level. The latest FAO reports are here. Keeping poultry in the household is a tradition in Egypt and presents a continuing infection venue. The efforts to dissuade people from keeping poultry for their own use and from selling poultry to shop keepers is a challenge. Shop owners who deal in unauthorized poultry sales can be prosecuted. Culling is also used to try to control the situation. Recently 76,000 poultry were destroyed in Dakahlia govenorate. On December 8 the Egyptian Ministry of Agriculture announced that 20 million doses of H5N1 poultry vaccine were being formulated with current strains and also under consideration is the move of all poultry farms to the desert and out of populated areas. Detection of active poultry infestations has been hampered in the past by the inadequacies of real-time RT-PCR tests. A recent study found that approximately 20% of positive cases were not detected by the real-time RT-PCR method.

A/H1N1 also continues to circulate in the Egyptian population. As of this writing the total number of MOH confirmed cases is 16,838 with 305 confirmed deaths. In some hospitals the isolation rooms designed to screen, evaluate, and house A/H5N1 patients are used also for A/H1N1 patients. Dakhalia governorate is an area where the reported A/H1N1 cases are high. Also 2 of the latest A/H5N1 cases emanate from this province. Several days ago in this govenorate a hospital administrator was fired, in part, because of complaints from citizens regarding the lack of preparedness of the hospital to handle A/H1N1 cases. It is also apparent that there is some confusion amongst medical personnel when diagnosing A/H5N1 and A/H1N1. News articles are increasingly intermingling the suspected and actual cases of the two viruses which complicates the comprehension of the facts.

We will continue to closely monitor the situation. The Ministry of Health announced a two day closure this weekend due to the on-site visit of President Mubarak. Evidently the health issues in Egypt have the attention of the top leadership.

[sharon sanders]

Re: Commentary - December in Egypt - A/H1N1 and A/H5N1 Quandary

Tuesday, December 21, 2010

Not Ignoring Egypt, But . . .





# 5166


The past 96 hours have seen a large number of articles appearing in the Arabic press regarding both `swine? and `bird? flu in Egypt. The machine translations of these stories are ? at best ? confusing, and in some cases, I believe are badly misleading.

Despite references to `bird flu?, most of these stories, I believe, are about the H1N1 virus.

But again, it is hard to tell for sure.

Given the ambiguities involved, and my wish not to echo `suspect? information across the internet, I?ve decided to wait until the situation in Egypt become clearer before blogging on these news reports.

So . . . for now, while I?m watching these news reports with interest (you can too, on by visiting the FluTrackers Egypt H1N1 and H5N1Forums), I don?t consider them reliable enough to include in my blog.

If and when media reports I perceive as credible become available, I will certainly write about them. That is obviously a personal, arbitrary, and very subjective evaluation on my part.

But it is the only one I can go with. Others will no doubt see this issue differently.

A couple of days ago, Sharon Sanders ofFluTrackers expressed similar concerns over the reliability and interpretation of these media reports (see Referral: A FluTrackers Commentary).

So I?m not alone in my concerns.

If there really is something unusual going on in Egypt, I?ve no doubt we will no doubt find that out in time.

[sharon sanders]

Re: Commentary - December in Egypt - A/H1N1 and A/H5N1 Quandary

At FluTrackers we are very concerned about the recent lack of visibility into the influenza situation in Egypt.

As a discussion forum, we are not endorsing any particular article or news reports.

We will continue to post all the articles we can find. We are lucky to have some of the leaders in disease tracking on the internet participating here. We have been searching and reporting on the disease situation in Egypt for almost 5 years. In addition, FT Senior Moderator and Editor, Twall, lives in Egypt and speaks fluent English and Arabic.

Thank you to everyone!

[Twall]

Re: Commentary - December in Egypt - A/H1N1 and A/H5N1 Quandary

I have read three articles over the last couple of days about swabs be taking and testing for H1N1 being performed with as many as half resulting in a negative test.

one of the mentioned groups had twelve suspected cases of influenza based on a long list of the normal symptoms with mentioned shortness of breath half produced a negative return. some mentioned taking three swabs!

another group of those (tested) fourteen had a similar result of fifty percent being negative.

I will say looking over these articles the last couple of days gave me the perception the media is the culprit in some of these cases of suspected h5n1 infections. but this could be driven by the material and terminology supplied to them directly from the source, or poor word selection on they're part.

in some of the other cases for some un-known reason google seems to pick and chose another term to use when translating the same Arabic word in another place within the same article.

I have read thru a few of the articles enough times to honestly think the out-lined details of the actions taking by the local authorities in certain suspect cases indicated, a suspect case of h5n1 infection as they utilized the protocols for bird flu infections. which instruct and direct first for quarantine in a fever hospital and immediate treatment, if there was contact with poultry then followed by later testing. only two of the total media reports fell within these parameters based on the descriptive outline of the process undertaking by the authorities and hospital.

the only item which was never indicated was direct contact with either live or dead poultry.

my observations of the published articles today via youm7.make it perfectly clear they are making a real effort to consistently, define clearly what type of flu virus they are speaking of .I hope others involved in the reporting chain make the same effort and follow this very good example.