Dan Lucey, 16 May 2015
The largest number of persons infected with the H5N1 avian influenza (“bird flu”) virus in any country in the world over any 12-month period since the discovery of this virus in 1997 occurred in Egypt over the 5-month period of November 2014 until April 30, 2015.
On May 15 the explanation was posted by a World Health Organization (WHO) team headed by Dr. Keiji Fukuda from WHO-Geneva. The official WHO report was posted on the both the main website of the WHO (www.who.int) and that of the WHO Eastern Mediterranean Regional Office (EMRO). The two most important findings
regarding this unprecedented surge in human infections are:
- A sharp increase in the number of infected poultry, and
- No evidence of a significant mutation in the virus.
The WHO team reported that “the upsurge of infections in poultry and the cases in people has likely been caused by changes in the economy and the poultry industry”. This team did not find that increases in laboratory testing explained the increased number of cases.
In meeting with colleagues in Cairo, I was reassured to hear that the number of human cases had sharply decreased in May. This observation was consistent with the end of the cooler season in Egypt, and would not be found if the virus had mutated and person-to-person transmission was occurring.
From an innovation perspective, something must be done to decrease the poultry infections by this H5N1 virus, and hence the even larger number of human infections that could otherwise be predicted to occur next November-April (2016). One innovative idea is to create new ‘poultry cities’, with better biosecurity to prevent bird flu, outside the current poultry areas near the Nile river and its delta.
A second potential innovation to help control the virus that is endemic in Egyptian poultry is to widely employ a vaccine based on the latest circulating sub-clade of the virus in Egypt itself.
Overall, however, improved biosecurity measures to prevent poultry infections with H5N1 virus and better practical measures to prevent people from getting infected from poultry are as essential now as at any time since Feb-March 2006 when H5N1 was first recognized in the poultry and humans here.
Having traveled to Egypt seven times since March 2006 and May 2015 for influenza-related issues, including as a team leader for USAID in 2012, it is clear that the need for successful innovations remains essential to mitigate short-term economic and health damages and the longer term risk of a novel pandemic influenza virus emerging in Egypt.
Daniel R. Lucey MD, MPH