SCENESETTER FOR INTERAGENCY AVIAN INFLUENZA TEAM,

1. (SBU) Embassy Cairo warmly welcomes the visit of
Ambassador John Lange and the interagency avian influenza
team. We are looking forward exchanging ideas on local avian
influenza challenges, potential areas of enhanced
cooperation, and developing a more cohesive interagency
strategy.



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VIRUS STATUS: HUMANS AND POULTRY


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2. (SBU) As of February 2007, the GOE confirmed twenty human
cases of H5N1 virus, resulting in twelve fatalities. All six
human victims since September 2006 have succumbed to the
disease. According to the WHO, in 2006 Egypt had the highest
number of human cases outside Asia. In January 2007, CDC
confirmed NAMRU,s diagnosis that the virus responsible for
the deaths of human cases 17 and 18 was Tamiflu resistant
(ref A). Case 19 did not show the same resistance to Tamiflu
(ref B) nor did the most recent death of a 17-year-old from
Fayyoum on February 4.



3. (SBU) In broader terms, mutations in specimens from
recent cases show Egypt could be acting as a type of &mixing
bowl8 for diverse strains of H5N1 originating thousands of
miles away. This is likely due to the fact that Egypt is
located on two major avian flight paths and millions of
migratory birds fly over the country annually.



4. (SBU) On January 28, the Minister of Health and
Population (MOHP) Hatem El Gebali announced the formation of
a committee to study use of alternative drugs to Tamiflu.
The Regional Medical Office at Embassy Cairo is also
preparing receive as shipment of a second antiviral
medication called Zanamivir (Relenza) as a backup medication.
We are scheduled to get enough to treat 23% of the official
Embassy population. We are also acquiring additional doses
of the older antiviral medication amantadine.



5. (SBU) The initial AI outbreak in February, 2006
devastated Egypt's poultry industry, and resulted in
significant layoffs and estimated losses of at least $100
million. The GOE placed a widely enforced ban on live bird
markets and backyard poultry raising in Cairo. Commercial
farmers began a stringent vaccination campaign, which
continues today. The commercial sector is almost
universally AI free. According to official MOHP figures,
since February 2006, there have been 859 outbreak sites in
the commercial poultry sector, but only one since July 2006.



6. (SBU) The &backyard8 poultry sector is ground zero for
both poultry and human AI infections in Egypt, largely due to
the fact that in rural areas, people live with poultry and
slaughter it in their homes. MOHP figures show a recent
upsurge in the number of backyard AI cases. Of the 244
backyard sites identified since February 2006, 50 were
identified during the period of December 2006-January 2007.
Consequently, 18 of the 20 human cases were backyard farmers.
Live poultry markets are up and running again both in Cairo
and in rural areas. Rooftop poultry raising is again common
in Cairo.



7. (SBU) During the initial AI outbreaks, the highest levels
of government recognized the need to greatly reform the
poultry sector. At a March 5, 2006 meeting with poultry
producers, Prime Minister Nazif stressed the need to
transform Egypt's poultry industry, calling for a move from
small-scale farming and live-bird trade to large-scale modern
production at collocated breeding and processing facilities
which would be subject to governmental health and
environmental oversight. The government is in the planning
stages of these reforms.



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CAIRO 00000379 002 OF 002


BRIEF OF YOUR MEETINGS


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8. (SBU) In addition to meetings with Embassy Cairo,s Avian
Influenza Working Group (AIWG), Ambassador Ricciardone, and
NAMRU, we are requesting the following non-Embassy meetings:

---Minister of Health and Population Hatem El Gebali.
Undersecretary Dr. Nasr El Sayed, an infectious disease
expert and our main interlocutor at the Ministry on AI, will
likely accompany the Minister at the meeting.

---Minister of Agriculture Amin Abaza. Dr. Mona Mahrez and
Dr. Ahmed Tawfik, Chairman of the General Organization of
Veterinary Services, will likely accompany the Minister at
this meeting. Giza Governor Fathi Saad, who leads the MOA's
technical committee on AI, may also attend.

---Tour of Central Public Health Labs, Dr. Hala Esmat. All
suspected human cases are initially analyzed at this lab
facility. Dr. Esmat works closely with NAMRU.

---Tour of Ministry of Agriculture labs, Dr. Mona Aly Mahrez.
All suspected poultry cases are analyzed at this lab.

---Ministry of Foreign Affairs, Counselor Omar Abou Eiche,
Environmental Affairs, and Minister Plenipotentiary Mohamed
Aboul Dahab, American Affairs.

---World Health Organization (WHO): Dr. Mohammed Jama,
Deputy Regional Director, and Dr. Zuhair Hallaj and Hassan
El-Bushra, Division of Communicable Diseases.

---Food and Agriculture Organization (FAO): Country Rep. Dr.
Ahmed Chikhaoui and Regional Rep Dr. Talib Ali.

---Abbassiya Chest Hospital. Ten of the twenty human cases
were treated in this hospital, adjacent to NAMRU.

---Visit to Kohia Poultry Farms, Bilbis. Bassim Kohia, owner
of this commercial poultry farm 45 minutes north of Cairo,
will lead the tour.

---World Food Program consultants Mohy Sabry, Nargis Labib,
Dr. Farid Hosni. WFP hired this team to draft a consolidated
national plan on avian influenza. They expect to be done
with the plan by February 19.

---The Deputy Chief of Mission plans to host a reception in
your honor on February 20 at his residence. A wide range of
ministry officials, international donor agencies, private
sector representatives, and third country diplomats, in
addition to Embassy staff working on AI, will be invited.
This will be an excellent opportunity for you to engage
informally with the AI community.

---Press will be very limited and coordinated directly with
the Ministry of Health.
RICCIARDONE