BIRD FLU IN EGYPT: ALL QUIET ON THE MIDDLE EASTERN

UNCLAS SECTION 01 OF 02 CAIRO 002445 SENSITIVE SIPDIS DEPT FOR AIAG (AMBASSADOR LANGE AND DAVID WINN),DEPT PASS TO AID (DENNIS CARROLL) E.O. 12958: N/A TAGS: TBIO KFLU KSTH PGOV ECON KSCA EAGR EG SUBJECT: BIRD FLU IN EGYPT: ALL QUIET ON THE MIDDLE EASTERN FRONT FOR NOW REF: A. 08 CAIRO 021 ¶B. 08 CAIRO 413 ¶C. 08 CAIRO 784 ¶D. 08 CAIRO 844 Sensitive But Unclassified. Please handle accordingly. ¶1. (SBU) Summary and comment: In July 2008, the World Organisation for Animal Health (OIE) declared the H5N1 avian influenza (AI) virus to be endemic in Egyptian poultry. Now, just four months later, some Egyptians are wondering why. Seven months have passed since the Ministry of Health and Population (MOHP) confirmed the last human case here. The Ministry of Agriculture and Land Reclamation's (MALR's) surveillance teams have not detected an afflicted farm or backyard bird for over six weeks. These facts beg the question: is victory over bird flu in sight in Egypt? The answer, given H5N1's limited track record here, its tenacity and its seasonal characteristics, is probably not. But winter is coming, and winter may hold some clues to the answer. End Summary and comment. -------------- No victims since April -------------- ¶2. (U) AI struck twelve Egyptians, seven fatally, in a four month period beginning December 17, 2007 (refs. A,B and C). On April 16, 2008, the MOHP announced the last of these dozen victims, a two-year-old boy from Sharqia, was infected with the H5N1 virus (ref. D). The boy, the 50th confirmed Egyptian AI case since the virus was first identified here in 2006, recovered. Seven months have passed without another human case. -------------- Human tests: no H5N1 for seven months -------------- ¶3. (SBU) MOHP regularly obtains and tests human samples for the H5N1 virus. MOHP sends a few of these samples to NAMRU-3 for H5 testing. None of these human samples have tested positive for H5 since Case No. 50 in April 2008. Additionally, from November 2007 through September 2008, at least 1,396 persons were enrolled in surveillance for "severe acute respiratory infections (SARI)" in eight Egyptian fever hospitals. While the surveillance, a cooperative effort involving MOHP and NAMRU-3, is not specifically designed to detect AI, 800 of these SARI patients were completely tested for influenza A and B viruses. The testing done would have detected H5. It did not. -------------- Animal tests: no H5N1 for six weeks -------------- ¶4. (SBU) In August 2008, not long after the OIE declared AI was endemic in Egyptian poultry, individuals working on USAID-supported AI projects within the Ministry of Agriculture and Land Reclamation (MALR) told ESTHOff the OIE's decision was premature. After OIE's announcement, MALR's surveillance teams continued to find the virus on farms and in backyards, but the virus was not as ubiquitous as it was in prior years. On November 24, 2008, Dr. Mona Mehrez Ali, Director of MALR's Animal Health Research Institute, told ESTHOff that MALR's recent poultry surveillance tests have all come back negative for H5N1. According to Dr. Mona, the last positive sample came from a backyard bird in Gharbia on October 7, 2008-- over six weeks ago. -------------- "Free of bird flu" or just a brief lull? -------------- ¶5. (SBU) In late March 2008, the GOE's Supreme Committee for Combating Bird Flu, then chaired by MALR Minister Amin Abaza, released a statement claiming the virus was in "continuous retreat" around the country. While this claim seemed hollow a few weeks later when MOHP confirmed the virus had claimed two new victims (ref. C),the announcement now seems almost prophetic. Indeed, on September 18, 2008, Dr. Hamed Samah, Chairman of MALR's General Authority for Veterinary Services, went a step further: he declared Egypt "free of bird flu." While the virus seems to have taken a break, at least for now, most of those involved in Egypt's AI fight are wary. One MALR contact told ESTHOff that Dr. Samah "knows better." CAIRO 00002445 002 OF 002 -------------- Winter may tell. -------------- ¶6. (SBU) USAID's former Senior AI Advisor, Gavin Macgregor-Skinner, knows Egypt's AI struggles well, having spent many weeks here working closely with the GOE as part of USAID's AI program. Dr. Macgregor-Skinner believes the virus circulating in Egypt has seasonal characteristics and that late December through March appears to be the high risk period for human infection. The facts support him. H5N1 first claimed a human victim in Egypt in March 2006. Since then, the virus has demonstrated a pronounced seasonality: 43 of the 50 human AI victims in Egypt got sick between mid-December and mid-April. In 2006, AI season began on December 14, when a 26-year-old man from Gharbiya's Zefta district first showed symptoms of the disease a day after his sister slaughtered three ducks. Both died-- as did the sister's 15-year-old daughter. Last year, AI season started on December 17, when a 50-year-old woman from Damietta got sick. She was the first of five victims from four Governorates who got sick and died in December 2007. ¶7. (SBU) Comment: While H5N1 no longer seems to be the apocalyptic bogeyman it was once thought to be here, the risk remains, December has arrived, and Egypt's health care providers are bracing for the bird flu season. End Comment. SCOBEY