Egypt may not have recorded a single case of swine flu but it is ready, say officials, to deal with the threat of a pandemic, Reem Leila reports The cull of Egypt's pig population, estimated at 350,000 animals, in response to growing concern of a swine flu pandemic, has already begun. The decision to slaughter was taken on Wednesday 29 April, at a meeting presided over by President Hosni Mubarak, though so far 1,100 pigs have been destroyed. Hamed Samaha, head of the General Authority for Veterinary Services (GAVS), has said the cull could take up to a month. Egypt has only two abattoirs licensed to slaughter pigs, one in Cairo and the other in Alexandria. "The Cairo slaughterhouse's maximum capacity is 1,200 pigs a day, and in Alexandria it is just 450," says Samaha. "In order to increase capacity the government has begun work on three extra slaughter houses, one each in Cairo, Giza and Qalioubiya governorates." More than 400 residents and pig farmers from Manshiet Nasser, a shantytown on Cairo's outskirts, blocked the road leading to their pig pens on Sunday, hurling stones, rocks and Molotov cocktails at police and veterinary officials. The police responded with a five-hour operation, surrounding the protesters with armoured cars and firing tear gas and rubber bullets to disperse the crowds. At least 14 people, including three policemen, were injured in the clashes. Major General Ismail El-Shaer, assistant to the Minister of Interior, who was present at the scene, says a few people have been detained. "Policemen were simply surrounding the neighbourhood to prevent residents from moving their animals and then hiding them from officials seeking to enforce the cull. We have been instructed to accompany the veterinary authorities to protect them from similar incidents and help them with their mission," said El-Shaer. The government initially announced that it would not be offering pig breeders any compensation for slaughtered pigs since the meat could still be sold. It subsequently backtracked, announcing it would pay LE100 for each slaughtered pig and LE30 for those culled, a move that carries a total bill of LE30 million. "We work and then they come and cut off our livelihood. The pigs don't have any disease. Take samples from the pigs and if they test positive we would happily see them culled," Manshiet Nasser pig breeder Marzouk Adli said after the clashes, complaining also that the compensation offered was inadequate. Samaha defends the level of payments. "Receiving LE30 for a culled pig is better than nothing, and the LE100 payment is perfectly fair given farmers can keep the pig meat after it has been frozen in GAVS's refrigerators." Though no case of the H1N1 virus has been reported in Egypt many people are alarmed at the possible appearance of the disease, and the government has been keen to stress that all necessary measures to tackle any outbreak are in place. Ahmed Abdel-Latif, the World Health Organisation's (WHO) director in Egypt, believes the country is well-prepared given its experience in dealing with the avian flu virus, though he stresses that swine flu is potentially far more dangerous since it is capable of human to human transmission. On Monday the WHO announced 1,003 confirmed swine flu cases in 20 countries, 568 of them in Mexico. The number of fatalities has increased to 22, one in the United States and the remainder in Mexico. Last week the organisation raised its swine flu pandemic alert to phase five, one short of the maximum alert. "Egypt is still free of the H1N1 virus to date. The WHO office is collaborating with the Ministry of Health and is providing them with updated and accurate technical information on a regular and continuous basis," says Abdel-Latif. The Cabinet Decision Support Centre (IDSC) is fully prepared for any pandemic, says Mohamed Abdel-Rahman Fawzi, IDSC head of crisis management. He predicts that in the event of a major outbreak between 20 to 40 per cent of employees will be absent from work either because they are infected or too worried to leave their homes. All ministries and public and private sector companies, says Fawzi, will be obliged to provide training where appropriate. They also need to develop telecommuting systems for their employees where feasible, determining the equipment, computer specifications, files, programmes and Internet access needed to enable people to work from home. Adequate infection control supplies, such as hand-hygiene products, tissues, and waste receptacles must also be procured by workplaces and factories. Fawzi also urges the public to make financial plans in the event of pandemic influenza and to factor in the financial consequences of fluctuations in the supply and demand for their products and services in the event the disease spreads. In the meantime, Egypt has developed a new vaccine for H5N1 in its poultry population. A research team at the National Research Centre (NRC) says the vaccine will be more effective in dealing with the strain of virus found in Egypt. The NRC has signed a contract with the Holding Company for Biological Products and Vaccines (VACSERA) to start producing the vaccine which is expected to be available on the market within 18 months to two years. NRC head Hani El-Nazer is optimistic about devising vaccines to combat possible mutations of the virus. "The NRC now has the technology to develop vaccines for the H5N1 virus, including any changes or mutations that may occur," he says. Abdel-Latif praised Egypt's efforts in producing the new vaccine. "We do not want the public to panic, but we urge vigilance and the practice of general preventive measures." The WHO does not believe travel restriction will slow the spread of the virus. Instead, it says, the focus should be on protecting travellers. The WHO recommends delaying travel plans should individuals feel sick, and seeking immediate medical attention should they begin to feel ill following their arrival. Minister of Health Hatem El-Gabali has already met with cabinet colleagues -- including officials from the ministries of education, higher education, civil aviation, transport and local development -- to ensure a coordinated response in case of a pandemic. "I have agreed with the minister of education, Yosri El-Gamal, to use schools as treatment centres and for quarantine spots. University students will also be relocated to avoid unnecessary crowding," he said. The Heliopolis mental hospital, close to Cairo International Airport, is now being used to quarantine any passengers showing symptoms of the disease. The hospital's 42 patients have been moved to Abbasiya hospital. El-Gabali also reports that 50 doctors, and the same number of nurses and health supervisors, are working round the clock at Cairo Airport to screen passengers, who will be checked before disembarking their aircraft. Doctors will also be available to check passengers arriving by sea. El-Gabali travelled to Saudi Arabia on Tuesday to discuss with Saudi officials and other Arab health ministers the possibility of postponing the omra (lesser pilgrimage). El-Gabali identifies Cairo, Giza, Alexandria, Mansoura and Assiut governorates as most vulnerable to the disease given the high density of their populations. "In case of a pandemic schools, universities, cinemas, restaurants, cafés and other places where people gather will be closed," he explained. Patients will be treated at home and only those in a critical condition will be hospitalised. He recommends that members of the public avoid close contact with anyone who appears unwell and urges them to wash their hands with soap and water regularly. "Those who feel sick should seek immediate medical advice, stay at home and keep away from work, school and crowds. They must rest and take plenty of fluids, cover the mouth and nose with disposable masks or tissues, and wash their hands with soap and water especially after sneezing or coughing. Finally they should let people they have come in contact with know that they are ill." Abdel-Rahman Shahin, official spokesman at the Ministry of Health, confirmed that strict quarantine measures are being applied at Egypt's 33 entry ports. Egypt is also stockpiling Tamiflu, with plans to double the current supply of 2.5 million doses, and up the number of protective masks available from 35 to 100 million. "There are ample emergency supplies of essential items, from babies' milk to filters required for those on kidney dialysis," says Shahin. Yet, however advanced the plans to contain any possible pandemic, employees of Egypt's embattled pork industry remain angry and afraid for their future. With the stock of fresh farm meat quickly drying up, some in the industry are bracing for layoffs and closures. Hala Marcos, managing director of Maison Marcos, one of the largest pork-product manufacturers in Egypt, says the diminishing supply of meat will see sales grind to a halt. "The decision to cull pigs will ruin our business. It will be total shutdown in no time," she says. Maison Marcos operates in Cairo, employing over 80 workers at four retail outlets, one processing factory and a pig farm. In a joint statement, the UN Food and Agricultural Organisation, the WHO and the World Organisation for Animal Health said there is no evidence that influenza viruses can be passed to people through eating processed pork or other food products derived from pigs. (see pp.8&9)
