Reem Leila reports on attempts to contain a fresh outbreak of Avian Flu Egypt is preparing itself for a new outbreak of the H5N1 avian flu strain which has now mutated into a form displaying moderate resistance to the frontline antiviral Tamiflu. Warda Eid Ahmed, 27, from Beni Sweif, succumbed to the disease earlier this month despite being treated with Tamiflu. Her death brings the total number of fatalities among the 19 people who have contracted the virus since March 2006 to 11. Ahmed died two days after the World Health Organisation (WHO) announced that a medication-resistant strain of the virus was responsible for the last two deaths in Egypt. Samples taken from the two patients, a 16- year-old girl and her 26-year-old uncle from Gharbiya Governorate, 90 kilometres north of Cairo, both showed the mutated 294S strain of the virus. The WHO has confirmed that the H5N1 virus isolated from the three patients in recent cases have also tested positive for 294S. According to Hassan El-Bushra, WHO regional adviser for communicable diseases surveillance, laboratory tests show the 294S mutation makes Tamiflu less efficient. More research is needed, he says, but for now there are "no wholesale recommendations on changes in treatment using Tamiflu. In cases that involve the 294S strain patients should receive Tamiflu as a frontline treatment and doctors should consider using it along with Adamine, an older class of effective flu drugs". Governments around the world have been stockpiling Tamiflu in case the H5N1 virus mutates and becomes easily transmissible among humans, "sparking a pandemic which could kill millions of people" warns El-Bushra. Despite the handful of cases showing the virus has undergone genetic mutation, there is no indication that Tamiflu resistance is widespread in Egypt or elsewhere. Abdel-Rahman Shaheen, the Health Ministry's official spokesman, declared in a press conference last Saturday that the mutations are not associated with any known change in the transmissibility of the virus among humans, which limits the public health implications of the mutant strain. There is no need, says Shaheen, for a change in the pandemic preparedness level. Egypt has large stocks of both Tamiflu and Adamine. "There is no need to panic, everything is under control," he said. Bird flu was first detected in humans in Egypt in March 2006, a month after the first cases were detected in birds. The majority of infections, and all deaths, have been among people who reared birds domestically. The initial outbreak caused panic in Egypt, where poultry is a major source of protein, and poor families frequently breed chicken and ducks domestically in rural areas to supplement their diet and income. Last November the cabinet announced that the country's poultry industry had recovered from the crisis that followed in the wake of the virus and which is estimated to have cost LE17 billion. Emad Eissa, spokesman at the Ministry of Agriculture and Land Reclamation, said the onset of cooler weather had caused a flare-up of cases in poultry. All infected birds, he says, have been culled and the testing of people who have been in direct contact with infected fowl is ongoing. "Bird flu virus has been placed under control and vaccination campaigns now cover Egypt's poultry population," said Eissa. He conceded, though, that "the avian flu virus will still remain a threat for at least the next three years." The Supreme National Committee Combating Bird Flu (SNCCBF), headed by Health Minister Hatem El-Gabali, is considering vaccinating all of Egypt's poultry at a cost of LE100 million, revealed Shaheen, though only LE35 million is currently available. "All concerned authorities are exerting every effort to secure the funds necessary for a comprehensive vaccination plan," he said. Experts fear the highly contagious virus could mutate into a strain capable of human to human transmission. Cairo International Airport has stepped up its surveillance of passengers coming from Asian countries which have a high incidence of infections from poultry. El-Zawahry El-Ashmawi, deputy director of quarantine at the airport, says doctors have been stationed at arrival halls and are closely following passengers, concentrating on those coming from Asian countries. Egyptian travelers are being advised to be vigilant and are "provided with guidelines concerning measures to prevent bird flu infection in a leaflet distributed at the airport".
