As another victim falls prey to avian flu, Reem Leila reports on the inadequacies of the national awareness campaign to combat the disease Last week 18-year-old Samah Abdel-Ghaffar from Menoufiya province, north of Cairo, was named as Egypt's 12th victim of bird flu. Her condition is stable, reported Ministry of Health spokesman Abdel-Rahman Shaheen, and members of her family are currently being tested to see if they, too, are infected. Abdel-Ghaffar is thought to have contracted the virus after regularly handling infected birds. The deadly H5N1 strain of avian influenza has claimed the lives of three Egyptians. Iman Mohamed Abdel-Gawwad, a 16-year-old girl from Menoufiya, is the latest victim to succumb to the deadly virus. She died after being rushed to hospital last week suffering from high fever and shortness of breath. "Wherever we find the virus we expect to find human cases. It is highly pathogenic," said Shaheen. "Transmission from poultry to humans is increasing because people continue to be exposed to infected birds and their droppings. It is essential that people change the way they behave and interact with poultry, to the extent of rearing birds within their homes." According to figures released by the World Health Organisation (WHO) the H5N1 strain of bird flu has killed at least 109 people worldwide, though experts think the real figure is higher given that many cases are likely to go unreported. The WHO remains concerned that the human toll has reached triple figures in a relatively short period of time. "Women, who make up all three of Egypt's fatalities, are often responsible for slaughtering and cooking domestic poultry, and the government has called for greater awareness about bird flu among women who can then protect themselves and their families," says Hassan Al-Bushra, WHO regional adviser for communicable disease surveillance. While the majority of human cases have occurred in the Far East and China, where the epidemic first broke out in 2003, Egypt has been among the worst affected countries in the new wave of westward spreading infections. While H5N1 remains, for the time being, an animal disease, that it could mutate into a form that can be spread between humans remains a very real danger. That danger grows the longer people continue to come into contact with infected poultry, allowing the virus an opportunity to combine with existing influenza viruses and develop a form that can be spread from person to person. Should this happen the results will be disastrous. "We predict that an influenza pandemic, which could cross the world in about three months, could end up killing hundreds of thousands of people," said Al-Bushra. "The urgent need to contain bird flu relates more to preventing the outbreak of a future pandemic rather than to H5N1 itself. We are urging the continued implementation of all appropriate recommendations. While there was a slight break in the frequency of awareness campaigns prior to the detection of the first human infections in Egypt, perhaps in a bid to calm the population, it is now clear that we can afford no more lapses. "We are encouraging the development of non-pharmaceutical intervention, including better hygiene and sanitation practices. As for potentially infected areas, they must be cordoned off and people should stay away, however low they deem the risk to be. Listen to your governments and implement the recommendations. A health crisis such as this is no time for mistrust," added Al-Bushra. Some experts have accused the government of inadequate planning. Bird flu was first detected in Egypt in February, and the first human infection was reported by mid- March. And although health officials are endeavouring to enforce preventive measures they are incapable of ensuring they are strictly implemented. "Government planning is random, and it is using the wrong vaccine to combat the virus," said Talaat Khatib, professor of veterinary medicine at Assiut University. "US scientists have already confirmed the H5N1 virus has evolved into two genetically distinct strains, potentially increasing the risk to humans," revealed Khatib, who believes the public awareness campaigns to date have been too weak. Egypt should, he says, have begun to plan its preventative measures when the virus was reported in Turkey in late December. In Egypt, where poverty and illiteracy rates are high and urban rooftop and backyard rearing of poultry have long been a way of life, a more systematic approach to monitoring the disease needs to be put in place. Saber Abdel-Aziz Galal, Ministry of Agriculture official in charge of poultry infections, said the increase in human cases had been expected. "People do not respect instructions from the authorities," he said. "They consider poultry capital for which it is worth risking their health, and the health of their neighbours."
