Experts warn it could take years to rid Egypt of the threat posed by avian flu, reports Reem Leila Last Sunday a six-year-old girl and her 18-month-old sister from the northern Nile Delta Governorate of Kafr Al-Sheikh tested positive for the H5N1 virus, bringing the number of confirmed cases of avian flu in Egypt to seven, two of whom have died. The children contracted the virus after coming into contact with chickens bred by their mother. No other members of the girls' family have been infected. "Some poultry owners and farmers remain unwilling to follow the culling and sanitation instructions issued by the government over six weeks ago," said Health Ministry spokesman Abdel-Rahman Shaheen. "It is likely that this is the reason we've had so many cases of human bird flu in such a short space of time." Within days of the virus being detected in fowl in mid-February the government ordered a nationwide cull of poultry. In some instances the military has overseen culling and sanitation procedures in and around infected areas. "To date at least 10 million birds have been culled," said Shaheen, "but the risk of contamination from infected birds remains high because public awareness is still low." The virus has killed more than 100 people worldwide, all of whom had come into direct and regular contact with infected birds. There is no evidence yet that the virus has mutated into a form that can be passed between humans. Ahmed Abdel-Ghany Al-Senousy, head of the virus department at the Veterinary Medicine Faculty and a former member of the Supreme National Committee to Combat Bird Flu (SNCCBF), believes that the number of human cases will grow, and does not discount the possibility of a pandemic. While concerned ministers are committed to ensuring adequate supplies of Tamiflu -- which lessens bird flu symptoms -- sufficient stockpiles are unlikely to be available for several months. Meanwhile, according to Al-Senousy, the government has announced that it has imported large quantities of H5N1 vaccines from China in an attempt to protect remaining flocks from the virus. "The problem is this is the wrong vaccine. The government should have imported the European-produced H5N2 or H5N9 vaccines which have been used by all European countries infected by the virus and by Israel, successfully eliminating the virus within one week," says Al-Senousy. Al-Senousy, who in a surprise move was dismissed from the SNCCBF, had joined other experts in advising health and agriculture officials on the importance of importing the European vaccines, which are cheaper than the Chinese-produced H5N1. "Inexplicably," he says, :they insisted on the less advanced vaccine though why the decision was taken to import the H5N1 vaccine when poultry is already infected with it is beyond me." Following the incidence of human infections the Health Ministry has stepped up its public awareness and health education campaigns, and is working closely with the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO) to develop plans for prevention and containment. According to Hassan Al-Bushra, WHO regional adviser for communicable diseases, the organisation is actively encouraging farmers to cull their birds and urging the public to follow official advice. Infected poultry have been found in 19 governorates out of 26 making Egypt, a major stopping off point for migratory birds from Asia and Africa, the hardest hit country in the Middle East. Mustafa Al-Bastamy, head of the poultry department at the Veterinary Medicine Faculty, predicts that the number of infected sites will increase and the virus is unlikely to be eradicated from Egypt in the foreseeable future. For that to happen, he argues, there must be a mass cull. New poultry species must then be given either the H5N2 or H5N9 vaccine to protect them against infection, and workers who come into contact with fowl must wear gloves, masks, and rubber boots, be given vaccinations and undergo regular medical check-ups. "Unless these measures are implemented the bird flu virus could quite possibly develop into a pandemic and mutate into a form whereby it can be transmitted from human to human." The poultry industry, which had attracted LE17 billion worth of investment and supported an estimated 2.5 to three million people, is estimated to be losing LE10 million a day and is unlikely to recover any time soon. Nearly 80 per cent of poultry farms have closed and many farmers face bankruptcy. Ismail Reda, a professor at the virus department of the Veterinary Medicine Faculty, fears the lack of bio- safety awareness in Egypt will result in delays -- that could run into years -- in ridding the country of the virus. "Breeding poultry in domestic settings and selling live poultry, both deeply ingrained in Egyptian society, exacerbate the difficulties," he says, as does the randomness location of poultry farms which are often very close to one another, facilitating the spread of the virus.
