According to a World Health Organisation report, Egypt is on the front line in the battle against avian flu. Reem Leila examines the threat Two-year-old Israa Saad Abdel-Shafi is the 60th case of the H5N1 strain of avian flu virus recorded in Egypt since the first outbreak of the disease in 2006 and the ninth victim since the start of the year. Twenty-three out of the 60 have died, the majority young girls or women from rural areas who raise fowl domestically. In early March the World Health Organisation (WHO) called for an investigation into why Egypt is seeing increasing numbers of victims. The WHO has identified the country as being at the forefront of the spread of the disease though Abdel-Rahman Shahin, official spokesman to the Ministry of Health, points out that despite the high number of victims the percentage of fatalities from bird flu in Egypt is still less than in other countries that have seen outbreaks of the disease. Egypt has reported nine cases since the beginning of the year, with zero fatalities. There were eight cases with four fatalities in 2008. Vietnam has reported two fatalities, and China seven victims with four fatalities. Shahin argues the figures indicate the disease is being controlled in Egypt. "This year we do not have any fatalities whereas last year it was 50 per cent. The fatality rate in China this year is more than 50 per cent, and in Vietnam it is 100 per cent. The situation in Egypt is improving, not deteriorating." Bird flu presents a massive challenge to the government given the uncertainty about the course of any possible pandemic. The virus has become endemic and it could take years to rid the country of the most virulent strain. The government, says Shahin, has prepared a detailed national plan to be implemented in case of a pandemic according to which half of Egypt's 150,000 hospitals beds will be reserved for avian flu patients. Hamid Samaha, head of the General Authority for Veterinary Services, says the government is focussing on comprehensive public health efforts -- monitoring outbreaks in order to identify any change in the virus, increasing anti-viral stockpiles and building a more robust capacity for vaccine production. Settlement patterns in Egypt, where 95 per cent of the population is concentrated on five per cent of the land, has serious implications for any pandemic outbreak. The virus has been found at nearly 300 sites and is now "rooted in the Egyptian environment" says Shahin, who now believes that following the first incidents of avian flu Egypt should have culled all poultry and taken draconian measures to stamp out the continued domestic rearing of birds. "The whole country must resort to consuming frozen chicken instead of purchasing fresh birds. We cannot afford to implement such a scheme at the moment, but the least we must do is ensure that in cities people abide by the regulations and limit direct and indirect communication with poultry." Shahin suggests the mortality rate resulting from bird flu infections is decreasing due to growing awareness in the wake of information campaigns conducted by the Ministry of Health. The WHO is still concerned that human infections have escalated over a relatively short period of time, leading some experts to accuse the government of inadequate planning. Health officials, they say, are endeavouring to enforce preventive measures but are incapable of ensuring they are strictly implemented. "Government planning is random. It is using the wrong vaccine to combat the virus," insists Talaat Khatib, professor of veterinary medicine at Assiut University. "American scientists have already confirmed the H5N1 virus has evolved into two genetically distinct strains, potentially increasing the risk to humans." Khatib believes public awareness campaigns to date have been too weak and Egypt should have begun to plan its preventative measures when the virus was first reported in the country in February 2006. In Egypt, where poverty and illiteracy rates are high and urban rooftop and backyard rearing of poultry has long been a way of life, a more systematic approach to monitoring the disease needs to be put in place, says Samaha. "People do not respect instructions from the authorities. They consider poultry capital for which it is worth risking their health, and the health of their neighbours." Egypt is one of very few countries affected by bird flu that does not offer compensation to farmers when poultry is destroyed. Since 2003 412 human cases of the virus have been reported in 15 countries, resulting in 256 deaths. More than 300 million birds have been culled worldwide.
