Avian Influenza in Humans: Lessons from Egypt

From Eurosurveillance -- January 28, 2010

Highly pathogenic avian influenza A(H5N1) has ravaged the Egyptian poultry population. Ninety human cases, including 27 fatalities have been recorded by 30 December, 2009. However, epidemiological information on the infection in humans in Egypt is scarce. We analyzed the first three years of highly pathogenic avian influenza A(H5N1) in Egypt between 20 March 2006 and 31 August 2009 and found that more cases occurred in females than males, especially in 2006 and 2007.

Women in the age group 20-39 years had the greatest tendency to be infected. It took an average of one day and 18 hours to seek medical assistance in patients who recovered and of six days in fatal cases. Children sought treatment much earlier than adults. On average, patients died 11 days after the onset of symptoms. Exposure to infected poultry remained the most important risk factor.

The overall case fatality in this study was 32% (27/85). This percentage may appear small when compared with statistics from other places, for example 82% in Indonesia (115/141), 68% in Thailand (17/25), 66% in China (25/38) and 50% in Vietnam (56/111). Nevertheless, with the exceptional surge in number of cases (especially in children) arising in Egypt in 2009 and the recent recurrence of human cases of avian influenza A(H5N1) in China and Vietnam despite an intensive control program in the poultry populations, the pandemic potential of this virus is still very evident.

Public health guidelines in Egypt will need to be tailored to meet the local situation, taking into consideration the agricultural practices and the people’s perceptions. It will also be necessary to conduct more studies on human H5N1 influenza infection in Africa to evaluate the situation of asymptomatic carriers and unreported cases.