Egypt Report

WHO to probe possible
symptomless carriers of H5N1
– new disease pattern raises fears of human-to-human transmission

The World Health Organisation was due (at the time of going to press) to send a team of doctors to investigate the recent resurgence of bird flu – H5N1 – in Egypt, particularly as nearly all of the recent cases have occurred in young children and almost none have died, which signifies a disturbing new pattern in the disease.

According to Bloomberg News, two WHO doctors and a scientist were due to travel to Cairo mid-April at the request of the Egyptian Ministry of Health and Population.

The request comes on the back of a resurgence of the disease since late 2008. Twelve of 17 patients (infected between December 2008 and late-April 2009) have been children 6 years of age or younger. Only one of the children has died.

Twelve months ago, it was mainly adults and older children who were affected. This represents a significant change in the pattern of the disease in Egypt and is raising concern among experts that this may lead to the virus mutating and, what is most feared, being spread from human to human.

Britain’s Independent newspaper says WHO fears that this year’s rise in infections in Egypt among small children, without similar cases being seen in older people, raises questions about whether adults are being infected but not falling ill, so acting as symptomless carriers of the disease.

A situation where the disease is transmissible from human to human could lead to the next global influenza pandemic, the last major one of which in 1918 killed many millions of people around the world. Studies show that an outbreak that kills as few as 5% of those it infects could still cause hundreds of millions of deaths around the world.

However, this is currently not the case and all instances of infection to date have been acquired from contact with sick or dead poultry. Around 5 million households in Egypt depend on domestically raised poultry as a key source of food and income.

Egypt is one of the only countries affected by bird flu that does not offer compensation for farmers when poultry is destroyed, which many experts say is the best way to ensure rapid detection of new outbreaks.

Experts say that, ironically, the more virulent the disease the safer it is. If it kills its victims swiftly it has less chance to mutate and be passed on. However, in the current situation in Egypt where victims are not dying and remain infected for long periods this gives the virus a chance to incubate and mutate into a more transmissible form.

The WHO investigation was expected to check whether this was happening by testing the blood of people who may have been in contact with infected birds, but who have not themselves become sick.

Reuters quotes John Jabbour, who works with WHO in Cairo as saying: “There is something strange happening in Egypt. Why in children now and not in adults? We need to see if there are sub-clinical cases in the community.” Jabbour added that if WHO’s research did find such cases they would be the first such cases in the world.

Egypt is the worst H5N1- affected country outside Asia. Of the 68 cases confirmed to date (23 April) in Egypt, 26 have been fatal.

The Independent on Sunday quoted Professor Robert Webster, of St Jude Children’s Research Hospital in Memphis, Tennessee – who is one of the world’s leading authorities on the disease – as saying this issue in Egypt should receive maximum attention.

“I hope to hell they are wrong. If this damn thing becomes less pathogenic, it will become more transmissible,” he said.

ate of upload: 16th May 2009

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