Zoonotic Transmission of Avian Influenza Virus | CDC EID

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Volume 16, Number 7–July 2010
Research
Zoonotic Transmission of Avian Influenza Virus (H5N1), Egypt, 2006–2009
Amr Kandeel, Serge Manoncourt, Eman Abd el Kareem, Abdel-Nasser Mohamed Ahmed, Samir El-Refaie, Hala Essmat, Jeffrey Tjaden, Cecilia C. de Mattos, Kenneth C. Earhart, Anthony A. Marfin, and Nasr El-Sayed
Author affiliations: Ministry of Health, Cairo, Egypt (A. Kandeel, E.A. el Kareem, A.-N. M. Ahmed, S. El-Refaie, H. Essmat, N. El-Sayed); US Naval Medical Research Unit 3, Cairo (S. Manoncourt, H. Essmat, J. Tjaden, C.C. de Mattos, K.C. Earhart, A.A. Marfin); and US Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A.A. Marfin)

Suggested citation for this article

Abstract
During March 2006–March 2009, a total of 6,355 suspected cases of avian influenza (H5N1) were reported to the Ministry of Health in Egypt. Sixty-three (1%) patients had confirmed infections; 24 (38%) died. Risk factors for death included female sex, age >15 years, and receiving the first dose of oseltamivir >2 days after illness onset. All but 2 case-patients reported exposure to domestic poultry probably infected with avian influenza virus (H5N1). No cases of human-to-human transmission were found. Greatest risks for infection and death were reported among women >15 years of age, who accounted for 38% of infections and 83% of deaths. The lower case-fatality rate in Egypt could be caused by a less virulent virus clade. However, the lower mortality rate seems to be caused by the large number of infected children who were identified early, received prompt treatment, and had less severe clinical disease.
During January 2003–March 2009, a total of 417 human cases of avian influenza (H5N1) and 256 deaths (61%) were reported worldwide (1). Although human-to-human transmission has occurred (2–4), most human cases have been caused by zoonotic transmission from poultry (5–8). Investigations have emphasized the need for timely identification to determine demographic groups at risk and activities more likely to cause human infection so that control and prevention measures may be implemented. Such investigations may also determine whether the virus can cause pandemic disease.

Avian influenza (H5N1) in Egypt was first reported in February 2006 when outbreaks were observed in domestic poultry at commercial farms and in backyard flocks in 3 governorates in northern Egypt. Within the first month, avian influenza (H5N1) was detected in 12 other governorates. Despite control measures that included culling, disinfection, vaccination, and controlled poultry movement, epizootic transmission of avian influenza virus (H5N1) continues.

During February 2006–March 2009, avian influenza virus (H5N1) was detected on 907 commercial poultry farms and in 606 backyard flocks. In 2006, poultry farms accounted for 84% of 1,052 outbreaks. In 2007, backyard flocks accounted for 89% of 274 outbreaks. As of March 2009, nineteen of 29 governorates reported infected poultry. The poultry industry in Egypt produces ≈2 million birds per day. Social and economic consequences have been dramatic (losses of ≈2–3 billion US$). Backyard flocks are common; 4–5 million families (≈25 million persons) raise poultry at home. During February 2006–March 2009, a total of 3,941 asymptomatic persons exposed to avian influenza (H5N1) from a person with a confirmed case or from infected poultry were tested by using a real-time PCR; none were positive.

Figure 1

Figure 1. Residences of 63 case-patients with avian influenza virus (H5N1) infections, Egypt, 2006–2009...


Figure 2

Figure 2. Illness onset for 63 case-patients with confirmed avian influenza (H5N1), by month, Egypt, 2006–2009.


In March 2006, the first human case of avian influenza (H5N1) in Egypt was reported from Qalubiya Governorate (Figure 1). We report the first 63 human cases. We also describe affected demographic groups, illness, mortality rates, and specific events that contributed to transmission.

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Suggested Citation for this Article
Kandeel A, Manoncourt S, el Kareem EA, Ahmed A-NM, El-Refaie S, Essmat H, et al. Zoonotic transmission of avian influenza virus (H5N1), Egypt, 2006–2009. Emerg Infect Dis [serial on the Internet]. 2010 Jul [date cited]. http://www.cdc.gov/EID/content/16/7/1101.htm

DOI: 10.3201/eid1607.091695