VZCZCXRO9598
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DE RUEHEG #0784/01 1071200
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P 161200Z APR 08
FM AMEMBASSY CAIRO
TO RUEHC/SECSTATE WASHDC PRIORITY 8948
INFO RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE PRIORITY
RUEAUSA/DEPT OF HHS WASHDC PRIORITY
RUEHPH/CDC ATLANTA GA PRIORITY

UNCLAS E F T O SECTION 01 OF 02 CAIRO 000784 
 
SIPDIS 
 
NOFORN 
SENSITIVE 
SIPDIS 
 
STATE FOR NEA/ELA (NAFZIGER) 
STATE FOR AIWG (WINN) 
 
E.O. 12958: DECL: 04/15/2018 
TAGS: TBIO KSCA KFLU ECON EAGR PGOV EG
SUBJECT: BIRD FLU KILLS SECOND EGYPTIAN THIS MONTH 
 
REF: CAIRO 413 
 
Sensitive But Unclassified NOFORN. To be disseminated only to 
U.S. personnel. Please handle accordingly. 
 
¶1. (SBU/NF) Summary: On April 11, the Ministry of Health and 
Population (MOHP) confirmed its sixth Human avian influenza 
(AI) case this year, the 49th overall, and the second in less 
than a week: a 30-year old woman from Al-Matarya in the Cairo 
Governorate.  The woman's death, which made her the 22nd 
confirmed victim of the H5N1 virus, and that of a 19-year-old 
poultry worker who died last week, have raised new questions 
about the health of the country's poultry flocks and the 
effectiveness of the government's response to the disease. 
End Summary. 
 
---------------------------------------- 
Public Claims of Progress, Private Fears 
---------------------------------------- 
 
¶2. (SBU/NF) The latest bird flu victim is the first in the 
Cairo area in about a year. Her death comes not long after 
Egypt's National Committee for Combating Bird Flu met and 
released a statement claiming avian influenza is in 
"continuous retreat" around the country.  A MOHP official, 
who was at the Committee's March 27 meeting, told us shortly 
thereafter that the announcement notwithstanding, "many 
questions" remain concerning the true situation in the 
country,s poultry flocks and the uncontrolled movement of 
poultry around the country (ref A). 
 
------------------------------ 
Sought Help, but didn't get it 
------------------------------ 
 
¶3. (SBU/NF) In the last two human AI cases, both victims 
sought medical treatment soon after the onset of symptoms, 
but neither received Tamiflu in a timely fashion. The young 
poultry worker from Kafr Al-Dawar, in the Beheira 
Governorate, got sick March 30th. He sought help at a private 
clinic the following day, and then went to a private 
hospital, but did not receive Tamiflu until April 3, when he 
checked in to Alexandria Fever Hospital. 
Delays in administering Tamiflu in the latest case, involving 
the woman from Cairo, are also disturbing. She got sick April 
¶2. According to the MOHP, beginning April 4, she sought help 
at least four different clinics and hospitals, including two 
government hospitals, over the course of several days. She 
eventually went to Abbasya Chest Hospital where, on April 9, 
she received Tamiflu. According to the MOHP, the woman and 
her family denied she had any contact with poultry until she 
arrived at Abbasya. Her family members then admitted that she 
bought two chickens from the poultry shop in their building, 
attended the slaughtering there, then de-feathered and 
cleaned the birds at home. 
 
--------------------------------------------- - 
Six confirmed cases; three dead so far in 2008 
--------------------------------------------- - 
 
¶4. (SBU) The MOHP confirmed four human AI cases (one from 
Minya, two from Fayoum, and one from Menoufiya) in late 
February and early March. According the MOHP, the 
epidemiological investigations into those cases confirmed 
contact with sick or dead poultry in all but one: case number 
45, a 25-year-old woman from the Sennoris District in Fayoum, 
who eventually died. Contact with sick poultry could not be 
ruled out, but the samples taken from poultry in the Sennoris 
District did not confirm the presence of the H5N1 virus. The 
investigations into the two recent cases confirmed contact 
with sick poultry. 
 
------------- 
The good news 
------------- 
 
¶5. (SBU/NF) The MOHP and the Ministry of Agriculture and Land 
Reclamation (MALR) have been deploying Rapid Response Teams, 
including, in at least one case, a joint team, to the sites 
of all human infections this year. By all accounts, these 
teams are getting to the sites quickly, taking samples, doing 
solid epidemiological work, and bringing the samples safely 
back to the MALR,s Animal Health Research Laboratory for 
testing. In the Menoufiya case, the MOHP asked NAMRU-3 to 
send a team to the site. NAMRU-3,s team was on the road to 
Menoufiya a little over an hour after the request was made. 
 
CAIRO 00000784  002 OF 002 
 
 
MALR,s Lab and the MOHP,s Central Lab are employing sound 
methods and getting reliable results. While Egypt trails only 
Indonesia in the number of human AI cases this year, the 
number is down 62.5% compared to April last year. 
 
--------------------------------------------- --------------- 
But the real question: not why so many cases, but why so few 
--------------------------------------------- --------------- 
 
¶6. (SBU/NF) Women and children, those who work and play 
closest to the birds, continue to bear the brunt of the 
disease in Egypt.  The virus has killed 22 Egyptians, 20 of 
them women or young girls. During a recent trip to Kafr 
Al-Dawar, we saw hundreds of women and young girls, entangled 
with thousands of ducks and chickens, along the canal road 
between Damanhoeur and Abu Hommus near Kafr Al-Dawar, the 
home of one of the recent victims. The vaccination program 
hasn't worked. The latest case from Cairo is evidence that 
the disease is not limited to the rural areas of the country: 
the woman bought the sick birds from a shop located on the 
ground floor of her building. Additionally, we understand 
MALR recently conducted tests on birds from ten poultry shops 
and nine open markets in Alexandria. Over 40% of the shops 
and markets tested had infected birds. One physician, who has 
been working closely on the AI issue in Egypt, told us he 
often hears people asking why Egypt has had so many human AI 
cases, trailing only Indonesia and Vietnam. He said the 
better question is why it has had so few. In his opinion, the 
answer is simple: the virus circulating here does not now 
move easily from poultry to people. 
 
----------------------------------- 
Uncontrolled movement of sick birds 
----------------------------------- 
 
¶7. (SBU/NF) As reported in ref A, MOHP officials remain very 
concerned about uncontrolled poultry movement around the 
country. On April 15, Egyptian media reported a gun battle 
took place at a checkpoint in Shabramant, Giza between 
police, who stopped a convoy of trucks, and a gang smuggling 
820 uninspected live chickens infected with the disease. 
 
¶8. (SBU/NF) COMMENT: The GOE has a long history of hiding 
environmental and health problems from the public, a fact 
confirmed recently by a leading Egyptian scientist who has 
dealt with these issues at the highest levels for over twenty 
years. The scientist told us that State Security has blocked 
disclosure of information about environmental and health 
issues. The MOHP has, however, made great strides toward 
transparency when it comes to bird flu matters. The 
disclosure that the last victim sought but did not receive 
treatment at several hospitals may be a good example of this 
new transparency. We do not understand how two government 
hospitals failed to administer Tamiflu in the most recent 
case. The reports that the victim denied any contact with 
birds, even if true, are no excuse for non-treatment. 
Egyptian bird flu victims usually deny contact with sick 
poultry if for no other reason than to avoid the culling that 
inevitably follows the discovery of a human case. Moreover, 
the latest victim apparently did not keep live birds in her 
home and, as a result, she had no compelling motive to lie 
about exposure. USAID will be meeting with the MOHP this week 
to discuss the latest case and the issues it raises. The case 
from Cairo and the recent test results from Alexandria 
confirm that the H5N1 virus is present in force in Egypt's 
urban areas and that it will continue to claim victims. END 
COMMENT. 
RICCIARDONE