VZCZCXRO3031
PP RUEHAST RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHTM
DE RUEHEG #2445/01 3361409
ZNR UUUUU ZZH
P 011409Z DEC 08
FM AMEMBASSY CAIRO
TO RUEHC/SECSTATE WASHDC PRIORITY 0974
INFO RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE PRIORITY
RUEAUSA/DEPT OF HHS WASHDC PRIORITY
RUEHPH/CDC ATLANTA GA PRIORITY

UNCLAS SECTION 01 OF 02 CAIRO 002445 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR AIAG (AMBASSADOR LANGE AND DAVID WINN), DEPT PASS 
TO AID (DENNIS CARROLL) 
 
E.O. 12958: N/A 
TAGS: TBIO KFLU KSTH PGOV ECON KSCA EAGR EG
SUBJECT: BIRD FLU IN EGYPT: ALL QUIET ON THE MIDDLE EASTERN 
FRONT FOR NOW 
 
REF: A. 08 CAIRO 021 
     ¶B. 08 CAIRO 413 
     ¶C. 08 CAIRO 784 
     ¶D. 08 CAIRO 844 
 
Sensitive But Unclassified. Please handle accordingly. 
 
¶1. (SBU) Summary and comment: In July 2008, the World 
Organisation for Animal Health (OIE) declared the H5N1 avian 
influenza (AI) virus to be endemic in Egyptian poultry. Now, 
just four months later, some Egyptians are wondering why. 
Seven months have passed since the Ministry of Health and 
Population (MOHP) confirmed the last human case here. The 
Ministry of Agriculture and Land Reclamation's (MALR's) 
surveillance teams have not detected an afflicted farm or 
backyard bird for over six weeks. These facts beg the 
question: is victory over bird flu in sight in Egypt? The 
answer, given H5N1's limited track record here, its tenacity 
and its seasonal characteristics, is probably not. But winter 
is coming, and winter may hold some clues to the answer. End 
Summary and comment. 
 
---------------------- 
No victims since April 
---------------------- 
¶2. (U) AI struck twelve Egyptians, seven fatally, in a four 
month period beginning December 17, 2007 (refs. A,B and C). 
On April 16, 2008, the MOHP announced the last of these dozen 
victims, a two-year-old boy from Sharqia, was infected with 
the H5N1 virus (ref. D). The boy, the 50th confirmed Egyptian 
AI case since the virus was first identified here in 2006, 
recovered. Seven months have passed without another human 
case. 
 
   ------------------------------------- 
     Human tests: no H5N1 for seven months 
     ------------------------------------- 
 
¶3. (SBU) MOHP regularly obtains and tests human samples for 
the H5N1 virus. MOHP sends a few of these samples to NAMRU-3 
for H5 testing. None of these human samples have tested 
positive for H5 since Case No. 50 in April 2008. 
Additionally, from November 2007 through September 2008, at 
least 1,396 persons were enrolled in surveillance for "severe 
acute respiratory infections (SARI)" in eight Egyptian fever 
hospitals. While the surveillance, a cooperative effort 
involving MOHP and NAMRU-3, is not specifically designed to 
detect AI, 800 of these SARI patients were completely tested 
for influenza A and B viruses. The testing done would have 
detected H5. It did not. 
 
----------------------------------- 
        Animal tests: no H5N1 for six weeks 
        ----------------------------------- 
 
¶4. (SBU) In August 2008, not long after the OIE declared AI 
was endemic in Egyptian poultry, individuals working on 
USAID-supported AI projects within the Ministry of 
Agriculture and Land Reclamation (MALR) told ESTHOff the 
OIE's decision was premature. After OIE's announcement, 
MALR's surveillance teams continued to find the virus on 
farms and in backyards, but the virus was not as ubiquitous 
as it was in prior years. On November 24, 2008, Dr. Mona 
Mehrez Ali, Director of MALR's Animal Health Research 
Institute, told ESTHOff that MALR's recent poultry 
surveillance tests have all come back negative for H5N1. 
According to Dr. Mona, the last positive sample came from a 
backyard bird in Gharbia on October 7, 2008-- over six weeks 
ago. 
 
---------------------------------------- 
"Free of bird flu" or just a brief lull? 
---------------------------------------- 
 
¶5. (SBU) In late March 2008, the GOE's Supreme Committee for 
Combating Bird Flu, then chaired by MALR Minister Amin Abaza, 
released a statement claiming the virus was in "continuous 
retreat" around the country. While this claim seemed hollow a 
few weeks later when MOHP confirmed the virus had claimed two 
new victims (ref. C), the announcement now seems almost 
prophetic. Indeed, on September 18, 2008, Dr. Hamed Samah, 
Chairman of MALR's General Authority for Veterinary Services, 
went a step further: he declared Egypt "free of bird flu." 
While the virus seems to have taken a break, at least for 
now, most of those involved in Egypt's AI fight are wary. One 
MALR contact told ESTHOff that Dr. Samah "knows better." 
 
CAIRO 00002445  002 OF 002 
 
 
 
---------------------- 
Winter may tell. 
---------------------- 
 
¶6. (SBU) USAID's former Senior AI Advisor, Gavin 
Macgregor-Skinner, knows Egypt's AI struggles well, having 
spent many weeks here working closely with the GOE as part of 
USAID's AI program. Dr. Macgregor-Skinner believes the virus 
circulating in Egypt has seasonal characteristics and that 
late December through March appears to be the high risk 
period for human infection. The facts support him. H5N1 first 
claimed a human victim in Egypt in March 2006. Since then, 
the virus has demonstrated a pronounced seasonality: 43 of 
the 50 human AI victims in Egypt got sick between 
mid-December and mid-April. In 2006, AI season began on 
December 14, when a 26-year-old man from Gharbiya's Zefta 
district first showed symptoms of the disease a day after his 
sister slaughtered three ducks. Both died-- as did the 
sister's 15-year-old daughter. Last year, AI season started 
on December 17, when a 50-year-old woman from Damietta got 
sick. She was the first of five victims from four 
Governorates who got sick and died in December 2007. 
 
¶7. (SBU) Comment: While H5N1 no longer seems to be the 
apocalyptic bogeyman it was once thought to be here, the risk 
remains, December has arrived, and Egypt's health care 
providers are bracing for the bird flu season. End Comment. 
SCOBEY