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PP RUEHAST RUEHDH RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHSL RUEHTM
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DE RUEHEG #1215/01 1801355
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P 291355Z JUN 09
FM AMEMBASSY CAIRO
TO RUEHC/SECSTATE WASHDC PRIORITY 3021
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 001215 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR AIAG (AMBASSADOR LOTFIS AND DAVID WINN), NEA/ELA 
DEPT PASS TO AID (DENNIS CARROLL) 
 
E.O. 12958: N/A 
TAGS: TBIO KFLU KSTH PGOV EAGR CASC PREL EAID EG
SUBJECT: INFUENZA CONFERENCE REVIEWS VIRUS SITUATION IN EGYPT 
 
Sensitive but Unclassified.  Please handle accordingly. 
 
1.(SBU)Summary: At the avian and human influenza strategic review 
workshop on June 22-23 in Cairo, the first ever lead by USAID, 
senior Ministry of Health (MOH) and Agriculture (MOA) officials, as 
well as representatives from UN agencies, the World Bank, and the 
Communication for Healthy Living Project, examined the H5N1 
situation in Egypt and identified ways to improve prevention and 
control of the virus.  Panel discussions also discussed the rapid 
emergence of the H1N1 virus and the potential implications which 
arise when in an H5N1 environment. End Summary. 
 
------------------ 
Tracking the Virus 
------------------ 
 
¶2. (SBU) USAID and Egyptian authorities recognized that nearly three 
and a half years into Egypt's H5N1 program (the first human case was 
reported in March 2006), the time had come for an assessment of the 
overall on-the-ground situation. USAID's Dennis Carroll, Director of 
Avian Influenza and Pandemic Preparedness in the Global Health 
Office, posed two key questions at the workshop's opening session: 
how best to support GOE efforts to combat the virus in the next 12 
months and whether current program investments are consistent with 
data emerging about the virus.  While the detection of H5N1 human 
cases in Egypt is faster and the fatality rate is lower in 
comparison to other developing countries, Carroll stated significant 
problems and gaps in information remain about the virus. 
 
¶3. (SBU) Since 2006, Egypt has accounted for a significant portion 
of the world's reported H5N1 poultry outbreaks and human cases. To 
date, the MOH has announced 81 confirmed cases, with 27 of those 
cases fatalities.  Worldwide, nearly 30% of all human H5N1 cases 
have emerged from Egypt - 11 governorates (8 from the country's 
Delta region) contain more than three quarters of the human cases. 
The virus primarily affects backyard famers and children. 
 
¶4. (SBU) More than 90% of H5N1 cases are the result of exposure to 
sick or dead poultry.  Yet, while the number of reported poultry 
outbreaks has decreased since 2006, and the number of human cases 
followed the same trend through 2008, H5N1 human cases increased in 
¶2009. It is unclear if this is a result of issues related to poultry 
outbreak reporting, increased environment viral load, or risky 
behaviors leading to bird-to-human transmission, or another factor. 
Carroll noted that several USAID program areas require 
consideration, including increasing capacity for detection and 
outbreak investigation; working with the commercial poultry sector 
to improve bio-security and control poultry movement; and refining 
the communications message to improve prevention behaviors for 
parents for all those who have contact with poultry. 
 
--------------------- 
GOE Capacity Building 
--------------------- 
 
¶5. (SBU) MOH and MOA officials confirmed the accuracy of this data 
and reviewed current GOE H5N1 efforts. According to a 2008 
demographic survey, a comprehensive and persistent media outreach 
program using print materials, television ads, has led to near 
universal awareness among men and women ages 15-59 years old, with 
80% of people learning about H5N1 through television advertising 
campaign. The MOH's Dr. Amr Kandeel detailed the Ministry's capacity 
building in recent years, including stockpiling 2.5 million Tamiflu 
doses, creating rapid response containment teams for health care 
workers, implementing surveillance measures at ports of entry, 
building new laboratories, and stronger coordination with other 
ministries. 
 
¶6. (SB) MOA efforts are not as comprehensive as those frm the MOH. 
Dr. Amira Kamal, a member of the Minisry's General Organization of 
Veterinary Services(GOVS), highlighted many problems confronting 
th Ministry's response to H5N1.  The MOA possesses aweak 
notification and reporting system, deficien surveillance 
mechanisms, inadequate bio-securitymeasures, and inefficient 
veterinary teams to repond to outbreaks.  The National Laboratory's 
Dr Mohamed Khalifa noted the virus is endemic and ageed there is 
no accurate reporting from affectedareas. 
 
------------------ 
Consensus Building------------------ 
 
¶7. (SBU) On the workshop's scond day, GOE officials split into MOA 
and MOH wrking groups to analyze ways in which their respecive 
ministries can improve communication, trainig, community outreach, 
and pandemic preparedness. A MOH presentation noted the need to 
decrease te H5N1 incidence rate among children and improve te 
 
CAIRO 00001215  002 OF 002 
 
 
response rate among infected women, who often wait more than 5 days 
to seek treatment. 
The MOA team distilled their approach into three main programs: 
bio-security (emphasizing segregating poultry and disinfecting 
anything that is visibly dirty); surveillance; and outbreak 
investigation. 
 
¶8. (SBU) Comment: There is a significant disparity between MOH and 
MOA H5N1 activities and preparedness.  The country has had only 27 
fatalities since the disease appeared in 2006, just 17 since 2007. 
It takes less than two-and-a-half days from virus symptoms (i.e. 
fever, coughing, sore throat) to the actual onset of the disease, 
which translates into people seeking immediate treatment for H5N1; 
other countries average more than 5 days. MOH officials communicate 
constantly with the public about human H5N1 cases.  In comparison, 
the MOA lacks a comprehensive and coherent plan to address the 
long-simmering internal squabbles among senior MOA officials, which 
were evident at the conference.  Two steps that could strengthen the 
GOE's H5N1 program are 1) a refocused effort on bio-security and 
surveillance programs which could improve the response to poultry 
outbreaks and commercial and backyard farms and 2) organizing 
regular GOE H5N1 stakeholder meetings (especially among senior MOH 
and MOA officials) to ensure that there is a unified approach to 
combating the virus. We will continue to stress the importance of 
these steps as we engage with our GOE interlocutors. 
 
Scobey