VZCZCXRO1453
PP RUEHAST RUEHDH RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHSL RUEHTM
RUEHTRO
DE RUEHEG #1218/01 1801446
ZNR UUUUU ZZH
P 291446Z JUN 09
FM AMEMBASSY CAIRO
TO RUEHC/SECSTATE WASHDC 3026
INFO RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE PRIORITY
RUEAUSA/DEPT OF HHS WASHDC PRIORITY

UNCLAS SECTION 01 OF 02 CAIRO 001218 
 
SENSITIVE 
 
SIPDIS 
 
DEPT FOR AIAG (AMBASSADOR LOTFIS AND DAVID WINN), CA/ACS, NEA/ELA 
DEPT PASS TO USAID (DENNIS CARROLL) 
 
E.O. 12958:  N/A 
TAGS: KFLU TBIO EAID PGOV EG
SUBJECT:  AVIAN INFLUENZA REMAINS MOST THE DANGEROUS THREAT 
 
Sensitive but unclassified.  Please handle accordingly. 
 
¶1. (SBU) Key issue: 
 
-- The real threat to Egypt is not swine flu (H1N1), but avian 
influenza (AI, or H5N1), now endemic in poultry flocks in Egypt and 
infecting people at an increasing rate, and the possibility it could 
change, with or without help from H1N1, into a virus that easily 
jumps from bird to human and human to human. 
 
¶2.  (SBU) After a year of working with the Government of Egypt (GOE) 
on a range of flu-related issues, and as coordinator of the 
Embassy's Avian Influenza Working Group, our recently departed ESTH 
officer shares the following observations on the state of avian 
influenza in Egypt, the current H1N1 outbreak, and opportunities for 
an enhanced USG role in addressing these twin challenges. 
 
SWINE FLU IS A DISTRACTION 
-------------------------- 
¶3.   (SBU) On June 12, Ministry of Health spokesperson Abdul Rahman 
Shahin commented publicly that the real threat in Egypt is not the 
H1N1 virus because it is a "weak" virus.  Instead, Shahin noted the 
real threat is the H5N1 virus and the possibility that it will 
combine with H1N1 into a new and more potent virus.  Shehab Abdul 
Hamid, a university veterinary medicine professor, emphasized the 
same message on a talk show last week.  He said "the problem of 
swine flu in Egypt is worse than anywhere else in the world because 
we have the highest rate of bird flu cases, which could join with 
the swine flu virus and create a new deadly virus."  COMMENT:  We 
agree with this assessment, and are glad to hear GOE officials 
making these comments publicly, despite current levels of media 
attention to, indeed hysteria concerning, swine flu.  END COMMENT. 
 
 
EGYPT GENERALLY SUCCESSFULLY TREATING AI 
------------------------------ 
¶4.  (SBU) Egyptian doctors continue to save AI patients at a 
remarkable rate at the Manshiyat El-Bakry Hospital, which primarily 
treats children.  It might be useful for doctors from Asian 
countries also affected by AI to visit Egypt and see first-hand how 
this disease can be managed.  Unfortunately, not all hospitals in 
Egypt provide the same level of treatment to their AI patients.  In 
a recent case at Ain Shams Hospital, which is not a member of the 
Ministry of Health's hospital network, a young patient was in the 
hospital for six days before receiving Tamiflu. He did not survive. 
 
 
REDUCING THE VIRAL LOAD 
----------------------- 
¶5.  (SBU) Reducing the viral AI load - determining how many birds 
are sick and how sick they are - throughout Egypt should be a 
priority.  Based on past experience, in November this year Egypt 
will start seeing mass die-offs in flocks nationwide and the first 
human case will follow in mid-December.  This happened in 2006, 2007 
and 2008.  Biosafety, vaccination and culling all have their place 
in breaking this cycle.  But according to the Dr. Mona Mehrez, who 
serves as the director of the Ministry of Agriculture's Animal 
Health Research Institute, not enough is known about the virus to 
roll out an effective vaccine in time. A 2007 reverse genetic strain 
developed by USDA's Agricultural Research Service holds promise, as 
may one created by a team from Egypt's National Research Center and 
St. Jude's Hospital in Memphis.  However neither seed strain 
candidate has undergone the challenge studies required to produce a 
viable vaccine.  A new vaccine that doesn't work may have little 
use, and even producing one in bulk that proves effective will take 
time. 
 
¶6.  (SBU) At the same time, according to Dr. Mehrez, many of the 
human cases this year involved vaccinated chickens.  An effective 
vaccination may not have much impact on backyard flocks, which tend 
to be outside the GOE vaccination system in any case.  Moreover, 
Minister of Agriculture Amin Abaza has already acknowledged publicly 
that he cannot finance a mass vaccination campaign this fall; the 
GOE simply does not have the money.  Culling is equally problematic. 
 Massive culls in 2006 and subsequent ones have led to increased 
prices for poultry and for other sources of protein as well.  A 
recent health survey indicated a 25 percent increase in stunting in 
children under the age of five since 2005. 
 
¶7.  (SBU) The Ministry of Agriculture's Dr. Mehrez believes a 
renewed emphasis on bio-security is the best option for reducing the 
risk of Avian Influenza (H5N1) in the near term.  We agree, as do 
other leading experts dealing with not only Avian Influenza but also 
the new threat of the H1N1 virus.  Our own USG experts here in Cairo 
have some proposals on clean caging, and a safe slaughtering method 
that might produce positive results in combating the H5N1 virus. In 
addition, on the satellite television OTV's Baladna show last week, 
 
CAIRO 00001218  002 OF 002 
 
 
Dr. Mustafa Arrokhan, former chief of the regional office of the 
WHO, stated cleanliness is the most important precaution when 
dealing with swine flu (H1N1), and the real threat will appear by 
the fall as the climate helps it become active. 
 
THE PUBLIC MESSAGE 
------------------ 
¶8.  (SBU) There is a need to continue to focus on public education 
about AI, with a strong message at the village level to keep 
children away from birds and to educate women about safe 
slaughtering methods.  The Egyptian public appears to have become 
somewhat complacent about these issues, and is ignoring bio-safety 
precautions as vaccinated chickens provide a false sense of 
security.  In this regard, the free vaccine program for backyard 
poultry flocks may actually be counterproductive.  Interestingly, 
the Ministry of Health's Dr. Samir Refaye has told us that 
pharmacists have proven to be unsung heroes in the AI campaign. 
Virtually any drug can be purchased without a prescription, 
over-the-counter in Egypt, and pharmacists are often the primary 
care provider of choice in the case of illness.  Several pharmacists 
suspected avian influenza when parents with sick children came in, 
and advised them to go to a fever hospital.  We might consider an 
education campaign aimed at pharmacists. 
 
THE SCIENCE 
----------- 
¶9.  (SBU) Working closely with NAMRU-3, and backed by USAID, Egypt 
has made progress in surveillance, epidemiology and genetic analysis 
at the human and animal levels.  Many questions remain about the 
turn that the disease has taken this year.  Why are so many children 
(26 out of 30 victims this year) getting sick, and not poultry 
workers?  Why aren't older people falling ill (only one victim this 
year was born before 1969)?  What role does the slaughtering process 
play in the spread of the disease?  Why have there been so many 
cases so late in the year?  Is there a difference between the 
backyard virus and the commercial farm virus?  Ultimately, where are 
the sick birds coming from? 
 
¶10.  (SBU) In conclusion, while Egypt faces daunting AI problems, 
the country's relatively transparent approach to fighting the 
disease, its ability to quickly implement policies, and its cadre of 
trained and battle-hardened veterinarians and physicians offer 
advantages for what may emerge in November and December this year. 
 
Scobey