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