Increased Number of Human Cases of Influenza Virus A(H5N1) Infection, Egypt, 2014–15

Abstract

During November 2014–April 2015, a total of 165 case-patients with influenza virus A(H5N1) infection, including 6 clusters and 51 deaths, were identified in Egypt. Among infected persons, 99% reported poultry exposure: 19% to ill poultry and 35% to dead poultry. Only 1 person reported wearing personal protective equipment while working with poultry.

Enhanced virulence of clade 2.3.2.1 highly pathogenic avian influenza A H5N1 viruses in ferrets

“…The persistent geographic spread and genetic evolution of select clades of A(H5N1) viruses, specifically those within the 2.2 and 2.3 clusters, have required further classification into third and fourth-tiered clades (Creanga et al, 2013; WHO/OIE/FAO, 2014; Younan et al, 2013). In Egypt, only clade 2.2 viruses have been found to circulate in poultry with all confirmed human infections between 2009 and 2016 caused by 2.2.1 and 2.2.1.2 viruses (Refaey et al, 2015; Younan et al, 2013). In Vietnam, based on the available surveillance data, clade 1 viruses were gradually replaced by clades 2.3.2 and 2.3.4 viruses beginning as early as 2005.…”

An overview of the epidemiology and emergence of influenza A infection in humans over time

“…However there are few incidences of larger scale outbreaks which have presented with more cases than would be expected in sporadic transmission: (i) large numbers of H7N9 human cases have occurred each year since it’s emergence in 2013 (159 cases in 2013, 334 cases in 2014, 210 cases in 2015 and 99 cases in 2016 [8], (ii) the H5N1 outbreak in Egypt from 2014 to 2015 which caused 114 cases [9], and (iii) H7N7 outbreak in the Netherlands in 2003 which caused 89 cases [10]. H7N9 infections were mainly identified or reported during winter months – in 2014 and 2016 most infections (51% and 32% respectively) occurred in January, in 2015 most infections (42%) occurred in February, however in 2013 most infections (64%) occurred in April (early spring) [8].…”

“…In recent years, several countries in west and central Africa experienced a resurgence of H5N1 poultry outbreaks: Cameroon, Burkina Faso, Niger, Cote d’Ivoire, Ghana, Nigeria and Nigeria (in these countries reports of H5N1 outbreaks had last occurred in 2006 – 2009) [8]. There is a concern poultry outbreaks in these regions could escalate and cause large numbers of human infections, similar to the 2014–2015 Egypt outbreak [9]. We recommend pandemic preparedness activities focus on improving AIV control measures in developing countries.…”

Improved capacity for influenza surveillance in the WHO Eastern Mediterranean Region: Progress in a challenging setting

“…The importance of having improved capacity for surveillance of and response to influenza and other respiratory diseases in the region cannot be overemphasized. The Eastern Mediterranean Region of WHO has reported the highest number of human infections with highly pathogenic avian influenza A(H5N1) virus to date [17], a virus with pandemic potential. The region has also experienced the emergence of Middle East Respiratory Syndrome (MERS-CoV), another new respiratory pathogen capable of causing a global health emergency.…”