18 Mar 2015

Avian influenza: Egypt and worldwide

Human infections with avian influenza viruses in Egypt and worldwide
  • Human cases and deaths due to influenza A(H5N1) virus continue to increase in Egypt, with cases from the country now accounting for the highest number of human cases reported by a single country since the outbreak began in 2003.
  • The risk of these viruses spreading in the community remains low. However, travellers to Egypt should avoid direct contact with poultry and birds or uncooked/untreated poultry products

An increased number of laboratory-confirmed human cases of avian influenza A(H5N1) has been reported in Egypt since November 2014 [1-2].

As of 3 March, 88 human cases of influenza A(H5N1), including 26 deaths, have been reported in Egypt in 2015. Most cases have been reported from central Egypt, along the Nile River and in the Nile Delta. Human cases reported direct exposure to live or sick poultry, mostly backyard poultry before the onset of disease.  As of 3 March 2015, Egypt has had the highest number of cases (292) reported by a single country since the emergence of the virus in 2003, with Indonesia reporting the second highest (197 cases), although Indonesia has not reported any cases so far in 2015 [3].

Avian influenza viruses (H5 and H7 subtypes)

Various influenza A(H5) subtypes, such as influenza A(H5N1), A(H5N2), A(H5N3), A(H5N6) and A(H5N8), have recently been detected in birds in Europe, North America, and Asia. No human cases of infection have been reported, with exception of the human infections with influenza A(H5N1) viruses and the three human infections with influenza A(H5N6) virus detected in China since 2014 [2].

Avian influenza A (H7N9) outbreaks have been ongoing in China since February 2013, including Hong Kong SAR and Taiwan. Malaysia reported one case in a Chinese traveller in 2014, and Canada reported two cases in travellers returning from China in January 2015 [1].

Avian influenza (H9N2) viruses

In January 2015, the first human case of A(H9N2) with exposure to healthy poultry was described in in a three-year-old boy from Aswan governorate [1-3].  H9N2 positive poultry have been detected in Egypt since 2010 [3].  Avian influenza A(H9N2) virus was also detected in China in late 2014, from Sichuan and Guangdong provinces [2].

Advice for travellers

Although there is no evidence of sustained human-to-human transmission, you are advised to follow special precautions to minimise the potential exposure if you are planning to visit a country currently affected by avian influenza outbreak, including Egypt.  In particular you should:

  • Avoid close contact with live poultry
  • Avoid visiting live bird and animal markets (including ‘wet’ markets) and poultry farms
  • Avoid contact with surfaces contaminated with animal faeces
  • Avoid untreated bird feathers and other animal and bird waste
  • Do not eat or handle undercooked or raw poultry, egg or duck dishes
  • Do not pick up or touch dead or dying birds
  • Do not attempt to bring any  poultry products back to the UK
  • Exercise good personal hygiene with regular hand washing with soap and use of alcohol-based hand rubs.

You are advised to seek medical advice promptly if you become ill with respiratory symptoms following a recent trip to Egypt or other countries affected by avian influenza outbreaks, from your GP or NHS 111.

Advice for healthcare professionals

Whenever avian influenza viruses are circulating in poultry, sporadic infections and small clusters of human cases are possible in people exposed to infected poultry or contaminated environments [2].

Healthcare professionals should be alert to the possibility of avian influenza in travellers presenting with a severe respiratory illness following recent travel from Egypt or other countries affected by outbreaks of avian influenza. Public Health England (PHE) has published avian influenza algorithms which provide guidance for physicians on the recognition, investigation and initial management of possible human cases of avian influenza, in travellers returning to the UK.


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