Since 2003, some 387 people in 15 countries have been infected by H5N1, according to the World Health Organization (WHO), and 245 have died. Hundreds of millions of domesticated birds have been killed to prevent and control outbreaks.

The avian virus occasionally jumps from birds to people, and scientists are concerned that if the virus mutates enough to become easily transmissible among people, highly pathogenic H5N1 could become a pandemic that might spread around the planet, killing millions and creating economic losses in the trillions of dollars.

H5N1 — first isolated from a farmed goose in China’s Guangdong province in 1996 — since has established a year-round, endemic presence in Bangladesh, China, Egypt, Indonesia, Pakistan and Vietnam, said Dennis Carroll, director of the Avian and Pandemic Preparedness and Response Unit at the U.S. Agency for International Development.

“Egypt in many ways is a model in terms of how the Ministry of Health has been able to inform and educate households and their own health system to maximize the time between onset of illness [of an H5N1-infected person] and beginning of treatment,” Carroll said during a two-day workshop for journalists in Cairo, Egypt, October 22-23.

More than 20 reporters from Egypt, Jordan, Kuwait, Morocco, Sudan, the United States, the West Bank and Yemen attended the workshop, which was funded by the U.S. State Department and organized by the Broadcasting Board of Governors with assistance from the U.S. Embassy-Cairo.

The workshop was held days in advance of the October 24-26 International Ministerial Conference on Avian and Pandemic Influenza, held in Egypt. The conference is a collaboration among the Egyptian government, the European Union and the International Partnership on Avian and Pandemic Influenza.

RAISING POULTRY

Journalists heard from Ministry of Health officials about preparing the Middle East and the world for human and avian pandemic flu. The group also heard from an animal disease surveillance specialist from the U.N. Food and Agriculture Organization (FAO) about avian flu and cross-border transmission.

Joseph Annelli, a veterinarian who is the scientific and technical adviser for emergency management at the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service, discussed poultry production, poultry vaccination and disease transmission in the range of poultry production operations — from large commercial facilities to village and backyard farmers.

“When we first met at the Ministry of Agriculture, we were reminded that the Egyptian people have been raising poultry this way for 5,000 years and it’s unlikely in a year or two that they’re going to change those practices,” Annelli told the journalists. “We have to recognize that, respect that and [determine how to] interrupt disease transmission without interrupting peoples’ livelihoods, hobbies and love for their birds and animals.”

The same biosafety practices apply “whether you’re in Egypt, Vietnam, Indonesia, the Philippines or the United States,” he added. “Birds are raised the same way everywhere.”

In February 2006, Egypt reported its first H5N1 in domestic poultry, and outbreaks continued through December 2006. The government sprang into action, creating a national plan and instituting regulatory measures, surveillance, culling and disinfection, vaccination, training and other efforts.

Today, with a dwindling number of reported cases of avian flu in poultry and people, complacency is creeping into the cities, said Dan Rutz, public health analyst with the National Center for Health Marketing at the U.S. Centers for Disease Control and Prevention.

“There are laws in Egypt banning live chickens in the cities,” he said, “and yet we know in Cairo, Alexandria and probably elsewhere that people have let down their guard and are bringing chickens back into the cities. Because of the crowded conditions and a virus that is still present, there is a huge risk being taken. We could lose a lot of ground.”

H5N1, AN EVOLVING VIRUS

According to Carroll, H5N1 is a dynamic, evolving pathogen whose threat is different today from what it was in the fall of 2005, when the virus that had been circulating in Southeast Asia moved very dramatically into Eurasia and Europe, and made its first appearance in Egypt and then Africa.

“Since 2006, Carroll said, “we have seen a steady decrease in the number of countries that are affected.” In Egypt, other things have changed since 2006.

Based on data and analysis from WHO, FAO, the World Organisation for Animal Health and the government of Egypt, Carroll said most H5N1 poultry outbreaks and human cases are focused geographically in the Nile Delta, between Cairo and the Mediterranean Sea, and most occur between January and March of any given year.

“That is significant information,” Carroll said, “in terms of understanding where to bring your greatest level of focused action to try and deal with the problem.”

Poultry outbreaks shifted from small- to medium-sized commercial farms (1,000 to 10,000 birds) in 2006 to smaller farms (1 to 1,000) with a mix of bird species, he added, suggesting a larger role for public awareness campaigns, particularly in the informal sectors, about what farmers can do to protect themselves from H5N1.

Genetic data on H5N1 has allowed scientists to track outbreaks outside the six endemic countries, Carroll said. “That data has shown us that outbreaks reported over the last couple of years in Israel, Jordan, West Bank/Gaza and Djibouti — the genetic evidence clearly indicates that the point of origin was in birds within Egypt.”

After the workshop, journalists felt armed with new information about avian flu.

“People are becoming complacent,” said Sherine El Madany, a business reporter for Daily News Egypt who writes about avian flu from an economic perspective. “Some people think it’s been two years [since a large outbreak], so the virus can’t come back. Maybe now is a good time to remind people there’s still a threat.”