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Cablegate: Bird Flu Kills Second Egyptian This Month

VZCZCXRO9598
PP RUEHHM RUEHPB
DE RUEHEG #0784/01 1071200
ZNY EEEEE ZZH
P 161200Z APR 08
FM AMEMBASSY CAIRO
TO RUEHC/SECSTATE WASHDC PRIORITY 8948
INFO RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE PRIORITY
RUEAUSA/DEPT OF HHS WASHDC PRIORITY
RUEHPH/CDC ATLANTA GA PRIORITY

UNCLAS E F T O SECTION 01 OF 02 CAIRO 000784

SIPDIS

NOFORN
SENSITIVE
SIPDIS

STATE FOR NEA/ELA (NAFZIGER)
STATE FOR AIWG (WINN)

E.O. 12958: DECL: 04/15/2018
TAGS: TBIO KSCA KFLU ECON EAGR PGOV EG
SUBJECT: BIRD FLU KILLS SECOND EGYPTIAN THIS MONTH

REF: CAIRO 413

Sensitive But Unclassified NOFORN. To be disseminated only to
U.S. personnel. Please handle accordingly.

1. (SBU/NF) Summary: On April 11, the Ministry of Health and
Population (MOHP) confirmed its sixth Human avian influenza
(AI) case this year, the 49th overall, and the second in less
than a week: a 30-year old woman from Al-Matarya in the Cairo
Governorate. The woman's death, which made her the 22nd
confirmed victim of the H5N1 virus, and that of a 19-year-old
poultry worker who died last week, have raised new questions
about the health of the country's poultry flocks and the
effectiveness of the government's response to the disease.
End Summary.

----------------------------------------
Public Claims of Progress, Private Fears
----------------------------------------

2. (SBU/NF) The latest bird flu victim is the first in the
Cairo area in about a year. Her death comes not long after
Egypt's National Committee for Combating Bird Flu met and
released a statement claiming avian influenza is in
"continuous retreat" around the country. A MOHP official,
who was at the Committee's March 27 meeting, told us shortly
thereafter that the announcement notwithstanding, "many
questions" remain concerning the true situation in the
country,s poultry flocks and the uncontrolled movement of
poultry around the country (ref A).

------------------------------
Sought Help, but didn't get it
------------------------------

3. (SBU/NF) In the last two human AI cases, both victims
sought medical treatment soon after the onset of symptoms,
but neither received Tamiflu in a timely fashion. The young
poultry worker from Kafr Al-Dawar, in the Beheira
Governorate, got sick March 30th. He sought help at a private
clinic the following day, and then went to a private
hospital, but did not receive Tamiflu until April 3, when he
checked in to Alexandria Fever Hospital.
Delays in administering Tamiflu in the latest case, involving
the woman from Cairo, are also disturbing. She got sick April
2. According to the MOHP, beginning April 4, she sought help
at least four different clinics and hospitals, including two
government hospitals, over the course of several days. She
eventually went to Abbasya Chest Hospital where, on April 9,
she received Tamiflu. According to the MOHP, the woman and
her family denied she had any contact with poultry until she
arrived at Abbasya. Her family members then admitted that she
bought two chickens from the poultry shop in their building,
attended the slaughtering there, then de-feathered and
cleaned the birds at home.

--------------------------------------------- -
Six confirmed cases; three dead so far in 2008
--------------------------------------------- -

4. (SBU) The MOHP confirmed four human AI cases (one from
Minya, two from Fayoum, and one from Menoufiya) in late
February and early March. According the MOHP, the
epidemiological investigations into those cases confirmed
contact with sick or dead poultry in all but one: case number
45, a 25-year-old woman from the Sennoris District in Fayoum,
who eventually died. Contact with sick poultry could not be
ruled out, but the samples taken from poultry in the Sennoris
District did not confirm the presence of the H5N1 virus. The
investigations into the two recent cases confirmed contact
with sick poultry.

-------------
The good news
-------------

5. (SBU/NF) The MOHP and the Ministry of Agriculture and Land
Reclamation (MALR) have been deploying Rapid Response Teams,
including, in at least one case, a joint team, to the sites
of all human infections this year. By all accounts, these
teams are getting to the sites quickly, taking samples, doing
solid epidemiological work, and bringing the samples safely
back to the MALR,s Animal Health Research Laboratory for
testing. In the Menoufiya case, the MOHP asked NAMRU-3 to
send a team to the site. NAMRU-3,s team was on the road to
Menoufiya a little over an hour after the request was made.

CAIRO 00000784 002 OF 002


MALR,s Lab and the MOHP,s Central Lab are employing sound
methods and getting reliable results. While Egypt trails only
Indonesia in the number of human AI cases this year, the
number is down 62.5% compared to April last year.

--------------------------------------------- ---------------
But the real question: not why so many cases, but why so few
--------------------------------------------- ---------------

6. (SBU/NF) Women and children, those who work and play
closest to the birds, continue to bear the brunt of the
disease in Egypt. The virus has killed 22 Egyptians, 20 of
them women or young girls. During a recent trip to Kafr
Al-Dawar, we saw hundreds of women and young girls, entangled
with thousands of ducks and chickens, along the canal road
between Damanhoeur and Abu Hommus near Kafr Al-Dawar, the
home of one of the recent victims. The vaccination program
hasn't worked. The latest case from Cairo is evidence that
the disease is not limited to the rural areas of the country:
the woman bought the sick birds from a shop located on the
ground floor of her building. Additionally, we understand
MALR recently conducted tests on birds from ten poultry shops
and nine open markets in Alexandria. Over 40% of the shops
and markets tested had infected birds. One physician, who has
been working closely on the AI issue in Egypt, told us he
often hears people asking why Egypt has had so many human AI
cases, trailing only Indonesia and Vietnam. He said the
better question is why it has had so few. In his opinion, the
answer is simple: the virus circulating here does not now
move easily from poultry to people.

-----------------------------------
Uncontrolled movement of sick birds
-----------------------------------

7. (SBU/NF) As reported in ref A, MOHP officials remain very
concerned about uncontrolled poultry movement around the
country. On April 15, Egyptian media reported a gun battle
took place at a checkpoint in Shabramant, Giza between
police, who stopped a convoy of trucks, and a gang smuggling
820 uninspected live chickens infected with the disease.

8. (SBU/NF) COMMENT: The GOE has a long history of hiding
environmental and health problems from the public, a fact
confirmed recently by a leading Egyptian scientist who has
dealt with these issues at the highest levels for over twenty
years. The scientist told us that State Security has blocked
disclosure of information about environmental and health
issues. The MOHP has, however, made great strides toward
transparency when it comes to bird flu matters. The
disclosure that the last victim sought but did not receive
treatment at several hospitals may be a good example of this
new transparency. We do not understand how two government
hospitals failed to administer Tamiflu in the most recent
case. The reports that the victim denied any contact with
birds, even if true, are no excuse for non-treatment.
Egyptian bird flu victims usually deny contact with sick
poultry if for no other reason than to avoid the culling that
inevitably follows the discovery of a human case. Moreover,
the latest victim apparently did not keep live birds in her
home and, as a result, she had no compelling motive to lie
about exposure. USAID will be meeting with the MOHP this week
to discuss the latest case and the issues it raises. The case
from Cairo and the recent test results from Alexandria
confirm that the H5N1 virus is present in force in Egypt's
urban areas and that it will continue to claim victims. END
COMMENT.
RICCIARDONE

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