Egypt - No human H5N1 cases publicly reported for May 2015

[sharon sanders]

Since September 2014 FluTrackers has compiled a list of Ministry of Health and WHO confirmed human H5N1 cases here and here. The total number of cases is 177 including 46 deaths. This is a case fatality rate of approximately 26%. While these lists are the best data the team at FluTrackers can collect from confirmed sources, this data is only an approximation of the actual situation. It is the minimum number of cases and deaths. The last officially reported onset date was April 6 for a human H5N1 case. No new cases have been publicly reported since then.

From September 22, 2014 through April 6, 2015 approximately 1 person per day was being confirmed as a human H5N1 case. In 2015 the rate has been also 1 per day. The reported cases seemed to have reached a peak in January and February. Reported cases declined to only 38 in March. April followed at 4 cases. In May there have been zero publicly reported cases. March to April to May is an incredible drop off.

If truly there were no reported human H5N1 cases in May, this would be perceived as "good" news. Why has this not been reported then?

No reports on the WHO Disease Outbreak News website. link

Latest WHO report on H5N1 in Egypt dated May 15 included reported data through April 30, 2015 link

Latest WHO report: Influenza at the Human-Animal Interface, monthly risk assessment summary dated May 1 included some April data. link

Latest public FAO Empress/GLEWS report dated February 26, 2015 link

Latest Eastern Mediterranean Regional Organization (WHO) report dated April 9 which included data through March 2015. link

Latest media report about human H5N1 suspected or confirmed cases picked up by FluTrackers was April 15: Egypt: Child Tested Positive H5N1 Bird Flu in Damietta


Apparently there is a total news and media block on this subject. So why - if the human H5N1 cases have declined to zero?

[sharon sanders]

Lisa Schnirring forwarded this me today. EMRO did make a report on April 30, but it contains the same information as the April 8 report - which is: The last onset date for any H5N1 case in Egypt is April 6, 2015:

Avian influenza update, 31 May 2015






This infographic provides an overview of the H5N1 situation in Egypt as of 31 May2015. Click here to view


A total of 342 human cases of avian influenza A(H5N1) were reported in Egypt between March 2006 and 30 April 2015. Of these cases, 115 were fatal (case?fatality rate: 33.6%). The country has experienced a surge of human cases since November 2014. A total of 163 cases including 47 deaths (case?fatality rate: 28.8%) were reported between 01 November 2014 to 30 April 2015. Cases have been reported from 21 out of 29 governorates in the country. The date of symptoms onset of last reported case of avian influenza A (H5N1) infection in the country was 6th of April 2015. After the laboratory confirmation of this last reported case on 14 April, no further case was reported in the country.
Amongst the cases reported during the recent surge (n=163), majority of cases were females (60%), compared to males who comprised of the remaining 40% cases. Comparatively a higher death rate (30%) was observed amongst the female cases compared to the males. Children in the under five years age group (29%) and those in the age group of 30 to 45 years (30%) were most at risk of acquiring the infection. However, children in the under 5 years age group had the lowest case?fatality rate (6%).
There is significant variation in the death rate between those who received antiviral treatment within 48 hours of onset of symptoms compared to those who received antiviral treatment after 48 hours (11% versus 32%).
Infographic

Avian influenza A(H5N1) update, 31 May 2015

http://www.emro.who.int/surveillance...-may-2015.html

[sharon sanders]

So - are the authorities in Egypt confirming to the global health authorities that the H5N1 bird flu infections abruptly stopped on April 6 after running at a rate of >1 a day for 4 months?

[Laidback Al]

The table below compares the distribution of human H5N1 cases in Egypt by month for 341 cases confirmed by WHO.^a The table contrasts the month of infection for the first 175 cases with 166 cases that have occurred in Egypt since June 1, 2014. The monthly distribution of infections during the last 12 months generally coincides with the monthly distribution of infections for the 8 years between 2006 and 2014 in Egypt.



Unless the Egyptian government is covering up H5N1cases, the distribution of human H5N1 cases appears to be following the annual cyclical pattern of human infection. Also the distribution suggests that these are sporadic human infections where the virus has jumped from animal to human. Again, unless the Egyptian government is covering up human cases, there is no evidence of sustained human to human transmission of H5N1 in Egypt.

^a WHO has reported a total of 342 H5N1 cases from Egypt.

[sharon sanders]

From the above chart I see:

The 2014-2015 outbreak has almost doubled the multi-year cumulative number of cases - which is a significant statistical deviation.

The monthly distribution of cases in the 2014-2015 year is similar to the cumulative monthly distribution.

The decline of case numbers in the 2014-2015 year is a significant variation from the decline in the cumulative comparison of 2006-2014. The rate of new cases was 1 per day this year - even through April 6. Then...nothing...

I think the numbers speak to the truth of the situation. Based on the numbers above, a forecast case count based on historical monthly trend is: April = 11, May = 4. Therefore, 15 cases are missing from the reported numbers.