Hear ye, hear ye

This morning I received word that the Egyptian government had issued a decree (thus the "Hear ye, hear ye" title) related to the control of H5N1, also known as highly-pathogenic avian influenza (HPAI). For just the very briefest of moments – and I do mean the very briefest; the thought couldn’t have lasted more than perhaps half a second – I was excited.

You see, Egypt has been hit by the H5N1 influenza strain harder than any other country in the world outside Asia. When the total number of cases is considered, and even when Asia is included, Egypt still falls third on the list, after Indonesia and Vietnam. However, unlike Indonesia and Vietnam and most other countries where H5N1 has been reported, the number of cases in Egypt is not decreasing. Already this year there have been 30 cases. Compare that with 18 cases in 2006, 25 in 2007 and 8 in 2008, and it’s not hard to see that over a third of all cases of H5N1 in Egypt have occurred this year – and it’s only the beginning of August! Not only that, but there hasn’t been much H5N1 reported elsewhere in the world in 2009; over 80% of all cases of H5N1 reported this year are in Egypt.

Another interesting fact about the cases in Egypt thus far this year is that only 4 patients (13%) have died from the virus. Although this may still seem like a high mortality ratio for an influenza virus, it’s very low relative to the average for H5N1, which is around 60% (or 64% if this year’s cases in Egypt are excluded).

Still, perhaps the most interesting aspect of this year’s cases of H5N1 in Egypt is the demographic affected by the disease. The vast majority of cases have occurred not among young men working on poultry farms or young women slaughtering chickens at home. Most cases have been among children and toddlers as young as eighteen months. Although there are a number of theories circulating about this shift in the age distribution of cases, the most believable (in my opinion) is rather simple. In rural areas of Egypt, where many families raise chickens and other poultry in their households for food and sustenance, it is common when it gets cold to bring the poultry inside the house for protection against the cold. Once inside the house, the children, who often already consider the chickens their pets, play with the poultry in very close quarters. Thus they are exposed to H5N1 and contract the virus. Voilà.

So, in summary, there’s a deadly disease circulating in Egypt that’s killed a high percentage of the people it’s infected and now it’s infecting a lot of very young children. And the government issued a decree today that it’s going to do something about it. As I already said, I was excited.

But then I realized that this decree was coming from the same government that ordered the culling of all the swine in the country when H1N1 – a strain of influenza that has never been transmitted from a pig to a human, that has never even been isolated in swine – broke out in the United States. I immediately knew the decree was going to be disappointing, and I was right.

The government of Egypt has now decreed that all official poultry farms will be moved out into the desert (a.k.a. the middle of nowhere) so as to eliminate any proximity to humans and strict biosafety measures will be implemented. At the same time, all unofficial poultry farms will be closed.

Now, if poultry farmers were the ones being affected by H5N1, this might seem like a logical and effective plan. Unfortunately, however, it seems to be just another attempt by the Egyptian government to show that they’re doing something, whether or not that something is appropriate.