Apart from hysterical peaks during ‘one-off’ poultry outbreaks in Western Europe [France/Germany in 2006 and UK in 2007] most sustained H5N1 coverage continues to focus on sheer concentration of poultry outbreaks and human cases across East and South East Asia where it all began.

H5N1 hit a number of other countries during east-west travel to Europe and West Africa and none more so than Egypt. Egyptian poultry suffered massive losses in 2006 while human cases and deaths are now increasing more rapidly than anywhere else in the world.  International media pays little attention to the country’s plight. That said Egypt is taking H5N1 in its stride and striking back with some of the most innovative ideas and programmes in the world.

When H5N1 appeared in migratory wild birds outbreaks in Egypt were inevitable. Egypt straddles the Black Sea Flyway that funnels millions of migratory birds from Arctic and Siberian Russia into the heart of Africa and back again. The River Nile Valley with reed beds and marshlands is the only resting place for wild waterfowl and refuge for Egypt’s huge urban and rural population in an otherwise huge and inhospitable arid landscape.

Egypt has a large and important commercial poultry sector plus 140 million backyard birds all supplying at least twenty five per cent of livestock products consumed by the country’s 65 million people. Egypt has experienced two waves of H5N1. First wave from February to May 2006 was stalled by a massive cull at least 30 million commercially reared birds. Infection on commercial farms is largely under control, but the backyard bird population has become a stubborn reservoir of disease which succoured a second wave in October 2006.

Human cases and deaths have accelerated during the second wave. They currently stand at 24 cases (13 fatal), all traced back to infected backyard village birds. At least two of the most recent human cases show Tamiflu resistant strains, first record of insensitivity to this anti-viral drug outside Asia.

According to the Ministry of Agriculture serious abuse has worsened the situation. Unscrupulous farmers purchased infected birds for up to $175 each to infect their flocks and claim compensation, instead of selling in a depressed market.

Persuading backyard poultry owners to report suspicious symptoms and thereby lose staple protein is virtually impossible. “Chicken is breakfast, lunch and dinner in Egypt”, says Dr John Jabbour, a senior epidemiologist with WHO’s office in Cairo. “Forty per cent of the population’s protein comes from poultry.” Poultry rearing in urban areas is banned. A ban in rural areas is impossible and will drive infection underground say government.