Although largely absent from the headlines, the number of human deaths attributable to infection with avian influenza around the world continues to rise.

Egypt has this week reported the death of a 40-year-old woman and, between January 1 this year and May 1, 40 people died worldwide -- almost double the number reported for the whole of 2014, reports the World Health Organization (WHO).

WHO reports that, between 2003 and May 1, 2015, there were 447 deaths and 840 cases of humans infected with the highly pathogenic avian influenza H5N1 virus. It should be remembered that the majority of these infections and deaths have occurred in rural areas of developing countries. It could well be argued that, given a lack a resources for diagnosis and reporting, an accurate figure would be somewhat higher.

That these deaths occurred in developing countries does not take away from the tragedy for the individuals concerned, their families and communities, but perhaps it makes the human impact of bird flu easier for those in the wider world to ignore.

Poor biosecurity and the migratory flight paths of wild birds are usually the two key points in any discussion of how avian influenza spreads and how it should be controlled. But it should also be remembered that poverty and lack of resources - as well as ignorance - can also play their part.

To return to Egypt, whose population has been hardest hit by the disease since the start of the decade, the country has gone through political turmoil and this has had consequences for the local economy. Many rural inhabitants have turned to keeping poultry in an effort to put food on the table. These small-scale backyard farmers can have little notion of what constitutes good biosecurity and its implementation; for them it is a question of making ends meet and having enough to eat.

This has created an ideal situation for the spread of disease, and a highly difficult situation to monitor or control - even where resources are available. If Egypt’s poultry production were restricted to indoor, modern facilities then implementing good biosecurity protocols would be much easier, and the disease less likely to spread.

More human fatalities

When news of human fatalities first started to emerge in Asia in the late 1990s, human deaths made the headlines, but this is no longer the case. Yet WHO warns that whenever avian influenza viruses are circulating in poultry, sporadic infections and small clusters of human cases are possible in people exposed to infected poultry or contaminated environments. Egypt is testament to this.

More human cases can only be expected, particularly where biosecurity controls are weak and there is a failure to properly respond to risk. Vigilance in the public health sector needs to be stepped up wherever the disease is spreading, as do on-farm controls.

WHO reports that, although an increased number of animal-to-human infections have been reported by Egypt over the past few months, the viruses circulating there do not appear to transmit easily among people. Consequently, the risk of community-level spread of these viruses remains low. However, don’t forget, bird flu viruses frequently mutate and recombine.

The average number of human fatalities from avian influenza each year since the start of the decade has been 25. With 40 deaths from the disease having already been reported so far this year, the disease’s impact on the human population perhaps needs a little more attention.