Viral time-bomb

Scientists fear the increasing number of bird flu cases among children may allow for the mutation of the pathogenic virus, reports Reem Leila

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As the number of reported bird flu cases in children continues to rise attention is increasingly being focussed on government efforts to control the disease. Although the virus is now causing fewer fatalities among those who contract it, scientists are worried about the changing profile of those who do develop symptoms. The World Health Organisation (WHO) fears the rise in infections among small children, without a similar increase in older people, could suggest adults are being infected but not falling ill, acting as symptom-free carriers of the disease.

A preparatory mission consisting of WHO, UNICEF, FAO and other UN agencies, will arrive in Egypt on 21 April.

"The mission will test blood and take swabs from people who contracted the virus and their families as well as those who are in direct or indirect contact with birds," says Ahmed Abdel-Latif, WHO representative in Egypt.

With three more cases reported last week, the WHO is concerned that the disease is now almost exclusively striking infants. There is also speculation that though symptoms are generally milder than in earlier cases, this could constitute a viral time-bomb. At the same time, Abdel-Latif strictly confirms that the virus has not yet mutated into a human-to-human strain.

Mohamed Sayed, plague and avian flu disease expert at the Research for Agricultural Guidance Centre, says that recent developments make it more likely the virus will spread.

"Ironically, its very virulence has provided an important safeguard. It did not get much chance to infect other people when it killed its victims swiftly, but now it has much more of a chance to mutate and be passed on. If the virus becomes less pathogenic it will become more transmissible."

The deadly strain of H5N1 usually kills half of those affected. Of this year's cases all were cured and discharged from hospital with the exception of the two most recent cases who remain hospitalised but whose condition is stable and who are, according to Abdel-Rahman Shahin, official spokesman to the Ministry of Health, expected to be discharged in the next few days.

Abdel-Latif argues that the higher rate of infection among children is a result of their weaker immunity systems and the fact that they "play with chickens in the streets".

"To control the deadly strain of H5N1 demands a convergence of biomedical, managerial and behavioural techniques," says Abdel-Latif. "So far Egypt is performing well on the biomedical front. Egypt's physicians can diagnose and medicate which is why the fatality rate is on the decrease." But what is needed, he argues, is a more holistic approach.

Combating the virus should be a national priority. Abdel-Latif advocates more awareness campaigns, particularly targeting children in rural areas.

"Existing campaigns are directed at adults. A change in the target audience is needed in order to avoid the spread of the disease."

He also believes the campaign should be directed through mosques and churches as well as the media. "People will respond more swiftly if they are advised by religious figures," he argues, adding that it remains essential for the owners of poultry farms to immediately report the presence of the virus.

Vaccine stocks only cover 30 per cent of the country's 300 million birds in rural farms, says Hamed Samaha, head of the General Authority for Veterinary Services (GAVS).

"The amount of vaccine is barely sufficient to cover the workforce that will distribute them and responsive farmers who are willing to inoculate their birds." Six million doses are needed to cover the entire poultry sector but, says Samaha, the authority can only afford to provide 120 million.

"Out of 13,000 registered veterinarians only 6,500 are available to work on vaccinations and 70 per cent of these are unsuited to field work being more than 50 years old. We end up with only 1,200 veterinarians while at least 34,000 are needed to cover targeted areas."

No new veterinarians have been appointed since 1994 because of a lack of funds. And while, says Samaha, Prime Minister Ahmed Nazif recently agreed on 1,500 new veterinarian appointments, "we are still massively understaffed."

Poultry farmers have also stopped reporting outbreaks for fear they will incur financial losses. The only way around the problem, Samaha argues, is to offer farmers compensation for any losses they might incur when revealing the real status of their farms.

Saber Abdel-Aziz, head of the epidemic and poultry department at GAVS, criticises the lack of human and financial resources without which veterinary services cannot play a more active role in combating the virus.

Currently there are 50 sites in Egypt that have tested positive for the virus. "Only two per cent of poultry farms apply bio-security measures," says Abdel-Aziz. Yet the veterinary authorities lack even vehicles to access many sites. While in 2006, he continues, the first avian flu campaign successfully vaccinated 90 million birds. "At first farmers were concerned so they cooperated with the authorities but now they are more confident and don't respond to our efforts."