Egyptian health officials confirmed another case of avian influenza in a human. (©AP/WWP).

Human Toll Rises with Avian Flu Deaths in Egypt, Cambodia NAMRU-3 Bird Flu (a State Dept./IIP webpage)

04 May 2006

(United States naval research facility key link in global disease surveillance)

Washington – Egyptian health officials report another laboratory-confirmed case of avian influenza in a human, the nation’s 13th case of the disease that originated in birds.

The World Health Organization (WHO) confirms the case in a May 4 statement, saying the patient is hospitalized and in stable condition after being treated for pneumonia brought on by the highly pathogenic H5N1 avian influenza virus that has caused 113 deaths worldwide.

Egypt’s first human case occurred in March after the first appearance of the disease in poultry in February.  (See related article.)

As the disease has spread through about two-thirds of the country’s governorates, the U.S. Naval Medical Research Unit Number 3 (NAMRU-3) has worked with Egyptian health officials to confirm and validate the identification of the flu virus that could become the trigger for an global influenza pandemic with the potential to take millions of lives.

CONFIRMING DIAGNOSIS

As a collaborating center with WHO in the Eastern Mediterranean region, NAMRU has verified all the work of Egyptian laboratories since the arrival of bird flu.

“The laboratory wanted to be extra sure,” of its finding of H5N1, said Major Samuel L. Yingst, a veterinarian and the deputy head of the virology and zoonotic disease program at the NAMRU labs in Cairo, Egypt.

NAMRU also has been the confirming laboratory in animal cases that have occurred in Iraq, Afghanistan, Kazakhstan, Jordan and Ukraine.

Virtually all cases of this animal disease that have occurred in humans have been a result of direct contact with birds. Opportunities for that to happen are greatest in cultures where animals and people live in close proximity, and chickens and ducks share the yard with their human owners.

Egypt is one of those cultures. So when animal cases were confirmed, it seemed apparent that human cases soon would follow.

”The Ministry of Health anticipated that there could be a problem [the disease] in humans,” said Dr. Kenneth Earhart, a commander in the Medical Corps of the U.S. Navy and the executive officer at NAMRU.

“When clinical cases presented, they were prepared to begin evaluating and making that diagnosis,” he said in a recent telephone interview with the Washington File from his Cairo office.

In each case, NAMRU labs affirmed the initial findings of the Egyptian medical professionals, and the cases then were counted in the official situation reports maintained by WHO.

IMPROVING DIAGNOSTICS; DISEASE SURVEILLANCE

The United States is working with the international community to prevent the emergence of a global influenza pandemic by helping improve health care infrastructure in vulnerable countries.

To achieve that end, U.S. policy is supporting other nations in developing diagnostics and laboratory capacity and supporting the work of international health organizations in their programs to detect and contain the disease.

NAMRU-3, a key entity in pursuit of those goals, was established in Cairo 60 years ago with a mission to conduct infectious disease research and disease surveillance to enhance the health of U.S. Defense Department personnel who could be deployed in the region.

“We’ll partner with the ministry of a respective country,” said Earhart. “Together we’ll study [a targeted disease or diseases] in that country, and we’ll help them to [develop] the capacity to diagnose the diseases themselves.”

Intestinal and viral diseases are frequent targets for study, but recently greater attention has been focused on respiratory diseases, specifically influenza.

The goal is to develop local capability to diagnose and identify viruses, Earhart said, so countries in the Eastern Mediterranean region will contribute to the global influenza surveillance network, which strives to identify the prevalent flu strains each year to direct development of effective vaccines.

Achieving that goal requires training, and Earhart said NAMRU-3 specialists are traveling to national labs in the region to provide coaching in laboratory techniques, and other governments are sending their specialists to the Cairo facility.

“There’s been really no week free without trainees here for the last six months,” Earhart said.

NAMRU-3 is also conducting research and surveillance to monitor and understand better viral diseases such as HIV, meningitis, encephalitis and hepatitis.

The U.S.-backed lab in Cairo also contributes to increasing public health awareness in the region, with development and distribution of publications and programs, notably an HIV/AIDS program in Afghanistan, and bird flu awareness in Egypt.

Information about NAMRU-3 is available at the Defense Department Web site.

For ongoing coverage of avian influenza and international efforts to combat it, see Bird Flu.