Between November 2014 and 30 April 2015, the period analysed by the international mission of six organisations, a total of 165 cases including 48 deaths were reported.

This is by far the highest number of human cases ever reported by a country over a similar period. There are indications that H5N1 is circulating in all sectors of poultry production and in all parts of Egypt.

The mission stressed that the way the influenza H5N1 virus is transmitted in Egypt appears to have remained stable despite the recent upsurge in numbers of human and poultry infections.

While the risk for the current situation to escalate into an H5N1 pandemic does not appear to have been changed appreciably, the situation remains a cause for considerable concern.

“Based on all the evidence we have, we believe the upsurge is not explained by changes in the virus itself,” said Dr Keiji Fukuda, WHO Assistant Director-General for Health Security and head of the H5N1 investigation team in Egypt.

“The most likely reason for the increase in cases is that more poultry in Egypt are infected by H5N1 and so more people are exposed to this virus. Coupled with insufficient awareness, behavioural patterns and inadequate precautions taken by humans when interacting with poultry this explains what we are seeing.”

Many small farmers have turned to raising poultry for food and income in an unmonitored and uncontrolled farming sector.

For successful reduction of the negative impact on human health and associated economic and food security consequences, it will be essential to strengthen animal and human disease surveillance, biosecurity and disease control programmes.

This will involve strengthened and close collaboration between Human Health and Animal Health Departments. This includes appropriate animal vaccination programmes through joint efforts by the public and private sector in charge of animal health.

Ensuring compliance with intergovernmental standards on animal health and regulatory statutes at national level, both in poultry production enterprises or households will be critical for limiting spread of the H5N1 virus.

In addition, the report found that there was no evidence for transmission from patients to health care workers during the upsurge. The vast majority of recent human cases, approximately 70 per cent, had known exposure to infected backyard poultry.

Although some of the apparent upsurge in cases might be a result of increased testing for H5N1 in humans, this cannot explain the whole picture. The upsurge of infections in poultry and the cases in people is likely been caused by changes in the economy and the poultry industry.

The report also notes that Egypt has already recognised the key features leading to the increase in disease, and has recently proposed important structures, sound policies and strategies.