New research indicates that the avian flu strain H5N1 has mutated and may be stalking Egypt. H5N1 is one of the most aggressive strains of influenza, and has kept the medical community concerned since it first made its debut in Asia.
Following the bird migration routes, the flu strain has made its home in a number of countries and is spreading in Africa and in Europe. The strain is particularly deadly to birds, which have died by the millions. But the strain has learned to infects mammals, and has a very high rate of mortality.
Egypt has come under the attention of researchers because it is a stopover for the migration routes of birds, and therefore one of the epicenters for the spread of the disease. And the type of H5N1 that is in Egypt has mutated and become a variant strain that further preoccupies scientists that follow its spread.
Through the study of Phylogeography, or how a country can become a nuclear focus for the development of a new strain and the reservoir for the avian flu, scientists hope to contain what could be a future epidemic, and better track its spread. Phylogeography tracks both the movement and the type of strain, including its variants and mutations.
Since H5N1 has been identified in Egypt a number of variant strains have emerged. Phylogeography then, could be the tool to stop an epidemic before it explodes through the Mediterranean basin and Europe. This novel science has already been tested for diseases such as Dengue Fever and Rabies. Its employment for tracking influenza could give the medical community clues as to the micromovements, and the pockets of cases that precede the advance of the infection.
Avian flu is now considered a foremost global threat, and H5N1 one of its most worrisome specimens. Its mortality rate so far has been pegged at a staggering 60%. That is much higher than the mortality rate of the Spanish flu, which is estimated to have killed between 50 and 100 million people in 1917-1918.
The only thing that is keeping H5N1 from achieving widespread growth is its limited ability to infect humans directly, but that could change. Although there is no way of telling what antigen shifts occur from year to year, the possibility of a shift that would make it highly viral is a very present danger.
Another concern that occupies researchers is also the the large number of avian strains now circulating around the globe. That means that the possibility of recombinant strains is higher each year. Recombination could afford a weak strain with the ability to become highly viral.
Since H5N1 surfaced in Egypt, 173 human cases have been recorded, of which 63 resulted in death.
Hence the value of Phylogeographical studies. It is a novel and practical tool to also visualize the incidence of zoonotic barrier breaches, when a virus whose reservoir is animal alone, becomes able to infect a human through animal-human contact.
The Phylogeographic study of Egypt's H5N1 outbreak shows that there are four primary areas along which the virus seems to travel: Cairo, Nile Delta, Canal, and Upper Egypt. That means that the area of Ash Sharqiyah in the north was the initial point where the virus surfaced. This also showed that spread occurred in the highly populated area of the Nile Delta.
A new software, very easy to use and which does not require in depth bioinformatic or phylogeography knowledge is avaialble for use to health officials. A vaccination campaign could then be designed according to the findings of the software results.
What the problem in Egypt also entails and its future ramification bring another question that is now under scrutiny by Nato. Is the European defense alliance ready for a major epidemic?
One of the issues with Nato personnel is the fact that they need to be protected from infection so that they can be deployed in the case of a pandemic in Europe and other regions. The issue now is do Nato troops and personnel have adequate training to face a pandemic?
The 2007 Nato Logistics Handbook points out however that individual nations retain responsibility for the medical support to the Nato forces, while the Nato commander also shares the responsibility for the medical support to Nato assigned forces.
Nato Countries
Under the subject "Planning" in the manual, is outlined how medical support plans structures and operating procedures must be understood and agreed upon by all involved. The medical support should ensure a surge capability to deal with peak casualty rates in excess of daily rates.
But does the peak in the phrasing employed in the manual come close to what the numbers of pandemic would be?
The US has engaged Novartis to produce a vaccine within six months from the first indications of a pandemic. That would allow at least 25% of the population to be covered. Another 40% of the population could find relief or a cure through the use of Tamiflu or antivirals. At least 81$ million have been put aside for the vaccination program of the military forces in the US.
The UK too has a plan in place. But what does that mean for the rest of the NATO allieance and beyond?
The other consideration that is not seemingly addressed in the preparation manual is the possibility of unrest or a breakdown of civil authority. Such eventuality would mean that forces from Nato would have to be deployed to intervene, and there is no consensus on how sovereign nations would receive or accept such troops on their soil, to restore order during a pandemic.
That problem is one which Nato must consider, since the Manual clearly speaks of the Nation's foremost sovereignty and responsibiilty to address their medical concern during a pandemic.
This should prompt Nato allies and others countries to set up a plan for the possibility of Nato intervention during an epidemic. But Nato's engagement in Asia means that the problematic of a pandemic is an argument that will have to wait. And that is a grave mistake, because although there is no indication yet of a pandemic, one is all too real and the "when" of its occurrence cannot be predicted in any way. That date could be next month, or the next decade.
Op-Ed
Partial sources: Science Daily/Nato/ 1.10.14
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