Avian Influenza Causes More Human Deaths in Indonesia, Egypt

By Cheryl Pellerin
USINFO Science Writer

This is second in a series of articles on U.S. Naval Medical Research Unit No. 3, Cairo, Egypt

Washington – U.S. Navy scientists and their Egyptian partners working in Cairo are helping confirm new human cases of highly pathogenic avian influenza in North Africa and the Middle East, and are building laboratory capacity in that region and elsewhere to allows scientists and technicians in many countries to quickly identify and diagnose human illness that arises from outbreaks of deadly bird flu in Asia and Egypt.

On January 22, the Indonesian Ministry of Health and the Egyptian Ministry of Health and Population announced new fatal cases of H5N1 avian influenza in those countries, according to the World Health Organization (WHO).

In Indonesia, a 26-year-old woman from West Java Province developed symptoms January 11 and died eight days later. Initial investigations indicate the woman helped slaughter sick chickens before she developed symptoms. Of 80 cases confirmed in Indonesia, 62 have been fatal.

In Egypt, the Central Public Health Laboratory and U.S. Naval Medical Research Unit No. 3 (NAMRU-3) confirmed that a 27-year-old woman from the Beni Sweif governate developed symptoms January 9 and died 10 days later. Initial investigations indicate the presence of sick and dead poultry at her residence before she became ill. Of 19 cases confirmed in Egypt, 11 have been fatal.

The new deaths bring the world total to 269 cases of avian influenza in people, and 163 deaths.


NAMRU-3, established in 1946, is well positioned geographically and logistically to provide outbreak support in the North Africa/Middle East region – what U.S. Navy Lieutenant Commander Marshall Monteville, head of the Viral and Zoonotic Diseases Research Program, calls “forward laboratory capacity.”

This consists of a veterinarian, a laboratory technician and special mobile equipment for something called real-time polymerase chain reaction (PCR), a process that “amplifies” or makes copies of DNA or RNA while the reaction is occurring rather than when it is completed, so scientists can identify the pathogen on the spot.

“If there was an outbreak and we needed to send someone today [to identify the pathogen],” Monteville said during a recent USINFO interview in Cairo, the 50-pound mobile system – called RAPID, for ruggedized advanced pathogen identification device – “turns into a suitcase, slides into a backpack, and you can go.”

NAMRU-3 provided 14 outbreak response missions in 2006, including missions in Afghanistan, Djibouti, Sudan, Egypt, Gaza, the Caucasus, Bulgaria and Romania.


For more than 10 years, NAMRU-3 has been a regional reference laboratory (a regional resource with specific technical capabilities) for the WHO Eastern Mediterranean Regional Office (EMRO), Monteville said, but NAMRU-3’s “involvement with avian influenza has happened within the last year and a half or so.”

NAMRU-3 scientists have trained 95 people from 18 countries over 17 to 18 months in diagnostic and laboratory techniques for seasonal and avian influenza, and other diseases.

“What we can provide that a lot of laboratories can’t provide is BL-3/BL-4 capability,” Monteville said, referring to the four biosafety levels (BLs) that define proper laboratory design, techniques and safety equipment to work with pathogens that range from harmless to lethal.

BL-1 labs, for example, study agents – bacteria or viruses – that do not consistently cause disease in healthy adults. BL-2 labs study moderate-risk agents that pose a danger if accidentally inhaled, swallowed or exposed to the skin. BL-3 labs study agents that can be transmitted through the air, and researchers handle bacteria or viruses under airtight laboratory hoods.

BL-4 labs study agents that pose a high risk of life-threatening disease for which no vaccine or therapy is available. Scientists wear full-body, air-supplied suits, shower when leaving the lab, and work with the agents in a BL-3 sealed lab hood.

“Any time you work with avian influenza,” Monteville said, “or do any kind of culturing [virus growing], you have to do that under BL-3 conditions.”

NAMRU-3 is one of only two BL-4 labs on the African continent.


Funding for NAMRU-3 science comes from a range of sources, including the U.S. Agency for International Development, the Health and Human Services Department’s Centers for Disease Control and Prevention, the Defense Department’s Global Emerging Infections Surveillance and Response System and the Defense Threat Reduction Agency, and even nongovernmental organizations like the Ford Foundation.

One major activity is a collaborative effort with funding partner Heath and Human Services to spend $450,000 building a disease-surveillance system in Baghdad, Iraq, that includes avian flu surveillance, Monteville said. This will mean “the ministries of Health and Agriculture there will have a more robust diagnostic and surveillance capacity,” he said.

To fulfill the increase in capacity, Monteville said, “we will be supporting laboratories on the ag[riculture] side and on the health side, and we will be working with epidemiologists.”

Iraq is not officially part of NAMRU-3’s operations area, but the Navy lab supports the region in its role as an EMRO reference laboratory for WHO, a valued partner of NAMRU-3 in the region.

The Department of State helped coordinate the effort, Monteville added, through an interagency agreement for international early warning surveillance for pandemic influenza, “to get us the appropriate permissions to engage the Iraqis and facilitate the trilateral involvement among NAMRU-3, [the ministries of] Health and Ag[riculture] in Iraq, and the Department of State. It’s sort of a team approach to doing this type of work.”

See also “U.S. Navy, Egyptian Scientists Fight Global Illness, Infection.”

More information about NAMRU-3 is available at the Naval Medical Research Center Web site.