Egypt reported five H5N1 avian influenza outbreaks in October, and the latest disease surveillance from Indonesia suggests that the highest incidence is in Bali, where three human fatal infections were recently reported, according to an overview from the United Nations Food and Agriculture Organization (FAO).

The Egyptian H5N1 outbreaks struck four governorates: Beheira, Fayoum, Gharbia, and Giza. The event in Beheira occurred at a farm where poultry was vaccinated against H5N1. The other four outbreaks affected unvaccinated backyard or rooftop poultry, according to the FAO.

In Indonesia, disease surveillance authorities said Bali had the highest incidence of villages affected by highly pathogenic avian flu in September, at 5.6 per 1,000, followed by Central Sulawesi (4.3 per 1,000), West Sulawesi (3.1), West Kalimantan (3.1), and South Sulawesi (2.8) provinces. The figures are from the Participatory Disease Surveillance and Response program, which covers 29 of the country´s 33 provinces.

In October, the H5N1 virus killed three Bali residents, a 29-year-old woman and two of her children, a 5-year-old girl and a 10-year-old boy. Poultry in the family´s household had died before the woman and her children got sick.

Outbreaks were also reported in two villages in East Nusa Tenggara province, the FAO reported.

More recently, the virus struck poultry in three subdistricts in South Sulawesi province, killing about 14,000 birds, according to a local media report cited on Nov 19 by Bird Flu Information Corner, a Web message board operated by Kobe University in Japan and Airlangga University in Indonesia.

The FAO overview of the latest H5N1 outbreaks also includes detections in Vietnam and Iran, which had been previously reported to the World Organization for Animal Health.

So far this year, 14 countries have reported H5N1 outbreaks, according to a chart in the FAO report.

H5N1 is endemic in a handful of countries, including China, Vietnam, Indonesia, Bangladesh, India, and Egypt.