The deaths of two women in Egypt from bird flu on Monday has now brought the death toll in the Arab country from the deadly virus to four in less than a week.
All four deaths have involved women and are believed to be the result of exposure to sick or dead backyard birds and have occurred during a warm-weather lull in avian flu cases.
Officials at Egypt's Health Ministry say Firdaus Mohamed Hadad of Menoufia province in the Nile Delta region north of Cairo was taken to hospital on Saturday with a high fever and difficulty breathing and she also had a pulmonary infection; she died early on Monday.
A World Health Organisation (WHO) official based in Egypt says a second woman Hanem Ibrahim from Damietta, also from the Nile Delta, also died of bird flu in northern Egypt.
These four recent deaths from bird flu over the past week in Egypt have broken a 5-month lull in human cases and is the third winter that the virus has struck after lying low during Egypt's hot summers, when it is much less likely to spread from one carrier to another.
The deaths bring the number of Egyptians who have died of the deadly H5N1 bird flu virus since it emerged in Egypt in early 2006 to 19.
The first bird flu case of the winter season was Ola Younis,who died last Wednesday in Beni Suef province south of Cairo; then on Sunday, a 25-year-old Egyptian woman died of bird flu in the Nile Delta city of Mansoura.
Health experts suspect the high fatality rate in the recent cases was possibly because there was a delay in diagnosis after patients and their family members denied exposure to infected birds; they say patients are most likely to survive if they start treatment with Tamiflu early after symptoms occur.
In Egypt as many as 5 million households depend on poultry as a main source of food and income and the government says this makes it unlikely the disease can be eradicated despite a large-scale poultry vaccination programme.
The WHO says the bird flu virus is now endemic in Egypt.
Egypt is located directly under major bird migration routes and the widespread practice of keeping domestic fowl in backyards has been a factor in it being the hardest-hit country outside Asia.
Though the government says it is conducting a vigorous campaign to combat the spread of the virus through vaccinations and raising awareness, some experts suggest not enough has been done and they accuse the authorities of reacting rather than acting.
Health experts and officials are warning the public not to drop their guard especially as winter approaches.
Some health officials have called for a ban on the raising of fowl in towns, the transportation of poultry between provinces without authorisation and controls reinforced on where they are raised and sold.
Since the H5N1 bird flu virus reappeared in 2003 deaths now total more than 210 worldwide.
The virus has appeared in a number of African and Asian countries, as well as in Turkey and Azerbaijan.
Egypt has to date had 43 confirmed human cases and is the single hardest-hit country outside of Asia.
Health experts fear the virus could eventually mutate into a form that spreads easily from one person to another, triggering a pandemic with the potential to kill millions.