TAWFIQIYA, Egypt – Chickens used to roam every dusty street in every village across Egypt, and many of its city alleys too.
But bird flu is changing that. Chickens have nearly all vanished from sight, slaughtered, abandoned or locked away by a population increasingly aware of, and frightened by, the disease's stubborn grip.
Even as bird flu has dropped out of global headlines, experts are worried about its persistence around the world. With 47 human cases and 20 deaths, Egypt is the third most affected country after Indonesia and Vietnam.
For the past two years the government has been trying to change the deep-rooted poultry-rearing behaviors that have turned the country of 76 million people into a bird flu hot spot.
But only with the rising death toll — mostly rural women who traditionally tend chickens — have Egypt's poor finally grasped the need to alter their ways.
"In the beginning, the people were just afraid for their chickens. Now they are afraid for themselves," said Abeer Hussein Moussa, describing the gradual change in attitudes in her village of Tawfiqiya, south of Cairo in the sprawling Fayyoum oasis.
Like Indonesia and Vietnam, Egyptian authorities have found it hard to keep people from growing chickens in their backyards, intertwining human and avian life in ways that could allow the deadly H5N1 influenza virus to someday mutate into a form contagious to humans.
"There are several hot spots around the world where we don't seem to be able to get ahead of the disease, and Egypt is certainly one of them," Juan Lebroth, head of infectious diseases for the Animal Health Service of the U.N.'s Food and Agriculture Organization, told The Associated Press by phone from Rome.
"Although we have avian flu in other countries, there is so much of it in Egypt that the risks are greater than elsewhere," he added.
Bird flu started sweeping through poultry populations across Asia in 2003 and has since jumped to humans, killing at least 236 people, nearly half of them in Indonesia.
It's still hard for people to catch it, and so far, most human cases have been linked to contact with infected birds, dead or alive.
A human catches the disease by inhaling the blood, feathers or powdered feces of the poultry. Thus, those tending the birds, in Egypt usually women and children, are most vulnerable. More than 90 percent of those infected have been either adult females or children and three-quarters of the fatalities have been women.
When the disease first appeared in Egypt in February 2006, 25 million birds were killed within weeks, devastating the poultry sector and particularly the family farmers.
"People lost a lot when the disease first appeared in Fayyoum," recalled Sahar Rabie, who educates people about bird flu in Tawfiqiya. "They would cull all the chickens in one square kilometer around a case, so people started to hide their chickens to protect them — some slaughtered them, others hid them under the bed."
The first human cases appeared a month later, with 14 people falling ill between March and May. Six died.
In Fayyoum villages, once famous for their chickens, five human cases have been recorded and three people have died, most recently a woman on March 4.
The U.S. Agency for International Development has funded grass-roots education through TV and house visits by local residents such as Rabie to explain the disease to villagers — especially women.
People are taught to keep their chickens in coops, rather than let them wander freely, especially into human living space. Villagers are also told to wear masks and gloves in the coops and wash carefully after cooking poultry.
But more than anything, the deaths have taught people to change their ways.
"There is total awareness now. People know to vaccinate their chickens," said villager Ragab Ahmed, who was quick to say his own chickens were healthy and had been inoculated with government-provided vaccine.
"Everyone is worried after Tirsa," he said, referring to the nearby village where the woman died two weeks earlier.
With most Egyptians getting out of the business of chicken raising, it is now largely restricted to big commercial farms — though many outside experts worry about how rigorous they are with vaccinations and say they could become reservoirs for the disease.
The government is starting to take notice and this year has closed 18 farms after discovering infected birds.
But while Egyptians may be safer from bird flu, they have lost a key source of protein.
Chicken once provided 43 percent of Egyptians' protein needs, but egg and chicken prices are doubling.
"It was very cheap before this outbreak, the cheapest meat you can get here in Egypt," said John Jabbour of the Eastern Mediterranean office of the World Health Organization. "Poultry in the backyard was a matter of breakfast, lunch and dinner."