An Egyptian woman and child have died of H5N1 bird flu, the health ministry reported on Monday. This marks the fourth and fifth death from the illness in the country since the beginning of 2015.

The 47-year-old woman died early Monday in the Assiut province while the 6-year-old child succumbed to the disease Monday evening in the Minya province, said ministry of health spokesman Hossam Abdel Ghaffar, according to Reuters.

Both Assiut and Minya provinces are rural areas that have seen a number of cases of H5N1 throughout the past year. The majority of cases have occurred in rural, southern regions where villagers raise and slaughter poultry themselves.

The ministry announced one other case currently in treatment. This brings the number of confirmed instances of H5N1 in Egypt to 20 so far this year. Six of the cases resulted in recovery while nine are still in treatment.

The World Health Organization (WHO)  notes that there has been a jump in the number of confirmed cases in Egypt, but that the genetic structure of the virus has not undergone any significant changes, according to the Center for Infectious Disease Research and Policy. The only explanation the organization offered was that whenever bird flu viruses are being circulated in poultry, there is an increased risk of human infections.

The WHO released a recent update to their Influenza at the Human-Animal Interface page that shows between the period of Dec. 6, 2014 and Jan. 4, 2015, there were 18 laboratory confirmed cases of H5N1 in Egypt that resulted in 4 deaths. This is the highest number of human cases ever recorded in a single month.