Another H5N1 Fatality in Fayyoum
Recombinomics Commentary
February 16, 2007
A 37-year-old Egyptian woman who tested positive for the bird flu virus has died in hospital, bringing the number of deaths from the disease in Egypt to 13, a government health official said on Friday.
"She died yesterday evening," said Amr Qandil, director of communicable diseases at the Egyptian Health Ministry.
The woman, Nadia Abdel Hafez, had been reported in stable and improving condition after being transferred to a Cairo hospital, but her condition later deteriorated, officials said.
The above description of the seventh H5N1 fatality this season raises additional concerns about Tamiflu (oseltamivir) resistance. All H5N1 confirmed cases in Egypt have died this season. The three cases this year have been from a region south of Cairo in Beni Suef or Fayyoum.
Sequence analysis of H5N1 from the cluster of cases in Gharbiya demonstrated NA N294S, which confirmed Tamiflu resistance. The resistance marker was present in samples collected prior to treatment, indicating the resistance was circulating in Egypt.
This marker was not detected in the recent cases, who was treated with Tamiflu, but the possibility of a low level of H5N1 with the marker was not addressed by the collections made prior to treatment. Patients that develop resistances can show improvement, as the treatment limits the spread of wild type virus. However, such limited spread by wild type favors spread by Tamiflu resistant versions of H5N1.
Therefore, collection of samples after Tamiflu treatment has begun, especially in patients that initially respond to treatment, would be useful.
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