Third H5N1 Infected Child in Aswan Egypt
Recombinomics Commentary
March 25, 2007
Health ministry spokesman Abdel Rahman Shahine said the girl — identified as Hajer Mohammed Awadallah from the southern city of Aswan — was admitted to a local hospital with a fever and cold symptoms.
She tested positive for the H5N1 bird flu strain on Sunday, he added.
The above comments are remarkably similar to the two other recent confirmed H5N1 infections in children (10F and 2M) in Aswan. The sequence of the H5N1 from today's confirmed case (3F) has not been generated, but the HA and NA sequences from the two prior Aswan cases were virtually identical.
They NA sequences from the two early cases were identical to each other, and very similar to the NA sequences from two fatal cases in central Egypt (Beni Suef and Fayyoum). The HA sequences from central Egypt had a three nucleotide deletion and were similar to each other.
In contrast, the two Aswan cases had a novel HA cleavage site that matched earlier Qinghai whooper swan isolates from Mongolia. However, the Aswan isolates were recombinants, with the Mongolian cleavage site appended onto an Egyptian H5N1 Clade 2.2 genetic background.
This altered HA cleavage site is similar to changes in early 2005 in northern Vietnam. New cases in 2005 had a novel HA cleavage site (missing an arginie) from Japan/China appended onto an H5N1 Vietnamese (Clade 1) genetic background. This new H5N1 was more easily transmitted, but had a markedly lower case fatality rate.
In Egypt, five of the fatal H5N1 had an HA sequence with M230I. However, the recent infections in children in northern (5F, 4F, 4M) and southern (10F, 2M, 3F) have had milder cases and the five case prior to the current case were all lacking M230I.
The description and location of the latest case in Aswan suggests the H5N1 is more easily transmitted and will also have the novel cleavage site in an H5N1 genetically similar to the two earlier cases from Aswan, infected by a common source.
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