First H5N1 Confirmed Case in Cairo Egypt
Recombinomics Commentary
April 9, 2007
A Cairo teenager has contracted the potentially deadly bird flu strain, bringing to 34 the number of people to be diagnosed with the disease since it appeared in this country last year, Egypt's state-run news agency said Sunday.
Maryana Kameel Michael, 15, was admitted to a Cairo hospital on Thursday because she had a fever, Health Ministry spokesman Abdel Rahman Shahin told the state news agency, MENA.
MENA said Michael is in stable conditions after being treated with Tamiflu, a drug that is commonly used to treat the disease. She contracted the virus from domestic birds her family raises at home, MENA quoted Shahin as saying.
The above comments describe the first confirmed H5N1 case in Cairo. This case may represent a return to the early demographic of cases this season in Gharbiya. Each of the sequences from Gharbiya patients had M230I and these cases were fatal. The H5N1 from the Gharbiya cluster of three family members hand M230I as well as the receptor binding domain change V223I. The Gharbiya cluster patients also had NA N294S, which confers resistance to oseltamivir (Tamiflu). These changes were in isolates collected prior to Tamiflu treatment.
The Gharbiya cases were diagnosed at the beginning of the current season in September and December of 2006. However, a chicken H5N1 isolate from February, 2007 had the M230I and V223I changes found in the Gharbiya cluster. Although NA N294S was not detected in the initial isolate, the sequence had a number of mixed signals, including the position that encodes M230I, indicating the chicken was infected with two or more Qinghai strains of H5N1. That isolate is currently being plaque purified to determine the genetic diversity in the infected chicken from Gharbiya.
The cases in Gharbiya were fatal and in teenagers and young adults, in contrast to the recent younger cases in central and southern Egypt. These cases fell into two readily distinguishable groups. The patients in Aswan and Mena were infected with H5N1 with a novel HA cleavage site, while the patient in Qena had a 3 BP HA deletion, which was in earlier adult cases in Beni Suef and Fayyoum.
These changes had not been previously reported in human cases infected with the Qinghai strain of H5N1. The 3 BP deletion was in chickens in Hunan isolated in 2006. The other changes had been previously detected in wild birds infected with the Qinghai strain. HA V223I was in a bar headed goose from Mongolia. The novel HA cleavage site was previously reported in whooper swans in Mongolia. M230I was found in a eagle owl in northern Germany. These earlier isolates to the north of Egypt signaled the arrival of these changes in Egyptian patients this season, on an Egyptian Qinghai genetic background.
The sequence of the H5N1 in the latest confirmed Cairo case will be of interest.
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