Fatal H5N1 in Cairo Suburb
Recombinomics Commentary 17:55
April 11, 2008
Wala Ahmed Abdel Galil, 30, from the northeast Cairo suburb of Mataria
the victim reported on the first signs of infection on April 2 and was transported Wednesday in a Cairo hospital, where she died.
The above comments describe another H5N1 fatality in Egypt, which further highlights differences between infections this spring and those recorded a year ago. Last season the early cases (late 2006 / early 2007) were fatal. These cases were primarily in the north. In the spring the cases were further south (primarily in Menia, Qena, and Aswan) and almost all were mild. Only one of seventeen was fatal and most cases did not develop pneumonia. These milder cases raised concerns of undetected cases in the area.
This season the cases in late 2007 / early 2008 were also fatal (4 of 5 died), but the most recent cases have also been severe. Although only half have died, the three that survived had pneumonia and were in critical condition.
These clinical differences may be related to H5n1 genetics. Last season 5 of the 7 fatal cases had M230I. No reported case with M230I survived. The milder cases in the spring were genetically distinct. Many had an HA cleavage site from Mongolia, and many had multiple polymorphisms that trace back to northeastern China.
This season none of the human H5N1 sequences have been released, but poultry isolates from the north, released by NAMRU-3, had M230I, as well as V223I and an HA cleavage site that matches the original RERRRKKR found in initial cases in Asia (first reported in 1996 in Guangdong province).
In addition, sequences from vaccinated flocks, released bu the National Veterinary Labs, had a large number of non synonymous changes, including M230V.
Thus, the poultry sequences from late 2007 / early 2008 raised concerns of a more virulent H5N1 in Egypt, which has been supported by the clinical course of cases this season.
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