Commentary
H5N1
Cairo Cases Cause Concern
Recombinomics Commentary
08:45
April 18, 2009
The woman, from El-Marg on Cairo's outskirts, was in a critical condition on a ventilator after falling ill with a fever on April 11.
The above comments describe the latest confirmed H5N1 case in Egypt. Earlier cases had been predominantly (10/11) toddlers (age 1 ½ to 2 ½) with mild H5N1 (only one of the 10 had been characterized as “critical”) and all have recovered, as did the first adult (38F).
Recently however, the cases have been critical (6M, 33F, 25F) and these cases have had a larger gap between disease onset day and the start of oseltamivir treatment. The delay in the first such case (6F) was due in part to a denial if contact with dead or dying poultry. In Egypt, patients with bird flu symptoms and stated contact with dead or dying poultry leads to the immediate start of osletamivir treatment, which is generally prior to test result.
The above comments that the patient had contact with infected birds suggest that the birds have been H5N1 confirmed, but there has been no confirmed birds reported in the area of the most recent case (see updated map). The closest H5N1 confirmation was the 6M case, raising concerns of a more efficiently transmitted H5N1.
There is concern that the mild toddler cases is linked to a 3 BP deletion that was in the H5N1 in a Qena cluster in 2007, when there was another series of mild cases (16/17 survived, and 16/17 were children between ages of 3-10). However, some of the older cases infected with H5N1 with the deletion died or survived after being in critical condition.
Therefore, the release of sequences from the 2009 sequences would be useful. The first two sequences were included in a WHO phylogenetic tree, which suggested that those two mild toddler cases had the deletion.
Identification of the “infected birds” in northeastern Cairo would also be useful.
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