H5N1 Fatality in Beni Suef Egypt
Recombinomics Commentary 14:56
December 26, 2007
It is the first human death in Egypt from the virus since June and the 16th since the disease arrived in early 2006.
The ministry named the woman as Ola Younis from Beni Haroun village in Beni Suef province, south of Cairo.
She entered Beni Suef hospital on December 21 with a high temperature and breathing problems, was diagnosed on Tuesday and died the same day, it said in a statement.
Younis had been in contact with birds thought to be infected with bird flu, the ministry said. The state news agency MENA said health officials were checking her relatives to see whether they showed traces of the virus.
The above comments provide additional detail on the first reported H5N1 fatality in Egypt this season. Earlier reports had described H5N1 positive birds in three governorates in the Nile Delta (Giza, Shariq, Gharbiya – see satellite map).
The Beni Suef location extends the presence of H5N1 to the south. At this time last year, Egypt reported its largest cluster to date, which was in Gharbiya. The HA sequence had two receptor binding domain changes, V223I and M230I. These same changes were subsequently found in birds in Gharbiya and Beni Suef. All patients positive for M230I died.
Sequence data on the first case this season in Egypt would be of interest. In the prior two seasons, the H5N1 had a number of regional sequences in common. However, wild birds can bring new sequences into the region, and the wild bird sequences this season in Europe link back to Uva Lake, which is distinct from the previous sequences in Egypt.
The large number of outbreaks in Egypt (see additional satellite maps here here here here), allow four extensive recombination between closely related clade 2.2 sequences. This lead to more genetic complexity last season, including the Tamiflu resistance marker, N294S, which was in H5N1 from the Gharbiya cluster collected prior to treatment.
The reports of H5N1 circulating in Europe and the Middle East, as well as a large human cluster in Pakistan, increases the likelihood of new human sequences in the region, with novel combinations of polymorphisms, including receptor binding domain changes, leading to larger clusters.
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