Three Confirmed H5N1 Cases in Egypt Raise Pandemic Concerns
Recombinomics Commentary 21:46
December 27, 2007
"There are two cases today, one in Damietta and one in Menoufia... Today lab results confirmed that they are infected with bird flu,"
On Wednesday, 25-year-old Ola Younis died of bird flu in Beni Suef province, south of Cairo, on the same day she was diagnosed as being infected with the highly pathogenic virus.
The confirmation of three cases of H5N1 in two days in Egypt is unusual. Last year at this time there was a cluster of three family members in Gharbiya in the Nile Delta. However, the cases this year are in three locations. One was in Beni Suef, south of Cairo, and two others were in separate governorates in the Nile Delta.
Egypt implemented an extensive vaccination program in the past few months, but poultry cases began to appear in the past few weeks (see satellite map). These new bird outbreaks led to an alert, which was followed by the dispersal of Tamiflu to hospitals and clinics in the Gharbiya.
Last season the H5N1 in Egypt had the regional markers present in the prior season, but the more recent isolates were more genetically complex. Included in the newly acquired polymorphisms were changes in or near the receptor binding domain as well as oseltamivir resistance. It is unclear if these changes are playing a role in the spike in cases.
Today WHO issued a situation update on the cluster in Pakistan. Although efforts by NAMRU-3’s mobile lab and the WHO reference lab in London have largely generated negatives, Pakistan had confirmed the cases previously, and one of the fatal cases was confirmed by the regional labs. The cluster in Pakistan raises concerns about more cases in Pakistan, as well as cases downstream, which may include Egypt.
Sequencing of human and poultry isolates in Egypt would resolve these questions and address the significance of three confirmed positive patients in two days in Egypt.
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