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Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009 - April 9, 2009
Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+
[A more cautious approach in Egypt epidemiological situation evaluation is needed at FT and elsewhere I think. See CP commentary below (Sic) IOH.]
AVIAN INFLUENZA, HUMAN (71): EGYPT, VIET NAM, WHO
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] Egypt - cases 61, 62 & 63, WHO confirmed
[2] Viet Nam - 55th fatality, WHO confirmed
Avian influenza situation in Egypt - WHO Update 10
--------------------------------------------------
The Ministry of Health of Egypt has reported 3 new confirmed human
cases of avian influenza.
The 1st case is a 2-year-old boy from Kom Hamada District, El Behira
governorate. He developed symptoms on 27 Mar 2009 and was admitted to
Naaora Fever Hospital on the 30 Mar 2009, where he was started on
oseltamivir the same day. He remains in a stable condition.
The 2nd case is also a 2-year-old boy from the same district and was
detected through the investigation around the above-mentioned case.
He developed symptoms on 31 Mar 2009 and was admitted to Damanhor
Fever Hospital on 1 Apr 2009, where he was started on oseltamivir the
same day. He remains in a stable condition.
Both boys had contact with sick/dead poultry prior to illness onset.
Close contacts of both boys have been identified, and none have shown
symptoms of the infection.
The 3rd case is a 6-year-old boy from Shubra El Khema District,
Qaliobia [Al Qalyubiyah] governorate. He developed symptoms on 22 Mar
2009 and was admitted to Ain Shams University Hospital on 28 Mar 2009,
where he was started on oseltamivir on 3 Apr 2009. He was exposed to
sick/dead poultry prior to illness onset. He is in a critical condition.
For all of the 3 cases reported above, infection with H5N1 avian
influenza virus was tested positive by the Egyptian Central Public
Health Laboratory and subsequently confirmed by the U.S. Naval
Medical Research Unit No. 3 (NAMRU-3). Of the 63 cases confirmed to
date in Egypt, 23 have been fatal.
Avian influenza situation in Viet Nam - WHO Update 5
----------------------------------------------------
As of 8 Apr 2009, The Ministry of Health in Viet Nam has reported a
new confirmed case of human infection with the H5N1 avian influenza
virus. The case has been confirmed at the National Institute of
Hygiene and Epidemiology (NIHE).
The case is a 3-year-old boy from Chau Thanh District, Dong Thap
Province. He developed symptoms on 12 Mar 2009, was hospitalized on
13 Mar 2009, and died on 19 Mar 2009. Investigations into the source
of infection indicated a history of close contact with sick and dead
poultry prior to the onset of symptoms.
Of the 110 cases confirmed to date in Viet Nam, 55 have been fatal.
[All these WHO-confirmed cases of human avian H5N1 influenza virus
infection have been children 6 years of age or younger. Since the
resurgence of human cases of avian influenza in Egypt at the end of
2008, 12 of the 13 cases have been children 6 years of age or under,
and all have had exposure to diseased or dead poultry. No onward
transmission of infection to family members has occurred.
The locations of the 13 most recent Egyptian cases can be viewed in
the map accompanying the text of the document at:
<http://www.saidr.org/en/humans.php#050409>.
- Mod.CP]
-
[A more cautious approach in Egypt epidemiological situation evaluation is needed at FT and elsewhere I think. See CP commentary below (Sic) IOH.]
AVIAN INFLUENZA, HUMAN (71): EGYPT, VIET NAM, WHO
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] Egypt - cases 61, 62 & 63, WHO confirmed
[2] Viet Nam - 55th fatality, WHO confirmed
Avian influenza situation in Egypt - WHO Update 10
--------------------------------------------------
The Ministry of Health of Egypt has reported 3 new confirmed human
cases of avian influenza.
The 1st case is a 2-year-old boy from Kom Hamada District, El Behira
governorate. He developed symptoms on 27 Mar 2009 and was admitted to
Naaora Fever Hospital on the 30 Mar 2009, where he was started on
oseltamivir the same day. He remains in a stable condition.
The 2nd case is also a 2-year-old boy from the same district and was
detected through the investigation around the above-mentioned case.
He developed symptoms on 31 Mar 2009 and was admitted to Damanhor
Fever Hospital on 1 Apr 2009, where he was started on oseltamivir the
same day. He remains in a stable condition.
Both boys had contact with sick/dead poultry prior to illness onset.
Close contacts of both boys have been identified, and none have shown
symptoms of the infection.
The 3rd case is a 6-year-old boy from Shubra El Khema District,
Qaliobia [Al Qalyubiyah] governorate. He developed symptoms on 22 Mar
2009 and was admitted to Ain Shams University Hospital on 28 Mar 2009,
where he was started on oseltamivir on 3 Apr 2009. He was exposed to
sick/dead poultry prior to illness onset. He is in a critical condition.
For all of the 3 cases reported above, infection with H5N1 avian
influenza virus was tested positive by the Egyptian Central Public
Health Laboratory and subsequently confirmed by the U.S. Naval
Medical Research Unit No. 3 (NAMRU-3). Of the 63 cases confirmed to
date in Egypt, 23 have been fatal.
Avian influenza situation in Viet Nam - WHO Update 5
----------------------------------------------------
As of 8 Apr 2009, The Ministry of Health in Viet Nam has reported a
new confirmed case of human infection with the H5N1 avian influenza
virus. The case has been confirmed at the National Institute of
Hygiene and Epidemiology (NIHE).
The case is a 3-year-old boy from Chau Thanh District, Dong Thap
Province. He developed symptoms on 12 Mar 2009, was hospitalized on
13 Mar 2009, and died on 19 Mar 2009. Investigations into the source
of infection indicated a history of close contact with sick and dead
poultry prior to the onset of symptoms.
Of the 110 cases confirmed to date in Viet Nam, 55 have been fatal.
[All these WHO-confirmed cases of human avian H5N1 influenza virus
infection have been children 6 years of age or younger. Since the
resurgence of human cases of avian influenza in Egypt at the end of
2008, 12 of the 13 cases have been children 6 years of age or under,
and all have had exposure to diseased or dead poultry. No onward
transmission of infection to family members has occurred.
The locations of the 13 most recent Egyptian cases can be viewed in
the map accompanying the text of the document at:
<http://www.saidr.org/en/humans.php#050409>.
- Mod.CP]
-
All participants must refrain from bashing comments in their words and tone.
I will not issue another warning.
I believe that the statement that no onward transmission has occured is WELL into the nonsense category. Nonsense is nonsense and the comment on onward transmission is similar to the nonsense about white meat and dark meat in the H2H transmisison of H5N1 in Jiangsu in an entertaining attempt to explain away the nine day gap in disease onset dates between the son and the father he infected.
CP is well aware of how "common source" is distinguished from H2H (which he has previously cited in rare clusters when there is no gap - and WHO has also cited the lack of a gap as proof of no H2H).
The nonsense is more annoying because it is directed to an audience that doesn't have the scientifuc background to recognize the nonsense is based on "beliefs" and wishful thinking, and a four day gap in disease onset dates is a VERY easy call.
[This exposure of father and son to the same poultry product (and
possibly the storage of refrigerated chicken in the father's house)
identifies a potential common source of infection and virtually
negates the possibility of human-to-human transmission being
responsible for these 2 cases. - Mod.CP
[This exposure of father and son to the same poultry product (and
possibly the storage of refrigerated chicken in the father's house)
identifies a potential common source of infection and virtually
negates the possibility of human-to-human transmission being
responsible for these 2 cases. - Mod.CP
Here is the actual ProMED post which is required reading because the number of absurdities cannot be easily summarized (including white meat / dark meat "possibilities"):
AVIAN INFLUENZA, HUMAN (157): CHINA (JIANGSU)
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[The following report provides new information relating to the source
of the H5N1 virus responsible for the death on 2 Dec 2007 of a
24-year-old man in Jiangsu province and the concurrent illness of his
father, and explains the possible relevance of the dog-bite incident.
- Mod.CP]
To celebrate [the 24-year-old's] acceptance [to a school of continuing
education], his mother and father took him and his girlfriend to
Nanjing's most bustling Confucian temple for some fun. At the temple's
restaurant, the 4 of them ate Beggar's Chicken, which was surrounded
by thick mud on the outside. [Dan Silver, the translator, comments
that a 1990 article from the New York Times provides a useful
introduction to Beggar's Chicken:
<http://query.nytimes.com/gst/fullpage.html?res=9C0CEFD91638F93BA35757C0A9669582 60>.]
According to analyses, perhaps because the mud on the outside was too
thick the chicken inside was not thoroughly cooked. On the 2nd day
after eating the chicken, [the young man] began feeling feverish. His
body temperature rose quickly and he was taken for emergency treatment
to Jiangsu Provincial People's Hospital. In the end, he could not be
saved.
As to why [he] was 1st to fall ill, a relative revealed that his
girlfriend keeps 2 pet dogs. Because she is from another part of China, Nanjing limits the number of dogs [she can keep]. To avoid
discovery, she sent one to be looked after by [her boyfriend]. 20 days
before eating chicken, he was bitten by this small dog. To prevent rabies, he began vaccine shots. 5 injections are needed and at the
time [of his illness] he had already completed 4 shots. His body's
immunity was [therefore] at its lowest point. When [the man] was 1st
sent to the hospital, he was not treated for avian influenza. The
physicians suspected he might have contracted plague.
After their son's sudden death, his father and mother were devastated.
On the 6th day after eating chicken, when the father developed fever,
he did not have the heart to seek treatment. Only after others begged
him did he go to the hospital. A relative said that [his] family loves
to eat chicken and his refrigerator is full of butchered chicken.
Because of this, the relative began to wonder if it might be avian
influenza, so [the man] went to the Nanjing
Municipal Infectious Disease Hospital where the diagnosis of avian
influenza was made.
The odd thing is that although 4 people went to eat chicken [at the
temple], only the 2 men fell ill and the 2 women are well. Reports say
that [the] girlfriend ate a lot of chicken but is perfectly fine.
Sources say that [the 24-year-old's mother] also has no similar
symptoms but has been isolated for observation. Her cell phone is
turned off and there is no contact with the outside world.
--
Communicated by:
ProMED-mail Rapporteur Dan Silver
[This exposure of father and son to the same poultry product (and
possibly the storage of refrigerated chicken in the father's house)
identifies a potential common source of infection and virtually
negates the possibility of human-to-human transmission being
responsible for these 2 cases. - Mod.CP
The possible relevance of the dog-bite incident is that 4 rabies
vaccine shots might have adversely affected the patient's immune
system. The 2 women who also ate the chicken should be checked for
antibody in case of asymptomatic infection. Or perhaps the men ate the
legs and thighs and the women the breast, with different degrees of
undercooking and/or original virus titer? - Mod.JW]
It is not productive to bash about inaccuracies in ProMed postings.
A short comment refuting the post and an explanation why is sufficient.
Actually, I have published multiple commentaries on this ProMED commentary as well as a long string that go back to 2004. The commentaries have a common thread which attempts to support CP's hypothesis that H5N1 is relatively benign and only a very small subset of genetically predisposed individuals are infected and H2H is virtually impossible.
The commentaries contain a series of ad hoc arguments that are without scientific basis , but are frequently quoted on the internet as somehing with scientific merit.
In this case, the idea that the 9 day gap in disease onset dates is somehow related to a differential risk to the four people who ate the dish has no basis. There is no hint that this bird had H5N1 symptoms or was H5N1 infected. Moreover, for H5N1 infected food, those at most risk would be those who prepared the dish BEFORE it was cooked (restaurant employees).
Similarly, the idea that the cooking could titer out the virus, so one perosn died, another got sick 9 days after the index case, while two others didn't get sick at all is pure hocus pocus based on ZERO data.
Then there is the speculation about the rabies shot, and who ate dark meat and who ate white meat (pure fatansy) as well as how refrigerated leftovers contributed was just an absurd story that was published in an infectious disease newsletter with the CLEAR intent of convincing non-scientists that there was no H2H (which was subsequently written up in thhe NEJM as an example of H2H - based on DISEASE ONSET DATES and irrelevant sequence identity between the H5N1 from father and son).
Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+
I am sure that further efforts to improve transparency in poultry and human impact of avian influenza virus H5N1 are urgently needed.
The time is running, and pandemic influenza cannot wait for short-sight politics.
People should also keep in mind that more therapeutical and preventative measures are also urgently needed.
It's not the time for concealing informations, distort reality or hope for business.
We testify in the past how many damages can be done with this short-sight and business hunger-driven policies.
Perhaps, there is time for mitigate an impending influenza pandemic effect.
It is a common obligation to explore every possible strategy to lessen the impact of avian influenza epizootics and epidemics both in economy and society.
Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+
Henry -
I would like to take this opportunity to tell you how much everyone at FT respects you. We thank you for all your work all these years, under less than optimal circumstances.
We know you as a scientist, co-worker, and educator. But mostly we know you as a friend.
"All truths are easy to understand once they are discovered; the point is to discover them.?
Well, then, what the heck has been going on in Indo?
There is B2H, but the odds are low for a given outbreak to cause a confirmed case. Overall, since 2004 there have 100's of millions of birds culled, but only 100's of confirmed human cases. If you lower the number of culled birds because in some instances the culling is precautionary and involve large holdings, instead of a million to 1 you could argue it is 10,000 to one.
However, even at 10,000, the odds of two cases happening between contacts and separated by days and be independent is still well north of a million to one.
However, H2H among close contacts is much more common. In Vietnam, about 1/3 of cases were in clusters. At one point the number in Indonesia was close to 50%. In Turkey, it approached 100%.
The clusters almost always have a disease onset date gap. Frequently it is large, like 4-10 days. Sometimes the number is in between clear-cut common source (0-1 days) and H2H (4 or more days), but 0-1 days is VERY rare.
Moreover, in clusters it is much more common for an index case to die and a contact to survive, than the other way around. One of the few examples of the other way around was the cluster in Pakistan. However, when there is a difference in mortality, the index case is usuallythe one to die (although frequently the index case is not tested, but just had symptoms and the contact was confirmed).
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