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Egypt - Confirmed H5N1 in Humans April 15, 2009 - May 18, 2009
girl child in the province Zidane Manar Ibrahim Saad
Saadia Mohamed Abdel Latif (31, 33F)
Does the Saad in the toddler's name relate to the Saadia in the name of the prior case from the Kellin district in Kafr el Sheik?
The Egyptian blogger called Saadia ....Latif "Mrs. Saadia" as though that was the equivalent of her last name, regardless of where it appears in the name Saadia Mohamed Abdel Latif as reported in the news.
Re: Egypt - Confirmed H5N1 in Humans April 15, 2009 +
وأوضحت المديرية أن الطفلة منار إبراهيم زيدان سعد (18 شهرًا) من قرية شباس عمير مركز قلين تأكد إصابتها بالمرض، وأنها تتلقى العلاج بمستشفى منشية البكري بالقاهرة بدءًا من عصر اليوم.
The Directorate girl Manar Saad Ibrahim Zidan (18 months) from the village of Chaabas Amir Kulain confirmed the status of her disease, and that they receive hospital treatment, the capital Cairo, starting from this afternoon.
Kulain [قلين] is one of 10 “centers” or “province centers” [مركز] (Administrative level 3) in Kafr El-Sheikh Governorate (Administrative level 2). Kulain covers about 161 sq kilometers and as of 2003 had a population of 197,773. There are five villages” [قرى ] (Administrative level 4) in Kulain one of which is Amir Chaabas, where the most recent human case is from. There are 5 separate “villages” [قرية] (Administrative level 5) reported for Amir Chaabas.
Link: http://ar.wikipedia.org/wiki/قلين
Kulain [قلين] is one of 10 ?centers? or ?province centers? [مركز] (Administrative level 3) in Kafr El-Sheikh Governorate (Administrative level 2). Kulain covers about 161 sq kilometers and as of 2003 had a population of 197,773. There are five villages? [قرى ] (Administrative level 4) in Kulain one of which is Amir Chaabas, where the most recent human case is from. There are 5 separate ?villages? [قرية] (Administrative level 5) reported for Amir Chaabas.
Link: http://ar.wikipedia.org/wiki/قلين
ويقع مركز قلين في الجنوب الغربى من المحافظة يحده من الشمال والشرق مركز كفر الشيخ ومن الشمال والغرب مركز دسوق ومن الجنوب محافظة الغربية .
Kulain Center is located in the south-west of the province is bounded on the north and east, the status of Kafr El-Sheikh from North-West Center Desouk from the south-western province.
Map updated to mark toddler in Shabas Emeir (which is about 2 miles from town of Kulain were markers originally place). Both Kulain cases placed in Shabas Emeir (as identifed by google which corresponds to 31.097410, 30.792983) in anticipation of updates
أنفلونزا الطيور تسببت في مقتل عدد غير قليل من البشر
Avian influenza has killed quite a few people
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كفر الشيخ- أحمد المصري:
Kafr El-Sheikh - Egyptian Ahmed:
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ارتفع عدد الحالات المصابة بمرض إنفلونزا الطيور بمحافظة كفر الشيخ إلى 64 حالةً بعد إصابة سعيدة محمد عبد اللطيف حامد (33 سنة- ربة منزل) بقلين بمرض إنفلونزا الطيور بعد التأكد من إصابتها بمرض (hsng) عن طريق التحاليل بمعامل وزارة الصحة.
The number of cases of bird flu-hit province of Kafr el-Sheikh to the situation after 64 injured happy Hamid Mohamed Abdel-Latif (33 years - housewife) Bkulain with avian flu after confirmation of her disease (hsng) through factor analysis and the Ministry of Health.
ويقول زوجها أحمد عبد السلام براغيث 42 سنة "ترجع إصابة زوجتي لشرائنا 20 فرخًا صغيرًا منذ 15 يومًا من أحد الباعة الجائلين وبعد 10 أيامٍ من شراء الكتاكيت بدأت تموت تباعًا حتى مات 15 فرخًا فقمت بتعبئتها في شكارة ووضعتها في جرار قمامة مجلس المدينة".
Says her husband, Ahmed Abdel-Salam fleas 42 years "due to injury, my wife our purchasing 20 chicken small since the 15 days of one street vendors, after 10 days of the purchase of chickens began dying in turn 15 until he died in the chicken and I _karp packed in jars and put the city's garbage."
وأضاف أنه بعد يومين انتابت زوجته كحة شديدة وارتفاع في درجة الحرارة فذهب لأحد الأطباء، وقال له إنه اشتبه بإصابتها بمرض إنفلونزا الطيور فنفي لي إصابتها وشخَّص الحالة على أنها نزلة شعبية حادة.
He cursed his wife two days after severe cough and high temperature went to a doctor, and said he had suspected bird flu disease, bird flu, and he denied me one of her situation as a severe bout of popularity.
وأكمل أنه بعد 3 أيام ذهب إلى الطبيب مرةً أخرى، وأخبره أن حالة زوجته في تحسن، ولكنه شعر أن الكحة تعود وبدرجة أكبر؛ الأمر الذي دفعه للذهاب لطبيب آخر أمر بعمل أشعة على الصدر، وشخَّص الحالة بأنها مياه على الرئة وقام بإرسالي إلى طبيب ثالث لشفط هذه المياه.
And completed it after 3 days went to the doctor again, and his wife told him that the situation is improving, but it is felt that cough and more; be paid to go to a doctor is the work of another scan on his chest and one on the water situation as the lung and Birsali to a third suction these waters.
واستطرد: "ذهبت إلى تحليل المياه التي تم شفطها فوجدتها إيجابية والحالة سليمة، ولكن يوجد تليف في الرئة، ويجب استئصال فصين من الرئة اليمني فرجعت للطبيب الذي بدوره أرسلني إلى طبيب رابع في الإسكندرية، والذي قرر بأن الحالة لا تستدعي استئصالاً، وكتب لي بعض الأدوية، وبعد عودتي من الإسكندرية مباشرةً تدهورت صحة زوجتي وتغيَّر وجهها، وأطرافها إلى اللون الأزرق، فأسرعت إلى مستشفى قلين المركزي عن طريق الإسعاف، وقام الطبيب بوضعها على جهاز التنفس، ووضعها في العناية المركزة التي حولتني إلى مستشفى الحميات وقاموا بسحب العينة وإرسالها إلى القاهرة، والتي أثبتت أن الحالة مصابة بإنفلونزا الطيور".
He: "I went to the analysis of water that have been Hvtha and found a positive and healthy situation, but there is fibrosis of the lung, and must be the eradication of the right lung Vchin Faragat to the doctor, who in turn sent me to a fourth doctor in Alexandria, which decided that the situation once and do not require, and wrote to me some medicine and, after my return from Alexandria directly to my wife's health has deteriorated and changed me, and the parties to the color blue, Vosrat Kulain Central Hospital by ambulance, the doctor put on a respirator and placed in intensive care to a hospital that Hotine diets had withdrawn and the sample and sent to Cairo, which proved that the situation with bird flu. "
واتهم عبد السلام أطباء العيادات الخاصة بالمسئولية عن تدهور حالة زوجته لعدم التشخيص السليم، وطالب المحافظ بعلاج الحالة على نفقته، خاصةً أنه أنفق حتى الآن 6 آلاف جنيه، وأشار إلى أن المستشفى لا يوجد به جهاز قياس الغازات بالدم وتقوم بشراء أدوية لا توجد بالمستشفى، وكذلك بعض التحاليل.
The accused Abdul Salam clinicians on responsibility for the deterioration of his wife, the lack of proper diagnosis and treatment of the situation called for the governor at his expense, especially since he spent so far 6 thousand pounds, and noted that the hospital had no system to measure blood gases and the purchase of medicines there is no hospital, as well as some analysis.
Clustering H5N1 Clusters Raise Pandemic Concerns in Egypt
Recombinomics Commentary 07:40 April 20, 2009
The Directorate girl Manar Saad Ibrahim Zidan (18 months) from the village of Chaabas Amir Kulain confirmed the status of her disease
The above translation describes the 66th confirmed H5N1 case in Egypt, which is the third confirmed case in three days. However, more alarming than the frequency is the fact that all three cases are members of clusters and the six most recent confirmed cases form three distinct clusters.
The 66th case is a toddler from the Kellin district of Kafir el Sheik as is case #64 (33F). The village of Shabas Emier is only a few miles from the town of Kellin (see updated map), suggesting the two members of the Kellin cluster are from a small geographic area. The precise location of case #64 was not released, but it is possible that both cases are from Shabass Ameir and/or are related or have contact. Since the disease onset dates are 8 days apart, contact between the two cases would strong support transmission of H5N1 from case #64 to case #66.
Similarly, case #65 forms a Cairo cluster with case #63. Both were admitted to the Ain Shams hospital in Cairo and treatment was delayed for both suggesting they denied a poultry connection. These two cases also appear to be a few miles apart at the northern edge of Cairo (see updated map).
The third is the Beheira cluster created by two cousins in . The cousins were next door neighbors and developed symptoms four days apart, strong supporting the infection of one cousin by the other.
These three clusters involving the six most recent confirmed cases create a significant cause for concern. A recent report described a relationship between a subset of H5N1 isolates in Egypt and season flu, H1N1, which is efficiently transmitted to humans. This relationship was tightly linked to a 3 BP deletion, which creates S129del, which involves a position that interacts with the receptor binding domain. Moreover, this deletion was in siblings in the Qena cluster in 2007 and the sibling sequences were identical.
Recently a phyologenetic analysis of the first two cases in 2009 in Egypt were released and the position of these isolates suggests they also have S129del. If these and other 2009 isolates have this deletion, including the six cases that form clusters in 2009, there would be a genetic explanation of the more efficient transmission represented by the clustering.
The release of the 2009 sequences from Egypt is long overdue. NAMRU-3 has not relased any human or poultry from the 2008/2009 season.
In addition, the relationship between the two Kellin cluster members including the distance between residences would be useful.
The clustering of clusters demands more transparency and a much more aggressive testing of toddlers without poultry contact as well as antibody levels in the suspect cases that are PCR negative.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Woman, age 25, 33 weeks pregnant, began experiencing symptoms of fever and cough on April 6. She was admitted to Ain Shams Hospital on April 11 and received Tamiflu April 16. Infection with avian influenza was confirmed April 17.
The above comments detail the gap between admission and the start of oseltamivir treatment for the 65th confirmed case (25F) in Egypt. This five day gap is unusual, because patients with bird flu symptoms and contact with poultry are immediately treated with Tamiflu, and a throat swab is collected for PCR analysis for H5N1.
The delay in treatment for this patient suggests she denied a poultry contact. The possibility is support by the delayed treatment of case #63 (6M), whose treatment was also delayed at the same hospital. Since she was confirmed and was in critical condition, the significance of the treatment should have been well known to the staff at Ain Shams Hospital, because case #63 was also treated there. These two cases appear to be a few miles apart (see updated map), raising concerns that this geographic cluster is signaling more efficient transmission of H5N1.
These concerns were increased by the confirmation of case #66 (2F) in Kafr El Sheik. This case followed a recent case (#64) in Kafr El Sheik in the same district (Kellin). Moreover the 8 day gap in disease onset dates raises concerns that these two cases are related, and case #64 infected case #66.
Such transmission was recent seen in Beheira where two cases from the same districts were subsequently described as next door neighbors and cousins (both 2M). Moreover the 4 day gap in disease onset dates strongly suggests that one cousin infected the other.
The presence of three distinct clusters in Egypt this month, as well as three confirmed cases in three days has raised concerns that H5N1 infections were much higher than the reported 66 cases. The latest case is the 11th toddler between the ages of 1 ½ or 2 ½ in Egypt this year, representing a significant increase in frequency and number of H5N1 confirmed toddlers. This concentration of so many cases in such as small age group (in contrast to 6 toddler cases in the three preceding years), raises concerns that many in older age groups has protective immunity due to a significant prior exposure to H5N1.
These results indicate that toddlers with bird flu symptoms, but no contact with poultry, should be tested for H5N1. Moreover, the 99% of suspect cases with poultry contact who test negative by PCR should be tested for H5N1 antibodies.
Recent results have suggested that the 3 BP deletion (S129del) in a subset of cases produces similarities with H1N1, and phylogenetic analysis of the first two toddler cases in 2009 had this deletion, raising concerns that this change, which interacts with the receptor binding domain, has produce H5N1 which is more efficiently transmitted.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
تأكدت مساء اليوم الأحد، الإصابة البشرية رقم 66 بمرض أنفلونزا الطيور لطفلة تدعى منار إبراهيم زيدان سعد، تبلغ من العمر سنة ونصف من قرية "شباص عمير" بمركز قلين بمحافظة كفر الشيخ، حسب تصريح الدكتور عبد الرحمن شاهين المتحدث الرسمى لوزارة الصحة.
Confirmed on Sunday evening, no human infection from bird flu, 66 to baby girl named Manar Saad Ibrahim Zidan, the old year and a half from the village, "Amir Chaabas" status Kulain province of Kafr el-Sheikh, according to a statement, Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health.
قال شاهين، إن بداية ظهور الأعراض على المصابة كانت يوم 15 من الشهر الجارى، دخلت على إثرها أمس السبت، مستشفى حميات كفر الشيخ وهى تعانى من ارتفاع فى درجة الحرارة وسعال عقب تعرضها لطيور نافقة يشتبه فى إصابتها بمرض أنفلونزا الطيور، لافتاً أنه فور الاشتباه فى إصابتها بالمرض تم إعطاؤها عقار التاميفلو وحالتها المرضية مستقرة.
Sahin said that the onset of symptoms were infected on 15 this month, entered on their impact on Saturday, Kafr El-Sheikh hospital fevers with a high temperature and cough after exposure to dead birds suspected of being infected with bird flu, he said that immediately after the suspected infected with the disease were given the drug Tamiflu, a stable and satisfactory condition.
الإعلان الإيجابى لإصابة الحالة رقم 66، والتى تعتبر ثالث حالة على التوالى فى أقل من ثلاثة أيام يفتح الباب من جديد حول مدى خطورة انتشار وباء أنفلونزا الطيور فى مصر وجدوى العلاج الحالى للمرض.
A positive injury case No. 66, which is the third in a row in less than three days open the door of the seriousness of a new outbreak of avian flu in Egypt and the feasibility of this treatment of the disease.
القاهرة 20 نيسان( بترا) -اعلن في القاهرة اليوم الاثنين عن اصابة طفلة بمرض انفلونزا الطيور ليرتفع عدد المصابين بالمرض منذ ظهوره في مصر شباط 2006 الى 66 توفي منهم 23 وشفي الاخرون بعد تلقيهم العلاج.
Cairo, April 20 (Petra) - announced in Cairo on Monday, injuring a girl infected with bird flu, bringing the number of people infected with bird flu since the disease appeared in Egypt in February 2006 to 66 of them died and 23 others recovered after receiving treatment.
ووفقا لوزارة الصحة المصرية فان المريضة من احدى قرى محافظة كفر الشيخ وتبلع من العمر عاما ونصف العام وان اصابتها جاءت نتيجة لمخالطتها لطيور مصابة.
According to the Ministry of Health in Egypt, the patient from one of the villages of Kafr Al-Sheikh and swallow-year-old and a half year, and she was the result of contact with the infected birds.
وتم ادخال الطفلة الى المستشفى لتلقي العلاج , وهي سادس حالة تدخل المستشفى مصابة بهذا المرض منذ بداية الشهر الحالي .
Was the introduction of the girl child to the hospital to receive treatment, it is the sixth case of entering the hospital with the disease since the beginning of this month.
Re: Egypt - Confirmed H5N1 in Humans April 15, 2009 +
Was the introduction of the girl child to the hospital to receive treatment, it is the sixth case of entering the hospital with the disease since the beginning of this month.
hmmm. Now I'll have to look into the name of the hospital, and check the suspected case listing....
hmmm. Now I'll have to look into the name of the hospital, and check the suspected case listing....
Case #64 amd #66 were admitted to the fever hospital in Kafr el Sheikh. #64 (33F) was delayed because she first went to local clinics and is now too sick to be moved from Kafr el Sheikh. The toddler (1.5 F) was initially also in Kafr el Sheik, but has since been transferred to Cairo.
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