Announcement

**Sharpe** · December 23, 2006, 03:48 PM

Re: Egyptian govt reports 2 human bird flu cases

More information. Patients from Hanut, Gharbiya.

http://news.yahoo.com/s/afp/20061223/wl_mideast_afp/healthfluegypt&printer=1

Egypt reports two new human cases of bird flu

38 minutes ago

Two Egyptians were taken to hospital after testing positive for the deadly H5N1 strain of bird flu in the central Nile delta region, the health ministry said.

The latest cases brings to 17 the total number of Egyptians infected, including seven who were killed by the virus.

The two Egyptians from the village of Hanut in the Gharbiya governorate contracted the disease after coming into contact with infected ducks they had been rearing in their homes, according to a ministry statement carried by the official MENA agency.

All the birds in the house and in neighbouring homes were slaughtered and the area disinfected, MENA said.

Egypt -- the Arab world's most populous state -- is on a major route for migratory birds and has seen the third highest number of H5N1 cases after Indonesia and China according to Dr David Nabarro, the UN official charged with battling bird flu.

The H5N1 strain of bird flu was first diagnosed in birds in Egypt in February, and the first case in humans was announced on March 18.

In its most aggressive form, the H5N1 strain has killed 154 people worldwide, according to the World Health Organisation (WHO).

**HenryN** · December 23, 2006, 05:23 PM

Re: Egyptian govt reports 2 human bird flu cases

Commentary at

http://www.recombinomics.com/News/12230601/H5N1_Egypt_2_New.html

**Mellie** · December 23, 2006, 05:27 PM

Re: Egyptian govt reports 2 human bird flu cases

Commentary

H5N1 Confirmed in Two New Egyptian Patients
Recombinomics Commentary
December 23, 2006

The two Egyptians from the village of Hanut in the Gharbiya governorate contracted the disease after coming into contact with infected ducks they had been rearing in their homes, according to a ministry statement carried by the official MENA agency.

The above description of two confirmed H5N1 cases is cause for concern. These two patients are from the same governate as the first confirmed case for this season. H5N1 from that case had many of the Egyptian associated polymorphisms seen in February 2006 human and bird isolates from Egypt.

However, the more recent isolate had several additional polymorphisms, including M230I, which is found in all human strains of influenza (H3N2, H1N1, and Influenza B). Moreover, the new acquisition creates of region of identity (QSGRI) at positions 226-230 in Influenza B.

The earlier isolate also has many additional polymorphisms that are found in isolates from Europe and western Africa, signaling additional recombination and acquisition of new polymorphisms circulating in the area. Recent reports describe additional receptor binding domain changes which increase the affinity for human receptors, including S227N in Egypt and Turkey, N186K in Azerbaijan, and N186S and Q196R in Iraq. Although these countries have not reported H5N1 this season, reports of H5N1 in Ukraine, Egypt, Sudan, and Nigeria signal new migration of H5N1 into the region, which has also been recently reported in South Korea and southern Vietnam. These new outbreaks signal migration of new H5N1 sequences into these regions.

Surveillance remains poor and transparency is becoming increasingly suspect.

Release of the recent sequence by US NAMRU3 has set an excellent example for this season. Release of H5N1 from the two new cases as well as poultry and wild birds in the region by Egypt and neighbors would be useful.

**Theresa42** · December 23, 2006, 06:10 PM

Re: Egyptian govt reports 2 human bird flu cases

Originally posted by Sharpe

More information. Patients from Hanut, Gharbiya.

http://news.yahoo.com/s/afp/20061223/wl_mideast_afp/healthfluegypt&printer=1

Egypt reports two new human cases of bird flu

38 minutes ago

Two Egyptians were taken to hospital after testing positive for the deadly H5N1 strain of bird flu in the central Nile delta region, the health ministry said.

The latest cases brings to 17 the total number of Egyptians infected, including seven who were killed by the virus.

The two Egyptians from the village of Hanut in the Gharbiya governorate contracted the disease after coming into contact with infected ducks they had been rearing in their homes, according to a ministry statement carried by the official MENA agency.

All the birds in the house and in neighbouring homes were slaughtered and the area disinfected, MENA said.

Egypt -- the Arab world's most populous state -- is on a major route for migratory birds and has seen the third highest number of H5N1 cases after Indonesia and China according to Dr David Nabarro, the UN official charged with battling bird flu.

The H5N1 strain of bird flu was first diagnosed in birds in Egypt in February, and the first case in humans was announced on March 18.

In its most aggressive form, the H5N1 strain has killed 154 people worldwide, according to the World Health Organisation (WHO).

A "new hotbed of avian influenza" in Al Gharbiya was mentioned in Al Wafd on Dec 10th -- the report specifically mentioned ducks, so I'm guessing this is the same incident. In the newspaper report, though, it sounded like any people who had been tested tested negative:

Google-translated from Arabic:

New hotbed of avian influenza enough
Dec 10, 2006

Mustafa wrote: Sanaa announced the Supreme Committee for avian flu headed by Dr. Hatim al-Jabali, minister of health and population emergence of a new hotbed of avian influenza in the province of Western [I think this is Al Gharbiyah] and injured birds included home village Aldjomon stab Zayyat, and the teams of the Ministry of Health and veterinary services, police called in to destroy infected birds and poultry-breeding places clean. Also check Almkhalten pen and ducks injured were sent samples to labs central Ministry of Health.

It also announced that the safety of human cases infected suspected cases of avian flu and Almkhalten of birds Navqh, following the results of the samples negative for the disease ...

http://www.flutrackers.com/forum/sho...37&postcount=4

Thanks for posting the news, Sharpe!

**Theresa42** · December 23, 2006, 06:51 PM

Family cluster - 2 cousins test pos - another sibling suspected case

Looks like there are (at least) 3 individuals involved in this cluster -- two male cousins aged 15 and 25 who have tested positive -- and a sister of one of the confirmed cases:

Hospitalized Dec 17:
Farid Abdul Halim's victory (30F?) - suspected case
brother - Reda Farid (25M) - H5N1 pos

Hospitalized Dec 20:
cousin of the 2 above - Shafika Farid (15M) - H5N1 pos

Machine-translated from Arabic:

The injury of a young man and his cousin with "my wedding procession" by the bird flu
Dec 24, 2006

Tanta - Atef Deibis: The Ministry of Health laboratories revealed the injury of a young man "25 years" and his cousin 15 years with "my wedding procession" [I'm guessing this is the name of the village that they're from] by the bird flu disease and have been transferred yesterday to the hospital of the Abbasid fevers and with them the sister of the first injured and who has been detained under the suspicion.

The Health Department by the western has detained in 17 December Farid Abdul Halim's victory 30 years and its brother Reda 25 years in "my wedding procession" fevers hospital and in 20 December detained their cousin Shafika Farid 15 years under the suspicion and taking samples took place from them for its sending to the ministry laboratories. Revealed yesterday due to the examination of conditions Reda Farid's injury and his cousin Shafika by the bird flu disease which led to causing a panic and the fear of citizens and especially after the detention of two new conditions took place in Tanta [I think this means 2 more suspected cases, in addition to the 3 in the Farid family] and the district and immediately stood Doctor Al Sayed Al Husseini the Ministry of Health deputy and sublime opened the door center president and "my wedding procession" city with the formation of a committee for the examination of all contacts and the execution of birds in the scope of half kilo from the injury focus and taking samples from all of the contacts in the village of "a shop disbelief".

And a condition of the panic dominates after the discovery of positive cases to the bird flu disease and the local council of the governorate demanded the necessity of emphasizing on the closure of selling shops the adder and that was still open until now despite the presence of a decision with the ban and the discussion of the alive birds in the markets.

http://www.alwafd.org/v2/News/NewsDetail.php?id=5330&type=first&PHPSESSID=13b61c580a107e6d9e5a3b1b811b081b

**HenryN** · December 23, 2006, 07:25 PM

Re: Egyptian govt reports 2 human bird flu cases

Tanta is in the Gharbiya govenorate also

http://encarta.msn.com/encnet/featur...ata=7429810870

**Theresa42** · December 23, 2006, 07:31 PM

Re: Egyptian govt reports 2 human bird flu cases

Originally posted by niman

Tanta is in the Gharbiya govenorate also

http://encarta.msn.com/encnet/featur...ata=7429810870

Yes -- so it looks like these patients were first in Tanta hospital and when they tested pos they were transferred to Abbasid Fevers Hosp (I think that's in Cairo).

Their village >>
Kafr Hanut:

Kafr Hanut - Egypt

http://www.indexmundi.com/z/?lat=30.78&lon=31.2291667&t=p&r=5060&p=kafr_hanut&cc=eg&c=egypt

**HenryN** · December 23, 2006, 07:55 PM

Re: Egyptian govt reports 2 human bird flu cases

Commentray at

http://www.recombinomics.com/News/12230602/H5N1_Egypt_Cluster.html

**AlaskaDenise** · December 23, 2006, 08:14 PM

Re: Egyptian govt reports 2 human bird flu cases

Originally posted by niman

Commentray at

http://www.recombinomics.com/News/12...t_Cluster.html

Commentary

H5N1 Familial Cluster in Nile Delta Raises Concerns
Recombinomics Commentary
December 23, 2006

Tanta - Atef Deibis: The Ministry of Health laboratories revealed the injury of a young man "25 years" and his cousin 15 years with "my wedding procession" by the bird flu disease and have been transferred yesterday to the hospital of the Abbasid fevers and with them the sister of the first injured and who has been detained under the suspicion.

The Health Department by the western has detained in 17 December Farid Abdul Halim's victory 30 years and its brother Reda 25 years in "my wedding procession" fevers hospital and in 20 December detained their cousin Shafika Farid 15 years under the suspicion and taking samples took place from them for its sending to the ministry laboratories. Revealed yesterday due to the examination of conditions Reda Farid's injury and his cousin Shafika by the bird flu disease which led to causing a panic and the fear of citizens and especially after the detention of two new conditions took place in Tanta

The above translation indicates the two H5N1 confirmed cases are cousins and were hospitalized three days apart. The index case (25M) was hospitalized December 17 and his cousin (15M) , hospitalized December 20 have confirmed H5N1. The sister of the index case has also been hospitalized with symptoms. There appear to be two more suspect cases hospitalized, indicating the three member familiar cluster may be part of a five member geographical cluster.

Clustering in the same Gharbiya govenorate as the earlier case is cause for concern. The current cluster as well as the initial case had linkages to ducks and the H5N1 from the first case had M230I. This polymorphism is found in all three strains of human flu (H3N2, H1N1, and influenza B), all of which are efficiently transmitted human-to-human. The earlier H5N1 is an exact match with positions 226-230 influenza B (QSGRI). The first indication of efficient transmission is a familial cluster, as described in the translation above.

More details on condition of the sister and any relationship with the other two hospitalized patients would be useful (as would tesing and sequencing updates).

.

**HenryN** · December 23, 2006, 09:10 PM

Re: Egyptian govt reports 2 human bird flu cases

Originally posted by Theresa42

Yes -- so it looks like these patients were first in Tanta hospital and when they tested pos they were transferred to Abbasid Fevers Hosp (I think that's in Cairo).

Their village >>
Kafr Hanut:
http://www.indexmundi.com/z/?lat=30....&cc=eg&c=egypt

The distance between the current cluster and the earlier case with M230I is only about 12 miles, as the migratory birds fly down the Nile.

**HenryN** · December 23, 2006, 09:20 PM

Re: Egyptian govt reports 2 human bird flu cases

Another translation

Injury of youth and daughter of wandering in asphalts [b'anflwnzaa] the birds

[TnTaa] Atif [de'bs]:
Treated ministry of the health discovered injury of youth? 25 year ?and daughter of wandering 15 year in asphalts in illness of influenza the birds and their transfer was complete yesterday to hospital of feverish [aale'baasyt] and with them sister stricken first and which retention under the suspecting was complete her.

Directorate of the health in the Westerner was detained on December 17 unique triumph AbdulHalim 30 year and her brother accepted 25 feverish year in hospital adequate asphalts December 20 their daughter detained of uncle [shfyqt] unique 15 year under the suspecting and taking of samples are complete from them for sending her for factories of the ministry.

Their her samples of blessing for sending for treated of the ministry. Discovered yesterday result examination of the cases is unique injury of satisfaction and daughter of wandering [shfyqt] in illness influenza of the birds [mmaa] ['adY] ['ilY] excitement of fear and fear of the citizens and regards after retention cases of new was complete in [TnTaa] and the district, ibexes effervescent medals opening of the door rose the sovereign doctor Al-Husseini agent ministry of the health concentrated head and asphalt city in formation of committee to examined all [aalmxaalTyn] and execution of the birds in range of half kilo from center of the injury and taking of samples from all [aalmxaalTyn] bovine hamlet [Haanwt].

The emphasis on locking reigns positive case from the fear after discovery of cases for illness influenza of the birds and local student the council for the preservation necessarily sweetened live selling the birds and which [maazaalt] open still in spite of presence of decision in prohibition and circulating the live birds in the markets

**AlaskaDenise** · December 23, 2006, 10:20 PM

Re: Egyptian govt reports 2 human bird flu cases

Discussion of these cases is at the discussion thread.
See http://www.flutrackers.com/forum/showthread.php?t=14446

.

**HenryN** · December 23, 2006, 10:48 PM

Re: Egyptian govt reports 2 human bird flu cases

Commentary at

http://www.recombinomics.com/News/12...Egypt_RBD.html

**AlaskaDenise** · December 23, 2006, 10:51 PM

Re: Egyptian govt reports 2 human bird flu cases

Originally posted by niman

Commentary at

http://www.recombinomics.com/News/12...Egypt_RBD.html

Commentary

Co-Circulation of Qinghai H5N1 RBD Changes in Nile Delta

Recombinomics Commentary
December 23, 2006

The report of a growing H5N1human cluster in the Nile Delta is cause for concern. The first case for this season in the region was a patient who live 12 miles north of the current cluster. That patient was hospitalized at the end of September and was confirmed in the middle of the month. Within days of the confirmation, the HA sequences was deposited at GenBank by US NAMRU3, the US Naval Research lab in Cairo. The sequence produced evidence for evolution via recombination. The Egyptian regional polymorphisms defined last season when human isolates were reported in February. The recent isolate also had a number of additional polymorphism which were in other Qinghai isolates in Europe and Africa.

The acquisition of polymorphisms via recombination creates additional concerns because of the receptor binding changes in Qinghai isolates in the region. PB2 E627K has become fixed in the Qinghai strain. This mammalian polymorphism allows H5N1 to grow more efficiently at lower temperatures, as found in humans (37 C) relative to birds (41 C). The preference for a lower temperature selects for E627K in humans. All human influenza isolates have E627K.However. isolates from last season had a number of additional changes in the receptor binding domain. Lab experiments identified several changes that increase affinity for human receptors. These include S227N was has been detected in human Qinghai isolates in Egypt and Turkey. Similarly, N186K has been found in H5N1 from patients in Azerbaijan. In Iraq the same position is changes to N186S in all human isolates, and two had the additional change of Q196R, which has been shown to synergize with S227N.

Moreover, the recent isolate from Egypt has M230I, which is found in all human flu isolates (H1N1, H3N3, influenza B. Thus, further recombination between co-circulating Qinghai isolates can lead to more efficient human-to-human transmission. In the past, there have been few clusters reported in Egypt. The confirmed cluster of two is the largest in Egypt. If the sister of the index is H5N1 positive, the current cluster will be the largest reported for Egypt. The patients also appear to be developing symptoms sequentially, providing additional evidence for human-to-human transmission. It is unclear if the two additional patients are related to the three described in more detail. However, all five either live or have been hospitalized in a region that is close to the first confirmed case with M230I. These three confirmed and one suspect case all live adjacent to the Nile and have a linkage to ducks.

Last year at this time, low path H5 and Qinghai H5N1 were identified in wild ducks (teal) in Egypt. It is likely that H5N1 is widespread in the region, although only Egypt, Sudan, and Nigeria have reported cases in Africa. None of the countries in the Middle East have reported H5N1, although H5N1 was widespread in Turkey at this time last year and was subsequently found in neighboring countries such was Azerbaijan, Iraq, Iran, and Israel.

The extent of H5N1 spread in these regions in this year is unclear because these countries have not detected or report the H5N1 which is clearly circulating in the area. This lack of transparency in the region, coupled with a confirmed human cluster in Egypt is cause for concern.

One year ago the first human cases of Qinghai infections were reported in Turkey. Neighboring countries subsequently began reporting H5N1 infections In January and February of this year. The first fatality in Egypt did not lead to widespread reporting of H5N1 outbreaks in the area. However, the current cluster may lead to more transparency in the region.

H5N1 does not read press releases or media reports. It continues to acquire new polymorphisms via recombination, and the number of such changes in the receptor binding domain of Qinghai H5N1 co-circulating in the Middle East, including Egypt, remains alarmingly high.

,