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Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009 - April 9, 2009

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  • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

    Egypt's first bird flu!!

    Egypt topped the list of countries worst hit by bird flu in 2009, after the Ministry of Health reported 9 injuries since the beginning of this year, compared with 8 cases over the past year.

    The Egyptian Ministry of Health on Sunday, wounding a child in the age of six virus (H 5 to 1) strain of bird flu, bringing the total number of people who have contracted the disease since it appeared for the first time in Egypt in 2006 to 63 people.

    In addition, said Dr. Abdel Rahman Shahin, spokesman of the Ministry of Health, said that despite the high number of casualties, Egypt is the least in the proportion of deaths, adding that among the 63 cases of which 23 occurred only event of the death, admitting that the virus is endemic in Egypt, and that he and eradicate it takes many years and perhaps decades, and the risk of it mutating into a form more virulent, "and is strongly," he said there was no way now to get out of the crisis, but the transformation of society to the frozen birds.

    In Qena, the Directorate of Health announced a state of emergency in a hospital after the fever in the central laboratories of the Ministry of Health wounded girl, "Israa Saad Shafi," which showed symptoms of the disease last Monday and was taken to the hospital.

    In Alexandria, was executed by the Directorate of Veterinary Medicine million birds because of the lack of certificates to prove they are free of the disease have been seized in raids on intensive farms, bird shops in the east and west of the city.

    In Fayoum, said Dr Hussein Sophie Abu Talib, Under-Secretary, Ministry of Health, the death of the girl child بسملة Mohammed "45 days" in hospital after the transfer of the Tamiflu drug to the hospital yesterday evening fevers Fayyoum first, on suspicion of having contracted the disease, adding that blood samples were taken and sent to the central laboratory, but she died before the results of the analysis, pointing out that the samples were withdrawn from her family as a precaution.

    http://alalam.ir/newspage.asp?newsid...20090406114607

    Comment


    • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

      Originally posted by Florida1 View Post
      I think the mention of Menofiyah is because that is where the child showed symptoms during a visit:

      "...was discovered during a visit to the house of her mother in one of the villages of Al-Menoufiya..."

      http://www.flutrackers.com/forum/sho...&postcount=151


      and

      "...He was discovered when he became very sick during
      visiting his grandparents in Monfia. He was given Tamiflu and
      currently is stable...."


      http://www.flutrackers.com/forum/sho...&postcount=164
      Here is the problem with an H5N1 source in Beheira for case #61. Reports indicated he lived in Beheira, but developed symptoms while visiting grandparents in Menoufiya. However, those same reports also mention a poultry contact, as well as hospitalization in Menoufiya a day after symptoms, strongly implying that he went to visit his grandparents in Menoufiya, was exposed to poultry in Menoufiya, developed symptoms in Menoufiya, and was hospitalized in Menoufiya.

      However, H5N1 in his next door neighbor in Beheira complicates the story, which is further complicated by the fact that a poultry exposure is NOT mentioned for case #62. If the poultry connection for case #61 was in Beheira, it is VERY likely that the same connection would be cited for case #62, who lived next door to case #61 in Beheira (and case #62 was hospitalized in Beheira).

      Comment


      • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

        Commentary

        http://www.recombinomics.com/News/04...pt_Delays.html

        Comment


        • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

          Originally posted by Florida1 View Post
          I think the mention of Menofiyah is because that is where the child showed symptoms during a visit:

          "...was discovered during a visit to the house of her mother in one of the villages of Al-Menoufiya..."

          http://www.flutrackers.com/forum/sho...&postcount=151


          and

          "...He was discovered when he became very sick during
          visiting his grandparents in Monfia. He was given Tamiflu and
          currently is stable...."


          http://www.flutrackers.com/forum/sho...&postcount=164
          No comment on cluster (cases 61 and 62) or poultry linkage for 63

          http://www.saidr.org/en/humans.php

          RECENT CASES:

          Date of report: 5 April 2009
          Governorate: Qalioubiya
          District: Shoubra el Kheima
          Event summary: Boy, age 6, began experiencing symptoms March 22. He was admitted to Ain Shames University hospital March 28 and received Tamiflu on April 3. Infection with avian influenza was confirmed April 5. He was reported in a critical condition under artificial ventilation on April 6. The MOHP reported this was the 63rd case of highly pathogenic avian influenza in Egypt.
          Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
          Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP
          ---------------------------------------

          Date of report: 26 March 2009
          Governorate: Qena
          District: Qena
          Event summary: Girl age 2?, began experiencing symptoms March 23. She was admitted to Qena Fever Hospital March 24 and received Tamiflu the same day. Infection with avian influenza was confirmed March 26, and the child was referred to Manshiyet el Bakry Hospital, Cairo. Her mother reported the child had close contact with a dead poultry. She was reported in a good general condition on March 18. The MOHP reported this was the 60th case of highly pathogenic avian influenza in Egypt.
          Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
          Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

          Comment


          • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

            Originally posted by niman View Post
            Here is the problem with an H5N1 source in Beheira for case #61. Reports indicated he lived in Beheira, but developed symptoms while visiting grandparents in Menoufiya. However, those same reports also mention a poultry contact, as well as hospitalization in Menoufiya a day after symptoms, strongly implying that he went to visit his grandparents in Menoufiya, was exposed to poultry in Menoufiya, developed symptoms in Menoufiya, and was hospitalized in Menoufiya.

            However, H5N1 in his next door neighbor in Beheira complicates the story, which is further complicated by the fact that a poultry exposure is NOT mentioned for case #62. If the poultry connection for case #61 was in Beheira, it is VERY likely that the same connection would be cited for case #62, who lived next door to case #61 in Beheira (and case #62 was hospitalized in Beheira).

            It is very difficult to ascertain the epidemiological facts from news reports, some of which are arabic machine translations. The news reports do not mention where # 61 was exposed to sick poultry.

            I think that #61 was exposed to sick poultry in Al Beheira, which is why there was a canvass of his home neighborhood and case # 62 was discovered.

            Given that # 61 and # 62 live next door to each other and became sick only 2 days apart (which would be an extremely short gestation period for H2H transmission between the two), it is most probable that they were exposed to a common contagion (poultry, human, other?).

            Comment


            • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

              Originally posted by Florida1 View Post
              It is very difficult to ascertain the epidemiological facts from news reports, some of which are arabic machine translations. The news reports do not mention where # 61 was exposed to sick poultry.

              I think that #61 was exposed to sick poultry in Al Beheira, which is why there was a canvass of his home neighborhood and case # 62 was discovered.

              Given that # 61 and # 62 live next door to each other and became sick only 2 days apart (which would be an extremely short gestation period for H2H transmission between the two), it is most probable that they were exposed to a common contagion (poultry, human, other?).
              Nonsense. A two day gap is sufficient for H2H (disease onset is commonly 2-4 days after exposure), but the two day onset gap is also suspect because of the difficulty in matching dates involving exposure date, grandparent visit dates, and disease onset dates, if infection originated in Beheira.

              Moreover, the official update (in ENGLISH) has skipped cases 61 and 62 (the Beheira cluster).

              http://www.saidr.org/en/humans.php

              Comment


              • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

                "...Limited data on the incubation period suggest that illness onset occurs <7 days after the last exposure to sick or dead poultry.

                For clusters in which limited human-to-human virus transmission likely occurred, the incubation period appeared to be 3–5 days but was estimated to be 8–9 days in 1 cluster..."


                Incubation Period for Human Cases of Avian Influenza A (H5N1) Infection, China

                Yang Huai, Nijuan Xiang, Lei Zhou, Luzhao Feng, Zhibin Peng, Robert S. Chapman, Timothy M. Uyeki, and Hongjie Yu

                Author affiliations: Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China (Y. Huai, N. Xiang, L. Zhou, L. Feng, Z. Peng, H. Yu); Chulalongkorn University, Bangkok, Thailand (Y. Huai, R.S. Chapman); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (T.M. Uyeki)


                http://www.flutrackers.com/forum/sho...d.php?p=210382

                Comment


                • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

                  Originally posted by Florida1 View Post
                  "...Limited data on the incubation period suggest that illness onset occurs <7 days after the last exposure to sick or dead poultry.

                  For clusters in which limited human-to-human virus transmission likely occurred, the incubation period appeared to be 3–5 days but was estimated to be 8–9 days in 1 cluster..."


                  Incubation Period for Human Cases of Avian Influenza A (H5N1) Infection, China

                  Yang Huai, Nijuan Xiang, Lei Zhou, Luzhao Feng, Zhibin Peng, Robert S. Chapman, Timothy M. Uyeki, and Hongjie Yu

                  Author affiliations: Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China (Y. Huai, N. Xiang, L. Zhou, L. Feng, Z. Peng, H. Yu); Chulalongkorn University, Bangkok, Thailand (Y. Huai, R.S. Chapman); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (T.M. Uyeki)


                  http://www.flutrackers.com/forum/sho...d.php?p=210382
                  Please. The incubation period is usually 2-4 day (which WHO admitted when pressed by Donald McNeil of NY Times with regard to the Karo cluster).

                  The Egyptian site has just added the Beheira cluster and the gap in disease onset dates is now FIVE days. March 27 for case #61 and April 1 for case #62.

                  Comment


                  • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+
                    • RECENT CASES:
                    • Date of report: 5 April 2009
                    • Governorate: Qalioubiya
                    • District: Shoubra el Kheima
                    • Event summary: Boy, age 6, began experiencing symptoms March 22. He was admitted to Ain Shams University hospital March 28 and received Tamiflu on April 3. Infection with avian influenza was confirmed April 5. He was reported in a critical condition under artificial ventilation on April 6. The MOHP reported this was the 63rd case of highly pathogenic avian influenza in Egypt.
                    • Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
                      Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

                    • ---------------------------------------
                    • Date of report: 2 April 2009
                    • Governorate: Beheira
                    • District: Kom Hamada
                    • Event summary: Boy, age 2, began experiencing fever, cough and runny nose on March 31. He was admitted to Damanhour Fever Hospital on April 1 and received Tamiflu the same day. Infection with avian influenza was confirmed April 2. He reported contact with a dead or sick poultry. He was reported in good general condition on April 6. The MOHP reported this was the 62rd case of highly pathogenic avian influenza in Egypt.
                    • Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
                      Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

                    • ---------------------------------------
                    • Date of report: 1 April 2009
                    • Governorate: Beheira
                    • District: Kom Hamada
                    • Event summary: Boy, age 2, began experiencing fever and cough symptoms on March 27. He was admitted to Naaora Fever Hospital on March 30 and received Tamiflu the same day. Infection with avian influenza was confirmed April 1. He was reported contact with dead and sick poultry. He was reported in good general condition on April 6. The MOHP reported this was the 61st case of highly pathogenic avian influenza in Egypt.
                    • Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
                      Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

                    • ---------------------------------------
                    • Date of report: 26 March 2009
                    • Governorate: Qena
                    • District: Qena
                    • Event summary: Girl age 2?, began experiencing symptoms March 23. She was admitted to Qena Fever Hospital March 24 and received Tamiflu the same day. Infection with avian influenza was confirmed March 26, and the child was referred to Manshiyet el Bakry Hospital, Cairo. Her mother reported the child had close contact with a dead poultry. She was reported in a good general condition on March 18. The MOHP reported this was the 60th case of highly pathogenic avian influenza in Egypt.
                    • Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
                      Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

                    Comment


                    • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

                      The above update leaves out the visit to the grandparents in Menoufiya, but leaves in the hospital in Menoufiya

                      Zawit El-Naaora Hospital


                      <!--FULL NO-FRAME : fin zone fixe du haut--> <!--FULL NO-FRAME : debut zone milieu--> <script type="text/javascript"> init();// permet d'ajuster la hauteur de la div kicontent par rapport au haut de page </script> <dl id="toprint"><dt> </dt><dd>Zawit El-Naaora Hospital

                      </dd></dl> <table style="border-collapse: collapse;"> <tbody> <tr> <td class="case" style="border: 1px solid lightgrey; padding: 10px;"> El-Moukaf El-Aam, Zawit El-Naaora
                      El-Shohadaa,Menoufeya, Menoufeya
                      Egypt
                      Phone : ‎+20 48 2772314
                      Fax : ‎+20 48 2772314(Tel & Fax)
                      <table class="tabfinance"><tbody></tbody></table> </td> </tr> </tbody> </table>

                      Comment


                      • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

                        Originally posted by niman View Post

                        • ---------------------------------------
                        • Date of report: 2 April 2009
                        • Governorate: Beheira
                        • District: Kom Hamada
                        • Event summary: Boy, age 2, began experiencing fever, cough and runny nose on March 31. He was admitted to Damanhour Fever Hospital on April 1 and received Tamiflu the same day. Infection with avian influenza was confirmed April 2. He reported contact with a dead or sick poultry. He was reported in good general condition on April 6. The MOHP reported this was the 62rd case of highly pathogenic avian influenza in Egypt.
                        • Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
                          Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

                        • ---------------------------------------
                        • Date of report: 1 April 2009
                        • Governorate: Beheira
                        • District: Kom Hamada
                        • Event summary: Boy, age 2, began experiencing fever and cough symptoms on March 27. He was admitted to Naaora Fever Hospital on March 30 and received Tamiflu the same day. Infection with avian influenza was confirmed April 1. He was reported contact with dead and sick poultry. He was reported in good general condition on April 6. The MOHP reported this was the 61st case of highly pathogenic avian influenza in Egypt.
                        • Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
                          Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP
                        The above update places both cases in the same district (Kom Hamada), supporting media reports that they were next door neighbors (who developed symptoms FIVE days apart as indicated in the update above).

                        Comment


                        • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

                          Originally posted by niman View Post
                          The above update places both cases in the same district (Kom Hamada), supporting media reports that they were next door neighbors (who developed symptoms FOUR days apart as indicated in the update above).
                          Updated map

                          http://maps.google.com/maps/ms?ie=UT...540833&t=p&z=9

                          Comment


                          • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

                            Commentary

                            http://www.recombinomics.com/News/04...heira_H2H.html

                            Comment


                            • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

                              I'll add my comment on the discussion of the source of infection for the two kids in Beheira. These children are very very young, that is why they are called toddlers. What we can not determine from translated news articles is whether they are doing more toddling with sick neighbor kids or more toddling with sick chickens. So is it human to human transmission or multiple cases of animal to human infection? I am not willing to guess.
                              http://novel-infectious-diseases.blogspot.com/

                              Comment


                              • Re: Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009+

                                Originally posted by Laidback Al View Post
                                I'll add my comment on the discussion of the source of infection for the two kids in Beheira. These children are very very young, that is why they are called toddlers. What we can not determine from translated news articles is whether they are doing more toddling with sick neighbor kids or more toddling with sick chickens. So is it human to human transmission or multiple cases of animal to human infection? I am not willing to guess.
                                The actual mechanism of infection is really not relevant. The bottom line is 12 confirmed cases in 3 months in the entire country. The chance of 2 confirmed cases happening at adjacent locations four days apart, when the frequency is so low, is VERY close to ZERO (no guessing required - this is VERY simple math).

                                Comment

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