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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+

    Originally posted by niman View Post
    Updated map with the 7 outbreaks in Beihera since March 1. None of these are close to the human cluster

    http://maps.google.com/maps/ms?ie=UT...1,1.521606&z=9
    Updated map with ALL reported poultry outbreaks (listed at SAIDR site) this season (beginning fall of 2008) and there are ZERO outbreaks near the Beheira cluster

    http://maps.google.com/maps/ms?ie=UT...3,2.971802&z=8

    Comment


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

      Originally posted by niman View Post
      Updated map with ALL reported poultry outbreaks (listed at SAIDR site) this season (beginning fall of 2008) and there are ZERO outbreaks near the Beheira cluster

      http://maps.google.com/maps/ms?ie=UT...3,2.971802&z=8

      The latest updates say that each toddler had exposure to dead or sick poultry.

      H5N1 is endemic in Egypt. The government has instituted strict controls. It is not possible to transport poultry between provinces without permits. There are still families who maintain poultry even though this has been discouraged.

      It is quite possible that all outbreaks of H5N1 are not accounted for since they are so numerous.

      Comment


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

        Originally posted by Florida1 View Post
        The latest updates say that each toddler had exposure to dead or sick poultry.

        H5N1 is endemic in Egypt. The government has instituted strict controls. It is not possible to transport poultry between provinces without permits. There are still families who maintain poultry even though this has been discouraged.

        It is quite possible that all outbreaks of H5N1 are not accounted for since they are so numerous.
        Yes, there is little doubt that all H5N1 poultry outbreaks in Egypt are not reported or confirmed (there are also no confirmed poultry outbreaks in Qena, the location of case #60 and a large number of suspect cases),

        http://maps.google.com/maps/ms?ie=UT...,13.513184&z=6

        but there is no detail on the "dead or sick poultry" and as noted earlier, the liklihood that two toddlers living next door to each other would be independently infected over a four day period is REMOTE, at best.

        Comment


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

          American medical institutions warning of the danger of the silent spread of avian flu in Egypt







          <!-- Capture -->
          صورة ارشيفية لفريق مكافحة انفلونزا الطيور فى مصر - رويترز

          Archival image of the anti-bird flu in Egypt - Reuters <!-- Capture -->




          4/7/2009 2:56:00 PM
          4/7/2009 2:56:00 PM

          واشنطن – محرر مصراوى - حذرت مؤسسة أبحاث طبية أمريكية من أن الحالات التي ظهرت مؤخرا من الإصابة بأنفلونزا الطيور في مصر، تثير القلق من تحول جديد في نمط انتشار المرض بين قطاعات عمرية وجغرافية مختلفة عن موجة اندلاع المرض السابقة في 2007.
          WASHINGTON - Editor Masrawy - The Foundation of the American medical research that recent cases of bird flu infection in Egypt, concern about the new shift in the pattern of spread of the disease between the age and geographical segments is different from the previous wave of the outbreak of the disease in 2007.

          وقال تقرير لمؤسسة ومعمل ريكوميبنوميكس الطبي الأمريكي إن حالتي الإصابة التي ظهرت على طفلين بمحافظة البحيرة في مصر مؤخرا تثير القلق من "انتشار صامت" لمرض انفلونزا الطيور بعد عامين من موجة الإصابة التي اندلعت في 2007.
          The report of the Foundation and the American Medical Laboratory Rekoumibnumiks The cases of infection, which appeared on the children in Beheira in Egypt has recently raised concern of the "silent spread of" bird flu, two years after the wave of infection which broke out in 2007.

          وحذر التقرير، الذي صدر السبت 4 أبريل، إلى أن هذا العام يشهد زيادة في عدد حالات الإصابة بالفيروس حيث تم الإبلاغ عن إصابة 11 شخص بالفيروس، من بينهم 10 حالات بين الأطفال، دون حدوث وفيات بينهم.
          The report warned, issued Saturday, April 4, that this year sees an increase in the number of cases of HIV were reported 11 people with HIV infection, including 10 cases among children, but no deaths among them.

          وأشارت المؤسسة الأمريكية، ومقرها بولاية كاليفورنيا، إلى أن هذا يشبه ما حدث في ربيع 2007، حيث كان هناك ارتفاع في الإصابات متوسطة الخطورة، لكنها رصدت تحولا في القطاعات التي حدثت بها الإصابة هذا العام.
          She Foundation of America, based in California, that this is like what happened in the spring of 2007, as there was a rise in the medium-risk injuries, but made a shift in the sectors in which the injury occurred this year.

          ففي حين كانت أغلب الإصابات في 2007 تحدث بين الفتيات وصغار البالغين، لكنها هذا العام تنتشر بين صغار الأطفال، حيث كان أغلب الأطفال تتراوح أعمارهم بين 3 إلى 10 سنوات.
          While the majority of injuries occurring in 2007 among girls and young adults, but this year, spread among young children, where the majority of children between the ages of 3 to 10 years.

          وفي حين كانت أغلب الإصابات في السابق في وسط وصعيد مصر ومعظم الحالات الحرجة تقع في شمال مصر، تم رصد الإصابات هذا العام في جميع أنحاء البلاد، بحسب المؤسسة الأمريكية.
          While the majority of injuries in the past in Central and Upper Egypt, and most critical situations occur in the north of Egypt, has been monitoring the cases this year in all parts of the country, according to the American Foundation.

          المصدر: وكالة أنباء أمريكا إن أرابيك.
          Source: The American News Agency Arabic.


          Last edited by AlaskaDenise; April 18, 2009, 02:17 AM. Reason: remove photo

          Comment


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

            Commentary

            http://www.recombinomics.com/News/04...heira_T2T.html

            Comment


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

              WHO lag in updates in Indonesia now extending to Egypt

              http://www.who.int/csr/disease/avian.../en/index.html

              Comment


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

                Locations of human cases updated with SAIDR detail. Most cases are quite close to poultry outbreaks. The exceptions are Beheira cluster and Qena

                http://maps.google.com/maps/ms?ie=UT...801514&t=p&z=8

                Comment


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

                  Commentary

                  Toddler to Toddler H5N1 Transmission in Beheira Egypt

                  Recombinomics Commentary 18:29
                  April 7, 2009

                  Boy, age 2, began experiencing fever and cough symptoms on March 27.
                  Boy, age 2, began experiencing fever, cough and runny nose on March 31.

                  The above comments describe the two most recently H5N1 confirmed toddlers in Egypt. These two cases were next door neighbors in the Kom Hamada district of Beheira and represent toddler to toddler transmission of H5N1. This cluster follows a spate of toddler cases in Egypt this year. 10 of the 12 confirmed cases have been toddlers and 9 of the 10 toddler cases have been mild. Both patients above are described as being in "good general condition" and will likely be discharged soon. None of the H5N1 cases this year in Egypt have died, which is similar to the mild cases of H5N1 in Egypt in the spring of 2007. However, unlike earlier cases, which included 6 toddlers over a three year period, the percentage of toddler cases has dramatically increased in 2009.

                  Although the two cases above are said to have had contact with dead or sick poultry, the confirmation of neighboring cases who developed symptoms four days apart is unlikely to be due to two independent poultry infections. There have been no confirmed poultry cases in the Kom Hamada area. Since March 1 there were 24 confirmed H5N1 poultry outbreaks in Egypt, and although 7 were in Beheira, these outbreaks were well to the north and not near the toddler cluster (see updated map). Over 60 outbreaks have been confirmed this season, and none were close to Kom Hamada. Similarly, the toddler case preceding the cluster was in Qena, and there have been no confirmed poultry outbreaks in Qena this season (see updated map).

                  Although there are clearly more H5N1 outbreaks than those confirmed, the targeting of toddlers raises concerns that old age groups have developed protective immunity, signaling a significant silent spread of H5N1 in Egypt. Over 6000 patients with poultry links have been hospitalized, but less than 1% have tested positive. However, it remains unclear if the low confirmation rate is due to an aggressive testing program, or a lack of sensitivity in the testing.

                  Confirmed H5N1 clusters have been rare in Egypt have been rare. The largest was the Ghabiya cluster at the end of 2006, but the prior clusters were among relatives and did not have the gap in disease onset dates. The Beheira cluster has the classical gap and there has been no indication that the two toddlers were related. Although it is likely that mild H5N1 has was transmitted human to human, based on the sequence identity between isolates from unrelated cases, the current cluster has the time and space signature associated with human to human transmission.

                  Sequences from this cluster, as well as testing of toddlers that have symptoms but lack a poultry link would be useful.


                  .
                  "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

                  Comment


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

                    Commentary

                    Lack of Confirmed H5N1 Poultry Linkage To Egyptian Cases

                    Recombinomics Commentary 21:09
                    April 6, 2009

                    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

                    The above comments describe the most recent confirmed H5N1 case in Egypt. Unlike earlier cases, there is no mention of contact with poultry. The lack of contact is not surprising because of the gap between the admission and confirmation dates. The above detail confirms that treatment was also delayed, which was almost certainly linked to an absence of a poultry contact. In Egypt, over 6000 patients have been hospitalized as suspect H5N1 patients. These cases generally have a poultry link and treatment with Tamiflu is begun prior to receipt of test results. The gap between the admission date of March 28 and treatment date of April 3, strongly suggests that these is no reported link to poultry for this case.

                    This case follows a spike in confirmed H5N1 in toddlers. The two prior cases were neighbors who lived in Beheira. The 4 day time gap between onset dates strongly suggests that there was toddler to toddler transmission, although both cases have a poultry link. However, the website that describes the patients contains a significant amount of detail, including the district for the two patients, which was Kom Hamada.

                    The site also details confirmed H5N1 outbreaks in poultry and although there have been 24 outbreaks since March 1, including 7 outbreaks in Beheira, none of the outbreaks were in Kom Hamada, indicating that the Beheira cluster is not linked to H5N1 confirmed poultry. The presence of confirmed H5N1 in the Beheira governorate, but not the Kom Hamada district, raises concerns that the toddlers were not infected by poultry, especially the second case, who was a neighbor of the first case.

                    The absence of a confirmed H5N1 in the most recent cases in Egypt adds to concerns that the number of mild H5N1 cases is markedly higher than then number of confirmed cases, and like the Beheira cluster, there is human to human transmission that is silently spreading.

                    More aggressive testing of symptomatic toddlers that lack a poultry contact is warranted.


                    .
                    "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

                    Comment


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

                      Originally posted by niman View Post
                      WHO lag in updates in Indonesia now extending to Egypt

                      http://www.who.int/csr/disease/avian.../en/index.html
                      Indonesia has publicly stated that they will only be reporting human cases every 3-6 months. Egypt, however, has always had timely reporting. The last WHO update for Egypt was on March 30th for the 2.5 year old girl from Qena Governorate. The update noted that she was confirmed on March 26th. News reports on the girl appeared about the 26th or 27th with a WHO update within 4 days of the announcement of the confirmation.

                      What do think is delaying WHO from providing timely updates from Egypt?
                      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
                        Indonesia has publicly stated that they will only be reporting human cases every 3-6 months. Egypt, however, has always had timely reporting. The last WHO update for Egypt was on March 30th for the 2.5 year old girl from Qena Governorate. The update noted that she was confirmed on March 26th. News reports on the girl appeared about the 26th or 27th with a WHO update within 4 days of the announcement of the confirmation.

                        What do think is delaying WHO from providing timely updates from Egypt?
                        I was just about to write a commentary. I think they are having problems with a lack of a poultry source as well as the toddler to toddler situation in Beheira. WHO updates are factually correct, but generally nuanced when H2H is involved or a poultry source is missing (and writing nuanced updates takes longer).

                        The SAIDR site is really a government site, with quotes from the MOPH, so the three most recent cases are confirmed, and the Beheira cluster has been confirmed for almost a week.

                        I think Qena (their last update) may also be a problem because there is no confirmed poultry outbreak. The vet lab appears to be chasing the human cases and reporting positive poultry in the area (usually right after the human case is confirmed). However, SAIDR has no such poultry positives listed yet for Qena or Beheira (and the most recent case (6M) almost certainly had no know link when the patient was admitted - although it remains unclear why they finally tested for H5N1 - but sometimes the testing is based on the failure of the patient to improve).

                        Comment


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

                          Originally posted by Laidback Al View Post
                          Indonesia has publicly stated that they will only be reporting human cases every 3-6 months. Egypt, however, has always had timely reporting. The last WHO update for Egypt was on March 30th for the 2.5 year old girl from Qena Governorate. The update noted that she was confirmed on March 26th. News reports on the girl appeared about the 26th or 27th with a WHO update within 4 days of the announcement of the confirmation.

                          What do think is delaying WHO from providing timely updates from Egypt?
                          Qena is also the last update from the WHO Mediterranean branch also.

                          http://www.emro.who.int/index.asp

                          Comment


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

                            Niman,
                            Is this a result of your commentary?:
                            The report of the Foundation and the American Medical Laboratory Rekoumibnumiks The cases of infection, which appeared on the children in Beheira in Egypt has recently raised concern of the "silent spread of" bird flu, two years after the wave of infection which broke out in 2007.
                            The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

                            Comment


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

                              Originally posted by mixin View Post
                              Niman,
                              Is this a result of your commentary?:
                              I thought that the comments here

                              http://www.flutrackers.com/forum/sho...&postcount=259

                              sounded much like a recent commentary, but I have not been contacted by any such agencies / media.

                              Comment


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

                                There is no proof that any of the recent cases in Egypt are the result of human to human transmission.

                                Poultry sources were cited for cases # 61 and # 62.

                                This kind of speculation is not productive.

                                Comment

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