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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 Florida1 View Post
    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.
    Please. The "coincidence" argument got VERY old several years ago. 4 day gap in neighbors with confirmed H5N1 is H2H (untested poultry not withstanding).
    A four day gap is PROOF (handwaving about some imaginary proof notwithstanding).

    Comment


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

      A quick review of H2H is in order. H5N1 infections of humans are quite rare, so when two people get infected and are very close in space and time, they are almost always connected. The connections can be from exposure to a common source, or the connection can be one infected the other (H2H).

      The only real PROOF that distinguishes the two possibilities is disease onset date. If infected by a common source, the disease onset date will be almost identical (same day or 1-2 days apart, because incubation times are generally 2-4 days). However, if one infects the other, there is usually a larger gap because the patient doing the infecting usually already has symptoms, so the patient infected trails by several days.

      These gaps are quite common in H5N1 clusters, because most are H2H. Many of these clusters have been written up in peer reviewed journals, and the PROOF is the time gap, such as the 4 days in the Beheira cluster.

      Occasionally there are also examples of H2H2H, which are more difficult to deny because of multiple time gaps, but there really isn't much difference in H5N1's that cause H2H or H2H2H. Its just a matter of opportunity.

      H2H clusters are VERY easy to call, demands of PROOF, notwithstanding.

      Comment


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

        A 4 day interval between disease onset dates makes human to human transmission a possibility -

        It is not the defining event.

        Again - H5N1 is endemic in poultry in Egypt. Beheira has a history of H5N1. Many poultry could be getting sick/are sick/dying in the neighborhoods there. H5N1 has been found in feces and feathers.

        What are the chances that some poultry between the 2 neighboring households are getting sick/are sick/dying over a few days time span?

        Comment


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

          Originally posted by Florida1 View Post
          A 4 day interval between disease onset dates makes human to human transmission a possibility -

          It is not the defining event.

          Again - H5N1 is endemic in poultry in Egypt. Beheira has a history of H5N1. Many poultry could be getting sick/are sick/dying in the neighborhoods there. H5N1 has been found in feces and feathers.

          What are the chances that some poultry between the 2 neighboring households are getting sick/are sick/dying over a few days time span?
          Four days IS the defining event (no hocus pocus about upcoming H5N1 positive birds required).

          The confirmed H5N1 poultry cases anywhere near the Beheira cluster remains at ZERO.

          The H5N1 in poultry is MANY orders of magnitude higher than confirmed human cases (minimal math required).

          Comment


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

            What biological tests could deny / confirm h2h?

            Comment


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

              Originally posted by Sally View Post
              What biological tests could deny / confirm h2h?
              None. H2H is confirmed by a gap in disease onset dates PERIOD.

              Comment


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

                Originally posted by Sally View Post
                What biological tests could deny / confirm h2h?
                The difference between common source and H2H is TIME. In both instances the same virus would be involved so the two victims would have the same sequence. If the two sequences were radically different, then an argument could be made for two independent infections. However, that would be an UNcommon source which is uncommon.

                Most of the time the sequences would match, regardless of whether the infections were due to a common source or H2H. However, those infected with a common source have the same disease onset date, while H2H produces a gap.

                Dead poultry means nothing.
                So far no H5N1 positive birds have been reported.
                However, even with H5N1 birds, that doesn't mean the birds were the source of the human infection. At a minimum, the sequences would have to match. However, even with a match, the likelihood of independent infection of two neighbors would be MUCH lower than infection of one, who then infected his neighbor.
                B2H is RARE
                H2H of close contacts is COMMON.

                In addition, contact with poultry in the past included:
                Drinking duck blood soup (no H5N1 infection required)
                Walking past a pond
                Living within X miles from a slaughter house
                Or as has been suggested on this thread, living within 25 miles of a confirmed outbreak!

                Comment


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

                  Originally posted by niman View Post
                  None. H2H is confirmed by a gap in disease onset dates PERIOD.

                  "...H5N1 viruses isolated from the two cases were genetically identical except for one non-synonymous nucleotide substitution.

                  Interpretation


                  Limited, non-sustained person-to-person transmission of H5N1 virus probably occurred in this family cluster...."



                  Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China

                  Hua Wang MD<sup>a</sup><sup>, </sup><sup>?</sup>, Zijian Feng MD<sup>b</sup><sup>, </sup><sup>?</sup>, Yuelong Shu PhD<sup>c</sup><sup>, </sup><sup>?</sup>, Hongjie Yu MD<sup>b</sup><sup>, </sup><sup>?</sup>, Lei Zhou MD<sup>b</sup>, Rongqiang Zu MD<sup>a</sup>, Yang Huai MD<sup>b</sup>, Jie Dong MD<sup>c</sup>, Changjun Bao MD<sup>a</sup>, Leying Wen MD<sup>c</sup>, Hong Wang MD<sup>d</sup>, Peng Yang PhD<sup>b</sup>, Wei Zhao MD<sup>e</sup>, Libo Dong PhD<sup>c</sup>, Minghao Zhou MD<sup>a</sup>, Qiaohong Liao MD<sup>b</sup>, Haitao Yang MD<sup>a</sup>, Min Wang MD<sup>c</sup>, Xiaojun Lu MD<sup>f</sup>, Zhiyang Shi MD<sup>a</sup>, Wei Wang MD<sup>c</sup>, Ling Gu MD<sup>a</sup>, Fengcai Zhu MD<sup>a</sup>, Qun Li MD<sup>b</sup>, Weidong Yin MBA<sup>g</sup>, Weizhong Yang MD<sup>b</sup>, Prof Dexin Li MD<sup>c</sup>, Timothy M Uyeki MD<sup>h</sup> and Prof Yu Wang PhD<sup>b</sup><sup>, </sup><sup></sup><sup>, </sup><sup></sup>
                  <sup>a</sup>Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
                  <sup>b</sup>Office for Disease Control and Emergency Response, Chinese Centre for Disease Control and Prevention (China CDC), Beijing, China
                  <sup>c</sup>State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
                  <sup>d</sup>Jiangsu Provincial People's Hospital, Nanjing, China
                  <sup>e</sup>Nanjing Secondary People's Hospital, Nanjing, China
                  <sup>f</sup>Najing Centre for Disease Control and Prevention, Nanjing, China
                  <sup>g</sup>Sinovac Biotech Co, Beijing, China
                  <sup>h</sup>Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA


                  http://www.flutrackers.com/forum/sho...06&postcount=2

                  Comment


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

                    Originally posted by Florida1 View Post
                    "...H5N1 viruses isolated from the two cases were genetically identical except for one non-synonymous nucleotide substitution.

                    Interpretation

                    Limited, non-sustained person-to-person transmission of H5N1 virus probably occurred in this family cluster...."



                    Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China

                    Hua Wang MD<SUP>a</SUP><SUP>, </SUP><SUP>?</SUP>, Zijian Feng MD<SUP>b</SUP><SUP>, </SUP><SUP>?</SUP>, Yuelong Shu PhD<SUP>c</SUP><SUP>, </SUP><SUP>?</SUP>, Hongjie Yu MD<SUP>b</SUP><SUP>, </SUP><SUP>?</SUP>, Lei Zhou MD<SUP>b</SUP>, Rongqiang Zu MD<SUP>a</SUP>, Yang Huai MD<SUP>b</SUP>, Jie Dong MD<SUP>c</SUP>, Changjun Bao MD<SUP>a</SUP>, Leying Wen MD<SUP>c</SUP>, Hong Wang MD<SUP>d</SUP>, Peng Yang PhD<SUP>b</SUP>, Wei Zhao MD<SUP>e</SUP>, Libo Dong PhD<SUP>c</SUP>, Minghao Zhou MD<SUP>a</SUP>, Qiaohong Liao MD<SUP>b</SUP>, Haitao Yang MD<SUP>a</SUP>, Min Wang MD<SUP>c</SUP>, Xiaojun Lu MD<SUP>f</SUP>, Zhiyang Shi MD<SUP>a</SUP>, Wei Wang MD<SUP>c</SUP>, Ling Gu MD<SUP>a</SUP>, Fengcai Zhu MD<SUP>a</SUP>, Qun Li MD<SUP>b</SUP>, Weidong Yin MBA<SUP>g</SUP>, Weizhong Yang MD<SUP>b</SUP>, Prof Dexin Li MD<SUP>c</SUP>, Timothy M Uyeki MD<SUP>h</SUP> and Prof Yu Wang PhD<SUP>b</SUP><SUP>, </SUP><SUP></SUP><SUP>, </SUP><SUP></SUP>
                    <SUP>a</SUP>Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
                    <SUP>b</SUP>Office for Disease Control and Emergency Response, Chinese Centre for Disease Control and Prevention (China CDC), Beijing, China
                    <SUP>c</SUP>State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
                    <SUP>d</SUP>Jiangsu Provincial People's Hospital, Nanjing, China
                    <SUP>e</SUP>Nanjing Secondary People's Hospital, Nanjing, China
                    <SUP>f</SUP>Najing Centre for Disease Control and Prevention, Nanjing, China
                    <SUP>g</SUP>Sinovac Biotech Co, Beijing, China
                    <SUP>h</SUP>Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA


                    http://www.flutrackers.com/forum/sho...06&postcount=2
                    Please. The time gap between the father and son was about a week.
                    Sequence identity means NOTHING.

                    Comment


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

                      Originally posted by Florida1 View Post
                      "...H5N1 viruses isolated from the two cases were genetically identical except for one non-synonymous nucleotide substitution.

                      Interpretation

                      Limited, non-sustained person-to-person transmission of H5N1 virus probably occurred in this family cluster...."



                      Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China

                      Hua Wang MD<SUP>a</SUP><SUP>, </SUP><SUP></SUP>, Zijian Feng MD<SUP>b</SUP><SUP>, </SUP><SUP></SUP>, Yuelong Shu PhD<SUP>c</SUP><SUP>, </SUP><SUP></SUP>, Hongjie Yu MD<SUP>b</SUP><SUP>, </SUP><SUP></SUP>, Lei Zhou MD<SUP>b</SUP>, Rongqiang Zu MD<SUP>a</SUP>, Yang Huai MD<SUP>b</SUP>, Jie Dong MD<SUP>c</SUP>, Changjun Bao MD<SUP>a</SUP>, Leying Wen MD<SUP>c</SUP>, Hong Wang MD<SUP>d</SUP>, Peng Yang PhD<SUP>b</SUP>, Wei Zhao MD<SUP>e</SUP>, Libo Dong PhD<SUP>c</SUP>, Minghao Zhou MD<SUP>a</SUP>, Qiaohong Liao MD<SUP>b</SUP>, Haitao Yang MD<SUP>a</SUP>, Min Wang MD<SUP>c</SUP>, Xiaojun Lu MD<SUP>f</SUP>, Zhiyang Shi MD<SUP>a</SUP>, Wei Wang MD<SUP>c</SUP>, Ling Gu MD<SUP>a</SUP>, Fengcai Zhu MD<SUP>a</SUP>, Qun Li MD<SUP>b</SUP>, Weidong Yin MBA<SUP>g</SUP>, Weizhong Yang MD<SUP>b</SUP>, Prof Dexin Li MD<SUP>c</SUP>, Timothy M Uyeki MD<SUP>h</SUP> and Prof Yu Wang PhD<SUP>b</SUP><SUP>, </SUP><SUP></SUP><SUP>, </SUP><SUP></SUP>
                      <SUP>a</SUP>Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
                      <SUP>b</SUP>Office for Disease Control and Emergency Response, Chinese Centre for Disease Control and Prevention (China CDC), Beijing, China
                      <SUP>c</SUP>State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
                      <SUP>d</SUP>Jiangsu Provincial People's Hospital, Nanjing, China
                      <SUP>e</SUP>Nanjing Secondary People's Hospital, Nanjing, China
                      <SUP>f</SUP>Najing Centre for Disease Control and Prevention, Nanjing, China
                      <SUP>g</SUP>Sinovac Biotech Co, Beijing, China
                      <SUP>h</SUP>Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA


                      http://www.flutrackers.com/forum/sho...06&postcount=2
                      As noted on Dec 8, 2007

                      http://www.recombinomics.com/News/12...angsu_H2H.html

                      Likely Human to Human H5N1 Transmission in Jiangsu China

                      Recombinomics Commentary
                      December 8, 2007

                      Joanna Brent, a Beijing-based WHO spokeswoman, said the father began presenting symptoms on Monday and was confirmed as having the virus on Wednesday. She said he was being monitored in hospital.

                      'Because the possibility of human to human transmission cannot be ruled out, we will be monitoring this case closely,' Brent told reporters.

                      'If it is found to be easily passed between humans, we would be concerned,' Ms Brent said.

                      Ms Brent said there was no evidence that the man had been infected by his 24-year-old son, who died on Dec 2, but said the possibility could not yet be eliminated.

                      Ms Brent said it was also possible that both men were infected by the same bird, or that they were infected separately from different sources.


                      The above comments by WHO offer multiple possibilities for transmission within the Jiangsu cluster, but the transmission is likely to be human-to-human because the son infected his father.

                      H5N1 clusters give rise to two main possibilities, infection from a common source or human-to-human transmission. These two possibilities are largely decided by the disease onset dates. Since confirmed H5N1 human cases are very rare, it is likely that two infections within one household are linked.

                      If a common source (bird or human) is involved, both family members will develop symptoms at a similar time. If the index case infects the family member, there will be a gap in the disease onset dates. In this cluster, the son developed symptoms on November 24, while the father developed symptoms on December 3. This gap would make human-to-human transmission likely.

                      This likelihood is increased because the index case has no known contact with infected poultry, decreasing the likelihood that the father and son were infected by a common source.

                      This cluster has attracted significant attention in the popular press, in part because of the gap in disease onset dates. However, there are additional reports in the
                      Chinese press indicating the father died on Thursday and the mother and girlfriend of the index case have symptoms. If H5N1 confirmed, the likelihood of human-to-human transmission would increase markedly.

                      Comment


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

                        Originally posted by Florida1 View Post
                        "...H5N1 viruses isolated from the two cases were genetically identical except for one non-synonymous nucleotide substitution.

                        Interpretation

                        Limited, non-sustained person-to-person transmission of H5N1 virus probably occurred in this family cluster...."



                        Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China

                        Hua Wang MD<SUP>a</SUP><SUP>, </SUP><SUP></SUP>, Zijian Feng MD<SUP>b</SUP><SUP>, </SUP><SUP></SUP>, Yuelong Shu PhD<SUP>c</SUP><SUP>, </SUP><SUP></SUP>, Hongjie Yu MD<SUP>b</SUP><SUP>, </SUP><SUP></SUP>, Lei Zhou MD<SUP>b</SUP>, Rongqiang Zu MD<SUP>a</SUP>, Yang Huai MD<SUP>b</SUP>, Jie Dong MD<SUP>c</SUP>, Changjun Bao MD<SUP>a</SUP>, Leying Wen MD<SUP>c</SUP>, Hong Wang MD<SUP>d</SUP>, Peng Yang PhD<SUP>b</SUP>, Wei Zhao MD<SUP>e</SUP>, Libo Dong PhD<SUP>c</SUP>, Minghao Zhou MD<SUP>a</SUP>, Qiaohong Liao MD<SUP>b</SUP>, Haitao Yang MD<SUP>a</SUP>, Min Wang MD<SUP>c</SUP>, Xiaojun Lu MD<SUP>f</SUP>, Zhiyang Shi MD<SUP>a</SUP>, Wei Wang MD<SUP>c</SUP>, Ling Gu MD<SUP>a</SUP>, Fengcai Zhu MD<SUP>a</SUP>, Qun Li MD<SUP>b</SUP>, Weidong Yin MBA<SUP>g</SUP>, Weizhong Yang MD<SUP>b</SUP>, Prof Dexin Li MD<SUP>c</SUP>, Timothy M Uyeki MD<SUP>h</SUP> and Prof Yu Wang PhD<SUP>b</SUP><SUP>, </SUP><SUP></SUP><SUP>, </SUP><SUP></SUP>
                        <SUP>a</SUP>Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
                        <SUP>b</SUP>Office for Disease Control and Emergency Response, Chinese Centre for Disease Control and Prevention (China CDC), Beijing, China
                        <SUP>c</SUP>State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
                        <SUP>d</SUP>Jiangsu Provincial People's Hospital, Nanjing, China
                        <SUP>e</SUP>Nanjing Secondary People's Hospital, Nanjing, China
                        <SUP>f</SUP>Najing Centre for Disease Control and Prevention, Nanjing, China
                        <SUP>g</SUP>Sinovac Biotech Co, Beijing, China
                        <SUP>h</SUP>Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA


                        http://www.flutrackers.com/forum/sho...06&postcount=2
                        So how does an identical sequence eliminate infection by the same bird, as WHO suggested?

                        You are posting NONSENSE.
                        The silly statement by WHO was silly because the TIME GAP in DISEASE ONSET dates was NINE DAYS! It had NOTHING to do with the sequences.

                        Comment


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

                          Originally posted by Sally View Post
                          What biological tests could deny / confirm h2h?
                          The issue of common source or H2H is not a new issue. It is not specific to H5N1.

                          However, it has continued for YEARS (after cluster after cluster has a significant time gap in disease onset dates), because of utter nonsense put out by the WHO (as show by statements made on the Jiangsu cluster where the disease onset dates were separated by 9 days) to an audience that doesn't have a background in science (or in some cases logic), and repeated again and again by its audience (supported by selective copy and pastes).

                          Common source and H2H are distinugished by disease onset dates PERIOD. No hocus pocus or sequences required.

                          Comment


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

                            Originally posted by niman View Post
                            Common source and H2H are distinugished by disease onset dates PERIOD. No hocus pocus or sequences required.
                            Despite the stepped onset dates both cases could have a common poultry source. There are many poultry out breaks in that province.

                            Comment


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

                              "...In this cluster, the son developed symptoms on November 24, while the father developed symptoms on December 3. This gap would make human-to-human transmission likely..."

                              Agreed since the original story was that the father and son were exposed to H5N1 infected chicken at a restaurant on the same day but had disease onset dates that were 9 days apart.

                              Comment


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

                                Originally posted by Florida1 View Post
                                "...In this cluster, the son developed symptoms on November 24, while the father developed symptoms on December 3. This gap would make human-to-human transmission likely..."

                                Agreed since the original story was that the father and son were exposed to H5N1 infected chicken at a restaurant on the same day but had disease onset dates that were 9 days apart.
                                So what role does a sequence have? If the infection was at the restaurant (common source) the sequences would match. If the infection was from son to father (H2H), the sequences would match.

                                It was OBVIOUS H2H (nonsense statements by the WHO notwithstanding) because of the TIME GAP, and the sequence would match regardless of mechanism of transmission.

                                Comment

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