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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 ironorehopper View Post
    WHO | Avian influenza - situation in Egypt - update 10
    Avian influenza - situation in Egypt - update 10

    8 April 2009 --

    The Ministry of Health of Egypt has reported 3 new confirmed human cases of avian influenza.




    Close contacts of both boys have been identified and none has shown symptoms of the infection .


    -
    <cite cite="http://www.who.int/csr/don/2009_04_08a/en/index.html">WHO | Avian influenza - situation in Egypt - update 10</cite>
    The two cases are CONFIRMED and COUSINS. WHO is clearly in DENIAL over H2H (or T2T).

    Comment


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

      [A more cautious approach in Egypt epidemiological situation evaluation is needed at FT and elsewhere I think. See CP commentary below (Sic) IOH.]


      AVIAN INFLUENZA, HUMAN (71): EGYPT, VIET NAM, WHO
      *************************************************
      A ProMED-mail post
      <http://www.promedmail.org>
      ProMED-mail is a program of the
      International Society for Infectious Diseases
      <http://www.isid.org>

      In this update:
      [1] Egypt - cases 61, 62 & 63, WHO confirmed
      [2] Viet Nam - 55th fatality, WHO confirmed

      ******
      [1] Egypt - cases 61, 62 & 63, WHO confirmed
      Date: Wed 8 Apr 2009
      Source: World Health Organization (WHO), EPR, Disease Outbreak News [edited]
      <http://www.who.int/csr/don/2009_04_08a/en/index.html>


      Avian influenza situation in Egypt - WHO Update 10
      --------------------------------------------------
      The Ministry of Health of Egypt has reported 3 new confirmed human
      cases of avian influenza.

      The 1st case is a 2-year-old boy from Kom Hamada District, El Behira
      governorate. He developed symptoms on 27 Mar 2009 and was admitted to
      Naaora Fever Hospital on the 30 Mar 2009, where he was started on
      oseltamivir the same day. He remains in a stable condition.

      The 2nd case is also a 2-year-old boy from the same district and was
      detected through the investigation around the above-mentioned case.
      He developed symptoms on 31 Mar 2009 and was admitted to Damanhor
      Fever Hospital on 1 Apr 2009, where he was started on oseltamivir the
      same day. He remains in a stable condition.

      Both boys had contact with sick/dead poultry prior to illness onset.
      Close contacts of both boys have been identified, and none have shown
      symptoms of the infection.

      The 3rd case is a 6-year-old boy from Shubra El Khema District,
      Qaliobia [Al Qalyubiyah] governorate. He developed symptoms on 22 Mar
      2009 and was admitted to Ain Shams University Hospital on 28 Mar 2009,
      where he was started on oseltamivir on 3 Apr 2009. He was exposed to
      sick/dead poultry prior to illness onset. He is in a critical condition.

      For all of the 3 cases reported above, infection with H5N1 avian
      influenza virus was tested positive by the Egyptian Central Public
      Health Laboratory and subsequently confirmed by the U.S. Naval
      Medical Research Unit No. 3 (NAMRU-3). Of the 63 cases confirmed to
      date in Egypt, 23 have been fatal.

      --
      Communicated by:
      ProMED-mail Rapporteur Marianne Hopp

      ******
      [2] Viet Nam - 55th fatality, WHO confirmed
      Date: Wed 8 Apr 2009
      Source: World Health Organization (WHO), EPR, Disease Outbreak News [edited]
      <http://www.who.int/csr/don/2009_04_08/en/index.html>


      Avian influenza situation in Viet Nam - WHO Update 5
      ----------------------------------------------------
      As of 8 Apr 2009, The Ministry of Health in Viet Nam has reported a
      new confirmed case of human infection with the H5N1 avian influenza
      virus. The case has been confirmed at the National Institute of
      Hygiene and Epidemiology (NIHE).

      The case is a 3-year-old boy from Chau Thanh District, Dong Thap
      Province. He developed symptoms on 12 Mar 2009, was hospitalized on
      13 Mar 2009, and died on 19 Mar 2009. Investigations into the source
      of infection indicated a history of close contact with sick and dead
      poultry prior to the onset of symptoms.

      Of the 110 cases confirmed to date in Viet Nam, 55 have been fatal.

      --
      Communicated by:
      ProMED-mail Rapporteur Marianne Hopp

      [All these WHO-confirmed cases of human avian H5N1 influenza virus
      infection have been children 6 years of age or younger. Since the
      resurgence of human cases of avian influenza in Egypt at the end of
      2008, 12 of the 13 cases have been children 6 years of age or under,
      and all have had exposure to diseased or dead poultry. No onward
      transmission of infection to family members has occurred.

      The locations of the 13 most recent Egyptian cases can be viewed in
      the map accompanying the text of the document at:
      <http://www.saidr.org/en/humans.php#050409>.
      - Mod.CP]
      -
      http://apex.oracle.com/pls/otn/f?p=2..._ID:1000,76964
      -----

      </pre>

      Comment


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

        Originally posted by ironorehopper View Post
        [A more cautious approach in Egypt epidemiological situation evaluation is needed at FT and elsewhere I think. See CP commentary below (Sic) IOH.]


        AVIAN INFLUENZA, HUMAN (71): EGYPT, VIET NAM, WHO
        *************************************************
        A ProMED-mail post
        <http://www.promedmail.org>
        ProMED-mail is a program of the
        International Society for Infectious Diseases
        <http://www.isid.org>

        In this update:
        [1] Egypt - cases 61, 62 & 63, WHO confirmed
        [2] Viet Nam - 55th fatality, WHO confirmed

        ******
        [1] Egypt - cases 61, 62 & 63, WHO confirmed
        Date: Wed 8 Apr 2009
        Source: World Health Organization (WHO), EPR, Disease Outbreak News [edited]
        <http://www.who.int/csr/don/2009_04_08a/en/index.html>


        Avian influenza situation in Egypt - WHO Update 10
        --------------------------------------------------
        The Ministry of Health of Egypt has reported 3 new confirmed human
        cases of avian influenza.

        The 1st case is a 2-year-old boy from Kom Hamada District, El Behira
        governorate. He developed symptoms on 27 Mar 2009 and was admitted to
        Naaora Fever Hospital on the 30 Mar 2009, where he was started on
        oseltamivir the same day. He remains in a stable condition.

        The 2nd case is also a 2-year-old boy from the same district and was
        detected through the investigation around the above-mentioned case.
        He developed symptoms on 31 Mar 2009 and was admitted to Damanhor
        Fever Hospital on 1 Apr 2009, where he was started on oseltamivir the
        same day. He remains in a stable condition.

        Both boys had contact with sick/dead poultry prior to illness onset.
        Close contacts of both boys have been identified, and none have shown
        symptoms of the infection.

        The 3rd case is a 6-year-old boy from Shubra El Khema District,
        Qaliobia [Al Qalyubiyah] governorate. He developed symptoms on 22 Mar
        2009 and was admitted to Ain Shams University Hospital on 28 Mar 2009,
        where he was started on oseltamivir on 3 Apr 2009. He was exposed to
        sick/dead poultry prior to illness onset. He is in a critical condition.

        For all of the 3 cases reported above, infection with H5N1 avian
        influenza virus was tested positive by the Egyptian Central Public
        Health Laboratory and subsequently confirmed by the U.S. Naval
        Medical Research Unit No. 3 (NAMRU-3). Of the 63 cases confirmed to
        date in Egypt, 23 have been fatal.

        --
        Communicated by:
        ProMED-mail Rapporteur Marianne Hopp

        ******
        [2] Viet Nam - 55th fatality, WHO confirmed
        Date: Wed 8 Apr 2009
        Source: World Health Organization (WHO), EPR, Disease Outbreak News [edited]
        <http://www.who.int/csr/don/2009_04_08/en/index.html>


        Avian influenza situation in Viet Nam - WHO Update 5
        ----------------------------------------------------
        As of 8 Apr 2009, The Ministry of Health in Viet Nam has reported a
        new confirmed case of human infection with the H5N1 avian influenza
        virus. The case has been confirmed at the National Institute of
        Hygiene and Epidemiology (NIHE).

        The case is a 3-year-old boy from Chau Thanh District, Dong Thap
        Province. He developed symptoms on 12 Mar 2009, was hospitalized on
        13 Mar 2009, and died on 19 Mar 2009. Investigations into the source
        of infection indicated a history of close contact with sick and dead
        poultry prior to the onset of symptoms.

        Of the 110 cases confirmed to date in Viet Nam, 55 have been fatal.

        --
        Communicated by:
        ProMED-mail Rapporteur Marianne Hopp

        [All these WHO-confirmed cases of human avian H5N1 influenza virus
        infection have been children 6 years of age or younger. Since the
        resurgence of human cases of avian influenza in Egypt at the end of
        2008, 12 of the 13 cases have been children 6 years of age or under,
        and all have had exposure to diseased or dead poultry. No onward
        transmission of infection to family members has occurred.

        The locations of the 13 most recent Egyptian cases can be viewed in
        the map accompanying the text of the document at:
        <http://www.saidr.org/en/humans.php#050409>.
        - Mod.CP]
        -
        http://apex.oracle.com/pls/otn/f?p=2..._ID:1000,76964
        -----
        CP has been posting nonsense of H5N1 since 2004. His record remains intact.

        Comment


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

          All participants must refrain from bashing comments in their words and tone.

          I will not issue another warning.

          Comment


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

            Originally posted by Florida1 View Post
            All participants must refrain from bashing comments in their words and tone.

            I will not issue another warning.
            I believe that the statement that no onward transmission has occured is WELL into the nonsense category. Nonsense is nonsense and the comment on onward transmission is similar to the nonsense about white meat and dark meat in the H2H transmisison of H5N1 in Jiangsu in an entertaining attempt to explain away the nine day gap in disease onset dates between the son and the father he infected.

            CP is well aware of how "common source" is distinguished from H2H (which he has previously cited in rare clusters when there is no gap - and WHO has also cited the lack of a gap as proof of no H2H).

            The nonsense is more annoying because it is directed to an audience that doesn't have the scientifuc background to recognize the nonsense is based on "beliefs" and wishful thinking, and a four day gap in disease onset dates is a VERY easy call.

            Comment


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

              Originally posted by niman View Post
              CP has been posting nonsense of H5N1 since 2004. His record remains intact.
              Here is ONE of the entertaining commentaries by CP on H5N1 H2H transmission (in this case H2H transmission was subsequently published in the NEJM)

              http://www.promedmail.org/pls/otn/f?...AIL_ID:X,40403

              [This exposure of father and son to the same poultry product (and
              possibly the storage of refrigerated chicken in the father's house)
              identifies a potential common source of infection and virtually
              negates the possibility of human-to-human transmission being
              responsible for these 2 cases. - Mod.CP

              Comment


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

                Originally posted by niman View Post
                Here is ONE of the entertaining commentaries by CP on H5N1 H2H transmission (in this case H2H transmission was subsequently published in the NEJM)

                http://www.promedmail.org/pls/otn/f?...AIL_ID:X,40403

                [This exposure of father and son to the same poultry product (and
                possibly the storage of refrigerated chicken in the father's house)
                identifies a potential common source of infection and virtually
                negates the possibility of human-to-human transmission being
                responsible for these 2 cases. - Mod.CP
                Here is the actual ProMED post which is required reading because the number of absurdities cannot be easily summarized (including white meat / dark meat "possibilities"):

                AVIAN INFLUENZA, HUMAN (157): CHINA (JIANGSU)
                *********************************************
                A ProMED-mail post
                <http://www.promedmail.org>
                ProMED-mail is a program of the
                International Society for Infectious Diseases
                <http://www.isid.org>

                Date: Mon 10 Dec 2007
                Source: Singtaonet.com [in Chinese, trans. Rappt.DS, edited]
                <http://www.singtaonet.com/society_focus/200712/t20071210_688120.html>


                [The following report provides new information relating to the source
                of the H5N1 virus responsible for the death on 2 Dec 2007 of a
                24-year-old man in Jiangsu province and the concurrent illness of his
                father, and explains the possible relevance of the dog-bite incident.
                - Mod.CP]

                To celebrate [the 24-year-old's] acceptance [to a school of continuing
                education], his mother and father took him and his girlfriend to
                Nanjing's most bustling Confucian temple for some fun. At the temple's
                restaurant, the 4 of them ate Beggar's Chicken, which was surrounded
                by thick mud on the outside. [Dan Silver, the translator, comments
                that a 1990 article from the New York Times provides a useful
                introduction to Beggar's Chicken:
                <http://query.nytimes.com/gst/fullpage.html?res=9C0CEFD91638F93BA35757C0A9669582 60>.]

                According to analyses, perhaps because the mud on the outside was too
                thick the chicken inside was not thoroughly cooked. On the 2nd day
                after eating the chicken, [the young man] began feeling feverish. His
                body temperature rose quickly and he was taken for emergency treatment
                to Jiangsu Provincial People's Hospital. In the end, he could not be
                saved.

                As to why [he] was 1st to fall ill, a relative revealed that his
                girlfriend keeps 2 pet dogs. Because she is from another part of
                China, Nanjing limits the number of dogs [she can keep]. To avoid
                discovery, she sent one to be looked after by [her boyfriend]. 20 days
                before eating chicken, he was bitten by this small dog. To prevent
                rabies, he began vaccine shots. 5 injections are needed and at the
                time [of his illness] he had already completed 4 shots. His body's
                immunity was [therefore] at its lowest point. When [the man] was 1st
                sent to the hospital, he was not treated for avian influenza. The
                physicians suspected he might have contracted plague.

                After their son's sudden death, his father and mother were devastated.
                On the 6th day after eating chicken, when the father developed fever,
                he did not have the heart to seek treatment. Only after others begged
                him did he go to the hospital. A relative said that [his] family loves
                to eat chicken and his refrigerator is full of butchered chicken.
                Because of this, the relative began to wonder if it might be avian
                influenza, so [the man] went to the Nanjing
                Municipal Infectious Disease Hospital where the diagnosis of avian
                influenza was made.

                The odd thing is that although 4 people went to eat chicken [at the
                temple], only the 2 men fell ill and the 2 women are well. Reports say
                that [the] girlfriend ate a lot of chicken but is perfectly fine.
                Sources say that [the 24-year-old's mother] also has no similar
                symptoms but has been isolated for observation. Her cell phone is
                turned off and there is no contact with the outside world.

                --
                Communicated by:
                ProMED-mail Rapporteur Dan Silver

                [This exposure of father and son to the same poultry product (and
                possibly the storage of refrigerated chicken in the father's house)
                identifies a potential common source of infection and virtually
                negates the possibility of human-to-human transmission being
                responsible for these 2 cases. - Mod.CP

                The possible relevance of the dog-bite incident is that 4 rabies
                vaccine shots might have adversely affected the patient's immune
                system. The 2 women who also ate the chicken should be checked for
                antibody in case of asymptomatic infection. Or perhaps the men ate the
                legs and thighs and the women the breast, with different degrees of
                undercooking and/or original virus titer? - Mod.JW]

                Comment


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

                  It is not productive to bash about inaccuracies in ProMed postings.

                  A short comment refuting the post and an explanation why is sufficient.

                  Comment


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

                    Originally posted by Florida1 View Post
                    It is not productive to bash about inaccuracies in ProMed postings.

                    A short comment refuting the post and an explanation why is sufficient.
                    Actually, I have published multiple commentaries on this ProMED commentary as well as a long string that go back to 2004. The commentaries have a common thread which attempts to support CP's hypothesis that H5N1 is relatively benign and only a very small subset of genetically predisposed individuals are infected and H2H is virtually impossible.

                    The commentaries contain a series of ad hoc arguments that are without scientific basis , but are frequently quoted on the internet as somehing with scientific merit.

                    In this case, the idea that the 9 day gap in disease onset dates is somehow related to a differential risk to the four people who ate the dish has no basis. There is no hint that this bird had H5N1 symptoms or was H5N1 infected. Moreover, for H5N1 infected food, those at most risk would be those who prepared the dish BEFORE it was cooked (restaurant employees).

                    Similarly, the idea that the cooking could titer out the virus, so one perosn died, another got sick 9 days after the index case, while two others didn't get sick at all is pure hocus pocus based on ZERO data.

                    Then there is the speculation about the rabies shot, and who ate dark meat and who ate white meat (pure fatansy) as well as how refrigerated leftovers contributed was just an absurd story that was published in an infectious disease newsletter with the CLEAR intent of convincing non-scientists that there was no H2H (which was subsequently written up in thhe NEJM as an example of H2H - based on DISEASE ONSET DATES and irrelevant sequence identity between the H5N1 from father and son).

                    Comment


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

                      Dr. Niman....you've got me very puzzled.

                      ...are you saying that B2H is a rare event?




                      From post #277:

                      Dead poultry means nothing.
                      B2H is RARE
                      H2H of close contacts is COMMON.
                      and from post #286:

                      B2H is EXTREMELY rare.

                      Comment


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

                        Originally posted by Commonground View Post
                        Dr. Niman....you've got me very puzzled.

                        ...are you saying that B2H is a rare event?




                        From post #277:

                        and from post #286:
                        Million to one. B2H is EXTREMELY rare.

                        Comment


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

                          Well, then, what the heck has been going on in Indo?

                          Comment


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

                            I am sure that further efforts to improve transparency in poultry and human impact of avian influenza virus H5N1 are urgently needed.

                            The time is running, and pandemic influenza cannot wait for short-sight politics.

                            People should also keep in mind that more therapeutical and preventative measures are also urgently needed.

                            It's not the time for concealing informations, distort reality or hope for business.

                            We testify in the past how many damages can be done with this short-sight and business hunger-driven policies.

                            Perhaps, there is time for mitigate an impending influenza pandemic effect.

                            It is a common obligation to explore every possible strategy to lessen the impact of avian influenza epizootics and epidemics both in economy and society.

                            Comment


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

                              Henry -

                              I would like to take this opportunity to tell you how much everyone at FT respects you. We thank you for all your work all these years, under less than optimal circumstances.

                              We know you as a scientist, co-worker, and educator. But mostly we know you as a friend.


                              "All truths are easy to understand once they are discovered; the point is to discover them.

                              Galileo

                              Comment


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

                                Originally posted by Commonground View Post
                                Well, then, what the heck has been going on in Indo?
                                There is B2H, but the odds are low for a given outbreak to cause a confirmed case. Overall, since 2004 there have 100's of millions of birds culled, but only 100's of confirmed human cases. If you lower the number of culled birds because in some instances the culling is precautionary and involve large holdings, instead of a million to 1 you could argue it is 10,000 to one.

                                However, even at 10,000, the odds of two cases happening between contacts and separated by days and be independent is still well north of a million to one.

                                However, H2H among close contacts is much more common. In Vietnam, about 1/3 of cases were in clusters. At one point the number in Indonesia was close to 50%. In Turkey, it approached 100%.

                                The clusters almost always have a disease onset date gap. Frequently it is large, like 4-10 days. Sometimes the number is in between clear-cut common source (0-1 days) and H2H (4 or more days), but 0-1 days is VERY rare.

                                Moreover, in clusters it is much more common for an index case to die and a contact to survive, than the other way around. One of the few examples of the other way around was the cluster in Pakistan. However, when there is a difference in mortality, the index case is usuallythe one to die (although frequently the index case is not tested, but just had symptoms and the contact was confirmed).

                                Comment

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