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Concerns arise over symptomless Egypt bird flu cases
Re: Concerns arise over symptomless Egypt bird flu cases
Is the clade of H5N1 infecting this boy oseltamivir resistant?
Yes? No?
Is Egypt testing use of Relenza?
At this time, is Relenza the last line in the sand when it comes to pharmaceutical antivirals?
"The third case is a 6 year-old boy from Shubra El Khema District, Qaliobia Governorate. He developed symptoms on 22 March and was admitted to Ain Shams University Hospital on the 28 March where he was started on oseltamivir on 3 April."
Re: Concerns arise over symptomless Egypt bird flu cases
I follow the facts where ever they lead. I found this a couple of hours ago and posted on the Egyptian human infection thread:
"...By a specialized committee of the Ministry of Health and Preventive Medicine and Veterinary Medicine to move to the child's home-Shahat, Mohamed Hassan Amer «years», which was No. 61 in the cases of bird flu in the province of the lake, immediately confirmed his illness, to examine the house and the houses nearby, Dr. Mohamed Farid , Director of Veterinary Medicine to maintain, the lack of birds at his home. "
Confirmation of Toddler H5N1 Transmission in Beheira Egypt
Recombinomics Commentary 16:24
April 8, 2009
But Jabbour said there was still no evidence of the disease being passed from person to person in Egypt. He added that two toddlers from the northern province of Beheira infected within days of one another in March were cousins.
The above comments on the Beheira cluster leave little doubt that the infections involved toddler to toddler transmission, based on the four day gap in disease onset dates. Local media reports indicated the two cases were next door neighbors, and the above comments state that they were cousins, yet neither the SAIDR updates, nor the WHO update by its Mediterranean branch mention that these two cases were cousins and almost certainly had contact, supporting human to human transmission.
The failure of these government agencies to include this most relevant information, and the delay in posting situation updates for the three most recent confirmations in Egypt by WHO in Geneva, creates significant cause for concern.
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"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
I follow the facts where ever they lead. I found this a couple of hours ago and posted on the Egyptian human infection thread:
"...By a specialized committee of the Ministry of Health and Preventive Medicine and Veterinary Medicine to move to the child's home-Shahat, Mohamed Hassan Amer ?years?, which was No. 61 in the cases of bird flu in the province of the lake, immediately confirmed his illness, to examine the house and the houses nearby, Dr. Mohamed Farid , Director of Veterinary Medicine to maintain, the lack of birds at his home. "
Actually, SAIDR has also provided verifiable DATA that casts serious doubt on the poultry connection, because as of April third sample test / collections there was no H5N1 positive poultry anywhere near the cluster
(see 2 purple markers with ZERO blue markers nearby)
Both boys had contact with sick/dead poultry prior to the illness onset.
Close contacts of both boys have been identified and none has shown symptoms of the infection .
The above comments from the latest WHO update represent glaring commission by omission. The update claims ?contact with sick/dead poultry?, but fails to give results of testing of such poultry. The SAIDR site, which has poultry results through April 3 does not include any confirmed poultry cases in the proximity (see updated map) of the Beheira cluster.
Moreover, the above comments imply that neither confirmed case has transmitted H5N1 to any contact, yet the update fails to mention that the two confirmed cases live "in adjacent houses", and are cousins.
The four day gap in disease onset dates leaves little doubt that the index case infected his cousin, who lives text door. This toddler to toddler transmission is cause for concern, because both cases had mild H5N1, including the index case, who began oseltamivir treatment after the recommended 48 hours after disease onset.
These mild bird flu cases in Egypt are not new, and were cause for concern in 2007, when children between the ages of 3-10 rapidly recovered and were infected with H5N1 sequences that were virtually identical and signaled extensive human to human transmission because the cases with identical H5N1 sequences were not epidemiologically linked.
Although WHO has recently acknowledged concern for silent transmission of H5N1, the above commissions by omission of an obvious case of human to human transmission raises serious pandemic concerns about WHO?s ability to analyze scientific data and transparently present results of such analysis.
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"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
Re: Concerns arise over symptomless Egypt bird flu cases
Close contacts of both boys have been identified and none has shown symptoms of the infection .
Why aren't they looking for extremely mild cases by testing those contacts for antibodies?
I've also wondered the same thing about chickens. Just because there have been no sick/dead poultry doesn't mean they're not the source of an infection, i.e., if the poultry was vaccinated they could still be shedding small amounts of virus.
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"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
Actually, SAIDR has also provided verifiable DATA that casts serious doubt on the poultry connection, because as of April third sample test / collections there was no H5N1 positive poultry anywhere near the cluster
(see 2 purple markers with ZERO blue markers nearby)
SAIDR is linked to government agencies in Egypt and the listings make it clear that central vet is chasing the CONFIRMED human cases and testing local poultry (after human confirmation). They would VERY MUCH like to show positive poultry in Beheira and Qena, but to date they have failed.
"There is no change in the virus at all in the virus strain in Egypt. It is the same since the beginning of the outbreak. There is no mutation, nothing," he said. (Writing by Cynthia Johnston)
There have been genetic changes to H5N1 in Egypt "since the beginning".
"...The * Spokesman of the Ministry of the injury, No. * 63 * Qaliubiya province, injuring a baby and was preceded by less than two years old in the province, the lake * *. warned the collapse of agricultural sources of the poultry industry and the closure of a large proportion of the poultry farms because of fears of disease,* and the high cost of production, * and the escalation of prices of chickens, * and doubling the price of * ? vaccine immunization *? against the disease, * and * useless because of several types of mutation of the virus that causes the disease *"
Egyptian H5N1 cases prompt speculation about silent infections
Robert Roos * News Editor
Apr 8, 2009 (CIDRAP News) ? The recent series of H5N1 avian influenza cases in Egyptian children yet very few in adults has raised concern that some Egyptians may be getting infected without getting sick, according to a Reuters news report published today.
John Jabbour, a World Health Organization (WHO) emerging diseases specialist based in Cairo, said the Egyptian government and the WHO are planning a study to find out if subclinical or asymptomatic cases have been occurring, according to the story.
Jabbour said the occurrence of asymptomatic cases would be worrisome because it could give the undetected virus more time to mutate in human hosts, Reuters reported.
"If there is any subclinical case in Egypt, the aim is to treat immediately to stop the reproduction of the virus," he told Reuters. "Because whether [through] mutation or reassortment, this will lead to the pandemic strain."
The story said that all but two of the 11 Egyptians infected with H5N1 this year have been children under age 3 (the official WHO count for Egypt reached 12 today). In the same period last year, most of the seven Egyptian case-patients were adults and older children, the report said.
Jabbour said the string of cases in children without similar cases in adults had prompted the questions whether adults were being infected without falling ill.
He said the Egyptian study would involve testing the blood of people who were potentially exposed to infected birds but had not gotten sick.
Tim Uyeki, MD, a medical epidemiologist in the Influenza Division at the Centers for Disease Control and Prevention, told CIDRAP News that limited studies in several countries over the past few years have found relatively little serologic evidence of asymptomatic or unrecognized cases of H5N1 virus infection.
When the H5N1 virus first infected humans in Hong Kong in 1997, there were two studies in which investigators looked for H5N1 antibodies in people who had potentially been exposed to the virus, Uyeki said. One study focused on 293 poultry cullers, of whom only nine (3%) were found to have H5N1 antibodies, indicating past infection. In the other study, involving 1,525 poultry workers, an estimated 10% had antibodies.
More recent studies "have either found no evidence of H5N1 virus infection or very low seroprevalence of H5N1 antibodies, around 1% or less, among different exposed populations," Uyeki said. "Since H5N1 virus strains continue to evolve, there's a continued need for these studies in people who have contact with poultry in countries where H5N1 virus strains are circulating in birds, since the risk of transmission to exposed persons could change."
Uyeki also noted that subclinical infection with seasonal influenza virus is known to occur. "But how that relates to H5N1 is unclear," he said.
Re: Concerns arise over symptomless Egypt bird flu cases
From the referenced Jan 25, 2008 CIDRAP story on Cambodia study:
More cases of mild disease might suggest that the virus is improving its ability to spread among humans, while becoming less virulent
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"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
Why aren't they looking for extremely mild cases by testing those contacts for antibodies?
I've also wondered the same thing about chickens. Just because there have been no sick/dead poultry doesn't mean they're not the source of an infection, i.e., if the poultry was vaccinated they could still be shedding small amounts of virus.
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A chicken that have been vaccinated will likely show an antibody response to the vaccination so a false positive is likely.
The humans are tested in this way to show "exposure" because they have not been vaccinated.
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