Concerns arise over symptomless Egypt bird flu cases

[AlaskaDenise]

Re: Concerns arise over symptomless Egypt bird flu cases

My comments in post #23 were about testing the contacts (assumed to be human) referenced in post #22, as part of this sentence...

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

The point was the value of testing asymptomatic human contacts.

When I said I was wondering the same thing about chickens, I did not mean to test a vaccinated chicken for what they had been vaccinated for. I was referring to the fact that some assume a chicken cannot be a source if it doesn't show symptoms, when in fact it can because a vaccinated chicken, when infected, still can pass small amounts of virus....hence, the use of sentinel members. it's doubtful that Egyptian backyard flocks maintain sentinel populations.

.

[AlaskaDenise]

Re: Concerns arise over symptomless Egypt bird flu cases

............Is the testing improved in Egypt? New (rapid) testing device used?

From post #1...

The Egyptian study, which Jabbour said should begin in the coming months, would test the blood of people who may have been in contact with infected birds but had not become sick.

We could call it improved, in that they will be testing asymptomatic humans with infected bird contacts.

IF there is a way to test asymptomatic birds for recent infections (like higher antibody levels that would be expected from vaccination) and they did those tests quickly upon human infection, a match should indicate something of value.

.

[AlaskaDenise]

Re: Concerns arise over symptomless Egypt bird flu cases

IF there is a way to test asymptomatic birds for recent infections (like higher antibody levels that would be expected from vaccination) and they did those tests quickly upon human infection, a match should indicate something of value.

In some human diseases you can identify an ongoing infection (of something that would normally test positive due to prior infection) by sequential testing for rising serum levels. I don't know if this would work to sort out antibodies levels in chickens.

.

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

I think that the actual testing has become lost in the discussion, Silent spread does not have to involve symptomless patients. Much can simply involve the absence of a poultry connection, because H2H spread is not monitored. Thus, those that have symptoms short of serious pneumonia are simply not tested for H5N1.

Similarly, those with symptoms, but lower titers would give a false negative when tested.

Neither of these issues is being addressed when it is assumed that the mild cases are asymptomatic and therefore cannot be identified with PCR.

[sharon sanders]

Re: Concerns arise over symptomless Egypt bird flu cases

hat tip Sally -


<table style="text-align: left; direction: ltr;"><tbody><tr><td class="nav" align="center"> After the announcement of our first global

أنفلونزا الطيور..

Avian flu ..

تعود بشراسة

Is fiercely

الخبراء: الفيروس نشط..

Experts: active virus ..

وينتقل بسرعة رهيبة

And move quickly terrible
</td></tr><tr><td class="auther" align="right">

متابعة: ريهام السعيد

Follow-up: Reham Al -
</td></tr><tr><td align="right">

جاء احتلال مصر للمركز الأول عالمياً في ظهور حالات أنفلونزا الطيور هذا العام والخامسة من حيث عدد الوفيات كما جاء في تقرير منظمة الصحة العالمية بمثابة الصدمة لكل القطاعات العاملة في هذا المجال.

The occupation of Egypt to the status of the first in the world, the emergence of bird flu cases this year and fifth in terms of the number of deaths according to the report of the World Health Organization as a shock to all sectors working in this area.

الخبراء أكدوا أن الأمر في غاية الخطورة خاصة أن فيروس أنفلونزا الطيور نشط وينتقل بسرعة رهيبة وأن عودته بصورة أكثر شراسة..

Experts emphasized that a very serious matter, especially that the bird flu virus active and move quickly back and terrible ferocity more ..

أشاروا إلي أن ثقافة المستهلك الخاطئة بالإصرار علي تناول الدجاج الحي وليس المجمد أو المبرد تساهم في تفاقم الأزمة.

They pointed out that the consumer culture by insisting on the wrong neighborhood and eating chicken is not frozen or refrigerated contribute to the worsening of the crisis.

طالبوا بتطوير التربية الريفية ومحاربة العشوائية في صناعة الدواجن وإنشاء صندوق بتمويل ذاتي لتعويض أصحاب المزارع المصابة.

Demanded the development of rural education and to combat outposts in the poultry industry and the establishment of a self-financing fund to compensate the owners of the affected farms.

"المساء" ناقشت القضية مع كافة الأطراف في هذا التحقيق.

"Evening," discussed the issue with all parties in this investigation.

* د.عبدالعزيز السيد "رئيس شعبة الثروة الداجنة بالغرف التجارية": خطورة الوضع تدعو إلي ضرورة التعجيل بإصدار تشريع من مجلس الشعب خاص بعدم تداول الطيور الحية حتي نحاصر الفيروس لأن الحملات الرقابية والسبل المستخدمة للسيطرة علي محلات بيع الدواجن والأكمنة الموجودة علي الطرق غير فعالة ولا توازي إصدار قانون يجرم ذلك حيث يستطيع المخالف العودة لنشاطه بمجرد انتهاء الرقابة أو مغادرة المفتشين أما القانون فيلقي الاحترام خوفاً من التعرض لعقوبة أو غرامة كبيرة.

*

D. Mr. Abdul Aziz, "Chief of the Division of poultry with chambers of commerce:" the seriousness of the situation calls for the need to expedite the enactment of legislation to parliament that a special handling of live birds, even as the campaigns Nhasr virus control and the means used to control the stores that sell poultry and ambushes on the roads are not effective equivalent to passing a new law that criminalizes the terms of the offender can return to activity once the inspectors leave the control or the legions of law respect for fear of punishment or a hefty fine.

أشار إلي محاربة العشوائية في صناعة الدواجن وأن تخضع جميع المزارع والمجازر إلي تطوير فعلي وبالنسبة للمزارع لابد من تطبيق نظام الأمن والأمان بصورة منتظمة وأن توضع الطيور الموجودة بها تحت إشراف بيطري وتطعيم الطيور من عمر يوم واحد وكذلك فتح مجازر جديدة لاستيعاب كم أكبر من الطيور.

Pointed to combat outposts in the poultry industry and to place all the farms and slaughterhouses to develop effective and for the farms to be the application of the safety and security on a regular basis and those birds are under the supervision of the veterinarian and the vaccination of birds from the age of one day opening of the massacres, as well as to accommodate the new larger body of birds.

أوضح أنه يجب أن تحصل التربية الريفية علي حظها من التطوير مشيراً إلي أنه في هذا الإطار سوف تطبق تجربة جديدة من خلال الصندوق الاجتماعي ووزارة الزراعة في إحدي محافظات الوجه البحري وأخري في الوجه القبلي من أجل التعميم..

He pointed out that education must have their share of rural development, noting that in the framework of this new experiment will be applied through the Social Fund and the Ministry of Agriculture in one of Lower Egypt and the other in Upper Egypt in order to generalize ..

وتقوم التجربة علي منح مربي الطيور عشة مجهزة بدلاً من التربية في البيوت مع مراعاة توحيد نوع وعمر الطيور فمثلاً تربية الحمام يتم فصلها عن البط والفراخ لأن الجينات المختلفة قد تؤدي إلي ظهور الفيروس.

The grant will experience Aviarist with straw instead of education in the home, taking into account the consolidation of the type and age of breeding birds for example, the bathroom is separated from the ducks and chickens, because different genes may lead to the emergence of the virus.

يقترح إنشاء صندوق خاص بالدواجن يعتمد في تمويله علي الحصول علي أصحاب المزارع بالحصول علي 0.5 إلي 1% من قيمة الدواجن الموجودة موضحاً أن من أكثر أسباب تفشي الفيرس خوف المزارع من كشف نفسه بعد اكتشافه دواجن مصابة فيحاول الهروب بها إلي مكان آخر لبيعها وبذلك ينتقل الفيروس بسرعة لكن هذا الصندوق سيكون ضامناً للمزارع إذا تعرض لمشكلة يجد ما يعوضه.

Proposed to establish a special fund financed by poultry depends on access to farm owners to obtain 0.5 to 1% of the value of existing poultry, adding that one of the most reasons for the spread of the virus of fear, revealed the same farm after finding a chicken tries to escape with the place of the last sale, so the virus moves quickly However, this fund will be the guarantor for the farmer if he had a problem or get compensated.

* د.عبدالرحمن شاهين "المتحدث الرسمي باسم وزارة الصحة": علي الرغم من أن مصر الأولي من حيث عدد الإصابات في الثلاثة شهور الأولي لعام 2009 لكنها مازالت الأولي في الحالات التي تم شفاؤها حيث إن عام 2008 شهد تعرض 8 حالات للإصابة وتم شفاء 50% منها وهذا العام أصيبت 12 حالة لم يتوف منها شخص واحد وهذا مؤشر جيد علي التقدم والنجاح في العلاج وزيادة الوعي لدي المواطنين بسرعة التوجه إلي المستشفي بمجرد ارتفاع درجة حرارة الجسم.

*

D. Abdel Rahman Shahin, "the spokesman of the Ministry of Health:" Although Egypt first in terms of the number of casualties in the first three months of 2009, but still in the initial cases that have been cured since 2008 has been 8 cases of infection were recovered 50% and this year was not the case 12 of them died and one person is a good indicator of progress and success in treatment and raise awareness among the citizens to come to the hospital quickly once the high temperature of the body.

أكد أن الأسواق العامة ومحلات الدواجن جميعها تخضع لرقابة وتفتيش يومي للتأكد من أن تداول الطيور الموجودة يتم بصورة سليمة لا تضر المواطن حيث يتم سحب عينات من الدواجن وتحليلها للتأكد من أنها غير مصابة بالفيروس وإذا أثبتت النتائج وجود طيور مصابة يتم إعدامها علي الفور بالطرق السليمة.

Emphasized that the public markets and poultry shops, all under the control and inspection on to make sure that the circulation of those birds is the sound does not harm people, withdrawing samples from poultry and analysis to ensure that they are not infected with HIV if the results proved the presence of infected birds are culled immediately through sound.

أوضح أنه يتم حالياً إجراء رقابة علي نقل الطيور الحية بين المحافظات وغير مسموح بدخول أو خروج الطيور إلا بتصريح موقع عليه طبيب بيطري.

He is currently on the transfer of control of live birds between provinces are not allowed to enter or exit the bird, however, a statement signed by a veterinarian.

أكد أن فيروس أنفلونزا الطيور موجود ومتوطن لذلك نتوقع ظهور حالات كل عام حتي يتم القضاء علي الفيروس مشيراً إلي وجود خطة وبرنامج متكامل لمواجهة الفيروس وسيجتمع رئيس الوزراء د.أحمد نظيف اليوم مع جميع الوزراء المعنيين بهذه المشكلة لمراجعة الإجراءات التي تم إنجازها ومتابعة الخطوات القادمة لمواجهة أنفلونزا الطيور.

Confirmed that the bird flu virus is endemic, and therefore we expect the emergence of cases every year until the elimination of the virus, referring to the existence of a plan and an integrated program to counter the virus and will meet Prime Minister Dr. Ahmed Nazif today with all the ministers concerned in this problem for a review of the actions that have been completed and follow-up to the next steps to address the avian birds.

* د.حسين خلف الله وكيل أول وزارة الزراعة للشئون البيطرية: ذوق المستهلك المصري هو السبب في تفاقم مشكلة أنفلونزا الطيور وتشجيع التجار علي تداول الدواجن الحية حيث يتجه بشكل أكبر نحو محلات بيع الدواجن الحية ويجد البائع أن المجمد والمبرد لا يجد التسويق المناسب مشيراً إلي أن الدواجن المبردة التي يتم ذبحها في المجازر ووضعها في ثلاجات وتظل صالحة لمدة ثلاثة أيام أفضل من الحية في الطعم والقيمة الغذائية.

*

D. Khalafalla's first undersecretary of the Ministry of Agriculture and Veterinary Affairs: Egyptian consumer taste is the reason why exacerbate the problem of avian influenza and to promote the circulation of traders, where live poultry is more about stores that sell live poultry, the seller finds that the frozen and refrigerated not find the appropriate marketing, noting that chilled poultry to be slaughtered in the massacres and putting them in refrigerators and remain valid for a period of three days is better than living in the taste and nutritional value.

أشار إلي أنه عند ضبط محلات لبيع الطيور الحية يتم إغلاقها وتوقيع غرامة من 200 إلي 500 جنيه كما يتعرض صاحبها للحبس من 6 شهور إلي سنة ورغم كم المحاضر ضد عدد كبير من المحلات إلا أن المخالفات لا تتراجع.

He pointed out that when shops for the sale of live birds will be closed and a fine of 200 to 500 pounds and is the owner of imprisonment of 6 months to years, despite the records on how many stores but that the irregularities did not back down.

* د.خالد نصر أستاذ التغذية والتغذية الإكلينيكية بطب بطري جامعة القاهرة: فيروس أنفلونزا الطيور نشط وينتشر بسرعة رهيبة فبمجرد خروج أحد الأفراد من مكان به إصابات ودخوله مكاناً آخر ينتقل إليه الفيروس لذلك يجب تطهير جميع العاملين بالمزارع وكل فرد يدخل للمزرعة وكذلك تطهير العلف المقدم للطيور بمضادات البكتريا.

*

D. Khaled Nasr, Professor of Clinical Nutrition, nutrition, medicine, Cairo University, Boutri: avian influenza virus is spreading fast and active dire Once out of an individual from the place of the injury and he moved to another place for the virus that must be cleared of all farm workers and every individual entering the farm, as well as clearance of feed given to birds anti-bacteria.

أشار إلي أن تربية الدواجن بالبيوت بدأت تزداد من جديد رغم خطورة ذلك والسبب يرجع لارتفاع سعر الدواجن نتيجة زيادة الطلب في مقابل قلة المعروض فأصبحت تتجه بعض الأسر إلي تربية "الكتاكيت" كمحاولة للتوفير وكذلك بدأت محلات الدجاج في العودة للنشاط ويتم بيع الطيور الحية بشكل طبيعي وهذه المشكلة يجب التصدي لها.

He said the poultry houses have begun to increase again, despite the gravity of the reason is due to the high price of poultry due to the increase in demand in return for a few before heading into some families to educate "the chicks" in an attempt to provide as well as poultry shops began to return to the activity and the sale of live birds is normal and this the problem must be addressed.

* المهندس مصطفي زهران رئيس حي الزيتون: تداول الطيور الحية في الأسواق مازال ممنوعاً والحملات الرقابية والتفتيشية علي المحلات يومية وفي حالة ضبط محل يبيع طيور حية يتم مصادرة الطيور وتوقيع غرامة تصل إلي 1000 جنيه والغلق لمدة أسبوع أما إذا تكرر ذلك وأعاد التاجر نفس نشاطه يتم غلق المحل بصورة نهائية لكن حتي الآن لم يتكرر ذلك بل إن الحي يساعد التجار في الحصول علي تراخيص جديدة لتغيير النشاط فمن يرغب في بيع الطيور المجمدة أو المبردة يتم منحه الترخيص.

*

Mostafa Zahran, head of Al-Zeitoun neighborhood: the circulation of live birds in the market is still banned and campaigns on the control and inspection shops daily in the case of the place settings sell live birds to be the confiscation of birds and a fine of up to 1000 pounds and sealed for a week if that and repeat the same activity will be the merchant to close the shop once, but so far it has not been repeated, but the district will help traders to obtain new licenses for the change of activity, it is willing to sell chilled or frozen birds to be granted a license.

أضاف أن حي الزيتون يسعي حالياً نحو فتح مجزر آلي لذبح الطيور من خلاله لضمان سلامتها وتقدم الحي بعرض التصميم والتخطيط علي المجلس التنفيذي بمحافظة القاهرة.

The Zeitoun neighborhood is currently seeking to open up automated abattoir for the slaughter of birds in which to ensure the integrity of the neighborhood offer and provide design and planning to the Executive Board Cairo Governorate.

* صلاح رمضان رئيس حي البساتين ودار السلام: محافظ القاهرة خلال اجتماعه برؤساء الأحياء والشئون الصحية الأسبوع الماضي أصدر تعليمات مشددة بضرورة تكثيف الأكمنة علي مداخل طرق المحافظة ومنع أي محاولة من العربات المحملة بالدواجن من الدخول والتعامل مع محلات بيع الدواجن الحية بالغلق ومصادرة الطيور وتحرير محاضر ضد المخالفين وتحويل المحلات لبيع الطيور المجمدة.

*

Salah Ramadan, chief of district of orchards and Dar es Salaam: the Governor of Cairo during a meeting with heads of districts and health affairs, last week issued strict instructions to intensify the need for ambushes on the roads to maintain the entrance and prevent any attempt by the vehicles carrying poultry from entering or dealing with the stores that sell live poultry closure and confiscation of birds and the liberalization of the records against offenders and the conversion of stores to sell frozen birds.

http://www.algomhuria.net.eg/almessa/today/third/detail07.asp

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[tropical]

Re: Concerns arise over symptomless Egypt bird flu cases

#35: "the bird flu virus active and move quickly back and terrible ferocity more"


Hmm, by reading the whole gived text translation, the general impression is that the above sentence was used primary for poultry infections only.

It seems clear that their actual wide practice of rear cooling, and trade/smug./stocking/sell/consumption of live/dead poultry at the street level of many already illnessed poultry outcomed in reinfections.

All this, instead of an centralized killing place with subsequent frozing, maked an ideal environment for back and forth renewned poultry infections with the bird flu virus which than decimate more and more new poultry flocks everywhere, which than could not be contained, so "the bird flu virus active and move quickly back and terrible ferocity more" - in poultry flocks, probably not in humans for now.

[sharon sanders]

Re: Concerns arise over symptomless Egypt bird flu cases

Yes. Those comments refer to poultry. It gives the background to the general situation in Egypt.

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

Yes. Those comments refer to poultry. It gives the background to the general situation in Egypt.

But there is no H5N1 confirmed poultry linked to the four most recent human cases.

[sharon sanders]

Re: Concerns arise over symptomless Egypt bird flu cases

Both the WHO and Saidr indicate these cases were connected to sick or dead poultry. I understand your comment to mean that you do not believe these statements?

http://www.who.int/csr/disease/avian_influenza/en/

http://www.saidr.org/en/humans.php#050409

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

Both the WHO and Saidr indicate these cases were connected to sick or dead poultry. I understand your comment to mean that you do not believe these statements?

http://www.who.int/csr/disease/avian_influenza/en/

http://www.saidr.org/en/humans.php#050409

Most patients who are tested for H5N1 in Egypt claim a connection to sick or dying poultry (which leads to treatment and testing). Neither WHO nor SAIDR have produced any evidence of H5N1 in poultry in the area of the recent cases in Beheira or Qena (in contrast to earlier cases).

Sick and dead poultry are common worldwide, and the use of the word "connection" by WHO has included prior examples that had nothing to do with H5N1 transmission to confirmed cases.

WHO says dead or dying poultry are "connected" and claims no symptoms in contacts, knowing full well that the two cases in Beheira are neighbors and cousins.

WHO's credibility on H2H has been suspect since 2004 and there is little evidence of change (other than the cluster in Beheira which has SIGNIFICANTLY lowered WHO H5N1 H2H credibility in Egypt).

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

<table align="center" bgcolor="#ffffff" cellpadding="3" cellspacing="3" width="650"><tbody><tr><td colspan="2">
<articlehed>Egypt must intensify efforts to combat avian flu, say experts</articlehed>
</td></tr><tr><td colspan="2"><articledek></articledek>
</td></tr><tr><td colspan="2"> By <articlewriter>Tamim Elyan</articlewriter>
</td></tr><tr><td colspan="2"> First Published 4/9/2009</td></tr><tr><td colspan="2"><articlebody></articlebody>CAIRO: As the number of reported bird flu cases continues to rise in Egypt, attention is directed towards the government’s efforts in controlling and eradicating the disease.
H5N1 first hit Egypt in February 2006. So far, 63 people have contracted the virus, 23 of which died and 35 were treated. Three patients are still undergoing treatment.
On Wednesday, another case was reported of a two-year-old from a village in Giza.
This week, the Ministry of Health announced that 6,337 cases were isolated for suspicion of carrying the virus. From Cairo alone 843 cases were tested but were all found negative.
The highest infected cases were found in Menufiya with seven people carrying the disease. Six cases were reported in Fayoum and Qena each; while Menya, Qaliubiya and Gharbeya reported five cases each.
Three cases were reported in each of Cairo, Aswan, Kafr El-Sheikh and Daqahleya, two cases in each of Assiut, Sohag, Beni Suef, Damietta, and Sharqeya, while Alexandria, Suez and Beheira only reported one case each.
Young victims
The disease has spread among children between the ages of one and two over the past month.
An 18-month-old child was reported to contract the H5N1 virus on March 10.
Also early March, two two-year-old boys from Alexandria and Fayoum were reported to be infected.
Young children, old people and health workers are most likely to contract the virus, and WHO called for an investigation of this phenomenon.
“The rapid growth rate of bird flu infections in children is worrying,” John Jabbour, senior epidemiologist with WHO, told the UN news agency IRIN.
Jabbour speculated that the reason for the increased number of cases in this age group was that families were no longer as alert as they were after the last awareness campaign.
“This is a problem that will not go away in poultry; hence people who deal with birds cannot afford to relax. Those who come in contact with birds must make caution part of their daily routine,” he said.
“When children are infected then the message hasn’t arrived yet. There must be better funding, support and subsidization policies for farmers,” Diaa Salman, a virology expert who has been working on avian flu in Egypt since 2006, said.
“The Ministry of Health has implemented a comprehensive awareness plan that comprised more than 13,000 rural advisors moving from house to house, in addition to mass media campaigns,” Abdel Rahman Shahin, spokesperson of the Ministry of Health told the press.
“We also succeeded in saving the lives of children infected with the virus,” he said, adding that no fatalities were reported for children under 10 years old.
However, experts think that there is still a long way to go.
Getting the science right
Salman believes there is still room for improvement.
“Although it hasn’t reached the epidemic stage yet, Egypt is now second to Indonesia among the most affected countries by avian flu virus,” he told Daily News Egypt.
“The number of human and poultry infections show that some policies are ineffective; we need to reevaluate and assess the current capacities from laboratories and personnel operating at these laboratories, and update them as well as reviewing expenditure in this field,” he explained.
Salman also called for reassessing the types of vaccinations used, their sources and quality. He also called for cooperation between the Ministries of Health, Environmental Affairs and Agriculture in monitoring immigrant birds and the developments of the virus in Egypt.
According to Salman, monitoring the disease requires highly equipped laboratories with isolation and identification devices that can spot the microbes in live and dead infected bodies as well as high safety standards.
“They aren’t available at most places,” he said.
Nasr El-Din Al-Tantawy, a former epidemiologist at the World Health Organization (WHO), said that the Egyptian government’s efforts are not sufficient especially since the virus is now enzootic in the poultry sector.
“In Egypt, we deal with special kind of cultural and economic habits related to poultry farming especially in rural areas which demands intensifying awareness campaigns among farmers,” he previously told Al-Masry Al-Youm independent daily.
“The level of biological safety and vaccinations is excellent in major farms but it declines in small and new farms which enables the virus to become enzootic there,” he explained.
However, Hala Esmat, technical officer at the WHO, says that Egypt is on the right track concerning developing its laboratories.
“Most of the laboratories in Egypt are highly equipped; the latest was the WHO’s laboratory which has been promoted last week as the national laboratory for examinations,” Esmat told Daily News Egypt.
She added that the WHO is working closely with the Ministry of Health to follow up on various issues.
While the chances of infections remain relatively low, experts fear H5N1 could mutate into a form that can easily be passed from one person to another, leading to a pandemic which could kill millions.
“Most farmers in rural areas don’t apply safety standards like having backyards for raising poultry or separation between immigrating birds and the farm birds. The ministry doesn’t visit these places regularly for inspection nor do the local authorities help farms get rid of dead birds safely or compensate them for dead animals,” Salman said.
“Alternative policies must be implemented as well as heavy awareness campaigns especially as economic circumstances force farmers to depend on poultry rather than meat,” he added.




http://www.thedailynewsegypt.com/printerfriendly.aspx?ArticleID=20974

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[Laidback Al]

Re: Concerns arise over symptomless Egypt bird flu cases

The selected targets are
A/Egypt/2321-NAMRU3/2007 and
A/Egypt/3300-NAMRU3/2008

which are distinct form the 2009 mild cases
A/Egypt/0585-NAMRU3/2009
A/Egypt/0001-NAMRU3/2009

but NAMRU-3 has not released ANY late 2008 / early 2009 sequences (poultry or patients)

So is the any public information on these two samples (A/Egypt/0585-NAMRU3/2009 and A/Egypt/0001-NAMRU3/2009)
or the other recent human samples you reference in your comment at:

http://www.recombinomics.com/News/02230904/WHO_Hoarding_Concerns.html

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

So is the any public information on these two samples (A/Egypt/0585-NAMRU3/2009 and A/Egypt/0001-NAMRU3/2009)
or the other recent human samples you reference in your comment at:

http://www.recombinomics.com/News/02..._Concerns.html

Names of flu isolates include the year of collection and sample number. Isolates named by NAMRU-3 are numbered sequentially and start over each calendar year. Human isolates have no species in the name, so the two isolates named above are human, and it is a safe bet that sample number 0001 is the first human cases in 2009 which would be the case listed below.

Since the WHO report came out in February, it is also safe to assume that sample 0585 was from one of the next three isolates in Egypt (one in late January and two in early February), with the odds favoring the second case of the year in late January.

However, all four cases were toddlers between the ages of 1 1/2 and 2 1/2 and had a "mild" course and recovered. Moreover, the four cases were scattered throughout Egypt, yet both 2009 isolates in the tree are on the same branch. They are somewhat related to the vaccine strain that is on the branch below, but have charcteristic of earlier isolates, suggesting they are recombinants.

However, the sequences have not been released and the branch has no public H5N1 sequences, so further analysis is limited.

There has not been any additional information in other isolates discussed earlier. None of those human sequences have been released at Genbank or GISAID (but clade 7 vaccine targets from poultry in Vietnam have been released).

Here is the first 2009 case in Egypt

• Date of report: 12 January 2009
• Per the Ministry of Health and Population/Epidemiology and Disease Surveillance (ESU)
• Governorate: Sixth of October
• District: Kerdasa (urban area located in western Giza; population 460,000)
• Village: Kafr Abu Hegazi (Saad Zaghloul Street near Abu Hegazi mosque)
• Event summary: Female infant, 21 months old, began experiencing symptoms January 9 evening. The family kept unvaccinated poultry that had become sick and died in the previous week. Infant was taken to hospital January 10. AI was suspected on Jan. 11; patient isolated; tests taken. Results on January 12 showed AI; patient was given Tamiflu and transferred. Specimens from mother and other contacts tested negative. The child was reported in good, stable condition Jan. 14.
  • This was Egypt's 52st human infection.
  • For Sixth of October Governorate, it was the fourth suspected human infection but the first to be confirmed positive. For Kerdasa district, it was the first suspected human case.
  
  
• Medical response: The infant around 8 p.m. January 9 began experiencing symptoms of fever, high temperature (41 C), cough, nasal discharge, vomiting, rapid breathing. Family sought medical care at Imbaba Fever Hospital on January 10.
  • On January 11, case suspected as AI; patient isolated; specimen taken; Tamiflu administered at 1 p.m. Lab test of specimen returned positive for H5N1 virus on January 12; results by Central Public Health Laboratory (CPHL) and NAMRU-III. Case was referred to Manshiet el Bakry Hospital, Cairo.
  • Specimens (blood samples and throat swabs) were taken at Imbaba Fever Hospital from mother and others who had contact with poultry; contacts were kept under supervision at home by Kerdasa Hospital health team. Negative results were found from specimen tests by CPHL.
  
  
• Condition of the home: The family had raised poultry at home that were unvaccinated. Last quantity was 150 chickens, 22 ducks, and 8 geese.
  • The mother said some poultry began dying about a week before the child became sick. During the week, the mother and her family slaughtered the remaining poultry that were sick: 70 chicken and 6 geese. ESU reported they kept some live ducks and sold some ducks in the local market; and discarded many of the dead poultry in the garbage and around an irrigation canal.
  • ESU said samples from poultry and from slaughtered birds stored in the house refrigerators were tested by MALR's National Laboratory for Veterinary Quality Control on Poultry Production (NLQP); all were found positive for H5N1 virus. MALR/GOVS said NLQP found only live ducks, only frozen. MALR/GOVS said samples were also taken from a neighbor's house located across a narrow street and were found positive. See related report.
  
  
• Findings of the Ministry of Health and Population's Epidemiology and Disease Surveillance (ESU): Mother's awareness and notification of dead poultry helped in early diagnosis and administering of Tamiflu (around 36 hours after the onset of the disease).

[sharon sanders]

Re: Concerns arise over symptomless Egypt bird flu cases

Most patients who are tested for H5N1 in Egypt claim a connection to sick or dying poultry (which leads to treatment and testing). Neither WHO nor SAIDR have produced any evidence of H5N1 in poultry in the area of the recent cases in Beheira or Qena (in contrast to earlier cases).

Sick and dead poultry are common worldwide, and the use of the word "connection" by WHO has included prior examples that had nothing to do with H5N1 transmission to confirmed cases.

WHO says dead or dying poultry are "connected" and claims no symptoms in contacts, knowing full well that the two cases in Beheira are neighbors and cousins.

WHO's credibility on H2H has been suspect since 2004 and there is little evidence of change (other than the cluster in Beheira which has SIGNIFICANTLY lowered WHO H5N1 H2H credibility in Egypt).

Thank you for making your position clear.

From my research none of the governmental, international, or other organizations have complete and/or irrefutable information.

I think it is prudent to accumulate as much information as possible, from as many sources as possible.

[Commonground]

Re: Concerns arise over symptomless Egypt bird flu cases

Concern of the mutation of avian influenza in Egypt to a pandemic strain in humans


Last Updated: Friday, April 10, 2009 11:28 GMT Cairo

The Council of Ministers held an emergency meeting yesterday chaired by Dr.. Ahmed Nazif to discuss the rising incidence of disease, bird flu, amid fears it could mutate to a lethal strain passed from human to human.

Did not attend the meeting, a representative of the union of poultry producers, as the majority of casualties were among the last birds in the jam of houses and farms, which is not in a total of 17 people in the republic.

The World Health Organization warned of the increased risk of some Egyptians highly pathogenic virus without showing any symptoms of infection, which may enable the virus to mutate into a strain that can spread easily among humans. And after the growing incidence of the disease in Egypt, where the Ministry of Health recorded 12 cases including 11 cases of children under the age of 9 of them, which is the highest in the world 2009.

"John Gabor specialist emerging diseases and health organization based in Cairo: that? there is a need to conduct tests to prove the existence of such cases infected with bird flu symptoms without the emergence of the patient ?. He pointed out that ?the study will be the focus of the Egyptian government intends to hold the support of the organization?.

Gabor said that the proliferation of such cases in Egypt, which has a total of 63 cases in which the case since 2006 ?a matter of concern just now .. It is a question to be put (..) and added: The change in the pattern of avian influenza infection in humans in Egypt this year, raised concerns about the presence of the virus without showing symptoms ?. According to Reuters.

He warned that ?the presence of carriers of the virus show no symptoms would be a worrying development, because it may allow the virus more time to mutate into the human body .. If there were cases of this kind in Egypt, the aim is to treat immediately to stop the proliferation of the virus. Because it either through mutation or restructuring will lead to a pandemic strain. ?

Of 12 Egyptians infected with bird flu this year were nine cases of children under three and I said, the incidence among adults a lot. All cases and corresponded to heal. The case differs significantly from the same period last year, as seven people were wounded, most adults and older children with HIV and three died.

Gabor said that the increase in cases among children under the emergence of similar injuries among adults raised questions about whether adults carrying the virus without showing any symptoms of the disease. He continued that ?there was something strange is happening in Egypt. Why is the child now does not appear to adults? We need to know whether there are situations that do not show symptoms. ?
He pointed out that ?there are no known cases of this type of injury among people in other countries hit by the disease but does not yet exist?.

For his part, said Dr. Abdel Rahman Shahin, spokesman of the Ministry of Health: The Ministry follows strict procedures to prevent mutation of the disease can be transmitted among humans, and that the Ministry of Health has been conducting regular research with an international high in America and Britain. He added that the death rates in cases in Egypt of the lowest world, which reflects the high degree of health care to them.