64 case of bird flu raises the possibility of disease transmission between humans

[Commonground]

64 case of bird flu Raises the possibility of disease transmission between humans

الخميس، 16 أبريل 2009 - 16:36

Thursday, April 16, 2009 - 16:36

مخاوف من انتشار مرض أنفلونزا الطيور فى مصر!

Fears of the spread of bird flu in Egypt!

كتبت أميرة عبد السلام

Written by Amira Abdel-Salam

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سجلت الحالة رقم 64 لأنفلونزا الطيور علامة استفهام جديدة فى هذا الملف، الذى تديره كل من وزارة الصحة والزارعة منذ ظهور المرض بمصر فى منتصف عام 2006، حيث إنها الحالة الثانية التى ظهرت فى غضون شهر واحد.

No. 64 The situation of avian influenza is a question mark in this new file, which is run by the Ministry of Health and Agriculture in Egypt since the virus first surfaced in mid-2006, where it is the second case, which appeared within a month.

فهل تتحول أنفلونزا الطيور إلى شبح يحارب البشر أم ستكتفى بالطيور فى الفترة القادمة؟

Is bird flu becoming the specter of people fighting to sell the birds in the coming period?

فمع تأكد إصابة الحالة الأخيرة أمس، الأربعاء، أعلن الدكتور حاتم الجبلى وزير الصحة، أن الوزارة على أهبة الاستعداد لمواجهة هذا المرض، فى حالة تحور الفيروس وانتقاله بين البشر، وأكد أن وزارته تتعامل مع مرض أنفلونزا الطيور بشفافية كاملة، "ولا نتستر على شىء، والمنظمات الدولية أشادت بدور الوزارة فى مواجهة المرض"، محذرا من خطورة هذه المرحلة، قائلا "نحن مستعدون لها بالخطط اللازمة"..

With the latter case has been confirmed yesterday, Wednesday, Dr. Hatem el-Gabali, Minister of Health, the Ministry stands ready to face this disease, in case the virus mutates and human-to-human transmission, and stressed that his ministry to deal with bird flu, with full transparency, "or something to mask, and international organizations, praised the role of the ministry in the face of the disease, "warning of the danger of this stage, saying," We are ready with plans for the "..

لكن هل خطط الوزير كافية لمواجهة أنفلونزا الطيور فى حالة تحولها إلى وباء؟

But is the Minister's plans sufficient to meet the avian flu in the case of transition to a pandemic?

الدكتور عبد الرحمن شاهين، المتحدث الرسمى باسم وزارة الصحة، أكد أن مخزون التاميفلو الموجود حاليا والترصد والترقب للحالات، يرفع من معدل السيطرة على المرض، مشيراً إلى أن مصر تعاملت دولياً بمنتهى الشفافية، فجميع المعلومات المتعلقة بظهور عدوى أنفلونزا الطيور بين الطيور والبشر، تم نقلها صراحة للجماهير، ولمنظمة الصحة العالمية، والمنظمات الدولية، ومنظمة الأغذية والزراعة التابعة للأمم المتحدة.

Dr. Abdel Rahman Shahin, spokesman for the Ministry of Health, confirmed that the stocks of Tamiflu, the existing surveillance and anticipation of the cases, raise the rate of disease control, pointing out that Egypt has dealt with utmost transparency internationally, all information related to the emergence of avian influenza infection in birds and humans, have been transferred explicitly to the public, and the World Health Organization, international organizations, the Food and Agriculture Organization of the United Nations.

وأضاف شاهين أن جميع الوفود المشاركة فى المؤتمر الدولى السادس لمكافحة مرض أنفلونزا الطيور، والذى عقد بمصر فى أكتوبر من العام الماضى، أشادت بالتجربة المصرية فى مكافحة أنفلونزا الطيور والشفافية الكاملة التى تعاملت بها الحكومة المصرية فى مواجهة المرض.

Shaheen added that all the delegates to the Sixth International Conference on the fight against bird flu, which was held in Egypt in October of last year, hailed the Egyptian experience in combating avian flu and full transparency handled by the Egyptian government in the face of the disease.

وتابع شاهين، أن المتحدث باسم الخارجية الأمريكية أشاد بالإجراءات التى اتخذتها وزارة الصحة فى مصر، والتى ساعدت فى أن تجعل البلد من أفضل ست دول أعلن فيها استقرار مرض أنفلونزا الطيور، منوهاً أن مصر تعد صاحبة أدنى معدل للوفيات بهذا المرض عن أى دولة متضررة فى العالم.

Shaheen said that the State Department spokesman praised the actions taken by the Ministry of Health in Egypt, which helped to make the country one of the best six countries announced the stability of the bird flu, noting that Egypt is the lowest rate of mortality from this disease of any country in the world affected by .

وأضاف "أن مصر تعد نموذجا من حيث قدرة وزارة الصحة على التوعية وتثقيف الأسر الريفية فى نظام الحياة المعيشية والصحية الخاصة بهم، وأيضاً الاكتشاف المبكر لأى حالة إصابة بشرية".

He added that "Egypt is a model in terms of the capacity of the Ministry of Health to raise awareness and educate rural families living in the life and health of their own, as well as early detection of a human case."

من جانبه، أعلن الدكتور عمرو قنديل، رئيس الإدارة المركزية للشئون الوقائية، أن نتيجة ترصد المرض، تؤكد أن إجمالى عدد الحالات المشتبه فى إصابتها بمرض أنفلونزا الطيور على مستوى الجمهورية بلغت 6443 حالة، موزعة كالــــتالى: 1991 حالة عام 2006, و1829 حالة عام 2007, و1907 حالات عام 2008، و701 حالة عام 2009، حيث تم حجزهم وإعطاؤهم عقار التاميفلو، وكان منهم فقط عدد 64 حالة ايجابية، وباقى الحالات سلبية لفيروس أنفلونزا الطيور.

For his part, Dr. Amr Kandil, chairman of the central administration of the affairs of preventive, to monitor the outcome of the disease, confirm that the total number of cases of suspected bird flu at the level of the Republic amounted to 6443 cases, broken down as follows: 1991 cases in 2006, and 1829 cases in 2007, and 1907 cases in 2008, and 701 cases in 2009, where he was detained and given the drug Tamiflu, the number was only 64 positive cases, and the rest of the cases negative for the bird flu virus.

وكان توزيع هذه الحالات الإيجابية كالآتى:

The distribution of these positive cases as follows:

* 18 حالة خلال عام 2006.

* 18 cases during 2006.

* 25 حالة خلال عام 2007.

* 25 cases during 2007.

* 8 حالات خلال عام 2008.

* 8 cases during 2008.

* 13 حالة خلال عام 2009.

* 13 cases during 2009.

وأوضح قنديل أن الـ 64 حالة إيجابية فى مصر، منهم 2 حالة من العاملين بمزارع الدواجن، و61 حالة من المخالطين للطيور المنزلية، وحالة بائعة طيور واحدة، وتم شفاء 37 حالة ووفاة 23 ، وتوجد أربع حالات بالمستشفى منها حالة أوحالتان حرجتان، حيث تبلغ نسبة الوفيات فى مصر 36.5% مقارنة بـنسبة 63,5% على مستوى العالم.

The jellyfish that the 64 positive in Egypt, including 2 cases of workers in poultry farms, and 61 cases of contact with domestic poultry, and the status of birds and one sells, and recovered 37 cases and 23 deaths, and there are four cases, including that of the hospital Oouhaltan critical regions, where the mortality rate in Egypt, 36.5%, compared with 63.5% in the world.

وحدثت هذه الإصابات البشرية منذ بداية المرض عام 2006 حتى الآن فى 19 محافظة.

There have been human cases of this disease since the beginning of 2006 so far in the 19 provinces.

[Giuseppe]

Re: 64 case of bird flu raises the possibility of disease transmission between humans

ECDC Health Content: Egypt, Observed low case fatality ratio in 2008-9.

Observed low case fatality ratio in 2008-9

Information made available to WHO indicates that, on 8 April 2009 the Ministry of Health of Egypt reported 3 new confirmed human cases of infection with avian influenza A(H5N1).


The latest report can be accessed here

The first case is a 2 year-old boy from Kom Hamada District, El Behira Governorate who developed symptoms on 27 March and was admitted to hospital on the 30 March where he was started on oseltamivir the same day. He is reported to remain in a stable condition.

The second case is also a 2 year old male from the same district and was detected through the investigation around the first case. He developed symptoms on 31 March and was admitted to hospital on 1 April where he was also started on oseltamivir the same day. He is also reported to remain in a stable condition.

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

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 hospital on the 28 March where he was again started on oseltamivir (on 3rd April). He was also reported to have been exposed to sick/dead poultry prior to the onset of his illness. He was reported to be in a critical condition.

For all of the three cases reported above, infection with H5N1 avian influenza virus was following testing by the Egyptian Central Public Health Laboratory and subsequently confirmed by the United States Naval Medical Research Unit No. 3 (NAMRU-3).

Of the 63 cases confirmed to date in Egypt, 23 have been fatal. The last fatal case, had an onset date of December 8th 2008 and died on December 15th see here. Details of all the Egyptian cases can be seen through the general country page on the WHO web-site. It means than since December 2008 there have been 12 new confirmed A(H5N1) infections in humans all in children under age 3 apart from one woman in her 30s and none of the 12 are known to have died as of April 16th .


ECDC Comment (09-04-15):

The low Case Fatality Ratio (CFR) for human infections with Highly Pathogenic Avian Influenza (HPAI) H5N1 virus in Egypt is most welcome. However it was noted at a WHO global review two years ago.(2)

Therefore, what is being described now is not entirely new, except that there have been a series of 12 cases in 2009 with no deaths.

Clinically, mild illness with HPAI H5N1 virus infection has been reported in children in several countries apart from Egypt i.e. Turkey, Indonesia and Bangladesh and it should be noted that Egypt seems to be testing more children with milder illness soon after onset than any other countries.

This could be because children are brought to medical care for H5N1 testing early in their illness.

Moreover, testing and care (including early commencement of the antivial oseltamivir as recommended by WHO and ECDC (3,4)) seems to be relatively available in Egypt. It is noticeable in the recent reports how soon after onset dates treatment with oseltamivir seems to have started.

The occurrence of so many cases late in 2008 and early in 2009 is not in itself unusual.

It was also the pattern in the 2007-8 period.(Figure) (5)

Despite the above speculation, it is not yet known how to explain the commendable low CFR being achieved in Egypt with a virus that overall has been observed to have a CFR of around 60-70%.(5)

Various hypotheses have to be tested.

It could reflect a further adaptation of the virus to humans and a lessening of its virulence but equally it could be the result of good local surveillance, or that the clade 2.2 virus infections in Egypt has a lower CFR, or that its because early oseltamivir and other treatment has a better outcome.

There are no reports as yet of a change in the virological sequences and it is commendable that the Egyptian authorities have been sharing viruses with the global community as evidence from the WHO A(H5N1) Tracking Mechanism.(6)

The clade hypothesis theory seems unlikely since in nearby Turkey the same clade of H5N1 cases in 2005/6 resulted in a CFR for Turkey of 4 out of 12 in circumstances where it was difficult to achieve early treatment (a rural areas in then middle of a severe winter).(5)

Hence the good surveillance / early treatment theory seems the strongest hypothesis.

However uncertainty remains and it will be important to investigate further. It is very welcome that the Egyptian authorities have invited WHO to send senior staff to Egypt next week to assess the current epidemiological situation.

It is especially reassuring that despite the low CFR and apart from two of the cases in the most recent report there have been no clusters in the cases suggesting more easy human to human transmission.

However it would be hoped that this would be investigated in Egypt with serological surveys to look for milder and asymptomatic cases and any suggestion of clustering since even though the seeming lack of significant change in the sequence of the virus is reassuring the changes can be subtle and its how the viruses behave that is most important.(7)

A good example of such investigations were recently published in the Weekly Epidemiological Report of joint National / WHO work done in Pakistan in 2007.(8)

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graph - reference 5


References:

1. Media Report New bird flu cases suggest the danger of pandemic is risingIndependent UK April 12th 2008
2. Writing Committee of the second WHO consultation on clinical aspects of human infection with avian influenza A (H5N1) virus. NEJM 2008; 358: 261-73 .
3. WHO Clinical management of human infection with avian influenza A (H5N1) virus August 2007
4. ECDC Oseltamivir prophylaxis following suspected exposure of humans to Highly Pathogenic Avian Influenza (HPAI) with particular reference to HPAI type A/H5N1, Version 30th April 2006
5. WHO Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO April 8th 2009 (see figure below)
6. WHO Influenza Virus Tracking System (interim)
7. Nicoll A (Yet) another human A/H5N1 influenza case and cluster ? when should Europe be concerned? Eurosurveillance 2008; Volume 13, Issue 15, 10 April 2008
8. WHO Human cases of avian influenza A(H5N1) in North- West Frontier Province, Pakistan, October?November 2007 WER 2008 3 October 2008, vol. 83, 40 (pp 357?364)
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<cite cite="http://ecdc.europa.eu/en/health_content/episu/090416_av_hh.aspx">ECDC Health Content</cite>