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<form name="cccform" action="https://s100.copyright.com/CommonApp/LoadingApplication.jsp" target="_Icon">Dr. Tim Uyeki, a flu specialist at the Centers for Disease Control and Prevention in Atlanta, said there had been mild cases of H5N1 among children in several countries. There have also, he said, been studies in Indonesia, Thailand, Cambodia and Nigeria similar to the one proposed for Egypt in which the blood of cullers, poultry workers and relatives of sick people has been tested.
“Those are the ideal people to look at,” he said. “And there was zero or extremely low prevalence of antibodies,” meaning silent infections were very uncommon.
Consultants spend a lot of time defending negative data. The paper from PLOS on H5N1 antibodies in suriving patients in southeast Asia shows that antibody levels drop rapidly, and titers at 182 days are much lower than 54 days, demonstrating how a poor expermiental design (collection of serum samples long after exposure) can create negative data for press releases and media reports
This is what the Egyptian government says so I would go with this location.
El Marg is in northern Cairo, adjacent to Qalubia, the location of case #63. Case #63 and #65 received delayed treatment at the same hospital, Ains Shams:
The first case is a 25-year old pregnant female from El Marg District, Cairo Governorate. Her symptoms began on 6 April and she was hospitalized at Ain Shams University hospital on 11 April where she was started on oseltamivir on 16 April.
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.
Scientists fear the increasing number of bird flu cases among children may allow for the mutation of the pathogenic virus, reports Reem Leila
<HR noShade><!-- STORY -->As the number of reported bird flu cases in children continues to rise attention is increasingly being focussed on government efforts to control the disease. Although the virus is now causing fewer fatalities among those who contract it, scientists are worried about the changing profile of those who do develop symptoms. The World Health Organisation (WHO) fears the rise in infections among small children, without a similar increase in older people, could suggest adults are being infected but not falling ill, acting as symptom-free carriers of the disease.
A preparatory mission consisting of WHO, UNICEF, FAO and other UN agencies, will arrive in Egypt on 21 April.
"The mission will test blood and take swabs from people who contracted the virus and their families as well as those who are in direct or indirect contact with birds," says Ahmed Abdel-Latif, WHO representative in Egypt.
With three more cases reported last week, the WHO is concerned that the disease is now almost exclusively striking infants. There is also speculation that though symptoms are generally milder than in earlier cases, this could constitute a viral time-bomb. At the same time, Abdel-Latif strictly confirms that the virus has not yet mutated into a human-to-human strain.
Mohamed Sayed, plague and avian flu disease expert at the Research for Agricultural Guidance Centre, says that recent developments make it more likely the virus will spread.
"Ironically, its very virulence has provided an important safeguard. It did not get much chance to infect other people when it killed its victims swiftly, but now it has much more of a chance to mutate and be passed on. If the virus becomes less pathogenic it will become more transmissible."
The deadly strain of H5N1 usually kills half of those affected. Of this year's cases all were cured and discharged from hospital with the exception of the two most recent cases who remain hospitalised but whose condition is stable and who are, according to Abdel-Rahman Shahin, official spokesman to the Ministry of Health, expected to be discharged in the next few days.
Abdel-Latif argues that the higher rate of infection among children is a result of their weaker immunity systems and the fact that they "play with chickens in the streets".
"To control the deadly strain of H5N1 demands a convergence of biomedical, managerial and behavioural techniques," says Abdel-Latif. "So far Egypt is performing well on the biomedical front. Egypt's physicians can diagnose and medicate which is why the fatality rate is on the decrease." But what is needed, he argues, is a more holistic approach.
Combating the virus should be a national priority. Abdel-Latif advocates more awareness campaigns, particularly targeting children in rural areas.
"Existing campaigns are directed at adults. A change in the target audience is needed in order to avoid the spread of the disease."
He also believes the campaign should be directed through mosques and churches as well as the media. "People will respond more swiftly if they are advised by religious figures," he argues, adding that it remains essential for the owners of poultry farms to immediately report the presence of the virus.
Vaccine stocks only cover 30 per cent of the country's 300 million birds in rural farms, says Hamed Samaha, head of the General Authority for Veterinary Services (GAVS).
"The amount of vaccine is barely sufficient to cover the workforce that will distribute them and responsive farmers who are willing to inoculate their birds." Six million doses are needed to cover the entire poultry sector but, says Samaha, the authority can only afford to provide 120 million.
"Out of 13,000 registered veterinarians only 6,500 are available to work on vaccinations and 70 per cent of these are unsuited to field work being more than 50 years old. We end up with only 1,200 veterinarians while at least 34,000 are needed to cover targeted areas."
No new veterinarians have been appointed since 1994 because of a lack of funds. And while, says Samaha, Prime Minister Ahmed Nazif recently agreed on 1,500 new veterinarian appointments, "we are still massively understaffed."
Poultry farmers have also stopped reporting outbreaks for fear they will incur financial losses. The only way around the problem, Samaha argues, is to offer farmers compensation for any losses they might incur when revealing the real status of their farms.
Saber Abdel-Aziz, head of the epidemic and poultry department at GAVS, criticises the lack of human and financial resources without which veterinary services cannot play a more active role in combating the virus.
Currently there are 50 sites in Egypt that have tested positive for the virus. "Only two per cent of poultry farms apply bio-security measures," says Abdel-Aziz. Yet the veterinary authorities lack even vehicles to access many sites. While in 2006, he continues, the first avian flu campaign successfully vaccinated 90 million birds. "At first farmers were concerned so they cooperated with the authorities but now they are more confident and don't respond to our efforts."
Serious WHO Analysis of H5N1 Transmission in Egypt Recombinomics Commentary 17:31
April 21, 2009
An April 8 Reuters article from Cairo quoted a visiting W.H.O. expert saying his agency feared “something strange happening in Egypt” and would help the government test the blood of healthy people for antibodies this summer.
But a W.H.O. spokesman said privately that the agency was just helping the Egyptians with a long-planned study and the article had “jumped the gun.”
Gregory Hartl, a spokesman for the WHO, told CIDRAP News that because of holiday observances in Egypt, the WHO team just left for that country today.
The above comments suggests there are two distinct WHO investigations of H5N1 in Egypt, which are related to mild cases in children in the spring of 2007, as well as mild cases in toddlers in 2009. The initial comments above reported in the Donald McNeil New York Times piece on the mild cases in toddlers are in reference to the 2007 data and such antibody studies have been previously planned for the summer.
The latter comments are with regard to WHO officials who are en route to Egypt, which are linked to the 2009 toddler cases and clusters. This week’s trip is also supported by a report from the European Centre for Disease Prevention and Control as well as local media in Egypt, which are focused on the high incidence of mild toddler cases this year.
In the spring of 2007, 16/17 H5N1 cases recovered, and 16/17 cases were in children between the ages of 3-10. The vast majority of these cases not only recovered, but did not develop pneumonia and the cases presented much like seasonal flu. In addition, sequences from cases that were not epidemiologically linked were virtually identical, and the one cluster that was epidemiologically linked involved siblings in Qena, whose sequences match each other and had a deletion, S129del. The identity of the sequences, and the four day spread in admission dates strongly supported human to human transmission. Moreover, additional contacts had symptoms, but tested negative. These data raised concerns that the H5N1 was silently spreading because many patients with symptoms would not seek treatment or would be treated for seasonal flu and would not be tested for H5N1.
Such spread could be identified by tests for H5 antibodies. However, recent data on immune responses in recovered H5N1 patients in southeast Asia indicates that antibody levels are largely not maintained over time, and therefore such patients may return false negatives if tested weeks, months, or years after exposure. Thus, such testing may not identify asymptomatic or mild cases because of delays in testing and reductions in antibody levels over time.
This year there were mild cases in Egypt again, except the demographics had changed. Instead of involvement of children between the ages of 3-10, almost all confirmed cases were toddlers. Previously, infections in toddlers were rare. In the 51 confirmed cases in 2006-2008, only six were toddlers. In contrast, 10 of the first 11 cases in 2009 were toddlers and the current count is 11 of 15 cases. Only one of the older cases was a child, so 11/12 children were toddlers between the ages of 1 ½ and 2 ½. This new demographers increased concerns that the mild cases in 2007 were widespread in children providing protective immunity, which limited the number of confirmed cases in 2009 to one child.
The data in 2009 was characterized as “something strange” as noted above and increased concerns that the number of human H5N1 cases in Egypt was orders of magnitude higher than the current 66 confirmed cases. Evidence for additional cases comes from test results as well as the mild nature of confirmed cases. In Egypt, suspect cases with a history of exposure to dead or dying poultry leads to rapid treatment and testing. However, more than 99% of hospitalized and suspect cases are PCR negative. Moreover, cases without a poultry connection are not tested, so cases without a stated connection could be silently spreading H5N1, even if symptomatic.
Thus, there is concern that the mild cases in the toddler demographic may signal a broad spectrum of testing failures and the recent cases should be tested for antibodies, which are at peak levels 3-4 weeks after disease onset. Therefore the symptomatic cases that are PCR negative should be tested for antibody now, not at some future date when antibody levels decline. Similarly, toddlers, which are the current major at risk population, should be PCR tested, and those who have recently recovered should be tested for antibodies.
Repeating failed experimental protocols of the past is not useful.
Serious testing for H5N1 in Egypt is long overdue as is the release of H5N1 sequences, which are expected to contain the same deletion seen in the Qena cluster in 2007.
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Egyptian health officials have just reported two deaths from bird flu within days of each other. The dangerous virus variant H5N1 struck down a six-year-old boy and a young woman, bringing the total death toll in Egypt to 25. While bird flu experts note that Egypt has seen a surge in human cases in recent months, with 16 confirmed since the start of the year, compared to seven cases between January 1 and April 17 last year [Reuters], they also say that the Egyptian people’s level of alarm is out of proportion to the threat.
Rumors have appeared in the Egyptian media that the virus is circulating widely, and that some people get “silent infections” which show no symptoms, but still allow them to pass on the virus. The rumors have been fueled by the pattern of recent infections: Many of the infected patients have been toddlers, leading to the belief that stronger adults are also infected but simply show no symptoms. Although thousands of Egyptians have rushed their children to hospitals this flu season, there is no evidence yet of asymptomatic avian flu cases or any significant mutation in the H5N1 virus. “Right now, it’s all hot air,” said Dr. Robert G. Webster, a flu expert…. “I hope to hell it’s not happening, because it would mean the virus is adapting to humans. But there’s not a shred of data” [The New York Times].
While the H5N1 virus rarely infects people, the looming fear is that the virus may mutate into a form that can be transmitted easily from person to person, which could spark a deadly pandemic. However, an outbreak of swine flu across the world from Egypt, in Southern California, has reminded people of the hazards of overreacting before all the information is in.
Swine flu is found in pigs and very rarely in humans who have direct contact with pigs; the United States reports one human case every one or two years. However, two California children were diagnosed with the disease this spring, sparking an investigation by the Centers for Disease Control. Since neither of the two children, a 10-year-old boy and a 9-year-old girl, had contact with pigs, it “increases the possibility that human-to-human transmission of this new influenza virus has occurred,” according to a CDC report. The girl did attend an agricultural fair four weeks before becoming sick, she said, but did not have any contact with pigs or other livestock [CNN].
The incident has brought back memories of another swine flu outbreak in 1976 among army recruits at Fort Dix, New Jersey, which taught public health officials a tough lesson. That winter, 13 men got sick and one died of what proved to be swine influenza viruses–viruses that were thought to be similar to the one responsible for the 1918 Spanish flu pandemic. U.S. officials ordered the manufacture of swine flu virus vaccine and the country proceeded to launch a mass immunization program that saw upwards of 40 million people injected with the vaccine. The feared pandemic never occurred. But the vaccine appeared to trigger a high level of cases of Guillain-Barre syndrome, a type of paralysis [The Canadian Press], and thousands of vaccine recipients filed injury claims.
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