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Egypt's Health Minister denies H5N1 & "Swine Flu" coinfection

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  • alert
    replied
    Re: Egypt's Health Minister denies H5N1 & "Swine Flu" coinfection

    And ProMed issues a correction to the correction.

    http://www.promedmail.org/pls/otn/f?..._ID:1000,79055

    Archive Number 20090903.3094
    Published Date 03-SEP-2009
    Subject PRO/AH/EDR> H5N1/H1N1 virus co-infection - Egypt (02): ex S.Arabia, NOT, corr.


    H5N1/H1N1 VIRUS CO-INFECTION - EGYPT (02): ex SAUDI ARABIA, NOT, CORRECTION
    ************************************************** *************************
    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: 3 Sep 2009
    From: ProMED-mail <promed@promedmail.org>


    Both the Egyptian Ministry of Health & CDC now concur that the
    dual-infected patient hospitalized in Egypt did not have avian (H5N1)
    together with pandemic (H1N1) 2009 virus (see 1st ProMED ref. below).
    The co-infection was with seasonal H3N2 virus.

    I introduced an error into Mod.CP's comment. The relevant sentence
    should read
    "It now appears that the co-infection is believed to be between 2 low
    virulence viruses (pandemic H1N1 & H3N2) and *not* between a highly
    virulent, poorly transmissible, virus (pandemic H5N1) and a highly
    transmissible strain of low virulence (H1N1)..."

    I regret adding to the confusion.
    --
    Jack Woodall (Mod.JW)
    Assoc.Ed. ProMED
    <woodall@promedmail.org>

    [see also:
    H5N1/H1N1 virus co-infection - Egypt (02): ex S.Arabia, NOT 20090902.3090
    H5N1/H1N1 virus co-infection - Egypt: ex S.Arabia, susp, RFI 20090901.3081]

    Leave a comment:


  • Hogweed
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Dr Niman has commented on this elsewhere. He points out that even co-transmission with human H3N2 (as CDC suggests in one case) is a problem because H3N2 has likely escaped the seasonal vaccine and has key polymorphisms which could help swine H1N1 do likewise and/or become more virulent if acquired by recombination.

    However Niman suspects that there may really be some H5N1/swine co-infections and some "hand-waving" is being done to buy time. If so then of course it is a very serious cause for concern if H5N1 is able to move h2h by piggybacking off of spreading swine H1N1. A scenario potentially worse than reasortment or recombination events according to Niman.

    Leave a comment:


  • Rwilmer
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    The italians denied one of their nationals cases.

    Leave a comment:


  • Hogweed
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    All the denials seem to be about one particular case. What about the others?

    Leave a comment:


  • Rwilmer
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    H5N1/H1N1 VIRUS CO-INFECTION - EGYPT (02): ex SAUDI ARABIA, NOT
    ************************************************** *************
    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: Tue 1 Sep 2009
    Source: Youm7 [in Arabic, machine trans., edited]
    <http://www.youm7.com/News.asp?NewsID=132676>

    The Ministry of Health through the Council of Ministers daily report
    on the situation regarding swine flu [pandemic (H1N1) 2009 influenza
    virus infection], has now discounted the rumour of [a co-infection]
    with avian influenza virus of one of the cases infected with H1N1 type
    virus upon his arrival at the port of Safaga from Umrah [pilgrimage to
    Saudi Arabia].

    The Ministry said that this pilgrim was infected with swine flu
    [pandemic (H1N1) 2009 virus] in addition to a common [seasonal] flu
    and not bird flu [avian H5N1 influenza virus]. [Previously it was
    suggested that the patient was co-infected with H1N1 and H5N1 viruses.
    - Mod.CP]. This patient's health is good and his condition stable. He
    will leave hospital within 2 days after treatment. This emphasizes the
    lack of any potential interaction between a mutant avian H5N1 virus in
    Egypt and an H1N1 strain.
    [Byline: Mona Zia]
    --
    Communicated by:
    ProMED-mail Rapporteur Mary Marshall

    ******
    Date: Wed, 2 Sep 2009 11:44:45 -0500 [12:44:45 EDT]
    From: Jason Garner <jasonlgarner@gmail.com>

    I would like to pass on information just released by both PLoS and the
    NIH regarding interaction of the pandemic A(H1N1) with co-infections
    of seasonal flu viruses.

    A University of Maryland/NIH study, using ferret animal models,
    suggests that co-infections of A(H1N1) with seasonal flu viruses do
    not produce chimeric or reassortant viruses. Said another way, the
    A(H1N1) outcompetes seasonal viruses, possibly demonstrating the
    pandemic strain is not under biological pressure and is perhaps more
    efficiently communicable.

    However, with regard to the H5N1-A(H1N1) co-infections reported
    recently, there is no data to suggest these latest findings could
    apply to H5N1 co-infections. In light of the characteristic that HPAI
    H5N1 has been shown to be a "dead-end" infection in humans, it could
    possibly be out-competed by a more robust strain such as A(H1N1)
    rather than being a player in a recombination event.

    Link to the NIH study results summary:
    <http://www.nih.gov/news/health/aug2009/niaid-31.htm>

    --
    Jason L Garner
    Senior Molecular Biologist
    Global Influenza Surveillance

    *******
    Date: Wed, 2 Sep 2009
    From: Mary Marshall <mjm2020@googlemail.com>
    Source: ScienceInsider
    <http://blogs.sciencemag.org/scienceinsider/2009/09/specious-report.html>

    Specious Report of Bird and Swine Flu Co-infection
    --------------------------------------------------
    An Egyptian news story that is starting to receive worldwide attention
    about a nightmare swine flu/bird flu co-infection is inaccurate,
    according to officials at the U.S. Centers for Disease Control and
    Prevention (CDC).
    On 30 August, the well-regarded Egyptian newspaper Almasry reported
    that an Egyptian man who returned from a religious pilgrimage to Saudi
    Arabia had tested positive for both the highly lethal bird flu virus,
    H5N1, and the novel H1N1 strain that is the cause of the swine flu
    pandemic.

    This was the first such report of a co-infection with the two viruses,
    which many researchers fear because the mix could create a new virus
    that has the virulence of bird flu, which does not move easily between
    humans, and the highly transmissible swine flu.

    The Egyptian report was picked up yesterday by the widely read
    electronic surveillance system ProMED. Although the ProMED moderators
    raised many questions about the story, it remained unclear whether it
    was accurate. According to Nancy Cox, head of the CDC?s influenza
    division, there is no evidence that this man is infected with both
    viruses. ?Our reliable sources indicate that this report is
    incorrect,? Cox told ScienceInsider in an e-mail. Apparently, tests
    have shown that the man is co-infected with the pandemic H1N1 and the
    seasonal H3N2 virus. ?There will be follow up testing to confirm,?
    according to Cox. As many as 5% [1 in 20] people who develop flu
    symptoms are infected with 2 different influenza viruses.
    [By Jon Cohen]

    [The statement from the Egyptian Ministry of Health denies the
    earlier report that a pilgrim returned from Saudi Arabia was infected
    with both pandemic H1N1 influenza virus and an avian (H5N1) influenza
    virus strain.
    It now appears that the co-infection is believed to be between 2 low
    virulence viruses (pandemic H1N1 & H3N2) and *not* between a highly
    virulent, poorly transmissible, virus (pandemic H1N1) and a highly
    transmissible strain of low virulence (H5N1) which might, as a result
    of genetic interaction, generate a highly transmissible and highly
    virulent strain. The consequences of the interaction as a result of
    co-infection of 2 highly transmissible viruses of low to moderate
    virulence, as in the present case, are unclear but less threatening.

    A question arises over the accuracy of the diagnostic procedures
    supporting the claim of co-infection. A highly relevant comment on the
    original report from Egypt has been received from Jason L Garner,
    Senior Molecular Biologist, Global Influenza Surveillance
    (<jasonlgarner@gmail.com>) and is reproduced in full below.

    "This is a worrisome event.
    1) My 1st and obvious question is how were these results obtained? DFA
    [direct fluorescence antibody]? RT-PCR? rRT-PCR?
    2) Also, what type of specimen was used in the assay, such as NP
    [nasopharyngeal], nasal wash, throat swab, virological culture? Unlike
    seasonal or pandemic A (H1N1) flu, the preferred method for collecting
    HPAI H5N1 specimens is via throat swab, and the others either NP or
    nasal wash. From a molecular standpoint HPAI H5N1 is difficult to
    discern even in sensitive rRT-PCR assays, unless an original throat
    swab and/or a cultured isolate was employed.
    3) If it was obtained with cultured isolate, wouldn't one strain
    perhaps out-compete the other as is usually the case with seasonal H1
    and H3 viruses?
    4) Are there substantial differences in LPAI and HPAI gene segment
    targets to discern with assay used?
    5) Lastly, how and by what methods, if any, were potential
    contamination variables controlled?
    Very interested to learn more."

    A response from the Egyptian Ministry of Health would be welcomed. -
    Mod.CP/JW]

    [see also:
    H5N1/H1N1 virus co-infection - Egypt: ex S.Arabia, susp, RFI 20090901.3081]
    ........................................cp/mj/jw
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    http://www.promedmail.com/pls/otn/f?..._ID:1000,79052

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  • Rwilmer
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Originally posted by alert View Post
    The good news is that all these questionable articles will cause the WHO, Egypt's MOH, and maybe even the US CDC to investigate this fully.

    You know, I think we should create a forum (and maybe even an award) for bad articles. The ProMed post gets a pass because it was a misunderstanding, but the Kronos article gets one of the awards.
    Lets not discount this just yet. I want to wait a bit longer and see what other news comes out on this.

    Leave a comment:


  • alert
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Originally posted by Rwilmer View Post
    This a tug of war it seems on minute we have a h5n1/h1n1 combo and the next it is denied. Then the cycle starts again.
    The good news is that all these questionable articles will cause the WHO, Egypt's MOH, and maybe even the US CDC to investigate this fully.

    You know, I think we should create a forum (and maybe even an award) for bad articles. The ProMed post gets a pass because it was a misunderstanding, but the Kronos article gets one of the awards.

    Leave a comment:


  • Rwilmer
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    This a tug of war it seems on minute we have a h5n1/h1n1 combo and the next it is denied. Then the cycle starts again.

    Leave a comment:


  • alert
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Yeah. It also looks like ADN Kronos produced a really bad article as well that has been posted in this thread twice, as well as on Crof's blog.

    Leave a comment:


  • Rwilmer
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Promed will do that. They will get alot of media involved.

    Leave a comment:


  • alert
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Yikes. Assuming there is no co-infection, that story has really taken off.

    On the other hand, if tourists are picking up H5N1, we would have a major problem, as tourists typically don't have contact with birds. But I do think the surveillance in Egypt is good enough to pick up the kind of large H5N1 outbreak that would lead to spread to tourists. And also keep in mind that kind of outbreak would produce massive piles of dead bodies, something we aren't seeing.

    Leave a comment:


  • Pathfinder
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Egypt: Italian suspected of swine flu and bird flu


    Rome, 2 Sept. (AKI) -

    A 35 year-old Italian tourist is one of three people believed to have been infected with A(H1N1) virus, or swine flu, as well as the H5N1 virus, known as avian flu. The patients are recovering in the Egyptian Red Sea resort of Hurghada, said Mohammed Rifai, director general of preventive medicine.

    Rifai also spoke of a 28-year-old man who tested positive for both viruses, after arriving at the port of Safaga after a pilgrimage to Saudi Arabia.

    "We are waiting the results of the tests that have already been carried out in some patients suspected of having been infected by the H5N1 and the A(H1N1)," said World Health Organisation spokesman Gregory Hartl in an interview with Adnkronos Salute.

    "However, at the moment there are no confirmed cases."

    Hartl, however, did not want to specify the nationality of the suspected cases.

    Last week in Chile, the A(H1N1) virus was found in turkeys, raising concern that poultry farms elsewhere in the world may also become infected with the pandemic swine flu virus.

    The United Nations Food and Agriculture Organization interim chief veterinary officer, Juan Lubroth, said that it could theoretically become more dangerous if the A(H1N1) combines with H5N1, commonly known as bird flu, which is far more deadly but harder to pass along among humans.

    The emergence of new influenza virus strains capable of affecting humans and domestic animals remains a broader, more general concern that is being closely monitored by FAO, the World Organization for Animal Health and the World Health Organization.

    In addition, the first mass vaccinations against swine flu will be available from November in Italy, the Italian government has announced.

    The vaccine is expected to be available for those most at risk, an estimated 24 million Italians or 40 percent of the population.

    According to Italian media reports, the government is planning to release eight million doses from mid-November until mid-December.

    Another 16 million doses of the vaccine are expected to be available from 31 January 2010.

    The ministry of health, together with medical officials and regional representatives, will work together with doctors to administer the vaccine free of charge.

    In the first phase, the vaccine will be offered to health workers and to those most at risk, including residents of nursing homes and pregnant women as well as family doctors.

    Another round of vaccines will be made available to those aged between two and 65 years of age, suffering from respiratory illnesses by the end of the year.

    Others aged between two and 27 years will be eligible for another round of vaccines at the end of January.


    http://www.adnkronos.com/AKI/English...3.0.3724836800

    Leave a comment:


  • Rwilmer
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Specious Report of Bird and Swine Flu Co-infection
    An Egyptian news story that is starting to receive worldwide attention about a nightmare swine flu/bird flu co-infection is inaccurate, according to officials at the U.S. Centers for Disease Control and Prevention (CDC).

    On 30 August, the well regarded Egyptian newspaper Almasry reported that an Egyptian man who returned from a religious pilgrimage to Saudi Arabia had tested positive for both the highly lethal bird flu virus, H5N1, and the novel H1N1 strain that’s behind the swine flu pandemic. This is the first such report of a co-infection with the two viruses, which many researchers fear because the mix could create a new virus that has the virulence of bird flu, which does not move easily between humans, and the highly transmissible swine flu.

    The Egyptian report was picked up yesterday by the widely read electronic surveillance system ProMED. Although the ProMED moderators raised many questions about the story, it remained unclear whether it was accurate. According to Nancy Cox, head of the CDC’s influenza division, there’s no evidence that this man is infected with both viruses. “Our reliable sources indicate that this report is incorrect,” Cox told ScienceInsider in an e-mail. Apparently, tests have shown that the man is coinfected with the pandemic H1N1 and the seasonal H3N2 virus. “There will be follow up testing to confirm,” according to Cox. As many as 5% of people who develop flu symptoms are infected with two different influenza viruses.

    http://blogs.sciencemag.org/sciencei...us-report.html

    Leave a comment:


  • Pathfinder
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    In case of dual infections H1N1 and H5N1, how would the tests perform? Would they both be positive? Or only positive for one of them?

    Leave a comment:


  • Rwilmer
    replied
    Re: Egypt's Health Minister denies H5N1 &amp; &quot;Swine Flu&quot; coinfection

    Excerpt from another article:

    ITALIAN ONLY IN EGYPT HIT BY H1N1
    The Egyptian authorities have denied that there is an Italian tourist in Hurghada hit by a double infection by the virus H1N1 and H5N1. The Italian, 22 years, as subsequently stated, has entered only the influenza A virus, said the doctor, and her condition is stable after being treated with Tamiflu Young said the doctor, was admitted August 27 last year, suffering because of high fever over 38 degrees and leave the hospital when tests carried out for 5 days will give negative results for its part, the hospital director, Hossameddin Hassan Abdou, also denied that a second person, Egyptian who was returning to Egypt after a pilgrimage to Mecca has been hospitalized for a double infection. The same denial from the Italian embassy in Cairo said that, after taking CONTACT with the Italian Consulate in Hurghada, the Italian tourist was hit only by influenza A.

    http://translate.google.com/translat...istory_state0=

    Leave a comment:

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