Concerns arise over symptomless Egypt bird flu cases

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

Insufficient resources to combat avian flu, say experts

By Tamim Elyan
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</td></tr></tbody></table></td></tr></tbody></table><articlebody>CAIRO: Vaccines available against avian flu only cover 36 percent of 300 million birds in rural farms, according to a workshop held Sunday by the UN Food and Agriculture Organization (FAO) and the General Authority for Veterinary Services.
Titled “Evaluation of the National Campaign to Combat Avian Flu,” the workshop brought together experts who said that veterinary authorities’ efforts only cover 10 percent of poultry production.
They also criticized the inefficiency in testing for other diseases and monitoring animal slaughterhouses.
"The amount of vaccinations is barely sufficient to cover the workforce that will distribute them and the responsive farmers who are willing to vaccinate their birds," Saber Abdel Aziz, head of the epidemic and poultry diseases at the General Authority for Veterinary Services, told Daily News Egypt.
Abdel Aziz said that 600 million doses are needed to cover the entire poultry sector; however, the authority can only afford to provide 120 million doses.
Participants at the workshop criticized the lack of sufficient human and financial resources and called for a more active role by the veterinary services authority in combating the virus.
"Out of 13,000 registered veterinarians, we only have 6500 available, 70 percent of which are unqualified for field work because they are over 50 years old. We end up with only 1,200 veterinarians while at least 5,000 are needed," Abdel Aziz said
He explained that no new veterinarians have been appointed since 1994 because of the lack of funds.
Abdel Aziz added that there is a lack of preventive equipment such as special vests or cars to transfer veterinarians. “We only have 1,350 cars, that’s one car for every 20 veterinarians.”
Hamed Samaha, head of the General Authority for Veterinary Services said that Minister of Agriculture Amin Abaza filed a request to Cabinet, asking them to assign the faculty of veterinary medicine graduates to work in various governorates to contain avian flu.
“Only two percent of poultry farms apply bio-security measures,” Samaha said.
According to Abdel Aziz, in 2006 the first avian flu campaign vaccinated 90 million birds. However, subsequent campaigns didn't achieve the same level of success because farmers were unresponsive.
"It is a problem of awareness," he said.
"At first farmers were concerned so they cooperated with the authorities but now they are more confident so they don't respond to our efforts,” he said.
He was, however, optimistic about efforts this year.
http://www.thedailynewsegypt.com/article.aspx?ArticleID=21062
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[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

March update

http://www.saidr.org/docs/pdf/ECTAD-EGYNewsReview2009_3.pdf

 

[AlaskaDenise]

Re: Concerns arise over symptomless Egypt bird flu cases

Commentary

http://www.recombinomics.com/News/04130902/H5N1_Qena_Clusters.html

Commentary

Suspect H5N1 Custers in Qena Egypt Raise Pandemic Concerns
Recombinomics Commentary 15:34
April 13, 2009

Detained hospital fevers QENA both happy Rizq "28 years" of the Naga village of solar modules and David Nasser Zaghloul Khulud "4 years" of the Naga village of Duma Mahrousa and Muhammad Arif Mahmood, "years and 4 months" from the village of Dandara, Nabil Abdalenaim Alhawwal "8 years" from the village of solar modules on suspicion of contracting bird flu virus.

QENA detained in hospital diets 5 people suspected of contracting the disease are: Omaima Fatehy ?41 years?, housewife, and her baby Ahmed Yacoub, two, and Zeinab Mahmoud Alhenwany ?40 years?, housewife, and Suad Abdullah Hamid, ?40 years?, and the Princess Razeq Abulhasan, ?21 years?, housewife, on suspicion of having bird flu

In Qena, the Directorate of Health announced a state of emergency in a hospital after the fever in the central laboratories of the Ministry of Health wounded girl, "Israa Saad Shafi," which showed symptoms of the disease last Monday and was taken to the hospital.

Detained hospital fevers QENA woman on suspicion of being infected with bird flu, which entered the El-Shafei Bkhittp (48 years old), a housewife from the village of Qena, the status of solar modules, in a very weak condition,

The above translations describe some of the patients hospitalized in Qena recently. It is unlikely that these patients will be confirmed, because less than 1% of patients hospitalized with bird flu symptoms and stated contact with dead or dying poultry are confirmed. This low confirmation rate leads to a lack of correspondence between suspect hospitalized patients described in media reports and those that are confirmed, because even if 10% of the hospitalized patients are covered in media reports, it is likely that the suspect cases will be the 99% of patients who test negative.

However, the survival of all confirmed cases this year and the concentration of cases among toddlers (10/12 confirmed cases) has raised concerns that the number of H5N1 infections in Egypt is markedly higher than the number of confirmed cases, and a significant number of the hospitalized patients produce false negatives in the PCR testing done to determine which patients eventually are confirmed.

These concerns have been heightened further because of two cousins who are next door neighbors and developed bird flu symptoms four days apart, signaling human to human transmission between the toddlers. Moreover, there have been no confirmed H5N1 poultry cases in the Beheira neighborhood of the two toddlers (see updated map), and the toddler confirmed prior to the cousins in Beheira was in Qena, where there has also been no confirmed poultry cases (see updated map).

The confirmation of H5N1 in toddlers that are not linked to confirmed poultry cases raises concerns of silent transmission among symptomatic patients that had relatively mild cases or respond to oseltamivir treatment, which is given to suspect patients prior to test results.

The analysis of clusters provides insight into potential false negatives. The largest confirmed cluster to date in Egypt was in Gharbiya in late 2006. Three family members were fatally infected, but only two were PCR positive, demonstrating that even symptomatic fatal cases could test negative on PCR testing.

Similar concerns were generated when NAMRU-3 investigated a cluster in Pakistan. Only one family member was PCR positive. He died, as did a brother who was not tested. However, the index case, who survived but developed pneumonia , tested negative in the PCR test, yet was found to have an H5N1 titer of 2560, a very high number. Moreover, another brother who survived had an H5N1 titer of 320, again giving a clear signal of H5N1 infection by the first brother to die. Moreover, a fifth brother, who was asymptomatic also tested negative by PCR, but also had a titer of 320. Thus, of the four brothers who were tested and were clearly infected with H5N1, only one was PCR positive (and that isolate was sequenced and found to be clade 2.2.3).

However, these false negatives are not limited to cases in Egypt or cases tested by NAMRU-3. The first four suspect siblings in Turkey in late 2006 also initially tested negative in PCR testing of throat swabs, but fluid collected when the first three cases were near death were PCR positive and clade 2.2 sequences were released from two of the siblings. Moreover, H5N1 was never confirmed in the fourth sibling.
Thus, the prior false negatives in clade 2.2 infections, raises concerns of false negatives in clade 2.2 infections in Egypt.

Therefore, in addition to testing of asymptomatic patients for neutralizing antibodies, the symptomatic patients who were PCR negative but had bird flu symptoms and poultry contacts should be among the first tested for H5N1 antibodies.

Similarly, at risk groups such as toddlers with symptoms but no reported poultry contacts should also be tested by PCR, as well as neutralizing antibodies in convalescent serum collections.

The confirmation of H5N1 in mild cases in toddlers, coupled with the large number of patients hospitalized with bird flu symptoms, should lead to much more aggressive testing of patients in Egypt.

.

 

[AlaskaDenise]

Re: Concerns arise over symptomless Egypt bird flu cases

Commentary

http://www.recombinomics.com/News/04130903/H5N1_Qena_Emergency.html

Commentary

H5N1 Emergency Near Qena Egypt
Recombinomics Commentary 17:34
April 13, 2009

Red Sea Governorate announced a state of emergency and tightened control over the southern port cities of Safaga and the short to fight with any suspected cases of avian influenza.

The Secretary-General Majid Obwafattouh Sunday to maintain the continued control campaigns and tighter control of the port 85 km, which connects between Safaga and Qena to prevent the entry into or the circulation of live poultry to maintain and remove all the nests near the house to prevent the breeding of poultry and intensify campaigns Investigation of Supply and veterinary control of vehicles carrying poultry.

The above translation describes efforts to limit poultry movement between Safaga and Qena, Egypt. Although no confirmed H5N1 infected poultry has been reported in Qena, a recently confirmed toddler (case #60) is from Qena and local media reports have described a large number of suspect cases and clusters hospitalized in Qena in recent days.

The events have precipitated a state of emergency in the area that involve tightened controls in Safaga, which is 85 km from Qena (see updated map) and signal additional concerns that the number of H5N1 in poultry and patients is significantly higher than the one confirmed toddler.

Antibody testing of sera collected from the hospitalized patients 3-4 weeks after symptoms should begin immediately. The possibility of false negatives in PCR tests remains high, and antibody testing of recovered symptomatic patients in Egypt is long overdue.

.

 

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

<TABLE id=autonumber2 style="DIRECTION: ltr; BORDER-COLLAPSE: collapse; TEXT-ALIGN: left" borderColor=#111111 cellSpacing=0 cellPadding=4 width=640 border=0><TBODY><TR><TD vAlign=center align=middle>Mountain: the World Health confirmed that a mutation of avian influenza in Egypt

‏3‏ جهات دولية تؤكد‏:‏ إصابة ابني العم بالبحيرة بسبب الطيور النافقة وليس بالعدوي بينهما‏​

3 international destinations stresses: two cousins hit the lake because the dead birds, not their infection <!--heade--></TD></TR><TR><TD>

[FONT=arial (arabic)]كتب ـ محمد حسان وأشرف بدر‏:[/FONT]​

‏​

For his part, Dr. Sayed, Assistant Minister of Health Affairs preventive cases No. 61 and 62 of the human cases had two children with my son but it proved they were playing in the remnants of birds, the mother of the first child after slaughtering the occurrence of mass deaths among them, and there Two cases of infection of two brothers in the West, said the four cases were subjected to thorough studies in the central laboratory and the Center for example is 3 and audit by the international reference laboratory of the United Kingdom did not report the results of any mutations in the virus and the infection was caused by infected birds and no cases of infection.​

​

http://translate.google.com/transla...mozilla:en-US:official&sa=N&as_qdr=d&start=10​

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Does the above indicate there were two cluster of two (to give four samples that were sent to Weybridge)?

 

[sharon sanders]

Re: Concerns arise over symptomless Egypt bird flu cases

Does the above indicate there were two cluster of two (to give four samples that were sent to Weybridge)?

Yes, that is how I read it, the 2 cousins and also 2 other brothers.

 

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

Yes, that is how I read it, the 2 cousins and also 2 other brothers.

There are no other confirmed cases with a location matching each other, so either the two brothers were not confirmed, not all data has been made public, or there is a translation error.

 

[Commonground]

Re: Concerns arise over symptomless Egypt bird flu cases

Maybe the two brothers are:
Nabil Abdel-Naim (8)
Muhammad Arif (6) or (8)
from Qena

but they are not confirmed.

 

[Treyfish]

Re: Concerns arise over symptomless Egypt bird flu cases

<TABLE style="BORDER-BOTTOM: gainsboro 1px solid; TEXT-ALIGN: left; BORDER-LEFT: gainsboro 1px solid; WIDTH: 564px; DIRECTION: ltr; HEIGHT: 22px; BORDER-TOP: gainsboro 1px solid; BORDER-RIGHT: gainsboro 1px solid" border=0 cellSpacing=0 cellPadding=0><TBODY><TR><TD style="BACKGROUND-IMAGE: url(images/backgrond_slider.jpg); BORDER-BOTTOM: gainsboro 1px solid; WIDTH: 100%; HEIGHT: 26px" vAlign=center align=right>98% ‬ of the poultry farms and the lack of safety standards we demand where new residents are far from integrated </TD></TR><TR><TD style="WIDTH: 100%" vAlign=top align=right>

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سماحة* ‬يعترف بتجاهل فحص مزارع الخنازير*..​

Samaha * ‬ examination recognized by ignoring the pig farms * ..

‬ويقترح نقلها فى الصحراء​

‬ It is proposed to transfer in the desert

كتب ـ عماد خيرة*:‬ اعترف الدكتور حامد سماحة رئيس الهيئة العامة للخدمات البيطرية بأن ضعف إمكانيات فرق المكافحة،* ‬وعدم التزام أصحاب مزارع الدواجن بمعايير الأمان الحيوى،* ‬وراء انتشار الاصابات بمرض انفلونزا الطيور*.​

Emad wrote the best *: ‬ admitted, Dr. Hamed Samaha Chairman of the General Authority for Veterinary Services to control the vulnerability of the potential difference, * ‬ and lack of commitment by the owners of poultry farms bio-safety standards, * ‬ infections and the spread of bird flu *.

‬قال سماحة فى تصريح لـ* ?‬الوفد*? ‬إن* ‬98٪* ‬من مزارع الدواجن علي* ‬مستوى الجمهورية لا تطبق معايير الأمان الحيوى اثناء دخول وخروج ونقل الطيور والتخلص من السبلة،* ‬كما اعترف سماحة بأن فرق مكافحة انفلونزا الطيور لم تصل حتى الآن لمعاينة مزارع الخنازير التي* ‬تعتبر حلقة فى سلسلة الاصابة بالمرض،* ‬وقال إن هيئة الخدمات البيطرية لايمكنها انجاز تقدم علي* ‬صعيد مكافحة المرض وهى تعمل بصورة منفردة ودعا جميع الجهات المختصة مثل الصحة والبيئة والمحليات بزيادة التعاون من أجل حماية البلاد من هذا المرض وردًا على سؤال حول مدى جدوى حملات التحصين*.​

‬ Samaha said in a statement to Al * ?‬ delegation *? ‬ The * ‬ 98% * ‬ Farms poultry * ‬ level of the republic is not bio-safety standards are applied during the entry and exit, transfer and disposal of birds Sblp, * ‬ Samaha also acknowledged that the combat teams Bird flu has yet to arrive to inspect pig farms that * ‬ considered a disease in a series, * ‬ He said that the veterinary services could not complete the * ‬ progress in the fight against the disease, which is working alone and called on all relevant actors, such as health, environment and increase local cooperation in order to protect the country from the disease and response to a question about the feasibility of immunization campaigns *.

‬أكد سماحة أن التحصين بدون اتباع اصحاب المزارع لإجراءات الأمان الحيوى لا* ‬يجدى*.​

Samaha ‬ confirmed that immunization with the owners of a farm bio-security procedures are not fruitless, * ‬ *.

‬وطالب سماحة بنقل مزارع الدواجن من المناطق السكنية،* ‬وبناء مزارع جديدة بعيدة عن العمران بشرط تكاملها لتحوى مجازر للدواجن ومصانع اعلاف،* ‬كما طالب رئيس الهيئة بنقل مزارع الخنازير من المناطق السكنية إلي* ‬أماكن بعيدة عن المواطنين باعتبارها موطنًا لنقل المرض*.​

‬ and demanded the transfer of poultry farms Samaha residential areas, * ‬ farms and building new construction is far from the condition for the integration of the massacres of the poultry house and forage plants, * ‬ also demanded the transfer of the head of the pig farms to residential areas to * ‬ places far from home to the citizens as the transmission of the disease * .

‬وطالب جميع الجهات التي* ‬تعمل فى مكافحة انفلونزا الطيور بالشفافية واعلان جميع البيانات الحقيقية الخاصة بالمرض حتي* ‬تتضح الصورة أمام المختصين بالمقاومة*.‬ وأكدت الادارة المركزية للشئون الوقائية بوزارة الصحة حالات الاشتباه فى الأيام الخمسة الماضية بصورة* ‬غير مسبوقة،* ‬سجلت قوائم المشتبة فى اصابتهم بمرض انفلونزا الطيور* ‬يوم الاثنين* ‬6* ‬أبريل* ‬12* ‬حالة اثنتان فى البحيرة تم ايداعهما حميات دمنهور و4* ‬حالات بالمنوفية تم ايداعهم بحميات منوف،* ‬وحالة فى كل من محافظة قنا والمنيا والغربية والزيتون بالقاهرة والعامرية بالاسكندرية وبلبيس بالشرقية،* ‬وبلغت قائمة المشتبه فى اصابتهم* ‬يوم الثلاثاء* ‬7* ‬ابريل* ‬15* ‬حالة منهم* ‬4* ‬حالات بالمنوفية و3* ‬حالات فى البحيرة وحالتان فى الاسكندرية وحالتان فى محافظة* ‬6* ‬أكتوبر وحالة فى كل من قنا وطما بسوهاج وبولاق بالقاهرة والمحلة بالغربية وتم ايداع جميع الحالات بالمستشفيات المتخصصة التابعين لها*.‬ وسجلت كشوف الادارة العامة لمكافحة الأمراض المعدية بوزارة الصحة الاشتباه فى اصابة* ‬16* ‬حالة* ‬يوم الأربعاء* ‬8* ‬ابريل تم الابلاغ* ‬عنها وايداعهم مستشفيات الحميات منها حالتان بمحافظات البحيرة والقاهرة وبورسعيد والدقهلية،* ‬وحالة فى كل من محافظات كفر الشيخ والإسكندرية والمنوفية والقليوبية والمنيا وقنا والغربية وأسوان*.‬ وسجلت وزارة الصحة* ‬12* ‬حالة اشتباه* ‬يوم الخميس* ‬9* ‬ابريل منها حالتان فى الاسكندرية وحالتان فى أسوان،* ‬وحالة فى كل من بنى سويف وسوهاج وقنا والسويس ودمياط والبحيرة*.‬ ووصلت حصيلة حالات الاشتباه ليوم الجمعة* ‬10* ‬أبريل خمس حالات فقط اثنتان فى الشرقية واثنان فى وادى النطرون بالبحيرة وحالة بالمحلة الكبرى وتم ايداعهم جميعًا مستشفيات الحميات*.‬​

‬ and demanded that all those * ‬ operate in the fight against bird flu and transparent declaration of all the real data for the disease so * ‬ clear picture to the relevant resistance *. ‬ confirmed the central administration of the affairs of the Ministry of preventive health of suspected cases in the past five days in an unprecedented * ‬, * ‬

registered lists of those suspected of having bird flu on
Monday, * ‬ * ‬ 6 * ‬ April * ‬ 12 * ‬ case of two in the lake was in front of Damanhour fevers and cases of 4 * ‬ Menoufia placed Bhmyat Mnov, * ‬ and one each in Qena West, Menya, and olives in Cairo and Alexandria and Ameriya Bilbeis eastern region, * ‬

The list of suspects injured on Tuesday * ‬ * ‬ 7 * ‬ April * ‬ 15 * ‬ case of them * ‬ 4 * ‬ Menoufia cases and 3 * ‬ situations in the lake and two in Alexandria and two County * ‬ 6 * ‬ October and one each in Qena, Sohag and surged Bulaq in Cairo and Mahalla were meeting Sunday attended by the deposit of all cases of hospital personnel specialized *. ‬ recorded statements of the General Administration for the control of infectious diseases in the Ministry of Health of suspected injury * ‬ 16 * ‬ *

‬ case of Wednesday, * ‬ 8 * ‬ April were reported * ‬ placement and fever hospitals, including two provinces of the lake, Cairo, Port Said and Dakahlia, * ‬ and one in each of the governorates of Kafr El-Sheikh, Alexandria, Monoufia Qalubia, Menya, Qena and Aswan West *. ‬
and the Health Ministry *

‬
12

suspected case on Thursday, * ‬ 9 * ‬ including two in April and two in Alexandria, Aswan, * ‬ and one each in Beni Suef, Qena, Sohag, Suez, Damietta, lake *. ‬ reached toll of suspected cases

Friday * ‬ 10 * ‬ April five only two cases in the East and two in the Wadi Natrun Mehalla the lake and the state had been brought all the major hospitals diets *. ‬
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[Laidback Al]

Re: Concerns arise over symptomless Egypt bird flu cases

March update

http://www.saidr.org/docs/pdf/ECTAD-EGYNewsReview2009_3.pdf

Table 5, passive surveillance of HPAI in the household poultry sector (page 11), reports 17 positive samples from 46 tests from 8 governorates, about 1 positive result for every three samples tested. However, 16 of the the tested samples were from Beheira (Behaira) where the two cousins were infected. Ten of the 16 samples, more than 60%, were positive, the highest percentage for any of the governorates that were subjected to testing.

This still leaves open the possibility that the infection of the the two children was B2H rather than H2H.

 

[Giuseppe]

Re: Concerns arise over symptomless Egypt bird flu cases

I continue to highlight the persistent lack of details about clinical course of pediatric H5N1 infections.

There aren't anamnestic details, vaccination status (ie: pneumococcal vaccine, Hemophilus Influenzae b vax etc.), treatment course, environmental and domestic hygiene descriptions.

WHO/FAO/OIE may start a wide sero-surveys activities but I wonder they could have some preliminary virological data suggesting changes in Hemagglutinin receptor binding domains and or in internal sub-units (ie: polymerase complex, nucleoprotein, non-structural ...)

If not, I think it is strange this upsurge in both Egyptian and foreign interest in less then a dozen of cases occurring during the last three months.

I suspect that the impending turmoil in Egyptian political scenario is playing a role in this incident.

A decades-long Egyptian regime is rumbling under internal and international pressure. The things don't happen almost alone...

We have:

1) a dozen of confirmed pediatric cases;
2) a time frame of several months;
3) different locations;
4) uncertain clinical courses, except for media sources and Egyptian official reports;
5) lack of clinical course and anamnestic description by the WHO;
6) no virological update by the WHO;
7) no clear epidemiologic changes described by the WHO;
8) no data about treatment courses and effectiveness of interventions;
9) widespread poultry epizootics;
10) poultry vaccinations effectiveness data is lacking;
11) environmental contamination of patient's houses unknown;
12) follow-up reports about pediatric cases by WHO continue to be absent.
13) increasing political turmoil;
14) civil unrests;
15) re-aligning international alliances and perspectives;
16) discrepancy in media interviews and statement and official public press releases by WHO;
17) unclear role of foreign laboratory and research facilities in Egypt.

I am surprised by the lack of travel warning for tourists directed to Egyptian resorts if there is a strong suspect of increased human-to-human transmissibility of H5N1 virus and likely existence of milder or abortive illness.

Migrants from Alexandria toward Italian Mediterranean Sea continue to arrive en masse.

No atypical or undiagnosed illness among them and among destination islands.

This post expresses only the opinions of the author (Inororehopper) and doesn't imply any endorsement by this website directors/members/owners.

(PS: Is it also possible that H5N1 virus involved in recent pediatric cases could have changed its human epithelial cells affinity or is it replication defective? Could be the virus resulted attenuated by exposure to environmental factors / solar radiation / dew / temperature?)

 

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

Table 5, passive surveillance of HPAI in the household poultry sector (page 11), reports 17 positive samples from 46 tests from 8 governorates, about 1 positive result for every three samples tested. However, 16 of the the tested samples were from Beheira (Behaira) where the two cousins were infected. Ten of the 16 samples, more than 60%, were positive, the highest percentage for any of the governorates that were subjected to testing.

This still leaves open the possibility that the infection of the the two children was B2H rather than H2H.

Beheira is a large governorate and the map of the outbreaks there clearly show ZERO confirmed cases near the cousins for the ENTIRE season (all of the poultry outbreaks, including those in March/April are in the north).

The H2H is WELL into the obvious category. The 4 day gap in disease onset dates is NOT a coincidence.

 

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

I continue to highlight the persistent lack of details about clinical course of pediatric H5N1 infections.

There aren't anamnestic details, vaccination status (ie: pneumococcal vaccine, Hemophilus Influenzae b vax etc.), treatment course, environmental and domestic hygiene descriptions.

WHO/FAO/OIE may start a wide sero-surveys activities but I wonder they could have some preliminary virological data suggesting changes in Hemagglutinin receptor binding domains and or in internal sub-units (ie: polymerase complex, nucleoprotein, non-structural ...)

If not, I think it is strange this upsurge in both Egyptian and foreign interest in less then a dozen of cases occurring during the last three months.

I suspect that the impending turmoil in Egyptian political scenario is playing a role in this incident.

A decades-long Egyptian regime is rumbling under internal and international pressure. The things don't happen almost alone...

We have:

1) a dozen of confirmed pediatric cases;
2) a time frame of several months;
3) different locations;
4) uncertain clinical courses, except for media sources and Egyptian official reports;
5) lack of clinical course and anamnestic description by the WHO;
6) no virological update by the WHO;
7) no clear epidemiologic changes described by the WHO;
8) no data about treatment courses and effectiveness of interventions;
9) widespread poultry epizootics;
10) poultry vaccinations effectiveness data is lacking;
11) environmental contamination of patient's houses unknown;
12) follow-up reports about pediatric cases by WHO continue to be absent.
13) increasing political turmoil;
14) civil unrests;
15) re-aligning international alliances and perspectives;
16) discrepancy in media interviews and statement and official public press releases by WHO;
17) unclear role of foreign laboratory and research facilities in Egypt.

I am surprised by the lack of travel warning for tourists directed to Egyptian resorts if there is a strong suspect of increased human-to-human transmissibility of H5N1 virus and likely existence of milder or abortive illness.

Migrants from Alexandria toward Italian Mediterranean Sea continue to arrive en masse.

No atypical or undiagnosed illness among them and among destination islands.

This post expresses only the opinions of the author (Inororehopper) and doesn't imply any endorsement by this website directors/members/owners.

(PS: Is it also possible that H5N1 virus involved in recent pediatric cases could have changed its human epithelial cells affinity or is it replication defective? Could be the virus resulted attenuated by exposure to environmental factors / solar radiation / dew / temperature?)

The mild cases in Egypt this year are a REPEAT of the mild cases in the spring of 2007, except the population target has changed. In 2007 the cases involved children, age 3-10. In 2009 the target population is toddlers, confirming that the 2007 cases were just the tip of a VERY large iceberg, which created protective immunity to H5N1 in a large segment of the population.

The mild cases were bracketed by severe cases. The CFR in the the 10 cases preceding the mild cases in 2007 was 100%. The cases between the two mild outbreaks involved cases that were in CRITICAL condition, and most died.

The low CFR in the two clusters of mild cases (1/17 in the spring of 2007 and 0/12 in 2009) is in addition to the fact that the patients not only didn't die, but most were never very sick and never developed pneumonia.

The low number of cases create concern, because the manipulation of the WHO case definition is OBVIOUS and has been OBVIOUS since 2005, which it was used to hide the mild cases in northern Vietnam (and has been used ever since to hide mild cases, as is done in India, where suspect cases that don't develop pneumonia are simply not tested).

 

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

AVIAN INFLUENZA, HUMAN (73): EGYPT, VIRULENCE
***********************************************
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: Mon 13 Apr 2009
Source: Bloomberg News online [edited]
<http://www.bloomberg.com/apps/news?pid=3D20601202&sid=3DakmwbqDeHpvE>


Egypt asked the World Health Organization [WHO] to help investigate
an outbreak of bird flu after a dozen non-fatal cases of the disease
this year [2009] prompted speculation the virus may be becoming less
virulent. Two WHO doctors and a scientist will travel to Cairo later
this week at the request of Egypt's Ministry of Health, said Gregory
Hartl, a spokesman for the United Nations agency in Geneva, in an
interview today [13 Apr 2009]. The UN team will assist local
authorities to identify how the patients were infected with the H5N1
strain of avian influenza and whether there have been any significant
changes in disease patterns in the virus itself.

Scientists have been following H5N1 for more than a decade because of
concern it could spark a pandemic if it becomes as infectious for
humans as it is for poultry. A less lethal strain could be more
contagious because people would have longer to transmit it through
coughing and sneezing. None of the 12 Egyptian cases reported to the
WHO this year [2009] has been fatal.

These data do indeed suggest that there may have been a reduction in
the virulence of the outbreak strain, and there is a perceived risk
of progression of the virus to a less virulent but more transmissible
form, the International Society for Infectious Diseases said today
[13 Apr 2009] in an e-mail via its ProMED-mail program [see, "Avian
influenza, human (72): Egypt, virulence 20090412.1403"]. The survival
of H5N1 patients in Egypt also may reflect early treatment with
antiviral medicines, ProMED said.

At least 417 people in 15 countries have contracted the virus since
2003. Three of every 5 cases worldwide were fatal. Most cases were
caused by contact with infected poultry, such as children playing
with them or adults butchering them or plucking feathers, according
to WHO.

H5N1 is continuing to circulate in poultry in Egypt, though there is
no evidence so far of any significant changes in the virus, said
Joseph Domenech, chief veterinary officer with the Food and
Agriculture Organization [FAO]. The Rome-based UN agency has also
agreed to a request by Egypt's government to provide technical
assistance, Domenech said in an interview today [13 Apr 2009].

Egypt has the highest number of avian-flu cases outside Asia, with 63
cases reported to WHO since 2006, of which 23 were fatal. In
comparison, more than 80 percent of the 141 people reported to have
been infected in Indonesia died.

Roche Holding AG says its Tamiflu antiviral medicine can reduce the
severity and duration of flu symptoms if taken within 48 hours of the
onset of disease. Early treatment for H5N1 may improve survival, some
uncontrolled studies have shown.

[Byline: Jason Gale]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The participation of the FAO in the WHO-led investigation of the
current H5N1 epidemic situation in Egypt is a logical development. As
of today (13 Apr 2009), the 11 cases of avian H5N1 influenza virus
confirmed in 2009 (all children) remain alive. This is in marked
contrast to the period from 2006 to 2008 when 23 of 51 H5N1-confirmed
patients did not survive infection. This suggests that there may have
been a change in the virulence of the H5N1 virus circulating in Egypt
at the present time. While diminished virulence is clearly
advantageous for the Egyptian population, it is feared that reduction
in virulence may favor increased transmissibility of the virus, which
might have adverse consequences for the global population.

However, other factors such as the role of the age of the victims,
the absence of evidence of person-to-person transmission, and the
effectiveness of treatment protocols have still to be evaluated. An
update on the current situation is awaited. - Mod.CP]

[see also:
Avian influenza, human (72): Egypt, virulence 20090412.1403
Avian influenza, human (71): Egypt, Viet Nam, WHO 20090408.1359
Avian influenza, human (70): Egypt (QL), 63rd case 20090406.1336
Avian influenza, human (69): Egypt (BH) 62nd case 20090404.1299
Avian influenza, human (66): Egypt (BH) 20090402.1271
Avian influenza, human (59): Viet Nam (ST) NOT 20090325.1162
Avian influenza, human (56): Viet Nam (DT) NOT, (ST) susp. 20090321.1128
Avian influenza, human (55): Egypt (AT), Viet Nam (DT) 20090320.1118
2006
----
Avian influenza (208): NS1 virulence determinant 20061106.3183]
..........................................................cp/msp/lm
</pre>

 

[HenryN]

Re: Concerns arise over symptomless Egypt bird flu cases

AVIAN INFLUENZA, HUMAN (73): EGYPT, VIRULENCE
***********************************************


[The participation of the FAO in the WHO-led investigation of the
current H5N1 epidemic situation in Egypt is a logical development. As
of today (13 Apr 2009), the 11 cases of avian H5N1 influenza virus
confirmed in 2009 (all children) remain alive. This is in marked
contrast to the period from 2006 to 2008 when 23 of 51 H5N1-confirmed
patients did not survive infection. This suggests that there may have
been a change in the virulence of the H5N1 virus circulating in Egypt
at the present time. While diminished virulence is clearly
advantageous for the Egyptian population, it is feared that reduction
in virulence may favor increased transmissibility of the virus, which
might have adverse consequences for the global population.

However, other factors such as the role of the age of the victims,
the absence of evidence of person-to-person transmission, and the
effectiveness of treatment protocols have still to be evaluated. An
update on the current situation is awaited. - Mod.CP]

The point is that the mild cases in 2009 are a REPEAT of the mild cases in 2007 except the target population has changed from children, age 3-10, to toddlers, age 1 1/2 to 2 1/2. The mild cases of 2007 are combined with the 100% CFR in the 10 patients prior to the mild cases, as well as the high CFR in the patients between to the two mild clusters to produce the rather normal (but low) CFR for the entire population prior to 2009.

This analysis hides the VERY glaring cluster in the spring of 2007, when only 1 of the 17 confirmed cases died, and extends the media myth that the mild cases in 2009 in Egypt are NEW, instead of a REPEAT (which signals H5N1 cases that are orders of magnitude higher than the confirmed cases).

 

[Giuseppe]

Re: Concerns arise over symptomless Egypt bird flu cases

The mild cases in Egypt this year are a REPEAT of the mild cases in the spring of 2007, except the population target has changed. In 2007 the cases involved children, age 3-10. In 2009 the target population is toddlers, confirming that the 2007 cases were just the tip of a VERY large iceberg, which created protective immunity to H5N1 in a large segment of the population.

The mild cases were bracketed by severe cases. The CFR in the the 10 cases preceding the mild cases in 2007 was 100%. The cases between the two mild outbreaks involved cases that were in CRITICAL condition, and most died.

The low CFR in the two clusters of mild cases (1/17 in the spring of 2007 and 0/12 in 2009) is in addition to the fact that the patients not only didn't die, but most were never very sick and never developed pneumonia.

The low number of cases create concern, because the manipulation of the WHO case definition is OBVIOUS and has been OBVIOUS since 2005, which it was used to hide the mild cases in northern Vietnam (and has been used ever since to hide mild cases, as is done in India, where suspect cases that don't develop pneumonia are simply not tested).

I know well as nonfatal cases aren't a news, as the history of H5N1 panzootics is now longer and longer.

Despite that, none of my questions have found a reply.

It this story is so obvious, why does nobody seem able to explain to large public almost a couple of the above questions?

It could be the case that the questions per se would be stupid or irrelevant but the aim of a public forum with a number of non-professional readers and contributors should be to make clear facts amidst the instense fog of media.

 

[sharon sanders]

Re: Concerns arise over symptomless Egypt bird flu cases

"..but the aim of a public forum with a number of non-professional readers and contributors should be to make clear facts amidst the instense fog of media."

I agree.

Your points in post # 91 are very pertinent.

 

[vinny]

Re: Concerns arise over symptomless Egypt bird flu cases

Does anyone think a pandemic could be close then,with whats happening in egypt.the reason i ask is because we no longer have a preps and i would need to restock,thanks.

 

[Giuseppe]

Re: Concerns arise over symptomless Egypt bird flu cases

Does anyone think a pandemic could be close then,with whats happening in egypt.the reason i ask is because we no longer have a preps and i would need to restock,thanks.

Disaster preparedness is a valuable activity, and should be done even for other natural or man-made disaster such as eartquakes, floods, hurricanes, civil unrests etc.

So, if you want to restock your personal stockpile, you can done this without problems.

It is enough you save money to daily life, ...

 

[Commonground]

Re: Concerns arise over symptomless Egypt bird flu cases

"..but the aim of a public forum with a number of non-professional readers and contributors should be to make clear facts amidst the instense fog of media."

the aim should be to make clear facts. Clear facts from whom?