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Concerns arise over symptomless Egypt bird flu cases

Re: Concerns arise over symptomless Egypt bird flu cases

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<articlehed>Egypt must intensify efforts to combat avian flu, say experts</articlehed>
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</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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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
 
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/02230904/WHO_Hoarding_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).
 
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.
 
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.
 
Re: Concerns arise over symptomless Egypt bird flu cases

<table style="border-collapse: collapse; text-align: left; direction: ltr;" id="autonumber2" border="0" bordercolor="#111111" cellpadding="4" cellspacing="0" width="640"><tbody><tr><td align="center" valign="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]
[FONT=arial (arabic)]Mohamed Al-Hassan, Ashraf Badr:[/FONT] [FONT=arial (arabic)][/FONT]
أكد الدكتور حاتم الجبلي وزير الصحة أنه لا توجد أي دراسات أو مؤشرات أو تقارير محلية أو دولية تشير إلي حدوث تحورات أو تغيرات في الفيروس المسبب للإصابة بمرض انفلونزا الطيور وقال مصر تلتزم بالشفافية الكاملة في التعامل مع المرض ولا تخفي أي معلومات ولا تتستر علي أي بيانات تتعلق بالمرض‏,‏ لافتا إلي أن اتصالات مصر مستمرة مع منظمة الصحة العالمية وأن المنظمة تتابع الموقف بدقة وأنها أكدت إن الفيروس لم يتغير أو يتحور في مصر‏.‏​
Dr. Hatem el-Gabali, Minister of Health that there are no studies or reports or indicators of local or international, pointing to the occurrence of mutations or changes in the virus that causes bird flu, said Egypt is committed to full transparency in dealing with the disease does not hide any information and does not cover up any data related to the disease, pointing out that Egypt's ongoing contacts with the World Health Organization and the Organization following the situation carefully and it was confirmed that the virus has not changed, or mutated in Egypt.

وأشار في تصريحات لـ الأهرام المسائي إلي أن مصر لا تتعامل بالمصادفة مع حالات الإصابة البشرية بالمرض وأن الأمر لا يقتصر علي مجرد تشخيص الحالة وعلاجها وإنما يتم بحث كل حالة باستفاضة شديدة ورصد التركيبة الجينية للفيروس لرصد أي تغيرات أو تحورات في الفيروس ومتابعة أي تحورات معمليا والمراجعة الدولية في ذلك‏,‏ وهو ما لم يحدث في مصر حتي الآن‏.‏​
He told Al-Ahram that Egypt was not, incidentally, deal with cases of human disease and that it is not just the diagnosis and treatment, but each case will be discussed very thoroughly and monitoring the genetic makeup of the virus to detect changes or mutations in the virus and laboratory follow-up of any mutations and review of international in this, which has not happened in Egypt until now.

من جانبه أوضح الدكتور نصر السيد مساعد وزير الصحة للشئون الوقائية أن الحالتين رقم‏61‏ و‏62‏ من الإصابات البشرية كانت لطفلين ابني عم إلا أنه ثبت أنهما كانا يلعبان في مخلفات طيور قامت والدة الطفل الأول بذبحها بعد حدوث حالات نفوق جماعي فيما بينها وهناك أيضا حالتان للإصابة لشقيقين في الغربية وقال الحالات الأربع خضعت لدراسات دقيقة في المعامل المركزية ومركز النمرو‏3‏ والمراجعة الدولية من جانب معمل مرجعي بالمملكة المتحدة ولم تشر النتائج إلي أي تحورات في الفيروس وأن الإصابة كانت بسبب الطيور المصابة وليس بالعدوي بين الحالات‏.‏​
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.

من جانبه أوضح الدكتور عبدالرحمن شاهين المتحدث الرسمي باسم وزارة الصحة أن مصر شهدت‏12‏ حالة للإصابة هذا العام مقابل‏18‏ حالة في عام‏2006‏ و‏25‏ حالة عام‏2007‏ و‏8‏ حالات العام الماضي وأنه لم تحدث أي وفيات بين الحالات الـ‏12‏ الأخيرة والتي كان آخرها لطفل من القليوبية عمره‏6‏ سنوات وقال‏:‏ إن زيادة الحالات تحت الاشتباه تؤكد جدية الدولة في الترصد الوبائي للمرضي والحرص علي الاكتشاف المبكر وأنه تم حتي الآن ومنذ الحالة الأولي للإصابة وضع‏6448‏ حالة تحت الاشتباه وتبين خلوها من الفيروس لافتا إلي أن مصر شهدت‏63‏ حالة للإصابة البشرية شفي منهم‏37‏ وتوفي‏23‏ منهم ومازالت هناك‏3‏ حالات تعالج في المستشفي‏.‏​
For his part, Dr. Abdel Rahman Shahin, spokesman of the Ministry of Health in Egypt had witnessed 12 cases of infection this year, compared with 18 cases in 2006 and 25 cases in 2007 and 8 cases of the past year and that did not happen no deaths among the 12 recent cases of the latest of which was for children from 6 years old Kalyobiya and said: "The increase in suspected cases under the State emphasizes the seriousness of the epidemiological surveillance of patients and to ensure early detection and has been so far since the first case of infection status 6448 under the suspicion of the case and found free of the virus, pointing out that Egypt had 63 human cases of infection were recovered, 37 died and 23 of them and there are still 3 cases treated in the hospital.

في غضون ذلك أكد الدكتور أحمد نظيف رئيس مجلس الوزراء عقب اجتماع اللجنة العليا لانفلونزا الطيور أن الدولة سوف تشدد إجراءات منع نقل الطيور الحية علي الطرق دون ترخيص والتوسع في تحصين الطيور ضد المرض وعمل إغلاق مؤقت للمزارع التي تظهر بها إصابات وحظر التربية المنزلية للطيور في المدن والعمل علي تحصينها في الريف‏.‏​
In the meantime, Dr. Ahmed Nazif, the Prime Minister following the meeting of the Higher Committee for the bird flu that the state will tighten its procedures for preventing the transport of live birds on the roads without a license and the expansion of influenza vaccination against the disease and the work of a temporary closure of the farms that show the injuries and the prohibition of domestic birds in the cities and work to fortify in the countryside.

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

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Re: Concerns arise over symptomless Egypt bird flu cases

(...)

"John Gabor specialist emerging diseases and health organization based in Cairo(...)

Note for the readers: Machine Translation from Arabic to English caused the change of the name of the WHO representantive or expert in Cairo from John Jabbour to John Gabor.

This for the due precision.
 
Re: Concerns arise over symptomless Egypt bird flu cases

New bird flu cases suggest the danger of pandemic is rising

Infections in Egypt raise scientists' fears that virus will be spread by humans
By Geoffrey Lean, Environment Editor

Sunday, 12 April 2009


First the good news: bird flu is becoming less deadly. Now the bad: scientists fear that this is the very thing that could make the virus more able to cause a pandemic that would kill hundreds of millions of people.

This paradox – emerging from Egypt, the most recent epicentre of the disease – threatens to increase the disease's ability to spread from person to person by helping it achieve the crucial mutation in the virus which could turn it into the greatest plague to hit Britain since the Black Death. Last year the Government identified the bird-flu virus, codenamed H5N1, as the biggest threat facing the country – with the potential to kill up to 750,000 Britons.

The World Health Organisation is to back an investigation into a change in the pattern of the disease in Egypt, the most seriously affected country outside Asia. Although infections have been on the rise this year, with three more reported last week, they have almost all been in children under the age of three, while 12 months ago it was mainly adults and older children who were affected. And the infections have been much milder than usual; the disease normally kills more than half of those affected; all of the 11 Egyptians so far infected this year are still alive.

Experts say that these developments make it more likely that 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.
The WHO fears that this year's rise in infections among small children, without similar cases being seen in older people, raises questions about whether adults are being infected but not falling ill, so acting as symptomless carriers of the disease. Its investigation, due to start this summer, will see if this is happening by testing the blood of people who may have been in contact with infected birds, but who have not themselves become sick.

John Jabbour, who works with WHO in Cairo, told Reuters last week: "There is something strange happening in Egypt. Why in children now and not in adults? We need to see if there are sub-clinical cases in the community." He added that if the research did find such cases, they would be the first to be discovered anywhere in the world.

Though he stressed that there was still no evidence of the disease passing from person to person, other experts are also becoming alarmed. Professor Robert Webster, of St Jude Children's Research Hospital in Memphis, Tennessee – who is the world's leading authority on the disease – told The Independent on Sunday that, while he himself had not seen firm data, the WHO in Egypt was raising "a very, very important issue" which should receive "maximum attention". He added: "I hope to hell they are wrong. If this **** thing becomes less pathogenic, it will become more transmissible."
And Professor John Oxford, of Queen Mary, University of London, said that any evidence that H5N1 was becoming less deadly would be serious, as the greatest cause for concern was the disease's ability to spread.

Even a much less virulent strain of the virus could result in a devastating pandemic. Studies show that an outbreak that killed as few as 5 per cent of those it infected could still cause hundreds of millions of deaths around the world.


http://www.independent.co.uk/news/s...the-danger-of-pandemic-is-rising-1667526.html
 
Re: Concerns arise over symptomless Egypt bird flu cases

from above:

We need to see if there are sub-clinical cases in the community." He added that if the research did find such cases, they would be the first to be discovered anywhere in the world.

Professor John Oxford, of Queen Mary, University of London, said that any evidence that H5N1 was becoming less deadly would be serious, as the greatest cause for concern was the disease's ability to spread.
Even a much less virulent strain of the virus could result in a devastating pandemic. Studies show that an outbreak that killed as few as 5 per cent of those it infected could still cause hundreds of millions of deaths around the world.

Now look at this article about pigs in Indonesia...(http://www.flutrackers.com/forum/showpost.php?p=216561&postcount=1)

H5N1 avian influenza viruses may be adapting to pigs, as evidenced by the finding that H5N1 viruses isolated from pigs in Indonesia were less harmful to mice than were H5N1 viruses from chickens.

growing in pigs, the virus may have become less harmful to mammals in general, the authors report. That sounds reassuring, but the authors say it may mean the virus is one step closer to turning into a human pandemic strain.

Pigs are seen as a possible intermediate host that can help avian flu viruses adapt to humans, because the epithelial cells in pigs' trachea can be infected by both avian and human flu viruses, the article notes.

H5N1 infections in pigs have been reported rarely or gone unnoticed because infected pigs show no signs of illness

Since our swine strains were isolated from pigs with no apparent influenza-like symptoms, the decrease of pathogenicity in mice suggests that the H5N1 viruses may have lost their pathogenicity in mammals during replication in pigs. Given that for the H5N1 viruses to cause a pandemic, they would likely become attenuated in humans, becoming attenuated in mammals may be a prelude to the generation of a pandemic strain."

because H5N1 infections in swine increase the risk that a pandemic strain could emerge, the findings point up the need for "continuous surveillance and management of H5N1 viruses in pigs."

Webby told CIDRAP News that it's not clear that H5N1 viruses have really become established in swine anywhere. "If these viruses have gone into swine, I think the key is whether they become established in swine. If that happened, we'd be concerned. I think the consensus now is that pigs are like humans; they can be infected, but it's unlikely there'd be a lot of transmission."

So the bottom line is..........the testing in Egypt should also be done on swine.

Has there been much of that?

.
 
Re: Concerns arise over symptomless Egypt bird flu cases

Well.

It's really possible that H5N1 avian influenza virus in Egypt could be - for some reasons - antigenic, genetic, human behaviour, epizootics dissemination - less deadly than elsewhere.

But we haven't solid proof to state that H5N1 in Egypt acutally is less deadly than in the past.

We have Egyptian authorities reports that all pediatric cases have had favorable clinical outcome.

We have a number of media reports about ''good conditions'' patients.

WHO doesn't provide follow-up on clinical course of patients.

So, propaganda may contribute to spread a better image of Egyptian health care system or treatment or prompt care for children.

Obviously, we cannot exclude that people is falling ill with an H5N1 strain with some mutations able to cause a mild or asymptomatic illnesses.

I clearly remember a situation of this kind when in Vietnam a series of human cases have had good clinical outcome.

The ''experts'' (notably some of those cited in the above news article) called for a ''good news'' (the low case-fatality rate) and the ''bad news'' (possible adaptation of H5N1 to humans), paventing the emersion of a new variant with improved human-to-human transmissibility.

I feel how absurd is a similar behaviour of ''experts'', periodically on the wave for not so clear intents toward public health safety.

I think that sometimes there is a poor sense of urgence in ascertaining the real scope of the problem in Egypt and elsewhere.

Why did WHO and other agencies or Institutes around the world not performed sero-surveys they pledged in the eve of outbreaks in Turkey, Vietnam or Indonesia?

Why did these ''experts'' not help their foreign counterparts to perford these surveys?

Because I think that it is not longer time to do business as usual both for us and for the so-called ''experts'' and ''public health safety agencies or institutes''.

These considerations are only mine and do not involve any kind of endorsement by FluTrackers.com Forum and members.

IOH (G.M.)
 
Re: Concerns arise over symptomless Egypt bird flu cases


I have the impression that H5N1 variants that are currently spreading in Egypt and Indonesia are quite different in terms of antigenic properties and genetic background.

Swine influenza, usually, doesn't infect humans, so it is possible that mild or asymptomatic infection in pigs would not immediately mean the same virological and pathological course in humans.

Mice aren't humans and sometimes things are valid for stabulary tests aren't promptly valid also for human beings.
 
Re: Concerns arise over symptomless Egypt bird flu cases

Perhaps these cases are getting more testing because Egypt puts out the welcome mat for NAMRU-3, as opposed to Indonesia who hasn't always been particularly cooperative with their own NAMRU facility.:(

.
 
Re: Concerns arise over symptomless Egypt bird flu cases

Perhaps these cases are getting more testing because Egypt puts out the welcome mat for NAMRU-3, as opposed to Indonesia who hasn't always been particularly cooperative with their own NAMRU facility.:(

.

It could be the case.

But I continue to wait for long-time pledged sero-surveys in Turkey, Vietnam and last-but-not-least Egypt.

Are there some not welcomed results that some people fear these surveys could provide?
 
Re: Concerns arise over symptomless Egypt bird flu cases

Are there some not welcomed results that some people fear these surveys could provide?

Maybe they think the end-of-the-world-conspiracy-theorists don't need any more fuel for their propaganda. :rolleyes:

.
 
Re: Concerns arise over symptomless Egypt bird flu cases

Maybe they think the end-of-the-world-conspiracy-theorists don't need any more fuel for their propaganda. :rolleyes:

.

Perhaps.

But Turkey sero-surveys pledged in 2006 were never performed...

I try only to put on the table some things.

If they would have found that a considerable number of people had H5N1-neutralizing antibodies?

Or perhaps that some seasonal strains antibodies cross-react - even poorly but reacts - with H5N1 at the time?

What's about the great fanfare about oseltamivir stockpiles...

Yes. We have a great number of IF, THEN, BUT, OR, too many IFs to be really able to have the clear picture of current events.

So, a more serious approach by international agencies is urgently needed.

...if - yes, again - they are able to react at all...
 
Re: Concerns arise over symptomless Egypt bird flu cases

Perhaps.

But Turkey sero-surveys pledged in 2006 were never performed...

I try only to put on the table some things.

If they would have found that a considerable number of people had H5N1-neutralizing antibodies?

Or perhaps that some seasonal strains antibodies cross-react - even poorly but reacts - with H5N1 at the time?

What's about the great fanfare about oseltamivir stockpiles...

Yes. We have a great number of IF, THEN, BUT, OR, too many IFs to be really able to have the clear picture of current events.

So, a more serious approach by international agencies is urgently needed.

...if - yes, again - they are able to react at all...
I think it is worth reviewing SOME of the politics surround H5N1 (in reality, H5N1 is ALL about politics).

The major underlying problem is "what if they gave a pandemic and nobody died" issue. The current system of phases does not include severity of disease. Thus, a mild H5N1 that caused large clusters and moved from location to location would move the phase from 3 to 5 and possibly 6 rather quickly. Changes to these levels would have MAJOR economic and political consequences (like SARS), which would be followed by MAJOR backlash if the spread only produced mild cases like seasonal flu.

Therefore, the attention paid to mild H5N1 has been minimal, and examples of mild spread, as detected in serologocal studies, has been largely hidden because of poor experimental design and curious data analysis.

The most obvious example of curious data analysis was northern Vietnam in the spring of 2005, when clusters and cases were growing and 1000 serum samples were collected. These samples were initially tested in Vietnam and produced a significant number of positives (the actual data was never released). The samples were then sent to the CDC in Atlanta, and more positives were found (the actual data was never released). That was followed by a WHO emergency meeting in Manila (May 5, 2005), and discussion of the 1000 serum samples was never released. Each time test results were generated, "further testing" was required.

The Manila meeting did discuss raising the pandemic level, but it was decided to wait and see. Eventually, Japan claimed the samples were negative, but again the data was never released.

Additional testing has been published and one of the more notable studies was in Thailand on samples taken from areas that had reported bird flu in poultry, and at least one human case. In that study the positive control had a titer of 160, signaling a relative low titer for H5N1 infection (in patients who were PCR confirmed). The study was relatively small (under 400) and samples were collected as late as 6 months after reports of prior outbreaks in poultry.

Normally a titer of 40 is considered a positive, and some companies testing pandemic vaccines consider a titer of 20 as evidence of a positive response to the vaccine. However, for the study in Thailand the cut-off for a positive was raised to 80. H5N1 antibody was detected in 7 villagers (2.2%). There was one with a titer of 40, two with a titer of 20, and four with a titer of 10.

This study was presented in Toronto in 2007 and was one of the few media stories to come out of the meeting. Of course the media stories didn't provide detail, but the take home message was no antibodies in asymptomatic patients.

In Egypt, the high frequency of detection in toddlers has raised a very big red flag. The first response of most scientists would be some sort of protective immunity in older patients. However, detection of neutralizing H5N1 antibodies requires a reasonable experimental design and the history of such testing has been suspect, at best.
 
Re: Concerns arise over symptomless Egypt bird flu cases

It could be the case.

But I continue to wait for long-time pledged sero-surveys in Turkey, Vietnam and last-but-not-least Egypt.

Are there some not welcomed results that some people fear these surveys could provide?
I believe those results were generated multiple times in samples collected in 2005 in northern and central Vietnam.

http://www.recombinomics.com/News/04150501/H5N1_Evolving_Analysis.html

Evolving H5N1 In Northern Vietnam Sent To US For Analysis[FONT=Arial,Helvetica]

Recombinomics Commentary
[/FONT]
April 15, 2005

>> Nguyen Tran Hien, director of the National Institute of Hygiene and Epidemiology, said he had already taken nearly 1,000 blood samples from patients, poultry, water birds and other animals in order to discover a distribution map of the H5N1 virus.

Hien said the H5N1 virus of this year is very different with that of the previous year.

While the toxicity has reduced, the spread is definitely faster. Samples have already been sent to the US for further testing, with results expected by the end of this week. <<
 
Re: Concerns arise over symptomless Egypt bird flu cases

"..In Egypt, the high frequency of detection in toddlers has raised a very big red flag. The first response of most scientists would be some sort of protective immunity in older patients..."

In Egypt isn't it possible that the adults near the infected toddlers have mild cases also? So mild that there are really no symptoms in most of them either?

Since they do not have any "symptoms" they are dispensed tamiflu as a precaution and as a result of low viral load/tamiflu, they test negative?
 
Re: Concerns arise over symptomless Egypt bird flu cases

"..In Egypt, the high frequency of detection in toddlers has raised a very big red flag. The first response of most scientists would be some sort of protective immunity in older patients..."

In Egypt isn't it possible that the adults near the infected toddlers have mild cases also? So mild that there are really no symptoms in most of them either?

Since they do not have any "symptoms" they are dispensed tamiflu as a precaution and as a result of low viral load/tamiflu, they test negative?
The cases in the toddlers present much like seasonal flu, so they have symptoms, but are not tested because they lack a poultry connection or a connection with a confirmed case. I would think that close contacts with the siblings would be tested as would the dead and dying poultry. I think the second toddler was discovered because he was a neighbor and cousin of the index case.

Since there have been no reports of H5N1 in contacts or poultry I would assume that they tested negative.

However, the concern is that mild cases in toddlers, may be even milder in adults who may have protective immunity. so there would be little if any testing in those without a stated link to dead or dying poultry.

Similarly, other toddlers would also not be tested if they were infected by playmates or relatives, because there would again be no link to poultry.

In Egypt H5N1 has been detect in mild cases, but only in about 1% of hospitalized patients. These positives come from samples collected prior to Tamiflu treatment. I think that repeated testing on samples collected after the start of testing is rare in Egypt, so false negatives due to Tamiflu treatment would also be rare.

Other countries, such as Indonesia test on samples collected after the start of Tamiflu treatment are more common.

The data on H5N1 can be heavily influenced by what samples are tested, as well as the sensitivity of the test (and where the cut-off line is drawn between positive and negative).
 
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