Egypt - Human Confirmed/Suspected Bird Flu Cases, Feb 8, 2009 - April 9, 2009

[HenryN]

CAIRO, April 5 (Reuters) - A 6-year-old Egyptian boy has contracted the highly pathogenic bird flu virus, the sixth case in a month in the most populous Arab country, state news agency MENA said on Sunday.
MENA named the boy as Ali Mahmoud Ali Somaa, from the Nile Delta province of Qalyubia. His case brings to 63 the number of confirmed cases of the H5N1 avian flu virus in Egypt, which has been hit harder by bird flu than any other country outside of Asia.
Health Ministry spokesman Abdel Rahman Shahine said Somaa started suffering symptoms two weeks ago and was admitted to hospital a week later, where he was treated with the antiviral drug tamiflu, according to MENA.
Somaa is in a critical condition and is breathing with an artificial respirator, MENA said.
On Friday, Egypt reported a 21-month-old boy had contracted bird flu.
Since 2003 the H5N1 avian influenza virus has infected at least 410 people in 15 countries and killed 254 of them. It has killed or forced the culling of more than 300 million birds in 61 countries in Asia, the Middle East, Africa and Europe.
Some 23 Egyptians have died after contracting the virus, most after coming into contact with infected domestic birds in a country where roughly 5 million households depend on domestically raised poultry as a significant source of food and income.
While H5N1 rarely infects people, experts say they fear it could mutate into a form that people could easily pass to one another, sparking a pandemic that could kill millions. (Writing by Aziz El-Kaissouni)

http://af.reuters.com/article/egyptN...Name=egyptNews

[SophiaZoe]

Originally Posted by Florida1

We have no idea if this is H2H or a common environmental contagion.

My thoughts exactly.

I am drawn to the epidemiological similarity of Egypt's current H5N1 and Polio prior to indoor plumbing. I am drawn to the environmental far more than the H2H theory.

Beyond the epidemiological similarity to low viral load polio infection in times of, my question has been: If it is truly a mild H2H2H2H version why are we not seeing it in tourists?

[HenryN]

Egyptian boy contracts bird flu
51 minutes ago
CAIRO (AFP) — A six-year-old boy has contracted bird flu, the 63rd recorded case since the first outbreak of the disease in Egypt in 2006 and the third in a week, the health ministry announced on Sunday.
Ali Mahmud Ali from Shubra al-Khaimah, north of Cairo, was hospitalised on March 28 in the Egyptian capital, ministry spokesman Abdel Rahman Shahin said, as cited by state news agency MENA.
The diagnosis came after about a week, he said.
The child is in a serious condition and is being treated with frontline anti-flu drug Tamiflu, Shahin added.
Hassan Gamil Hassan, 21 months old, was hospitalised on Wednesday in the northern province of Beheira with a high fever, while a two-year-old was taken to hospital in Beheira last Monday.
The toddler had been exposed to dead fowl thought to have been infected with the virus.
Twenty-three people have died of bird flu in Egypt. Most of the victims have been young girls or women, who are generally in charge of looking after poultry in rural areas.
The World Health Organisation (WHO) called last month for an investigation into why many of the victims have been young children.
Egypt hosted an international conference on bird flu in October, when Washington pledged an additional 320 million dollars to the fight against the disease amid fears it may yet escalate into a global pandemic.
The H5N1 strain of the virus that is most dangerous to humans first emerged in Asia in 2003 and has since caused nearly 250 deaths, according to WHO figures.
Scientists fear that a mutation of the bird flu virus resulting in a strain easily transmitted among humans could create a pandemic, potentially affecting up to one-fifth of the world's population.

http://www.google.com/hostednews/afp...wkipczR9ef526g

[Treyfish]

Egypt announces 63 human infection with bird flu

رويترز Reuters GMT 17:47:19 2009 الأحد 5 أبريل GMT 17:47:19 2009 Sunday, April 5

القاهرة (رويترز) - قالت وكالة انباء الشرق الاوسط المصرية يوم الاحد إنه تم اكتشاف الاصابة البشرية رقم 63 بمرض انفلونزا الطيور لطفل من محافظة القليوبية شمال القاهرة. CAIRO (Reuters) - An Egyptian news agency MENA on Sunday that it had been no discovery of human infection with bird flu, 63 of the children of the province north of Cairo Qaliubiya. وقالت الوكالة نقلا عن بيان لوزارة الصحة إن الطفل يدعى على محمود على سمعة ويبلغ من العمر ست سنوات وهو من شبرا الخيمة بمحافظة القليوبية. The agency said, quoting a statement from the Ministry of Health that the child named on the reputation of Mahmoud, a six-year-old, one of the Shubra al-Khaimah government to. واضاف البيان ان بداية ظهور الاعراض على الطفل كانت يوم 22 مارس اذار الماضى ودخل على اثرها مستشفى عين شمس الجامعى يوم 28 مارس وفور الاشتباه فى اصابته بالمرض تم اعطاؤه عقار تاميفلو وحالته الصحية حرجة ويرقد الان على جهاز التنفس الصناعى. The statement added that the onset of symptoms the child was on March 22 last March and came to hospital, Ain Shams University on March 28 and immediately after suspected bird flu have been given Tamiflu, and his health condition is critical and is now on a ventilator. ومصر هي اكثر الدول تضررا بانفلونزا الطيور خارج قارة اسيا. Egypt is one of the countries affected by bird flu outside of Asia. وتوفي حوالي 23 مصريا بعد اصابتهم بالفيروس واغلبهم بعد مخالطة طيور منزلية مصابة في بلد تعتمد فيه خمسة ملايين اسرة تقريبا على الدواجن التي تربى في المنزل كمصدر مهم للطعام والدخل. He died about 23 Egyptians have died of the virus after contact with birds, mostly found in the home country adopts the nearly five million households that kept poultry at home as an important source of food and income. ومنذ عام 2003 اصاب فيروس انفلونزا الطيور 410 اشخاص على الاقل في 15 دولة واودى بحياة 254 منهم. Since the 2003 avian flu virus has infected at least 410 people in 15 countries and killed 254 of them. وادى الى نفوق او اعدام اكثر من 300 مليون طائر في 61 دولة في اسيا والشرق الاوسط وافريقيا واوروبا. And led to the deaths or culling of more than 300 million birds in 61 countries in Asia and the Middle East, Africa and Europe. http://translate.google.com/translat...3Den%26tl%3Dar

[HenryN]

Originally Posted by SophiaZoe

My thoughts exactly.

I am drawn to the epidemiological similarity of Egypt's current H5N1 and Polio prior to indoor plumbing. I am drawn to the environmental far more than the H2H theory.

Beyond the epidemiological similarity to low viral load polio infection in times of, my question has been: If it is truly a mild H2H2H2H version why are we not seeing it in tourists?

Next door neighbors is not a coincidence (and the MOH did not mention Menofiyah for case #61 just to fill white space).

[Treyfish]

Avian flu in Alexandria

2009-04-05

2009-04-05

احتجزت مستشفيات فى قنا والمنيا والدقهلية، أمس مواطنين للاشتباه فى إصابتهم بمرض أنفلونزا الطيور، فيما تواصل مباحث التموين بالمحافظات جهودها لضبط محال تجارة الطيور الحية، وأسفرت الحملات عن ضبط 31 محلا بالإسكندرية، فضلاً عن إعدام 412 طائرًا تم ضبطها داخلها.فى قنا احتجز مستشفى الحميات 5 مواطنين للاشتباه فى إصابتهم بالمرض هم: أميمة فتحى «41 سنة»، ربة منزل، وطفلها أحمد على يعقوب، عامان، وزينب محمود الشنوانى «40 سنة»، ربة منزل، وسعاد حامد عبدالله، «40 سنة»، وأميرة عبدالرازق أبو الحسن، «21 سنة»، ربة منزل، للاشتباه فى إصابتهم بأنفلونزا الطيور بعد ظهور أعراض مشابهة للمرض عليهم."من المصري اليوم"

Detained in hospital in Qena, Minya, Dakahliya, citizens yesterday on suspicion of bird flu patients, as it continues its efforts GOVERNORATES Investigation of Supply stores to control the trade of live birds, and the campaigns have resulted in the seizure of 31 shops in Alexandria, as well as the execution of 412 birds were seized inside.
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 after an outbreak of similar symptoms of the disease on them. "from Egypt today,"http://translate.google.com/translat...r%26start%3D20

[SophiaZoe]

Originally Posted by niman

Next door neighbors is not a coincidence (and the MOH did not mention Menofiyah for case #61 just to fill white space).

I don't disagree that next door neighbors is not a coincidence... however... to restate (in a different way)... neither were the infections of polio all acquired at a common outhouse.

It could just as easily be a common environmental contamination source. And, I would go further in saying that the mildness of the disease in these cases also strongly suggests low viral load environmental sources. And, IIRC, you have commented on that very low viral load environmental acquisition yourself not too long ago.

However, I do not presume to say what *is* happening in Egypt, only that there is "X" amount of circumstantial evidence to support more than one theory, and which one I weigh as the more likely of the theories.

[sharon sanders]

Originally Posted by niman

Next door neighbors is not a coincidence (and the MOH did not mention Menofiyah for case #61 just to fill white space).

I think the mention of Menofiyah is because that is where the child showed symptoms during a visit:

"...was discovered during a visit to the house of her mother in one of the villages of Al-Menoufiya..."

http://www.flutrackers.com/forum/sho...&postcount=151


and

"...He was discovered when he became very sick during
visiting his grandparents in Monfia. He was given Tamiflu and
currently is stable...."


http://www.flutrackers.com/forum/sho...&postcount=164

[HenryN]

Map updated

http://maps.google.com/maps/ms?ie=UT...1,3.186035&z=8

[HenryN]

Originally Posted by Florida1

I think the mention of Menofiyah is because that is where the child showed symptoms during a visit:

"...was discovered during a visit to the house of her mother in one of the villages of Al-Menoufiya..."

http://www.flutrackers.com/forum/sho...&postcount=151


and

"...He was discovered when he became very sick during
visiting his grandparents in Monfia. He was given Tamiflu and
currently is stable...."


http://www.flutrackers.com/forum/sho...&postcount=164

If he was infected in Beheira, the visit to his grandparents really has little relevance unless someone in Monfia has symptoms. I strongly suspect that the "poultry connection" is in Monifia, which is a probelm since the neighbor in Beheira has been confirmed.

There also is a delay in these reports, which I suspect is because there are some major issues of where and when.

[HenryN]

Egypt announces 63rd bird flu case

Health 4/5/2009 11:00:00 PM

CAIRO, April 5 (KUNA) -- Egypt announced Sunday that a six-year-old child was infected with bird flu, making him the 63rd case since the outbreak of the disease in the north African country. Ministry of Health spokesman dr. Abdulrahman Shahin said in a statement the boy, whose name was not disclosed, was in "critical" condition. He added that the boy was given the Tamiflu medication once doctors suspected he was infected with bird flu. (end) nor.bs KUNA 052300 Apr 09NNNN http://www.kuna.net.kw/NewsAgenciesP...02&Language=en

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04050901/H5N1_Egypt_Remarkable.html

Commentary


Remarkable H5N1 Demographic in Egypt

Recombinomics Commentary 15:44
April 5, 2009

In February, 2009 the Egyptian health authorities confirmed two new human cases of HPAI H5N1. The first case was of an 18-month-old-boy from Maghagha District on Minya Governorate who is now in stable/good health after being hospitalized a day after manifesting symptoms suggestive of HPAI Infection on 6 February.

The other case was a 2-year-old boy from Ganain District, Suez Governorate, who first showed symptoms suumbleble to HPAI H5N1 infection on 2 February and was admitted to the hospital the next day. He is now in stable condition.

Remarkably, all 4 cases of HPAI H5N1 influenza recorded so far this year have been children between 1-2 years of age. The total number of HPAI H5N1 infected people in Egypt by the end of February 2009 reached 55 of which 23 died.

The above comments are from the official report on H5N1 in Egypt in February, which qualifies the fact that all four cases in 2009 were toddlers, with "Remarkably". However, this characterization has now moved into the "Alarmingly" category, since four of the five cases in March were toddlers, as were the two Beheira cases last week bring the 2009 total to 10/11 (see updated map). Moreover, 10/11 cases this year were mild, and all 11 have recovered or are likely to recover, since there is no hint of pneumonia or requirements for respirators in any cases from the last month.

Although the reduction of the case fatality rate for 2009 to zero may seem to be a positive, the fact that almost all cases were toddlers raises concerns that protective immunity is reducing viral loads in older patients to the undetectable level. Media reports continue to describe large numbers of patients hospitalized with symptoms, and these hospitalized patients represent a wide age range, which includes many familial clusters. Historically, less than 1% of hospitalized suspect patients test PCR positive for H5N1, which raises concerns that many cases have viral loads below the detection limit, and now the detection rate for these older populations has fallen from 1% of cases to 0% of cases.

Protective immunity could be due to prior exposure to H5N1 or cross protection from seasonal flu, which would be most likely from H1N1. However, the large number of cases in toddlers, which have previously been limited to 1-3 cases per year, raises concerns that the efficiency of human infections has increased, but is only reflected in the toddler data.

If the efficiency has increased, or if the absence of older cases is due to protective immunity from H5N1, then there should be H5N1 positive toddlers who lack a poultry link, or there should be detectable levels of H5N1 antibodies in the older patients.

The alarming concentration of mild H5N1 confirmed cases in toddlers in 2009, requires a significant expansion of testing to address the above concerns. These concerns have increased because local media reports are now describing the two Beheira toddlers as neighbors.

.

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04...a_Cluster.html

Commentary

H5N1 Toddler Cluster in Beheira Egypt Raises Concerns
Recombinomics Commentary 19:14
April 5, 2009

A spokesman of the Ministry of Health, Dr. Abdel Rahman Shahin said in a statement here today that the onset of symptoms the child was sick at his place of his injury, the lake was discovered during a visit to the house of her mother in one of the villages of Al-Menoufiya.

Magdy Attallah Al-Chief of the Unit for the local center town of Badr in Beheira, the 61 cases and 62 of the bird-flu-affected children, Mohamed El-Shahat Mohamed Hassan Amer, two years, and Jamil Hassan Mohamed Hassan Amer, years and 9 months, with two children and live in adjacent houses

The above translations describe the two most recent confirmed toddlers in Beheira. The index case (confirmed case #61) developed symptoms while visiting relatives in Menoufiya, suggesting the infection was linked to that visit. However, the second translation describes the second case (confirmed case #62), who is the next door neighbor of the index case (see updated map), suggesting the second case was infected in Beheira and the infection was from the neighbor, supporting human to human (H2H) transmission, and predicting that the H5N1 from the neighbors will be virtually identical.

However, these cases have much in common with an earlier mild outbreak in the summer of 2007. The spike in cases involved young children aged 3-10, which was a distinct departure for prior cases which were frequently fatal and were female teenagers and young adults. The mild outbreak of the spring of 2007 was largely confined to central and southern Egypt and the sequences fell into two major sub-clades, one with a Mongolian cleavage site and another with a 3 BP deletion. More striking however, was the virtual identity between isolates from unrelated patients. This identity, coupled with the mild nature of the infections, raised concerns that H5N1 was silently spreading among this patient population.

Because the cases were mild and did not develop pneumonia, misdiagnosis as seasonal flu or some other respiratory disease was a concern. Moreover, almost all H5N1 testing was limited to patients with a known poultry contact, so human to human transmission would be largely missed because those without a poultry contact would not be tested.

Moreover, widespread mild H5N1 infections would create protective immunity, which would limit confirmed cases in this age group. In the current outbreak, none of the confirmed cases are in this age group. 10/11 cases in 2009 are toddlers, and the remaining confirmed case is an adult (38F). Like the low case fatality rate in the spring of 2007 (16/17 patients survived), the case fatality rate in the 2009 cases is zero. The latest confirmed fatality in Egypt was in 2008.

The two confirmed cases in Beheira raise significant H2H concerns. WHO has not issued an update on these cases to clarify where the index case was infected. Similarly, a poultry contact with the Beheira neighbor has not been cited. More detail on these cases, and both poultry and human H5N1 sequences from 2009 would be useful. To date, only two isolates, represented in a phylogenetic tree in the WHO update on vaccine targets has been released. The delay in the release of sequences by NAMRU-3, a WHO regional center, continues to be cause for concern.

.

[HenryN]

April 5, 2009 16:17 ET
Follow UP : H5N1 Human infection No. 63

This is too fast , the time interval is too close with the last human infection !!
Today the ministry of health announced 6 years old Ali Mahmoud Ali as the H5N1 human infection No.63 . Ali is from Shubra El-Khemia, Qalyubia .
Interesting enough Ali began to have the symptoms on the 22nd of March and he entered Ain Shams hospital in Cairo on the 28th of March , he was given Tamflu. I hope that he will be cured insh Allah , already he is suffering for time now.
It is worth to mention that Qalyubia Governorate was the center Governorate for poultry raising industry in Egypt , it was a multi billion industry there before being hit by the epidemic.
Technorati Tags: Qalyubia,Egypt,health,Citizen Journalism,H5N1,News,society,Shubra El-Kheima,Avian flu



http://www.globalpost.com/webblog/eg...nfection-no-63

[Laidback Al]

Below is my breakdown of the ages of human H5N1 infections by year in Egypt. It is based on onset date and includes all 60 cases confirmed by WHO and the three locally confirmed recent cases that have not yet been included in the WHO totals for 2009 year-to-date total.

[HenryN]

Egypt's first bird flu!!

Egypt topped the list of countries worst hit by bird flu in 2009, after the Ministry of Health reported 9 injuries since the beginning of this year, compared with 8 cases over the past year.

The Egyptian Ministry of Health on Sunday, wounding a child in the age of six virus (H 5 to 1) strain of bird flu, bringing the total number of people who have contracted the disease since it appeared for the first time in Egypt in 2006 to 63 people.

In addition, said Dr. Abdel Rahman Shahin, spokesman of the Ministry of Health, said that despite the high number of casualties, Egypt is the least in the proportion of deaths, adding that among the 63 cases of which 23 occurred only event of the death, admitting that the virus is endemic in Egypt, and that he and eradicate it takes many years and perhaps decades, and the risk of it mutating into a form more virulent, "and is strongly," he said there was no way now to get out of the crisis, but the transformation of society to the frozen birds.

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.

In Alexandria, was executed by the Directorate of Veterinary Medicine million birds because of the lack of certificates to prove they are free of the disease have been seized in raids on intensive farms, bird shops in the east and west of the city.

In Fayoum, said Dr Hussein Sophie Abu Talib, Under-Secretary, Ministry of Health, the death of the girl child بسملة Mohammed "45 days" in hospital after the transfer of the Tamiflu drug to the hospital yesterday evening fevers Fayyoum first, on suspicion of having contracted the disease, adding that blood samples were taken and sent to the central laboratory, but she died before the results of the analysis, pointing out that the samples were withdrawn from her family as a precaution.

http://alalam.ir/newspage.asp?newsid...20090406114607

[HenryN]

Originally Posted by Florida1

I think the mention of Menofiyah is because that is where the child showed symptoms during a visit:

"...was discovered during a visit to the house of her mother in one of the villages of Al-Menoufiya..."

http://www.flutrackers.com/forum/sho...&postcount=151


and

"...He was discovered when he became very sick during
visiting his grandparents in Monfia. He was given Tamiflu and
currently is stable...."


http://www.flutrackers.com/forum/sho...&postcount=164

Here is the problem with an H5N1 source in Beheira for case #61. Reports indicated he lived in Beheira, but developed symptoms while visiting grandparents in Menoufiya. However, those same reports also mention a poultry contact, as well as hospitalization in Menoufiya a day after symptoms, strongly implying that he went to visit his grandparents in Menoufiya, was exposed to poultry in Menoufiya, developed symptoms in Menoufiya, and was hospitalized in Menoufiya.

However, H5N1 in his next door neighbor in Beheira complicates the story, which is further complicated by the fact that a poultry exposure is NOT mentioned for case #62. If the poultry connection for case #61 was in Beheira, it is VERY likely that the same connection would be cited for case #62, who lived next door to case #61 in Beheira (and case #62 was hospitalized in Beheira).

[HenryN]

Commentary

http://www.recombinomics.com/News/04...pt_Delays.html

[HenryN]

Originally Posted by Florida1

I think the mention of Menofiyah is because that is where the child showed symptoms during a visit:

"...was discovered during a visit to the house of her mother in one of the villages of Al-Menoufiya..."

http://www.flutrackers.com/forum/sho...&postcount=151


and

"...He was discovered when he became very sick during
visiting his grandparents in Monfia. He was given Tamiflu and
currently is stable...."


http://www.flutrackers.com/forum/sho...&postcount=164

No comment on cluster (cases 61 and 62) or poultry linkage for 63

http://www.saidr.org/en/humans.php

RECENT CASES:

Date of report: 5 April 2009
Governorate: Qalioubiya
District: Shoubra el Kheima
Event summary: Boy, age 6, began experiencing symptoms March 22. He was admitted to Ain Shames University hospital March 28 and received Tamiflu on April 3. Infection with avian influenza was confirmed April 5. He was reported in a critical condition under artificial ventilation on April 6. The MOHP reported this was the 63rd case of highly pathogenic avian influenza in Egypt.
Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP
---------------------------------------

Date of report: 26 March 2009
Governorate: Qena
District: Qena
Event summary: Girl age 2½, began experiencing symptoms March 23. She was admitted to Qena Fever Hospital March 24 and received Tamiflu the same day. Infection with avian influenza was confirmed March 26, and the child was referred to Manshiyet el Bakry Hospital, Cairo. Her mother reported the child had close contact with a dead poultry. She was reported in a good general condition on March 18. The MOHP reported this was the 60th case of highly pathogenic avian influenza in Egypt.
Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

[sharon sanders]

Originally Posted by niman

Here is the problem with an H5N1 source in Beheira for case #61. Reports indicated he lived in Beheira, but developed symptoms while visiting grandparents in Menoufiya. However, those same reports also mention a poultry contact, as well as hospitalization in Menoufiya a day after symptoms, strongly implying that he went to visit his grandparents in Menoufiya, was exposed to poultry in Menoufiya, developed symptoms in Menoufiya, and was hospitalized in Menoufiya.

However, H5N1 in his next door neighbor in Beheira complicates the story, which is further complicated by the fact that a poultry exposure is NOT mentioned for case #62. If the poultry connection for case #61 was in Beheira, it is VERY likely that the same connection would be cited for case #62, who lived next door to case #61 in Beheira (and case #62 was hospitalized in Beheira).

It is very difficult to ascertain the epidemiological facts from news reports, some of which are arabic machine translations. The news reports do not mention where # 61 was exposed to sick poultry.

I think that #61 was exposed to sick poultry in Al Beheira, which is why there was a canvass of his home neighborhood and case # 62 was discovered.

Given that # 61 and # 62 live next door to each other and became sick only 2 days apart (which would be an extremely short gestation period for H2H transmission between the two), it is most probable that they were exposed to a common contagion (poultry, human, other?).

[HenryN]

Originally Posted by Florida1

It is very difficult to ascertain the epidemiological facts from news reports, some of which are arabic machine translations. The news reports do not mention where # 61 was exposed to sick poultry.

I think that #61 was exposed to sick poultry in Al Beheira, which is why there was a canvass of his home neighborhood and case # 62 was discovered.

Given that # 61 and # 62 live next door to each other and became sick only 2 days apart (which would be an extremely short gestation period for H2H transmission between the two), it is most probable that they were exposed to a common contagion (poultry, human, other?).

Nonsense. A two day gap is sufficient for H2H (disease onset is commonly 2-4 days after exposure), but the two day onset gap is also suspect because of the difficulty in matching dates involving exposure date, grandparent visit dates, and disease onset dates, if infection originated in Beheira.

Moreover, the official update (in ENGLISH) has skipped cases 61 and 62 (the Beheira cluster).

http://www.saidr.org/en/humans.php

[sharon sanders]

"...Limited data on the incubation period suggest that illness onset occurs <7 days after the last exposure to sick or dead poultry.

For clusters in which limited human-to-human virus transmission likely occurred, the incubation period appeared to be 3–5 days but was estimated to be 8–9 days in 1 cluster..."


Incubation Period for Human Cases of Avian Influenza A (H5N1) Infection, China

Yang Huai, Nijuan Xiang, Lei Zhou, Luzhao Feng, Zhibin Peng, Robert S. Chapman, Timothy M. Uyeki, and Hongjie Yu

Author affiliations: Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China (Y. Huai, N. Xiang, L. Zhou, L. Feng, Z. Peng, H. Yu); Chulalongkorn University, Bangkok, Thailand (Y. Huai, R.S. Chapman); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (T.M. Uyeki)


http://www.flutrackers.com/forum/sho...d.php?p=210382

[HenryN]

Originally Posted by Florida1

"...Limited data on the incubation period suggest that illness onset occurs <7 days after the last exposure to sick or dead poultry.

For clusters in which limited human-to-human virus transmission likely occurred, the incubation period appeared to be 3–5 days but was estimated to be 8–9 days in 1 cluster..."


Incubation Period for Human Cases of Avian Influenza A (H5N1) Infection, China

Yang Huai, Nijuan Xiang, Lei Zhou, Luzhao Feng, Zhibin Peng, Robert S. Chapman, Timothy M. Uyeki, and Hongjie Yu

Author affiliations: Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China (Y. Huai, N. Xiang, L. Zhou, L. Feng, Z. Peng, H. Yu); Chulalongkorn University, Bangkok, Thailand (Y. Huai, R.S. Chapman); and Centers for Disease Control and Prevention, Atlanta, Georgia, USA (T.M. Uyeki)


http://www.flutrackers.com/forum/sho...d.php?p=210382

Please. The incubation period is usually 2-4 day (which WHO admitted when pressed by Donald McNeil of NY Times with regard to the Karo cluster).

The Egyptian site has just added the Beheira cluster and the gap in disease onset dates is now FIVE days. March 27 for case #61 and April 1 for case #62.

[HenryN]

• RECENT CASES:
• Date of report: 5 April 2009
• Governorate: Qalioubiya
• District: Shoubra el Kheima
• Event summary: Boy, age 6, began experiencing symptoms March 22. He was admitted to Ain Shams University hospital March 28 and received Tamiflu on April 3. Infection with avian influenza was confirmed April 5. He was reported in a critical condition under artificial ventilation on April 6. The MOHP reported this was the 63rd case of highly pathogenic avian influenza in Egypt.
• Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
  Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP
• 
  ---------------------------------------
• Date of report: 2 April 2009
• Governorate: Beheira
• District: Kom Hamada
• Event summary: Boy, age 2, began experiencing fever, cough and runny nose on March 31. He was admitted to Damanhour Fever Hospital on April 1 and received Tamiflu the same day. Infection with avian influenza was confirmed April 2. He reported contact with a dead or sick poultry. He was reported in good general condition on April 6. The MOHP reported this was the 62rd case of highly pathogenic avian influenza in Egypt.
• Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
  Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP
• 
  ---------------------------------------
• Date of report: 1 April 2009
• Governorate: Beheira
• District: Kom Hamada
• Event summary: Boy, age 2, began experiencing fever and cough symptoms on March 27. He was admitted to Naaora Fever Hospital on March 30 and received Tamiflu the same day. Infection with avian influenza was confirmed April 1. He was reported contact with dead and sick poultry. He was reported in good general condition on April 6. The MOHP reported this was the 61st case of highly pathogenic avian influenza in Egypt.
• Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
  Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP
• 
  ---------------------------------------
• Date of report: 26 March 2009
• Governorate: Qena
• District: Qena
• Event summary: Girl age 2½, began experiencing symptoms March 23. She was admitted to Qena Fever Hospital March 24 and received Tamiflu the same day. Infection with avian influenza was confirmed March 26, and the child was referred to Manshiyet el Bakry Hospital, Cairo. Her mother reported the child had close contact with a dead poultry. She was reported in a good general condition on March 18. The MOHP reported this was the 60th case of highly pathogenic avian influenza in Egypt.
• Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
  Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

[HenryN]

The above update leaves out the visit to the grandparents in Menoufiya, but leaves in the hospital in Menoufiya

Zawit El-Naaora Hospital

Zawit El-Naaora Hospital

El-Moukaf El-Aam, Zawit El-Naaora El-Shohadaa,Menoufeya, Menoufeya Egypt Phone : ‎+20 48 2772314 Fax : ‎+20 48 2772314(Tel & Fax)

[HenryN]

Originally Posted by niman

• 
  ---------------------------------------
• Date of report: 2 April 2009
• Governorate: Beheira
• District: Kom Hamada
• Event summary: Boy, age 2, began experiencing fever, cough and runny nose on March 31. He was admitted to Damanhour Fever Hospital on April 1 and received Tamiflu the same day. Infection with avian influenza was confirmed April 2. He reported contact with a dead or sick poultry. He was reported in good general condition on April 6. The MOHP reported this was the 62rd case of highly pathogenic avian influenza in Egypt.
• Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
  Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP
• 
  ---------------------------------------
• Date of report: 1 April 2009
• Governorate: Beheira
• District: Kom Hamada
• Event summary: Boy, age 2, began experiencing fever and cough symptoms on March 27. He was admitted to Naaora Fever Hospital on March 30 and received Tamiflu the same day. Infection with avian influenza was confirmed April 1. He was reported contact with dead and sick poultry. He was reported in good general condition on April 6. The MOHP reported this was the 61st case of highly pathogenic avian influenza in Egypt.
• Source of report: Amr Kandeel, Undersecretary for preventative affairs, MOHP
  Samir Refaie, Head of Epidemiology and Surveillance Unit, MOHP

The above update places both cases in the same district (Kom Hamada), supporting media reports that they were next door neighbors (who developed symptoms FIVE days apart as indicated in the update above).

[HenryN]

Originally Posted by niman

The above update places both cases in the same district (Kom Hamada), supporting media reports that they were next door neighbors (who developed symptoms FOUR days apart as indicated in the update above).

Updated map

http://maps.google.com/maps/ms?ie=UT...540833&t=p&z=9

[HenryN]

Commentary

http://www.recombinomics.com/News/04...heira_H2H.html

[Laidback Al]

I'll add my comment on the discussion of the source of infection for the two kids in Beheira. These children are very very young, that is why they are called toddlers. What we can not determine from translated news articles is whether they are doing more toddling with sick neighbor kids or more toddling with sick chickens. So is it human to human transmission or multiple cases of animal to human infection? I am not willing to guess.

[HenryN]

Originally Posted by Laidback Al

I'll add my comment on the discussion of the source of infection for the two kids in Beheira. These children are very very young, that is why they are called toddlers. What we can not determine from translated news articles is whether they are doing more toddling with sick neighbor kids or more toddling with sick chickens. So is it human to human transmission or multiple cases of animal to human infection? I am not willing to guess.

The actual mechanism of infection is really not relevant. The bottom line is 12 confirmed cases in 3 months in the entire country. The chance of 2 confirmed cases happening at adjacent locations four days apart, when the frequency is so low, is VERY close to ZERO (no guessing required - this is VERY simple math).