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

[ironorehopper]

Since human to human transmission cannot be discounted a priori, without an in depth field investigation, we should keep an open mind approach.

However, the widespread poultry presence into egyptians' houses and probable environmental contamination could also be one of the main causes of this year higher incidence of avian influenza infections in young children.

A WHO update on this new development in Egypt epidemiological behaviour of H5N1 virus in humans is long overdue.

[HenryN]

Originally Posted by ironorehopper

Since human to human transmission cannot be discounted a priori, without an in depth field investigation, we should keep an open mind approach.

However, the widespread poultry presence into egyptians' houses and probable environmental contamination could also be one of the main causes of this year higher incidence of avian influenza infections in young children.

A WHO update on this new development in Egypt epidemiological behaviour of H5N1 virus in humans is long overdue.

Actually, there isn't much evidence that much has changed in Egypt. There has always been a close relationship between backyard flocks and residents. If anything, the numbers would be lower now than in the past. Moreover, there has been an aggressive vaccination program, which appears to have lowered the frequency of H5N1 in commercial holdings, but outbreaks in backyard holdings are still common.

The big change has really been demographic, which has produced mild cases in toddlers at a rate that is much higher than the prior three years. The incidence in other groups, such as children, teenagers, or young adults has declined. There has been little evidence that the change in demographics is due to changes in behavior (especially in toddlers) or increases in backyard flocks that are H5N1 positive.

[sharon sanders]

Originally Posted by niman

The actual mechanism of infection is really not relevant.

I think the mechanism of infection is extremely important.

In a country where H5N1 is endemic, many poultry to human cases could be possible.

The danger is the development of efficient and sustained human to human transmission.

Since the update states that the symptoms of the Al Beheira toddlers began 4 days apart instead of 2 days, this is inside the window for possible human to human transmission between them.

Why are not any of the relatives ill? Toddlers need attention when they are sick and some of the adults must have held and had close contact with these sick children prior to diagnosis.

[HenryN]

Originally Posted by Florida1

I think the mechanism of infection is extremely important.

In a country where H5N1 is endemic, many poultry to human cases could be possible.

The danger is the development of efficient and sustained human to human transmission.

Since the update states that the symptoms of the Al Beheira toddlers began 4 days apart instead of 2 days, this is inside the window for possible human to human transmission between them.

Why are not any of the relatives ill? Toddlers need attention when they are sick and some of the adults must have held and had close contact with these sick children prior to diagnosis.

The change in demographics is pretty striking. Why are not more adults, teenagers, or children ill?

When I commented on mechanism, I was refering to a crawling toddler as opposed to other age groups. The point was that even though most cases are toddlers (who might be more likely to contacted H5N1 in feces or birds), toddler cases are still VERY rare, so getting two independent infections in neighboring houses over a four day period is not likely.

However, even if these two cases were two independent infections, it would indicated an increased transmision rate to humans (or at least to toddlers), because the two cases were so close in time and space.

[Treyfish]

A suspected case of avian influenza Rawash
الأثنين، 6 أبريل 2009 - 19:21
Monday, April 6, 2009 - 19:21

The discovery of new infections of bird flu Rawash
W
ا 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, suffering from high fever and cough continued and similar symptoms of the disease and was shown to contact with birds she died a number of them.


Were sampled, and was sent to the central Ministry of Health laboratories for analysis.


http://tinyurl.com/cl68vr

[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.

It is also worth noting that there was canvessing of the neighborhood, but the number of confirmed H5N1 outbreaks in poultry in March or April in Kom Hamada is ZERO:

RECENT CASES:




Date of sampling: 3 April 2009
Date of result: 3 April 2009

Governorate: Kafr el Sheikh
District: Seidi Salem
Village: Saafan Village
Type of rearing: Backyard
Species: Chicken
Number of birds: 4

Vaccine status: Not available
Purpose of sampling: Notified case


--------------------------------------------------



Date of sampling: 31 March 2009
Date of result: 1 April 2009

Governorate: Sixth of October
District: Oseim
City: Oseim
Type of rearing: Backyard
Species: Mixed
Number of birds: 46

Vaccine status: Not available
Purpose of sampling: Notified case


--------------------------------------------------





Date of sampling: 31 March 2009
Date of result: 1 April 2009


Governorate: Sixth of October
District: Al Badrachin
Village: 1-Manshiet Dahshour-Ezbet el Sakran.
Type of rearing: Backyard
Species: Mixed
Number of birds: 77

Vaccine status: Not available
Purpose of sampling: Notified case


--------------------------------------------------





Date of sampling: 31 March 2009
Date of result: 1 April 2009


Governorate: Alexandria
District: Khorshid
Village: Hay Khorshid
Type of rearing: Backyard
Species: Mixed
Number of birds: 42

Vaccine status: Not available
Purpose of sampling: Notified case


--------------------------------------------------





Date of sampling: 31 March 2009
Date of result: 1 April 2009


Governorate: Alexandria
District: Al Kabari
Village: Hay al Kabari
Type of rearing: Backyard
Species: Chicken
Number of birds: 42

Vaccine status: Not available
Purpose of sampling: Notified case


--------------------------------------------------





Date of sampling: 31 March 2009
Date of result: 1 April 2009


Governorate: Minya
District: Minya
City: Minya
Type of rearing: Backyard
Species: Mixed
Number of birds: 26

Vaccine status: Unvaccinated
Purpose of sampling: Notified case


--------------------------------------------------


Date of sampling: 27 March 2009
Date of result: 29 March 2009

Governorate: Kafr el Sheikh
District: Al Hamoul
Village: Ezbet Shehata – Abo Sekin
Type of rearing: Backyard
Species: Mixed
Number of birds: 12

Vaccine status: Not available
Purpose of sampling: Active surveillance


--------------------------------------------------





Date of sampling: 18 March 2009
Date of result: 19 March 2009

Governorate: Gharbiya
District: Tanta
Village: Sanadid
Type of rearing: Backyard
Species: Mixed
Number of birds: 53

Vaccine status: Not available
Purpose of sampling: Notified case


--------------------------------------------------




Date of sampling: 18 March 2009
Date of result: 19 March 2009

Governorate: Beheira
District: Hosh Eisa
Village: Al Kordor-Al Maghazi
Type of rearing: Backyard
Species: Mixed
Number of birds: Not available

Vaccine status: Not available
Purpose of sampling: Active surveillance: Participatory Disease Surveillance (PDS) visit


--------------------------------------------------



Date of sampling: 17 March 2009
Date of result: 18 March 2009

Governorate: Gharbiya
District: Kotor
Village: Sagein al Kom
Type of rearing: Backyard
Species: Mixed
Number of birds: 42

Vaccine status: Not available
Purpose of sampling: Notified case


---------------------------------------------------



Date of sampling: 16 March 2009
Date of result: 18 March 2009

Governorate: Beheira
District: Kafr el Dawar
Village: Manshiya Amer Barawla
Type of rearing: Backyard
Species: Mixed
Number of birds: 38

Vaccine status: Not available
Purpose of sampling: Active surveillance: Participatory Disease Surveillance (PDS) visit


---------------------------------------------------



Date of sampling: 13 March 2009
Date of result: 13 March 2009

Governorate: Beheira
District: Kafr el Dawar
Village: Al Akreisha
Type of rearing: Backyard
Species: Mixed
Number of birds: 12

Vaccine status: Vaccinated 8 December 2008
Purpose of sampling: Active surveillance: Participatory Disease Surveillance (PDS) visit


---------------------------------------------------



Date of sampling: 12 March 2009
Date of result: 13 March 2009

Governorate: Qalyoubiya*
District: Not available
Village: Not available
Type of rearing: Not indicated
*A truck from Sharkiya Governorate carrying 520 layer hens was stopped by authorities in Qalyoubiya Governorate
Species: Chicken
Number of birds: 520

Vaccine status: Unknown
Purpose of sampling: Passive surveillance


---------------------------------------------------



Date of sampling: 11 March 2009
Date of result: 13 March 2009

Governorate: Sharkiya
District: El Kenayat
Village: Ezbet Abu Hasona
Type of rearing: Backyard
Species: Mixed
Number of birds: Not available

Vaccine status: Unknown
Purpose of sampling: Notified case


---------------------------------------------------



Date of sampling: 11 March 2009
Date of result: 13 March 2009

Governorate: Sixth of October
District: Kerdasa
Village: Kerdasa
Type of rearing: Backyard
Species: Unknown
Number of birds: Not available

Vaccine status: Not vaccinated
Purpose of sampling: Notified case


---------------------------------------------------



Date of sampling: 11 March 2009
Date of result: 12 March 2009

Governorate: Gharbiya
District: Tanta
Village: Ezbet Shaban, Berma village
Type of rearing: Backyard
Species: Chicken
Number of birds: 8

Vaccine status: Unavailable
Purpose of sampling: Active surveillance: Participatory Disease Surveillance (PDS) visit


---------------------------------------------------



Date of sampling: 11 March 2009
Date of result: 11 March 2009

Governorate: Assiut
District: Assiut
Village: Al Walideia
Type of rearing: Backyard
Species: Mixed
Number of birds: 45

Vaccine status: Vaccinated
Purpose of sampling: Notified case


---------------------------------------------------



Date of sampling: 10 March 2009
Date of result: 11 March 2009

Governorate: Minya
District: Samalout
Village: Gaber al Ghaber al Keblia
Type of rearing: Backyard
Species: Mixed
Number of birds: 8

Vaccine status: Vaccinated against H5N2 on 25 December 2008
Purpose of sampling: Notified case


---------------------------------------------------




Date of sampling: 8 March 2009
Date of result: 9 March 2009

Governorate: Alexandria
District: Al King / Al Ameria
Village: Abo el Reish
Type of rearing: Backyard
Species: Chicken, duck
Number of birds: 50 total

Vaccine status: Unavailable
Purpose of sampling: Notified case


---------------------------------------------------



Date of sampling: 6 March 2009
Date of result: 10 March 2009

Governorate: Beheira
District: Damanhour
Village: Nediba
Type of rearing: Backyard
Species: Mixed
Number of birds: Unavailable

Vaccine status: Unavailable
Purpose of sampling: Notification




---------------------------------------------------



Date of sampling: 6 March 2009
Date of result: 7 March 2009

Governorate: Beheira
District: Kafr el Dawar
Village: Owan
Type of rearing: Backyard
Species: Chicken
Number of birds: 20

Vaccine status: Unavailable
Purpose of sampling: Active surveillance: Participatory Disease Surveillance (PDS) visit


---------------------------------------------------



Date of report: 2 March 2009
Date of result: 3 March 2009

Governorate: Suez
District: Al Ganain
Village: Abo Saial
Type of rearing: Backyard
Species: Chicken
Number of birds: 15

Vaccine status: Unvaccinated
Purpose of sampling: Notified case


---------------------------------------------------


Date of report: 1 March 2009
Date of result: 2 March 2009

Governorate: Beheira
District: Hosh Eisa
Village: Seriut
Type of rearing: Backyard
Species: Chicken
Number of birds: 2

Vaccine status: Unvaccinated
Purpose of sampling: Active surveillance: Participatory Disease Surveillance (PDS) visit


---------------------------------------------------


Date of report: 1 March 2009
Date of result: 2 March 2009

Governorate: Beheira
District: Kafr el Dawar
Village: Al Malaka
Type of rearing: Backyard

Type of birds	chickens	ducks	geese
Number of birds	22	45	10

Vaccine status: Unvaccinated
Purpose of sampling: Active surveillance: Participatory Disease Surveillance (PDS) visit

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04060901/H5N1_Egypt_Delays.html

Commentary


H5N1 Confirmation Delays in Egypt Raise Concerns

Recombinomics Commentary 13:04
April 6, 2009

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.

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,

The above comments describe the latest confirmed case (6M) in Egypt (#63 since 2006). Unlike the vast majority of cases in 2009, who are toddlers with mild courses, the latest case is in critical condition and on a respirator (see updated map). Only one other case in 2009 was described as critical, and since that case was hospitalized March, 1, the patient has probably recovered, because all 12 confirmed cases this year have survived.

The severity of the above case may be associated with the delay in hospitalization and the delay in diagnosis. These delays may be linked to an absence of a poultry connection. Over 6000 Egyptians have been hospitalized with suspected bird flu, but less than 1% test positive for H5N1. However, these cases begin treatment shortly after admission, based on symptoms and a poultry connection. The above case developed symptoms on March 22 and was hospitalized on March 28, but was reported confirmed yesterday, which was well after confirmation of case 61 who was hospitalized on March 31, and case 62, who was hospitalized on April 2. The delay in confirmation of case 63 is likely linked to a delay in testing and treatment. Since descriptions of case 63 have not mentioned a poultry source, it is likely that the lack of a source contributed to the admission and treatment delays.

However, these delays raise concerns that many milder cases would go untreated and/or unreported, because of resolution in the absence of treatment, or treatment based on an assumption of seasonal flu. Since patients without poultry links are not tested for H5N1, recovery of such patients would lead to a serious undercount of H5N1 infections. Moreover, a lack of such testing would also lead to a serious undercount of clusters, such as cases 61 and 62.

These two cases are toddlers from Beheira who were confirmed this month. They are next door neighbors, but case 61 was diagnosed in Menoufiya, where he developed symptoms and was hospitalized. Case 61 had a poultry connection, but it remains unclear if that connection was in Beheira, or in association with his visit to grandparents in Menoufiya. Case 62 was confirmed a few days after case 61, but no poultry connection was described for case 62, suggesting an absence of poultry deaths in the Beheira neighborhood where cases 61 and 62 lived.

This type of detail and associations are usually clarified in WHO updates, which are lagging cases. The last WHO update was on patient 60, who was confirmed last month. Moreover, there is also confusion regarding a 45 day old infant who died March 27 after being hospitalized March 26. Although samples were collected from the patient and family, and Tamiflu was given, the test results on this patient have not been announced, even though hospitalization and death were prior to confirmed cases 61-63.

The delays in clarification of these cases are causes for concern. Similarly, sequences from poultry and human cases in 2009 have not been released.

Clarifications and release of sequences would be useful.

.

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04060902/H5N1_Beheira_H2H.html

Commentary


Human Transmission in H5N1 Toddler Cluster in Beheira Egypt

Recombinomics Commentary 17:56
April 6, 2009

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 comments are from the SAIDR site in Egypt, which provides detail on human and avian H5N1 outbreaks. The detail helps with some confusion in media reports, which noted that the index case developed symptoms during a visit to his grandparents in Menoufiya, where he was subsequently hospitalized. That report was followed by a confirmed case in Beheira, who was said to be the next door neighbor of the index case (which is supported by the above report indicating both cases were in the Kom Hamada district), raising concerns of human to human transmission.

The above detail changes the disease onset date of the index case to March 27, indicating symptoms began in Beheira prior to his trip to his grandparents and subsequent hospitalization in Menoufiya (see updated map). The earlier onset date also indicates Tamiflu treatment began more than 48 hours after disease onset, yet the patients is currently in “general good condition” and there were no indications that he developed pneumonia or was placed on a ventilator, supporting a “mild” H5N1 infection. The earlier date also creates a 4 day gap between the disease onset date of the index case and his neighbor, strongly suggesting that the index case infected his neighbor.

The likelihood of next door neighbors developing H5N1 five days apart is remote. Although there has been a spike in confirmed cases in toddlers, the overall number of cases is low and two independent introductions into neighbors is unlikely. This cluster also increases concerns that the number of cases is markedly higher than the confirmed cases because the cases are mild, and only cases with a poultry contact are tested for H5N1. Therefore, cases that resolve without treatment, or after treatment for seasonal flu, would not be counted as a confirmed case.

This cluster also discounts the media myth that transmission is limited to blood relatives. Although there are multiple clusters that do not involve blood relatives, this cluster increases that number, and supports the likelihood of additional unreported cluster due to an absence of testing in patients without a poultry connection.

The human to human transmission would be further supported by a close similarity between sequences from the neighbors, as was seen in the outbreak of mild H5N1 in the spring of 2007. That outbreak involved older children, but the H5N1 infections were also mild and the number of infections was also likely to have been much higher than the confirmed cases of which 16/17 survived.

Therefore, release of sequence data from the Beheira cluster would be useful as would aggressive testing of toddlers who have symptoms but lack a poultry connection.

.

[HenryN]

Commentary

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

[Laidback Al]

Originally Posted by Laidback Al View Post
The name and location of the actual village where the two infected children (cases #61 and #62) who were neighbors in Beheira would be helpful.

The first child (case #61) was reported (post #150 and #156) to be from the “Department of Liberation” or “Directorate of Liberation” (مديريةالتحرير , also translates as editorial department). Post #176 notes that the second child (case #62) is also from Directorate of Liberation, Badr Center. The saidr reports cited by Niman (post #234) indicate that these two individuals were from Kom Hamada [Center Kom Hamada?].

The map from the Beheira governorate web site below shows the location of both Badr Center [Directorate of Liberation?] and Kom Hamada Center. The two centers are adjacent to each other in the southeastern portion of the governorate. A more exact village name and location would be beneficial.

map link: http://www.behera.gov.eg/division.htm

[HenryN]

Originally Posted by Laidback Al

Originally Posted by Laidback Al View Post
The name and location of the actual village where the two infected children (cases #61 and #62) who were neighbors in Beheira would be helpful.

The first child (case #61) was reported (post #150 and #156) to be from the “Department of Liberation” or “Directorate of Liberation” (مديريةالتحرير , also translates as editorial department). Post #176 notes that the second child (case #62) is also from Directorate of Liberation, Badr Center. The saidr reports cited by Niman (post #234) indicate that these two individuals were from Kom Hamada [Center Kom Hamada?].

The map from the Beheira governorate web site below shows the location of both Badr Center [Directorate of Liberation?] and Kom Hamada Center. The two centers are adjacent to each other in the southeastern portion of the governorate. A more exact village name and location would be beneficial.

map link: http://www.behera.gov.eg/division.htm

Attachment 3057

This site has Kom Hamada marked on a Google map

http://www.traveljournals.net/explor...om_hamada.html
The key however, is the fact that the SAIDR site has them both coming from the same district, confirming that they are neighbors.

[sharon sanders]

2009 / 4 / 6 -- 07:25 GMT

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


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

[HenryN]

Originally Posted by niman

This site has Kom Hamada marked on a Google map

http://www.traveljournals.net/explor...om_hamada.html
The key however, is the fact that the SAIDR site has them both coming from the same district, confirming that they are neighbors.

The second key comes from the bird outbreaks, which are also detailed on the SAIDR site and there have not been any reports from Kom Hamada, although there are seven reports for Beheira since March 1. Thus, there is quite a bit of reported H5N1 in poultry in the general area, but not at the cluster location.

For Egypt, confirmation of two toddlers four days apart at the same location is VERY unusual. However, it is likely that the unusual part is the CONFIRMATION.

[Sally Furniss]

The government is considering compensation «farm» affected by the avian flu .. And suspected infection Rawash

Day wrote Abduljawad, Mohamed Hamdi Mohamed Asamkory 4-7 / 2009

Hospital admitted QENA held yesterday at the El-Shafei Bkhittp «45 years», the mayor of the hamlet, the village of solar modules, after her symptoms similar to bird flu, the government is considering establishing a fund to compensate affected farmers.............

http://www.almasry-alyoum.com/articl...ticleID=206024

[HenryN]

Originally Posted by niman

The second key comes from the bird outbreaks, which are also detailed on the SAIDR site and there have not been any reports from Kom Hamada, although there are seven reports for Beheira since March 1. Thus, there is quite a bit of reported H5N1 in poultry in the general area, but not at the cluster location.

For Egypt, confirmation of two toddlers four days apart at the same location is VERY unusual. However, it is likely that the unusual part is the CONFIRMATION.

Updated map with the 7 outbreaks in Beihera since March 1. None of these are close to the human cluster

http://maps.google.com/maps/ms?ie=UT...1,1.521606&z=9

[HenryN]

Originally Posted by niman

Updated map with the 7 outbreaks in Beihera since March 1. None of these are close to the human cluster

http://maps.google.com/maps/ms?ie=UT...1,1.521606&z=9

Updated map with ALL reported poultry outbreaks (listed at SAIDR site) this season (beginning fall of 2008) and there are ZERO outbreaks near the Beheira cluster

http://maps.google.com/maps/ms?ie=UT...3,2.971802&z=8

[sharon sanders]

Originally Posted by niman

Updated map with ALL reported poultry outbreaks (listed at SAIDR site) this season (beginning fall of 2008) and there are ZERO outbreaks near the Beheira cluster

http://maps.google.com/maps/ms?ie=UT...3,2.971802&z=8

The latest updates say that each toddler had exposure to dead or sick poultry.

H5N1 is endemic in Egypt. The government has instituted strict controls. It is not possible to transport poultry between provinces without permits. There are still families who maintain poultry even though this has been discouraged.

It is quite possible that all outbreaks of H5N1 are not accounted for since they are so numerous.

[HenryN]

Originally Posted by Florida1

The latest updates say that each toddler had exposure to dead or sick poultry.

H5N1 is endemic in Egypt. The government has instituted strict controls. It is not possible to transport poultry between provinces without permits. There are still families who maintain poultry even though this has been discouraged.

It is quite possible that all outbreaks of H5N1 are not accounted for since they are so numerous.

Yes, there is little doubt that all H5N1 poultry outbreaks in Egypt are not reported or confirmed (there are also no confirmed poultry outbreaks in Qena, the location of case #60 and a large number of suspect cases),

http://maps.google.com/maps/ms?ie=UT...,13.513184&z=6

but there is no detail on the "dead or sick poultry" and as noted earlier, the liklihood that two toddlers living next door to each other would be independently infected over a four day period is REMOTE, at best.

[HenryN]

American medical institutions warning of the danger of the silent spread of avian flu in Egypt

اضغط للتكبير

صورة ارشيفية لفريق مكافحة انفلونزا الطيور فى مصر - رويترز

Archival image of the anti-bird flu in Egypt - Reuters

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4/7/2009 2:56:00 PM

4/7/2009 2:56:00 PM

واشنطن – محرر مصراوى - حذرت مؤسسة أبحاث طبية أمريكية من أن الحالات التي ظهرت مؤخرا من الإصابة بأنفلونزا الطيور في مصر، تثير القلق من تحول جديد في نمط انتشار المرض بين قطاعات عمرية وجغرافية مختلفة عن موجة اندلاع المرض السابقة في 2007.

WASHINGTON - Editor Masrawy - The Foundation of the American medical research that recent cases of bird flu infection in Egypt, concern about the new shift in the pattern of spread of the disease between the age and geographical segments is different from the previous wave of the outbreak of the disease in 2007.

وقال تقرير لمؤسسة ومعمل ريكوميبنوميكس الطبي الأمريكي إن حالتي الإصابة التي ظهرت على طفلين بمحافظة البحيرة في مصر مؤخرا تثير القلق من "انتشار صامت" لمرض انفلونزا الطيور بعد عامين من موجة الإصابة التي اندلعت في 2007.

The report of the Foundation and the American Medical Laboratory Rekoumibnumiks The cases of infection, which appeared on the children in Beheira in Egypt has recently raised concern of the "silent spread of" bird flu, two years after the wave of infection which broke out in 2007.

وحذر التقرير، الذي صدر السبت 4 أبريل، إلى أن هذا العام يشهد زيادة في عدد حالات الإصابة بالفيروس حيث تم الإبلاغ عن إصابة 11 شخص بالفيروس، من بينهم 10 حالات بين الأطفال، دون حدوث وفيات بينهم.

The report warned, issued Saturday, April 4, that this year sees an increase in the number of cases of HIV were reported 11 people with HIV infection, including 10 cases among children, but no deaths among them.

وأشارت المؤسسة الأمريكية، ومقرها بولاية كاليفورنيا، إلى أن هذا يشبه ما حدث في ربيع 2007، حيث كان هناك ارتفاع في الإصابات متوسطة الخطورة، لكنها رصدت تحولا في القطاعات التي حدثت بها الإصابة هذا العام.

She Foundation of America, based in California, that this is like what happened in the spring of 2007, as there was a rise in the medium-risk injuries, but made a shift in the sectors in which the injury occurred this year.

ففي حين كانت أغلب الإصابات في 2007 تحدث بين الفتيات وصغار البالغين، لكنها هذا العام تنتشر بين صغار الأطفال، حيث كان أغلب الأطفال تتراوح أعمارهم بين 3 إلى 10 سنوات.

While the majority of injuries occurring in 2007 among girls and young adults, but this year, spread among young children, where the majority of children between the ages of 3 to 10 years.

وفي حين كانت أغلب الإصابات في السابق في وسط وصعيد مصر ومعظم الحالات الحرجة تقع في شمال مصر، تم رصد الإصابات هذا العام في جميع أنحاء البلاد، بحسب المؤسسة الأمريكية.

While the majority of injuries in the past in Central and Upper Egypt, and most critical situations occur in the north of Egypt, has been monitoring the cases this year in all parts of the country, according to the American Foundation.

المصدر: وكالة أنباء أمريكا إن أرابيك.

Source: The American News Agency Arabic.

http://translate.google.com/translat...d%26start%3D20

[HenryN]

Commentary

http://www.recombinomics.com/News/04...heira_T2T.html

[HenryN]

WHO lag in updates in Indonesia now extending to Egypt

http://www.who.int/csr/disease/avian.../en/index.html

[HenryN]

Locations of human cases updated with SAIDR detail. Most cases are quite close to poultry outbreaks. The exceptions are Beheira cluster and Qena

http://maps.google.com/maps/ms?ie=UT...801514&t=p&z=8

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04...heira_T2T.html

Commentary

Toddler to Toddler H5N1 Transmission in Beheira Egypt

Recombinomics Commentary 18:29
April 7, 2009

Boy, age 2, began experiencing fever and cough symptoms on March 27.
Boy, age 2, began experiencing fever, cough and runny nose on March 31.

The above comments describe the two most recently H5N1 confirmed toddlers in Egypt. These two cases were next door neighbors in the Kom Hamada district of Beheira and represent toddler to toddler transmission of H5N1. This cluster follows a spate of toddler cases in Egypt this year. 10 of the 12 confirmed cases have been toddlers and 9 of the 10 toddler cases have been mild. Both patients above are described as being in "good general condition" and will likely be discharged soon. None of the H5N1 cases this year in Egypt have died, which is similar to the mild cases of H5N1 in Egypt in the spring of 2007. However, unlike earlier cases, which included 6 toddlers over a three year period, the percentage of toddler cases has dramatically increased in 2009.

Although the two cases above are said to have had contact with dead or sick poultry, the confirmation of neighboring cases who developed symptoms four days apart is unlikely to be due to two independent poultry infections. There have been no confirmed poultry cases in the Kom Hamada area. Since March 1 there were 24 confirmed H5N1 poultry outbreaks in Egypt, and although 7 were in Beheira, these outbreaks were well to the north and not near the toddler cluster (see updated map). Over 60 outbreaks have been confirmed this season, and none were close to Kom Hamada. Similarly, the toddler case preceding the cluster was in Qena, and there have been no confirmed poultry outbreaks in Qena this season (see updated map).

Although there are clearly more H5N1 outbreaks than those confirmed, the targeting of toddlers raises concerns that old age groups have developed protective immunity, signaling a significant silent spread of H5N1 in Egypt. Over 6000 patients with poultry links have been hospitalized, but less than 1% have tested positive. However, it remains unclear if the low confirmation rate is due to an aggressive testing program, or a lack of sensitivity in the testing.

Confirmed H5N1 clusters have been rare in Egypt have been rare. The largest was the Ghabiya cluster at the end of 2006, but the prior clusters were among relatives and did not have the gap in disease onset dates. The Beheira cluster has the classical gap and there has been no indication that the two toddlers were related. Although it is likely that mild H5N1 has was transmitted human to human, based on the sequence identity between isolates from unrelated cases, the current cluster has the time and space signature associated with human to human transmission.

Sequences from this cluster, as well as testing of toddlers that have symptoms but lack a poultry link would be useful.

.

[AlaskaDenise]

Originally Posted by niman

Commentary

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

Commentary

Lack of Confirmed H5N1 Poultry Linkage To Egyptian Cases

Recombinomics Commentary 21:09
April 6, 2009

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

The above comments describe the most recent confirmed H5N1 case in Egypt. Unlike earlier cases, there is no mention of contact with poultry. The lack of contact is not surprising because of the gap between the admission and confirmation dates. The above detail confirms that treatment was also delayed, which was almost certainly linked to an absence of a poultry contact. In Egypt, over 6000 patients have been hospitalized as suspect H5N1 patients. These cases generally have a poultry link and treatment with Tamiflu is begun prior to receipt of test results. The gap between the admission date of March 28 and treatment date of April 3, strongly suggests that these is no reported link to poultry for this case.

This case follows a spike in confirmed H5N1 in toddlers. The two prior cases were neighbors who lived in Beheira. The 4 day time gap between onset dates strongly suggests that there was toddler to toddler transmission, although both cases have a poultry link. However, the website that describes the patients contains a significant amount of detail, including the district for the two patients, which was Kom Hamada.

The site also details confirmed H5N1 outbreaks in poultry and although there have been 24 outbreaks since March 1, including 7 outbreaks in Beheira, none of the outbreaks were in Kom Hamada, indicating that the Beheira cluster is not linked to H5N1 confirmed poultry. The presence of confirmed H5N1 in the Beheira governorate, but not the Kom Hamada district, raises concerns that the toddlers were not infected by poultry, especially the second case, who was a neighbor of the first case.

The absence of a confirmed H5N1 in the most recent cases in Egypt adds to concerns that the number of mild H5N1 cases is markedly higher than then number of confirmed cases, and like the Beheira cluster, there is human to human transmission that is silently spreading.

More aggressive testing of symptomatic toddlers that lack a poultry contact is warranted.

.

[Laidback Al]

Originally Posted by niman

WHO lag in updates in Indonesia now extending to Egypt

http://www.who.int/csr/disease/avian.../en/index.html

Indonesia has publicly stated that they will only be reporting human cases every 3-6 months. Egypt, however, has always had timely reporting. The last WHO update for Egypt was on March 30th for the 2.5 year old girl from Qena Governorate. The update noted that she was confirmed on March 26th. News reports on the girl appeared about the 26th or 27th with a WHO update within 4 days of the announcement of the confirmation.

What do think is delaying WHO from providing timely updates from Egypt?

[HenryN]

Originally Posted by Laidback Al

Indonesia has publicly stated that they will only be reporting human cases every 3-6 months. Egypt, however, has always had timely reporting. The last WHO update for Egypt was on March 30th for the 2.5 year old girl from Qena Governorate. The update noted that she was confirmed on March 26th. News reports on the girl appeared about the 26th or 27th with a WHO update within 4 days of the announcement of the confirmation.

What do think is delaying WHO from providing timely updates from Egypt?

I was just about to write a commentary. I think they are having problems with a lack of a poultry source as well as the toddler to toddler situation in Beheira. WHO updates are factually correct, but generally nuanced when H2H is involved or a poultry source is missing (and writing nuanced updates takes longer).

The SAIDR site is really a government site, with quotes from the MOPH, so the three most recent cases are confirmed, and the Beheira cluster has been confirmed for almost a week.

I think Qena (their last update) may also be a problem because there is no confirmed poultry outbreak. The vet lab appears to be chasing the human cases and reporting positive poultry in the area (usually right after the human case is confirmed). However, SAIDR has no such poultry positives listed yet for Qena or Beheira (and the most recent case (6M) almost certainly had no know link when the patient was admitted - although it remains unclear why they finally tested for H5N1 - but sometimes the testing is based on the failure of the patient to improve).

[HenryN]

Originally Posted by Laidback Al

Indonesia has publicly stated that they will only be reporting human cases every 3-6 months. Egypt, however, has always had timely reporting. The last WHO update for Egypt was on March 30th for the 2.5 year old girl from Qena Governorate. The update noted that she was confirmed on March 26th. News reports on the girl appeared about the 26th or 27th with a WHO update within 4 days of the announcement of the confirmation.

What do think is delaying WHO from providing timely updates from Egypt?

Qena is also the last update from the WHO Mediterranean branch also.

http://www.emro.who.int/index.asp

[mixin]

Niman,
Is this a result of your commentary?:

The report of the Foundation and the American Medical Laboratory Rekoumibnumiks The cases of infection, which appeared on the children in Beheira in Egypt has recently raised concern of the "silent spread of" bird flu, two years after the wave of infection which broke out in 2007.

[HenryN]

Originally Posted by mixin

Niman,
Is this a result of your commentary?:

I thought that the comments here

http://www.flutrackers.com/forum/sho...&postcount=259

sounded much like a recent commentary, but I have not been contacted by any such agencies / media.

[sharon sanders]

There is no proof that any of the recent cases in Egypt are the result of human to human transmission.

Poultry sources were cited for cases # 61 and # 62.

This kind of speculation is not productive.