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Re: Concerns arise over symptomless Egypt bird flu cases
Increasing coverage in or around Egypt
http://tinyurl.com/c69m3h
Increasing coverage in or around Egypt
http://tinyurl.com/c69m3h
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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 Egypt3 جهات دولية تؤكد: إصابة ابني العم بالبحيرة بسبب الطيور النافقة وليس بالعدوي بينهما3 international destinations stresses: two cousins hit the lake because the dead birds, not their infection <!--heade--></td></tr><tr><td>كتب ـ محمد حسان وأشرف بدر:Mohamed Al-Hassan, Ashraf Badr:
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.
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Re: Concerns arise over symptomless Egypt bird flu cases
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.Originally posted by Commonground View Post
This for the due precision.Comment
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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.
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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.Now look at this article about pigs in Indonesia...(http://www.flutrackers.com/forum/sho...61&postcount=1)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.
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 illnessSince 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."So the bottom line is..........the testing in Egypt should also be done on swine.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."
Has there been much of that?
."The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller FoundationComment
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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.)Comment
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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.Originally posted by AlaskaDenise View Post
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.Comment
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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.
."The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller FoundationComment
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Re: Concerns arise over symptomless Egypt bird flu cases
It could be the case.Originally posted by AlaskaDenise View PostPerhaps 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.
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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?Comment
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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.Are there some not welcomed results that some people fear these surveys could provide?
."The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller FoundationComment
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Re: Concerns arise over symptomless Egypt bird flu cases
Perhaps.Originally posted by AlaskaDenise View PostMaybe they think the end-of-the-world-conspiracy-theorists don't need any more fuel for their propaganda.
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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...Comment
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Re: Concerns arise over symptomless Egypt bird flu cases
I think it is worth reviewing SOME of the politics surround H5N1 (in reality, H5N1 is ALL about politics).Originally posted by ironorehopper View Post
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.Comment
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Re: Concerns arise over symptomless Egypt bird flu cases
I believe those results were generated multiple times in samples collected in 2005 in northern and central Vietnam.Originally posted by ironorehopper View Post
Evolving H5N1 In Northern Vietnam Sent To US For Analysis
Recombinomics Commentary
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. <<Comment
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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?Comment
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Re: Concerns arise over symptomless Egypt bird flu cases
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.Originally posted by Florida1 View Post
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).Comment
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