Avian Flu Cases in Egypt Raise Alarms

[HenryN]

Avian Flu Cases in Egypt Raise Alarms
Amr Dalsh/Reuters
A woman in Menoufia, Egypt, bringing a chicken for a vaccination. Bird flu still exists in poultry in Egypt, Indonesia, China, Vietnam and on the India-Bangladesh border.

By DONALD G. MCNEIL Jr.



Published: April 20, 2009
An unusual pattern of avian flu cases in Egypt — almost all are in toddlers, all of whom have survived — has led some flu-tracking Web sites to speculate that dozens of silent cases are circulating there.
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Health Guide: Avian Influenza




That would be an alarming development, but other experts, including those at the World Health Organization, say such fears are exaggerated. Although thousands of Egyptians have rushed their children to hospitals this flu season, there is no evidence yet of asymptomatic avian flu cases or any significant mutation in the H5N1 virus.

“Right now, it’s all hot air,” said Dr. Robert G. Webster, a flu expert at St. Jude Children’s Research Hospital in Memphis. “I hope to hell it’s not happening, because it would mean the virus is adapting to humans. But there’s not a shred of data.”

Bird flu has faded from world headlines because it has not caused a pandemic. But the disease is still circulating in poultry in Egypt, Indonesia, China, Vietnam and along the India-Bangladesh border. It has mutated into at least 10 strains and occasionally infects humans.

An April 8 Reuters article from Cairo quoted a visiting W.H.O. expert saying his agency feared “something strange happening in Egypt” and would help the government test the blood of healthy people for antibodies this summer.

Antibodies to the flu would indicate they had recovered from silent infections.

But a W.H.O. spokesman said privately that the agency was just helping the Egyptians with a long-planned study and the article had “jumped the gun.”
Translations of Egyptian media reports posted on flu-tracking sites say dozens of suspected cases have been hospitalized, but some seem to confuse avian flu with seasonal flu and even confirmed poultry cases. The Egyptian health ministry, which works closely with a United States Navy laboratory based in Cairo, has confirmed 15 human cases this year, with no deaths; almost all were in young children.

Dr. Nikki Shindo, a W.H.O. medical officer who works in Egypt, said the surge in toddler cases and survivals had a possible explanation. The government has loudly warned its citizens to avoid sick poultry and has trained doctors in remote clinics to give Tamiflu quickly and move cases to state hospitals, where treatment is free. In a country where chickens are both kept as pets and eaten, toddlers still touch dying birds but poultry workers would not.

Egypt’s outbreak response contrasts sharply to Indonesia’s, where the sick often take herbal medicine first and where rural clinics lack Tamiflu, she said.
Dr. Arnold S. Monto, a flu expert at the University of Michigan School of Public Health who also teaches in Egypt, said even geography helps. All cases are along the Nile and easily moved to Cairo, while travel among Indonesia’s thousands of islands is slower.

Also, he said, the government has been more aggressive since it was criticized by opposition parties for not wiping out the poultry epidemic that began in 2006.

Henry L. Niman, a biochemist who tracks flu mutations, has speculated that a mild strain of H5N1 is more common in Egypt than has been found because nasal swabs for flu are inaccurate. He noted that mild cases were found in Qena, Egypt, in 2007, and has called for more testing and for releasing the genetic sequences of strains found in both poultry and people.

Dr. Tim Uyeki, a flu specialist at the Centers for Disease Control and Prevention in Atlanta, said there had been mild cases of H5N1 among children in several countries. There have also, he said, been studies in Indonesia, Thailand, Cambodia and Nigeria similar to the one proposed for Egypt in which the blood of cullers, poultry workers and relatives of sick people has been tested.

“Those are the ideal people to look at,” he said. “And there was zero or extremely low prevalence of antibodies,” meaning silent infections were very uncommon.

[sharon sanders]

"..An April 8 Reuters article from Cairo quoted a visiting W.H.O. expert saying his agency feared “something strange happening in Egypt” and would help the government test the blood of healthy people for antibodies this summer.

Antibodies to the flu would indicate they had recovered from silent infections.

But a W.H.O. spokesman said privately that the agency was just helping the Egyptians with a long-planned study and the article had “jumped the gun.”

Translations of Egyptian media reports posted on flu-tracking sites say dozens of suspected cases have been hospitalized, but some seem to confuse avian flu with seasonal flu and even confirmed poultry cases..."



Since there have been thousands of suspected cases screened by the Egyptian government - the list on FT is only a partial list.

In fact, if FT and other "bird flu" sites had not been compiling a partial list of suspected cases for years, the current outbreak of confirmed cases in Egypt would be a surprise.

And - dozens of suspected cases have been hospitalized, on occasion, while tests are pending. It is the protocol in Egypt.

Also, sometimes we think aloud on the threads when we work with difficult translations. This is a journey - not a race.

[HenryN]

Originally Posted by niman

Avian Flu Cases in Egypt Raise Alarms
“Right now, it’s all hot air,” said Dr. Robert G. Webster, a flu expert at St. Jude Children’s Research Hospital in Memphis. “I hope to hell it’s not happening, because it would mean the virus is adapting to humans. But there’s not a shred of data.”

The sequences with S129del also have I152T, which was identified in escape mutants generated by Webster's lab.

[AlaskaDenise]

Originally Posted by niman

......in escape mutants generated by Webster's lab.

what was generated in the lab?

.

[HenryN]

Originally Posted by AlaskaDenise

what was generated in the lab?

.

Escape mutants are flu virus that can "escape" from a monoclonal antibody that neutralizes the virus. Thus, these antibodies bind to the HA and prevent the virus from entering a cell because the ability to bind to the receptor on the cell surface is blocked by the antibody.

Escape mutants represent rare changes that allow the virus to escape from the binding of the antibody and are identified by adding the antibody to the virus in the lab experiment and then identify what "escapes" from the neutralizing antibody.

One such change that allows H5N1 to escape is I152T, which is present on all Egyptian isolates with the 3 BP deletion (S129del).

[HenryN]

Originally Posted by AlaskaDenise

what was generated in the lab?

.

1: J Virol. 2007 Dec;81(23):12911-7. Epub 2007 Sep 19. Links

Epitope mapping of the hemagglutinin molecule of a highly pathogenic H5N1 influenza virus by using monoclonal antibodies.

Kaverin NV, Rudneva IA, Govorkova EA, Timofeeva TA, Shilov AA, Kochergin-Nikitsky KS, Krylov PS, Webster RG.
D. I. Ivanovsky Institute of Virology, 123098 Moscow, Russia.
We mapped the hemagglutinin (HA) antigenic epitopes of a highly pathogenic H5N1 influenza virus on the three-dimensional HA structure by characterizing escape mutants of a recombinant virus containing A/Vietnam/1203/04 (H5N1) deltaHA and neuraminidase genes in the genetic background of A/Puerto Rico/8/34 (H1N1) virus. The mutants were selected with a panel of eight anti-HA monoclonal antibodies (MAbs), seven to A/Vietnam/1203/04 (H5N1) virus and one to A/Chicken/Pennsylvania/8125/83 (H5N2) virus, and the mutants' HA genes were sequenced. The amino acid changes suggested three MAb groups: four MAbs reacted with the complex epitope comprising parts of the antigenic site B of H3 HA and site Sa of H1 HA, two MAbs reacted with the epitope corresponding to the antigenic site A in H3 HA, and two MAbs displayed unusual behavior: each recognized amino acid changes at two widely separate antigenic sites. Five changes were detected in amino acid residues not previously reported as changed in H5 escape mutants, and four others had substitutions not previously described. The HA antigenic structure differs substantially between A/Vietnam/1203/04 (H5N1) virus and the low-pathogenic A/Mallard/Pennsylvania/10218/84 (H5N2) virus we previously characterized (N. V. Kaverin et al., J. Gen. Virol. 83:2497-2505, 2002). The hemagglutination inhibition reactions of the MAbs with recent highly pathogenic H5N1 viruses were consistent with the antigenic-site amino acid changes but not with clades and subclades based on H5 phylogenetic analysis. These results provide information on the recognition sites of the MAbs widely used to study H5N1 viruses and demonstrate the involvement of the HA antigenic sites in the evolution of highly pathogenic H5N1 viruses, findings that can be critical for characterizing pathogenesis and vaccine design.

[HenryN]

Escape mutant	HA amino acid changea		Reactivity with MAbb:
	H3 numbering	H5 numbering	VN04-2	VN04-8	VN04-9	VN04-10	VN04-13	VN04-15	VN04-16	777/1
m2(1)	S126Y, I155T	S121Y, I151T	<	0	0	0	0	0	0	0

[ironorehopper]

Perhaps, in addition to ''the hot air'' suggested by prof. R. Webster, there could be some conflicts of interests, because the timely interview of J.J. and today explanation by an ''unnamed'' int. health agency about an upcoming start of a study in Egypt.

Some of the people interviewed or prone to ''press releases'' may be involved in these studies, and, when concluded, probably ''best sellers'' in international reviews.

However, the increased incidence of human cases in Egypt continues to be of concern; I remember that ''clusters of human cases closely related in time and space may signal a change in epidemiological behaviour of the virus''.

I am confronting with this current incident with open mind, when keeping into account the probable existence of conflicts of interests and other issues, political and - more concerning - epidemiological.

[HenryN]

Originally Posted by ironorehopper

However, the increased incidence of human cases in Egypt continues to be of concern; I remember that ''clusters of human cases closely related in time and space may signal a change in epidemiological behaviour of the virus''.

.

Yes, everything is defined by time and space, and clusters are NOT coincidences.

[ironorehopper]

CIDRAP >> Egyptian woman, baby have H5N1 infections

Egyptian woman, baby have H5N1 infections

Apr 20, 2009 (CIDRAP News) -

Egypt's state media reported two new H5N1 avian influenza infections within 2 days of each other, in a 25-year-old woman and an 18-month girl.


The state-run paper Al Ahram, quoting the country's health ministry, reported on Apr 17 that the woman is from Qalubia governorate and was hospitalized in critical condition, according to report from Agence France-Presse.

The woman is 33 weeks pregnant and began experiencing a fever and cough on Apr 6, according to an Apr 17 report from Strengthening Avian Influenza Detection and Response (SAIDR), an Egypt-based project funded by the US Agency for International Development. She was admitted to a Cairo hospital on Apr 11 and received oseltamivir (Tamiflu) 6 day later when her H5N1 infection was confirmed. The woman's family reported she had close contact with sick poultry.

Two days later MENA, Egypt's state news agency, said the baby girl was hospitalized after having contact with infected birds and that she was treated immediately with oseltamivir (Tamiflu), Reuters reported today.

The girl is from Kafr el-Sheikh, the same province as another of Egypt's recent H5N1 case-patients, a 33-year-old woman who was in critical condition, according to an Apr 17 report from the WHO. On Apr 15 agriculture officials confirmed an H5N1 outbreak in backyard birds in Kafr el-Sheikh, according to a report from SAIDR.

If the World Health Organization confirms the cases in the 25-year-old and the 18-month-old, Egypt's H5N1 count will increase to 66 cases, of which 23 have been fatal.

So far this year, Egypt has had 15 H5N1 cases, including the two latest ones, outpacing all other countries in 2009. However, none of the cases have been fatal. The preponderance of cases in children—only four patients have been adults—and number of new human cases have raised global speculation about possible subclinical cases or a change in the H5N1 virus in Egypt that might have made the virus more transmissible but somewhat less lethal.

It was reported last week that the WHO planned to send a team to Egypt to investigate the avian flu situation there.

Gregory Hartl, a spokesman for the WHO, told CIDRAP News that because of holiday observances in Egypt, the WHO team just left for that country today.
-

CIDRAP >> Egyptian woman, baby have H5N1 infections

[ironorehopper]

“Right now, it’s all hot air,” said Dr. Robert G. Webster, a flu expert at St. Jude Children’s Research Hospital in Memphis. “I hope to hell it’s not happening, because it would mean the virus is adapting to humans. But there’s not a shred of data.”

Bird flu has faded from world headlines because it has not caused a pandemic. But the disease is still circulating in poultry in Egypt, Indonesia, China, Vietnam and along the India-Bangladesh border. It has mutated into at least 10 strains and occasionally infects humans.

An April 8 Reuters article from Cairo quoted a visiting W.H.O. expert saying his agency feared “something strange happening in Egypt” and would help the government test the blood of healthy people for antibodies this summer.

Antibodies to the flu would indicate they had recovered from silent infections.

But a W.H.O. spokesman said privately that the agency was just helping the Egyptians with a long-planned study and the article had “jumped the gun.”

Post no. 1: http://www.flutrackers.com/forum/sho...40&postcount=1

It was reported last week that the WHO planned to send a team to Egypt to investigate the avian flu situation there.

Gregory Hartl, a spokesman for the WHO, told CIDRAP News that because of holiday observances in Egypt, the WHO team just left for that country today.

Post no. 2: http://www.flutrackers.com/forum/sho...4&postcount=10


Conflicting versions?

[HenryN]

Originally Posted by ironorehopper

Post no. 1: http://www.flutrackers.com/forum/sho...40&postcount=1




Post no. 2: http://www.flutrackers.com/forum/sho...4&postcount=10


Conflicting versions?

There are TWO WHO issues. One is focused on antibodies in asymptomatic individuals. That study was planned because of the high frequency of children in mild cases in the spring of 2007 (no need to rush because the cases are mild and the pandemic is still phase 3 according to WHO). However, this year the mild cases changed demographics, and now the target population is TODDLERS that are involved in CLUSTERS, so now WHO is sending a team to understand why the demographics has changed.

This subtle difference has been lost on recent reports which lump the toddlers in 2009 with the children in 2007. Although both outbreaks involve mild H5N1 cases, the change in demographics speak volumes, even if the writers of these recent reports on similarities between 2007 and 2009 can't hear.

[Sally Furniss]

Experts and officials: the spread of avian influenza among children confirms the absence of state control of the disease

كتب متولى سالم ٢١/ ٤/ ٢٠٠٩

Salem wrote Metwaly 4-21-2009

أكدت مصادر رسمية بوزارة الزراعة أن الشهور المقبلة ستكون «كارثية»، بسبب انتشار مرض أنفلونزا الطيور بين الأطفال، ومواصلة ارتفاع معدلات الإصابة بالمرض فى مختلف المحافظات، مؤكدة أن غياب التنسيق بين الأجهزة المعنية لمكافحة المرض وعدم توفير الاعتمادات المالية اللازمة لأعمال المكافحة وراء هذه الأزمة ـ على حد ما ذكرته المصادر. Official sources confirmed that the Ministry of Agriculture, the coming months would be «disastrous», due to the spread of bird flu among children, and continuing high rates of infection in the various provinces, confirming that the absence of coordination between the relevant bodies to fight the disease and failure to provide funds for the fight behind the crisis to some extent, sources said. وبرر الدكتور حسين منصور، رئيس مشروع سلامة الغذاء، ارتفاع حالات الإصابة بمرض أنفلونزا الطيور بين الأطفال خلال الفترة الأخيرة بسبب موجات الانتشار الشديدة للمرض بين الطيور وتعرض الأطفال للفيروس من خلال مخالطتهم للدواجن، خاصة فى التربية الريفية، مشيراً إلى أن الكبار تعرضوا فى السابق لجرعات مخففة من الفيروس مما يمنحهم مناعة أكثر من الأطفال. He justified Dr. Hussein Mansour, Chairman of the draft food safety, the high incidence of bird flu among children during the recent period due to strong waves spread of the disease among birds and children's exposure to the virus through poultry Mkhaltthm, especially in rural education, noting that adults exposed to doses in the previous reduced of the virus, which gives them the most vulnerable children. وكشف منصور عن أن انتشار المرض يعود إلى غياب تطبيق قواعد الأمان الحيوى فى هذه المزارع، وانتقال المرض من مزرعة إلى أخرى، من خلال وسائل النقل المختلفة دون إجراء عمليات التعقيم اللازمة، لها بالإضافة إلى انتقاله عبر مخلفات الطيور فى المزارع المصابة أو ما يسمى «السبلة»، وهى الأكثر خطورة حيث إن انتشار المرض بها أكثر ضراوة خاصة فى حالة استخدامها فى تسميد الأراضى الزراعية التى تعتمد على عمالة الأطفال أو العمالة المكثفة. Mansour revealed that the spread of the disease due to the absence of application of the rules of bio-safety in the farms, and the transmission of disease from one farm to another, through various means of transport without sterilization required, in addition to transmission through the remnants of infected birds in the farms or the so-called «Sblp », is the most serious since the spread of the disease more virulent, especially in the case of fertilizer used in agricultural lands, which depends on the child labor or labor-intensive. وشدد على أن التحصين ليس علاجاً ولكنه يحتاج إلى متابعة من خلال جرعات أخرى منشطة، والفائدة الرئيسية من التحصين هى منع انتشار الفيروس خارج جسم الطائر، مشيراً إلى أهمية التأكد من التحصين وتشكيل لجان لها صلاحيات كبيرة فى التأكد من إجراءات الأمان الحيوى فى مزارع الدواجن أو التربية الريفية ومعاقبة المخالفين، لأننا دخلنا فعلياً «مرحلة الخطر» التى تستلزم حالة استنفار قصوى من أجهزة الدولة للمشاركة بفاعلية فى أعمال المكافحة لحماية أطفالنا وحماية المجتمع بأسره. He stressed that vaccination is not treated, but needs to be pursued through the other doses of stimulant drugs, the principal and interest of the immunization is to prevent the spread of the virus outside the body of the bird, noting the importance of immunization, make sure to set up committees have broad powers to make sure of the bio-security procedures in poultry farms or education rural and punishment of offenders, because we actually entered the «out of danger», which require high alert of the organs of the State to participate actively in the fight to protect our children and the protection of society as a whole. ومن جانبه قال الدكتور سامى البساطى رئيس الجمعية المصرية لعلم الحيوان إن زيادة معدلات الإصابة بمرض أنفلونزا الطيور لدى الأطفال تؤكد أن البؤر «النائمة» بدأت تتحرك وأصبحت أكثر تهديداً لجميع فئات المجتمع خاصة الأطفال، معللاً ذلك باستمرار حالة التراخى من قبل الأجهزة الحكومية للتعامل مع المرض بجدية. For his part, Dr. Sami Bisatti head of the Egyptian Society of Animal Science that the higher rates of infection from bird flu in children confirm that the spots «dormant» started to move and become more of a threat to all segments of society especially children, citing the continuing inaction by the government agencies to deal with serious illness . وأضاف «الدولة تقرر تشكيل لجان وتقوم بفض لجان أخرى كما أن اللجنة القومية لمكافحة المرض تصدر القرارات ولا تتابعها والنتيجة (كارثية) وهى انتشار المرض مع انتقال الطيور بين المحافظات دون رقيب». The «state decided to form committees and other committees of the resolution of the National Committee to combat the disease do not make decisions and follow up result (disastrous), the spread of the disease, with the transfer of birds between provinces uncontrolled». وأكد أن لغة المصالح تتغلب حالياً على اعتبارات الأمن الجماعى للمواطنين. He emphasized that the language of interests, overcome the current considerations of collective security of the citizens. وشدد البساطى على أن الدولة اقترحت وسائل للسيطرة على المرض دون أن تتخذ الإجراءات اللازمة للمتابعة بسبب النقص الحاد فى الأطباء والعاملين فى مجال المكافحة، بينما اتبعت الدولة سياسة التجاهل فى التعامل الجدى مع مرض أنفلونزا الطيور، مشيراً إلى استمرار مزارع الخنازير داخل الكتلة السكنية بالقاهرة الكبرى وهى الأكثر خطورة و مؤهلة لتحول الفيروس من حالته الحالية إلى حالة أكثر شراسة، حيث إن الخنزير «معمل» جاهز لتحور الفيروس وعندها ستكون مصر الدولة الأولى التى يتحور فيها الفيروس للانتقال بين البشر وعندها سيكون وباء عالمياً لا يبقى ولا يذر. He stressed that the State Bisatti suggested ways to control the disease without taking the necessary action to follow up because of an acute shortage of doctors and workers in the field of control, while the state pursued a policy of ignoring serious in dealing with the bird flu, adding to the continuation of pig farms within the residential block, the Greater Cairo the most serious and qualified for the transformation of the virus from its current state to a more aggressive as the pig «laboratory» Ready to mutate the virus and then Egypt will be the first where the virus mutate to move between humans and then will be a pandemic Israeli peace process. http://www.almasry-alyoum.com/articl...ticleID=208029

[Sally Furniss]

Egypt most of bird flu in the world and the highest recovery

News Date: 10:15 2009/04/21

News No.: 0025

Cairo, April 21 / Qena / said here today that the list of the top Msrali the more bird flu in the world and the highest rates of recovery. The report published by the newspaper / pyramids / The rate of injuries over the past four months, up to / 15 / of them / 12 / the case of DD children ages two and a half. The report pointed out that it had not been recorded among these cases has been one death so far .. He said that a positive indicator of the high degree of awareness among the citizens of disease symptoms and the speed to go to the hospitals, resulting in early detection and therapeutic intervention during the 48 hours of injury, which contributed to a clear recovery in the cases. The spokesman of the Egyptian Ministry of Health, the total deaths since the beginning of an outbreak of bird flu in Egypt arrived to / 23 / of the / 66 / a case of bird were recorded during the 3 years from among the thousands of 7 suspected case has been booked in the hospitals to ensure that they are free of the disease, noting that Egypt is still highest in the world and has affected recovery of the cases.

http://www.qnaol.net/QNAAr/News_Bull..._842_0025.aspx

[Commonground]

Post #10:

Egypt's state media reported two new H5N1 avian influenza infections within 2 days of each other, in a 25-year-old woman and an 18-month girl.


The state-run paper Al Ahram, quoting the country's health ministry, reported on Apr 17 that the woman is from Qalubia governorate and was hospitalized in critical condition, according to report from Agence France-Presse.
http://www.cidrap.umn.edu/cidrap/con...9egypt-br.html

versus:

The first case is a 25-year old pregnant female from El Marg District, Cairo Governorate.

http://www.who.int/csr/don/2009_04_21/en/index.html


What is correct? The CIDRAP version, or the WHO version?

[sharon sanders]

"..El Marg District, Cairo Governorate..."

This is what the Egyptian government says so I would go with this location.

[HenryN]

Originally Posted by niman

Avian Flu Cases in Egypt Raise Alarms

Dr. Tim Uyeki, a flu specialist at the Centers for Disease Control and Prevention in Atlanta, said there had been mild cases of H5N1 among children in several countries. There have also, he said, been studies in Indonesia, Thailand, Cambodia and Nigeria similar to the one proposed for Egypt in which the blood of cullers, poultry workers and relatives of sick people has been tested.

“Those are the ideal people to look at,” he said. “And there was zero or extremely low prevalence of antibodies,” meaning silent infections were very uncommon.

Consultants spend a lot of time defending negative data. The paper from PLOS on H5N1 antibodies in suriving patients in southeast Asia shows that antibody levels drop rapidly, and titers at 182 days are much lower than 54 days, demonstrating how a poor expermiental design (collection of serum samples long after exposure) can create negative data for press releases and media reports

HA antibody data:

http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fj ournal.pmed.1000049.g003&representation=PNG_L

[HenryN]

Originally Posted by Florida1

"..El Marg District, Cairo Governorate..."

This is what the Egyptian government says so I would go with this location.

El Marg is in northern Cairo, adjacent to Qalubia, the location of case #63. Case #63 and #65 received delayed treatment at the same hospital, Ains Shams:

The first case is a 25-year old pregnant female from El Marg District, Cairo Governorate. Her symptoms began on 6 April and she was hospitalized at Ain Shams University hospital on 11 April where she was started on oseltamivir on 16 April.

The third case is a 6 year-old boy from Shubra El Khema District, Qaliobia Governorate. He developed symptoms on 22 March and was admitted to Ain Shams University Hospital on the 28 March where he was started on oseltamivir on 3 April.

[HenryN]

Commentary

[HenryN]

Viral time-bomb

Scientists fear the increasing number of bird flu cases among children may allow for the mutation of the pathogenic virus, reports Reem Leila

---

As the number of reported bird flu cases in children continues to rise attention is increasingly being focussed on government efforts to control the disease. Although the virus is now causing fewer fatalities among those who contract it, scientists are worried about the changing profile of those who do develop symptoms. The World Health Organisation (WHO) fears the rise in infections among small children, without a similar increase in older people, could suggest adults are being infected but not falling ill, acting as symptom-free carriers of the disease.
A preparatory mission consisting of WHO, UNICEF, FAO and other UN agencies, will arrive in Egypt on 21 April.
"The mission will test blood and take swabs from people who contracted the virus and their families as well as those who are in direct or indirect contact with birds," says Ahmed Abdel-Latif, WHO representative in Egypt.
With three more cases reported last week, the WHO is concerned that the disease is now almost exclusively striking infants. There is also speculation that though symptoms are generally milder than in earlier cases, this could constitute a viral time-bomb. At the same time, Abdel-Latif strictly confirms that the virus has not yet mutated into a human-to-human strain.
Mohamed Sayed, plague and avian flu disease expert at the Research for Agricultural Guidance Centre, says that recent developments make it more likely 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. If the virus becomes less pathogenic it will become more transmissible."
The deadly strain of H5N1 usually kills half of those affected. Of this year's cases all were cured and discharged from hospital with the exception of the two most recent cases who remain hospitalised but whose condition is stable and who are, according to Abdel-Rahman Shahin, official spokesman to the Ministry of Health, expected to be discharged in the next few days.
Abdel-Latif argues that the higher rate of infection among children is a result of their weaker immunity systems and the fact that they "play with chickens in the streets".
"To control the deadly strain of H5N1 demands a convergence of biomedical, managerial and behavioural techniques," says Abdel-Latif. "So far Egypt is performing well on the biomedical front. Egypt's physicians can diagnose and medicate which is why the fatality rate is on the decrease." But what is needed, he argues, is a more holistic approach.
Combating the virus should be a national priority. Abdel-Latif advocates more awareness campaigns, particularly targeting children in rural areas.
"Existing campaigns are directed at adults. A change in the target audience is needed in order to avoid the spread of the disease."
He also believes the campaign should be directed through mosques and churches as well as the media. "People will respond more swiftly if they are advised by religious figures," he argues, adding that it remains essential for the owners of poultry farms to immediately report the presence of the virus.
Vaccine stocks only cover 30 per cent of the country's 300 million birds in rural farms, says Hamed Samaha, head of the General Authority for Veterinary Services (GAVS).
"The amount of vaccine is barely sufficient to cover the workforce that will distribute them and responsive farmers who are willing to inoculate their birds." Six million doses are needed to cover the entire poultry sector but, says Samaha, the authority can only afford to provide 120 million.
"Out of 13,000 registered veterinarians only 6,500 are available to work on vaccinations and 70 per cent of these are unsuited to field work being more than 50 years old. We end up with only 1,200 veterinarians while at least 34,000 are needed to cover targeted areas."
No new veterinarians have been appointed since 1994 because of a lack of funds. And while, says Samaha, Prime Minister Ahmed Nazif recently agreed on 1,500 new veterinarian appointments, "we are still massively understaffed."
Poultry farmers have also stopped reporting outbreaks for fear they will incur financial losses. The only way around the problem, Samaha argues, is to offer farmers compensation for any losses they might incur when revealing the real status of their farms.
Saber Abdel-Aziz, head of the epidemic and poultry department at GAVS, criticises the lack of human and financial resources without which veterinary services cannot play a more active role in combating the virus.
Currently there are 50 sites in Egypt that have tested positive for the virus. "Only two per cent of poultry farms apply bio-security measures," says Abdel-Aziz. Yet the veterinary authorities lack even vehicles to access many sites. While in 2006, he continues, the first avian flu campaign successfully vaccinated 90 million birds. "At first farmers were concerned so they cooperated with the authorities but now they are more confident and don't respond to our efforts."

http://weekly.ahram.org.eg/2009/943/eg6.htm

[AlaskaDenise]

Originally Posted by niman

Commentary

http://www.recombinomics.com/News/04...rel="nofollow"

Commentary

Serious WHO Analysis of H5N1 Transmission in Egypt

Recombinomics Commentary 17:31
April 21, 2009

An April 8 Reuters article from Cairo quoted a visiting W.H.O. expert saying his agency feared “something strange happening in Egypt” and would help the government test the blood of healthy people for antibodies this summer.

But a W.H.O. spokesman said privately that the agency was just helping the Egyptians with a long-planned study and the article had “jumped the gun.”

Gregory Hartl, a spokesman for the WHO, told CIDRAP News that because of holiday observances in Egypt, the WHO team just left for that country today.

The above comments suggests there are two distinct WHO investigations of H5N1 in Egypt, which are related to mild cases in children in the spring of 2007, as well as mild cases in toddlers in 2009. The initial comments above reported in the Donald McNeil New York Times piece on the mild cases in toddlers are in reference to the 2007 data and such antibody studies have been previously planned for the summer.

The latter comments are with regard to WHO officials who are en route to Egypt, which are linked to the 2009 toddler cases and clusters. This week’s trip is also supported by a report from the European Centre for Disease Prevention and Control as well as local media in Egypt, which are focused on the high incidence of mild toddler cases this year.

In the spring of 2007, 16/17 H5N1 cases recovered, and 16/17 cases were in children between the ages of 3-10. The vast majority of these cases not only recovered, but did not develop pneumonia and the cases presented much like seasonal flu. In addition, sequences from cases that were not epidemiologically linked were virtually identical, and the one cluster that was epidemiologically linked involved siblings in Qena, whose sequences match each other and had a deletion, S129del. The identity of the sequences, and the four day spread in admission dates strongly supported human to human transmission. Moreover, additional contacts had symptoms, but tested negative. These data raised concerns that the H5N1 was silently spreading because many patients with symptoms would not seek treatment or would be treated for seasonal flu and would not be tested for H5N1.

Such spread could be identified by tests for H5 antibodies. However, recent data on immune responses in recovered H5N1 patients in southeast Asia indicates that antibody levels are largely not maintained over time, and therefore such patients may return false negatives if tested weeks, months, or years after exposure. Thus, such testing may not identify asymptomatic or mild cases because of delays in testing and reductions in antibody levels over time.

This year there were mild cases in Egypt again, except the demographics had changed. Instead of involvement of children between the ages of 3-10, almost all confirmed cases were toddlers. Previously, infections in toddlers were rare. In the 51 confirmed cases in 2006-2008, only six were toddlers. In contrast, 10 of the first 11 cases in 2009 were toddlers and the current count is 11 of 15 cases. Only one of the older cases was a child, so 11/12 children were toddlers between the ages of 1 ½ and 2 ½. This new demographers increased concerns that the mild cases in 2007 were widespread in children providing protective immunity, which limited the number of confirmed cases in 2009 to one child.

The data in 2009 was characterized as “something strange” as noted above and increased concerns that the number of human H5N1 cases in Egypt was orders of magnitude higher than the current 66 confirmed cases. Evidence for additional cases comes from test results as well as the mild nature of confirmed cases. In Egypt, suspect cases with a history of exposure to dead or dying poultry leads to rapid treatment and testing. However, more than 99% of hospitalized and suspect cases are PCR negative. Moreover, cases without a poultry connection are not tested, so cases without a stated connection could be silently spreading H5N1, even if symptomatic.

Thus, there is concern that the mild cases in the toddler demographic may signal a broad spectrum of testing failures and the recent cases should be tested for antibodies, which are at peak levels 3-4 weeks after disease onset. Therefore the symptomatic cases that are PCR negative should be tested for antibody now, not at some future date when antibody levels decline. Similarly, toddlers, which are the current major at risk population, should be PCR tested, and those who have recently recovered should be tested for antibodies.

Repeating failed experimental protocols of the past is not useful.

Serious testing for H5N1 in Egypt is long overdue as is the release of H5N1 sequences, which are expected to contain the same deletion seen in the Qena cluster in 2007.

.

[HenryN]

Bird Flu and Swine Flu Outbreaks The Health Risks of Hysteria

Egyptian health officials have just reported two deaths from bird flu within days of each other. The dangerous virus variant H5N1 struck down a six-year-old boy and a young woman, bringing the total death toll in Egypt to 25. While bird flu experts note that Egypt has seen a surge in human cases in recent months, with 16 confirmed since the start of the year, compared to seven cases between January 1 and April 17 last year [Reuters], they also say that the Egyptian people’s level of alarm is out of proportion to the threat.

Rumors have appeared in the Egyptian media that the virus is circulating widely, and that some people get “silent infections” which show no symptoms, but still allow them to pass on the virus. The rumors have been fueled by the pattern of recent infections: Many of the infected patients have been toddlers, leading to the belief that stronger adults are also infected but simply show no symptoms. Although thousands of Egyptians have rushed their children to hospitals this flu season, there is no evidence yet of asymptomatic avian flu cases or any significant mutation in the H5N1 virus. “Right now, it’s all hot air,” said Dr. Robert G. Webster, a flu expert…. “I hope to hell it’s not happening, because it would mean the virus is adapting to humans. But there’s not a shred of data” [The New York Times].

While the H5N1 virus rarely infects people, the looming fear is that the virus may mutate into a form that can be transmitted easily from person to person, which could spark a deadly pandemic. However, an outbreak of swine flu across the world from Egypt, in Southern California, has reminded people of the hazards of overreacting before all the information is in.

Swine flu is found in pigs and very rarely in humans who have direct contact with pigs; the United States reports one human case every one or two years. However, two California children were diagnosed with the disease this spring, sparking an investigation by the Centers for Disease Control. Since neither of the two children, a 10-year-old boy and a 9-year-old girl, had contact with pigs, it “increases the possibility that human-to-human transmission of this new influenza virus has occurred,” according to a CDC report. The girl did attend an agricultural fair four weeks before becoming sick, she said, but did not have any contact with pigs or other livestock [CNN].

The incident has brought back memories of another swine flu outbreak in 1976 among army recruits at Fort Dix, New Jersey, which taught public health officials a tough lesson. That winter, 13 men got sick and one died of what proved to be swine influenza viruses–viruses that were thought to be similar to the one responsible for the 1918 Spanish flu pandemic. U.S. officials ordered the manufacture of swine flu virus vaccine and the country proceeded to launch a mass immunization program that saw upwards of 40 million people injected with the vaccine. The feared pandemic never occurred. But the vaccine appeared to trigger a high level of cases of Guillain-Barre syndrome, a type of paralysis [The Canadian Press], and thousands of vaccine recipients filed injury claims.

Related Content:
80beats: Winter Flu Season Brings New Bird Flu Outbreaks Across Asia
80beats: Lack of Genetic Diversity in Chicken Coops Could Worsen Bird Flu Outbreaks
80beats: Ignored Strain of Bird Flu Could Lead to a Pandemic… of Light Sneezing
DISCOVER: The Science of Avian Flu
Image: flickr / Effervescing Elephant


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