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AVIAN INFLUENZA, HUMAN (11): EGYPT, FATAL
*****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 10 Feb 2011
Source: H5N1 Pandemic Information News [partly in Arabic, paraphrased &
edited]
<http://pandemicinformationnews.blogspot ... lu-in.html>


A new fatal case of bird flu [avian influenza A/(H5N1) virus infection] was
reported yesterday [9 Feb 2011] in Monoufia [governorate]. The victim was a
43 year old agricultural worker.

Dr Hisham Atta, deputy minister of health said that the victim had been
detained at hospital in Shebin 2 days ago after symptoms of the disease had
begun. He had a high temperature and experienced joint pain. Clinical
samples were obtained from his family to determine whether they have been
exposed to the virus. The victim's house has been treated with disinfectant.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[If confirmed, this will be the 123rd case and 41st fatality recorded in
Egypt. This is the 4th case this year (2011) and the 1st fatality in 2011.

A map of the governorates of Egypt can be accessed at
<http://en.wikipedia.org/wiki/Governorates_of_Egypt>. The
HealthMap/ProMED-mail interactive map of Egypt can be seen at
<http://healthmap.org/r/008F>. - Mod.CP]

Avian influenza - situation in Egypt - update 44
28.02.2011 - WHO

The Ministry of Health of Egypt has announced 3 new confirmed cases of human infection with avian influenza A (H5N1) virus.

The first case is a 26 year-old female from Dakahlia Governorate. She developed symptoms on 18 January and was hospitalized on 23 January. She has recovered and was discharged on 7 February.

The second case is a 45 year-old male from Menofia Governorate. He developed symptoms on 20 January and was hospitalized on 26 January. He died on 5 February.

The third case is a 4 year-old male from Damiata Governorate. He developed symptoms on 14 February and was hospitalized on 16 February. He is in a stable condition.

Investigations into the source of infection indicate that the three cases had exposure to poultry suspected to have avian influenza. The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 125 cases confirmed to date in Egypt, 41 have been fatal.

Avian influenza - situation in Egypt - update 45
07.03.2011 - WHO

The Ministry of Health of Egypt has announced two new confirmed cases of human infection with avian influenza A (H5N1) virus.

The first case is a 32 year old female from Sharkia Governorate. She developed symptoms on 10 February and was hospitalized on 14 February. She is in a critical condition.

The second case is a two year old male from Kafr Elsheikh Governorate. He developed symptoms on 18 February and was hospitalized on 20 February. He is under treatment and is in a good general condition.

Investigations into the source of infection indicate that the two cases had exposure to poultry suspected to have avian influenza. The cases were confirmed by the Egyptian Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 127 cases confirmed to date in Egypt, 41 have been fatal.

Avian influenza - situation in Egypt - update 46
10.03.2011 - WHO

The Ministry of Health of Egypt has announced two new confirmed case of human infection with avian influenza A (H5N1) virus and the death of a previously announced case.

The first case is a 17 year old female from Behira Governorate. She developed symptoms on 27 February and was hospitalized on 1 March. She is in a stable condition.

The second case is a 17 year old female from Dakahlia Governorate. She developed symptoms on 24 February and was hospitalized on 26 February. She died on 28 February.

Investigations into the source of infection indicate that the both cases had exposure to sick and dead poultry. Both cases received oseltamivir treatment. The cases were confirmed by the Egyptian Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network. The previously reported case, a 32 year old female from Sharkia Governorate (see update 45), died on 3 March.

Of the 129 cases confirmed to date in Egypt, 43 have been fatal.

Avian influenza - situation in Egypt - update 47
15.03.2011 - WHO

The Ministry of Health of Egypt has announced a new confirmed case of human infection with avian influenza A (H5N1) virus. The case is a 38 year old female from Ismailia Governorate. She developed symptoms on 1 March and was hospitalized on 7 March. She was in a critical condition under artificial ventilation and died on 11 March. Investigations into the source of infection indicate that the case had exposure to sick poultry suspected to have avian influenza. The case was confirmed by the Egyptian Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 130 cases confirmed to date in Egypt, 44 have been fatal.

AVIAN INFLUENZA, HUMAN (29): EGYPT
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 22 Mar 2011
Source: CIDRAP News [edited]
<http://www.cidrap.umn.edu/cidrap/conten ... egypt.html>


A study of human H5N1 influenza cases in Egypt, including a genetic
analysis of some of the isolates, shows that most cases have occurred
in children and females but does not explain why the fatality rate
there is significantly lower than in other countries. Writing in the
open-access journal PLoS One, a team of US and Egyptian scientists
says Egypt became the epicenter of human H5N1 cases in 2009 and 2010,
with 68 of the 121 cases reported worldwide. But the country's H5N1
case-fatality rate (CFR) is 34 percent, versus 60 percent for other
countries with human cases.

Because the H5N1 viruses in Egypt seem to be less virulent than those
elsewhere, there is concern that they are becoming more adapted to
humans, say the authors, who are from St. Jude Children's Hospital in
Memphis and the Egypt's National Research Center in Cairo. Their
report was published yesterday [21 Mar 2011]. Egypt had 119 human H5N1
cases from 2006 through 2010, with 40 deaths (CFR, 34 percent), the
report says. In 2006 the cases peaked in the spring, and in the
ensuing 4 years, they peaked in the winter and spring. There were 3
family clusters [?] totaling 7 cases during that time.

62 percent of the patients were under age 18, and 60 percent were
female. The mean age for all patients was 10.0 years, with a range of
1-75 years. The young age distribution could reflect Egypt's
demographics or children's level of contact with poultry, the authors
say. They also note that women typically play the lead role in tending
backyard poultry, perhaps explaining the burden of cases in females,
but this needs corroboration.

The fatality rate increased with age and was 3 times as high in
females as in males, the investigators found. The CFR ranged from 4
percent for children under 5 to 10 percent for 5- to 9-year-olds and
53 percent for 10- to 18-year olds. Adults up to age 49 had a 61
percent CFR, and the rate was 75 percent for older adults. The rate
for females was 47 percent, versus 15 percent for males, a significant
difference. The CFR also varied considerably by year and was
particularly low in 2009, at 10 percent, before bouncing up to 45
percent in 2010, the authors note.

Most of the cases in 2009 were in children under age 5, but a
regression analysis showed that mortality was significantly lower in
2009 than in other years, even when the different age distribution was
taken into account. The time from illness onset to hospitalization was
found to be a key factor in risk of death. The CFR for patients who
were hospitalized within the 1st 2 days was 8 percent, versus 54
percent for those who were hospitalized later, a significant
difference. The authors caution that the overall 34 percent CFR may be
an overestimate, because the rate of unrecognized cases is unknown.

The team found that the pattern of H5N1 cases in humans tends to
mirror the pattern in poultry, both in frequency and severity. "Milder
disease among poultry leads to mild human infection," the report says.
"For instance, a decrease in human case-fatality rate in 2009 was
accompanied by an observed decrease in mortality among poultry."

On the genetic front, the scientists say several sublineages of H5N1
clade 2.2.1 have been reported in Egypt, of which at least 3 are still
circulating. They identified what they believe is a new sublineage,
which they call Egypt-G, represented by 4 isolates. But they found no
specific lineages that seemed to circulate in humans but not in birds
or vice versa, and thus no "host-adaptation mutation." Similarly, they
couldn't find particular changes in the virus that seemed linked to
changes in the fatality rate: "We were not able to confirm that lower
pathogenicity of the viruses is the main reason for increase or
decrease in the mortality rate among humans in Egypt." The virus
appeared "in its most virulent form in 2006," and any significant
mutation may be expected to lead to lower virulence, they add. But
they caution that other host and environmental factors that may affect
disease severity must be properly studied before concluding that any
decrease in mortality is due to mutations.

The study was limited to lab-confirmed cases reported to the World
Health Organization, and a lack of data for many variables forbade an
in-depth epidemiologic investigation, the authors say. They say
experts are concerned about "the potential of H5N1 viruses circulating
in Egypt to become more adapted to human-to-human transmission,"
because the viruses are less virulent and may be causing asymptomatic
infections, especially in adults. Consequently, there is an urgent
need for more epidemiologic studies in Egypt, they conclude.

[Byline: Robert Roos]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[The reference for the paper summarised in the above report is the
following: "The epidemiological and molecular aspects of influenza
H5N1 viruses at the human-animal interface in Egypt." By Kayali G,
Webby RJ, Ducatez MR, et al., PLoS One, published 21 Mar 2011 10.1371/
journal.pone.0017730
(<http://www.plosone.org/article/info%3Ad ... 1C.ambra02>).


The Abstract reads as follows: "With 119 confirmed cases between
March 2006 and December 2010, Egypt ranks 2nd among countries
reporting human H5N1 influenza virus infections. In 2009-2010, Egypt
reported 68 new human cases and became the new epicenter for H5N1
infections. We conducted an epidemiological and molecular analysis in
order to better understand the situation in Egypt. The onset of new
cases peaked annually during the winter and spring months, with
majority of cases reported in the Nile Delta region. Most cases were
less than 18 years old (62 percent) and females (60 percent). The
overall case-fatality rate was 34 percent and significantly increased
by age. There was a significant difference between the case-fatality
rates among females and males. We observed a significant drop (p =
0.004) in case fatality rate in 2009 (10 percent) as compared to
higher rates (36-56 percent) in other years. Hospitalization within 2
or 3 days after onset of symptoms significantly decreased mortality.
Molecular analysis showed that variations do occur among viruses
isolated from birds as well as from humans in Egypt, and these
mutations were especially noted in 2009 viruses. As the
epidemiological profile of Egyptian cases differs from other
countries, there is an urgent need to conduct prospective studies to
enhance our understanding of incidence, prevalence, and determinants
of virulence of human infections with avian H5N1 influenza viruses."

This analysis of human cases of avian A/(H5N1) virus infection in
Egypt (as summarised in the CIDRAP account) leaves some questions
unanswered, but it is reassuring to have the authors' opinion that
their phylogenetic analyses revealed no evidence so far for
host-adaptation mutation, which suggests that the main transmission
route of H5N1 in Egypt is still contact with infected birds, just as
observed in the rest of the world.

A peculiar feature of the epidemiology of avian influenza A (H5N1)
virus infection in the human population is the almost complete absence
of overt infection among the large number of people involved both in
the rearing of poultry and their culling and disposal after infection.
- Mod.CP]

Avian influenza - situation in Egypt - update 48
29.03.2011 - WHO

The Ministry of Health of Egypt has announced three new confirmed cases of human infection with avian influenza A(H5N1) virus.

The first case is a 32 year old male from Suez Governorate. He developed symptoms on 8 March, was hospitalized on 12 March and died on 13 March.

The second case is a 28 year old female from Giza Governorate. She developed symptoms on 8 March and was hospitalized on 10 March. She is in a stable condition.

The third case is a 4 year old male from Behira Governorate. He developed symptoms on 5 March and was hospitalized on 7 March. He recovered and was discharged on 12 March.

Investigations into the source of infection indicate that the cases had exposure to sick and/or dead poultry suspected to have avian influenza. The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 133 cases confirmed to date in Egypt, 45 have been fatal.

Avian influenza - situation in Egypt - update 49
06.04.2011 - WHO

The Ministry of Health of Egypt has announced four new confirmed cases of human infection with avian influenza A(H5N1) virus.

The first case is a one year old male from Behaira Governorate. He developed symptoms on 14 February, was hospitalized on 16 February. He recovered and was discharged on 22 February.

The second case is a three years old female from Behaira Governorate. She developed symptoms on 10 March, was hospitalized on 12 March. She recovered and was discharged on 18 March. The previous two cases are from the same district but different villages and they are not relatives.

The third case a 34 year old female from Alexandria Governorate. She developed symptoms on 9 March and was hospitalized on 15th March. She is still under treatment in a stable condition.

The fourth case is a 30 years old female from Kafr El-Shaikh Governorate. She developed symptoms on 7 March and was hospitalized on 15 March. She recovered and was discharged on 27 March.

Investigations into the source of infection indicate that all cases had exposure to sick and/or dead poultry suspected to have avian influenza. The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 137 cases confirmed to date in Egypt, 45 have been fatal.

Avian influenza - situation in Egypt - update 50
11.04.2011 - WHO

The Ministry of Health of Egypt has announced four new confirmed cases of human infection with avian influenza A(H5N1) virus.

The first case is a 20 years old female from Behaira Governorate. She developed symptoms on 14 March and was hospitalized on 19 March. She was in a critical condition and died on 28 March.

The second case is a two years old female from Menofeya Governorate. She developed symptoms on 26 March and was hospitalized on 27 March. She is still under treatment and in a stable condition.

The third case is a 55 year old female from Behaira Governorate. She developed symptoms on 20 March and was hospitalized on 22 March. She recovered and was discharged on 5 April.

The fourth case is a 1 year old male from Fayoum Governorate He developed symptoms on 20 March and was hospitalized on 28 March. He is still under treatment and in a stable condition.

All the cases received oseltamivir treatment at the time of hospitalization. Investigations into the source of infection indicate that the cases had exposure to sick and/or dead poultry suspected to have avian influenza. The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 141 cases confirmed to date in Egypt, 46 have been fatal.

leider wird immer wieder vergessen, dass die hochinfektiöse vogelgrippe von hunden auf den menschen übertragen werden kann-
während man infizierte hühner massenschlachtet, bleiben die hauptüberträger ungeschoren.... auch an die wildhunde denken....
http://www.nlga.niedersachsen.de/live/l ... int#frage8

Avian influenza - situation in Egypt - update 51
21.04.2011 - WHO

On 16 April 2011, the Ministry of Health of Egypt notified WHO of two new cases of human infection with avian influenza A (H5N1) virus.

The first case was a 29 years-old male from Fayoum Governorate Wadi Elrian area who developed symptoms on 1 April , was hospitalized on 4 April and died on 7 April.

The second case was a one -and-a -half year-old male child from Fayoum Governorate, Sennores District who developed symptoms on 9 April and was hospitalized on 11 April. He is under treatment and is in stable condition.

All the cases received oseltamivir treatment at the time of hospitalization.

Investigations into the source of infection indicate that both the cases had exposure to sick and/or dead poultry suspected to have avian influenza. There is no epidemiological link identified between these two cases. The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 143 cases confirmed to date in Egypt, 47 have been fatal .

AVIAN INFLUENZA HUMAN (43): EGYPTIAN SUBLINEAGE
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 27 May 2011
Source: CIDRAP (Center for Infectious Disease Research & Policy) News
[edited]
<http://www.cidrap.umn.edu/cidrap/conten ... sscan.html>


H5N1 strains in Egypt show increased ability to bind to human cells
-------------------------------------------------------------------
H5N1 avian influenza viruses in Egypt have branched into new
sublineages and have shown a mutation that helps them bind more
readily to human cell receptors in the lower respiratory tract, which
may indicate an increased pandemic potential, according to a study
published yesterday [26 May issue of PLoS Pathogens -- see below for
reference, author summary, and abstract - Mod.CP].

Researchers from Egypt, Japan, and Thailand conducted a phylogenetic
analysis of H5N1 viruses isolated from 2006 to 2009 in Egypt. Using
reverse genetics, they found that several new sublineages have
acquired an enhanced receptor-binding affinity of the viral
hemagglutinin to alpha-2,6-linked sialic acid (SA), which is a
receptor-binding trait of human influenza strains. The mutation was
associated with increased attachment to and infectivity in the lower
respiratory tract but not the larynx of humans and also demonstrated
increased virulence in mice.

The authors conclude, "Our findings suggested that emergence of new
H5 sublineages with alpha-2,6 SA specificity caused a subsequent
increase in human H5N1 influenza virus infections in Egypt, and
provided data for understanding the virus's pandemic potential."

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Following are the reference, abstract, and author summary of the
publication referred to above. The full article is available at
<http://www.plospathogens.org/article/in ... at.1002068>

Title: Acquisition of human-type receptor binding specificity by new
H5N1 influenza virus sublineages during their emergence in birds in
Egypt
Authors: Y Watanabe 1, MS Ibrahim 1,2, HF Ellakany 3, N Kawashita
4,5, R Mizuike 1, H Hiramatsu 6, N Sriwilaijaroen 6,7, T Takagi 4,5, Y
Suzuki 6, K Ikuta 1
1. Department of Virology, Research Institute for Microbial Diseases
(BIKEN), Osaka University, Osaka, Japan
2. Department of Microbiology, Faculty of Veterinary Medicine,
Alexandria University, Damanhour Branch, Egypt
3. Department of Poultry Diseases and Hygiene, Faculty of Veterinary
Medicine, Alexandria University, Edfina Branch, Egypt
4. Graduate School of Pharmaceutical Sciences, Osaka University,
Osaka, Japan
5. Genome Information Research Center, Research Institute for
Microbial Diseases, Osaka University, Osaka, Japan
6. Health Scientific Hills, College of Life and Health Sciences,
Chubu University, Aichi, Japan
7. Faculty of Medicine, Thammasat University (Rangsit Campus),
PathumThani, Thailand

Author summary
---------------
"Even though highly pathogenic avian H5N1 influenza viruses lack an
efficient mechanism for human-human transmission, these viruses are
endemic in birds in China, Indonesia, Viet Nam, and Egypt. Hotspots
for bird-human transmission are indicated in areas where human cases
are more than 80 percent of total H5N1 influenza cases. Circulation
among hosts may allow H5N1 virus to acquire amino acid changes
enabling efficient bird-human transmission and eventually human-human
transmission. The receptor specificity of viral hemagglutinin (HA) is
considered a main factor affecting efficient transmissibility. Several
amino acid substitutions in H5 virus HAs that increase their
human-type receptor specificity have been described in virus isolates
from patients, but their prevalence has been limited. In contrast, we
show here that new H5 sublineages in Egypt have acquired a change in
receptor specificity during their diversification in birds. We found
that viruses in those sublineages exhibited increased attachment and
infectivity in the human lower respiratory tract, but not in the
larynx. Our findings may not allow a conclusion on the high pandemic
potential of H5N1 virus in Egypt, but helps explain why Egypt has
recently had the highest number of human H5 cases worldwide."

Abstract
--------
"Highly pathogenic avian influenza A virus subtype H5N1 is currently
widespread in Asia, Europe, and Africa, with 60 percent mortality in
humans. In particular, since 2009 Egypt has unexpectedly had the
highest number of human cases of H5N1 virus infection, with more than
50 percent of the cases worldwide, but the basis for this high
incidence has not been elucidated. A change in receptor binding
affinity of the viral hemagglutinin (HA) from alpha-2,3- to
alpha-2,6-linked sialic acid (SA) is thought to be necessary for H5N1
virus to become pandemic. In this study, we conducted a phylogenetic
analysis of H5N1 viruses isolated between 2006 and 2009 in Egypt. The
phylogenetic results showed that recent human isolates clustered
disproportionately into several new H5 sublineages suggesting that
their HAs have changed their receptor specificity. Using reverse
genetics, we found that these H5 sublineages have acquired an enhanced
binding affinity for alpha-2,6 SA in combination with residual
affinity for alpha-2,3 SA, and identified the amino acid mutations
that produced this new receptor specificity. Recombinant H5N1 viruses
with a single mutation at HA residue 192 or a double mutation at HA
residues 129 and 151 had increased attachment to and infectivity in
the human lower respiratory tract but not in the larynx. These
findings correlated with enhanced virulence of the mutant viruses in
mice. Interestingly, these H5 viruses, with increased affinity to
alpha-2,6 SA, emerged during viral diversification in bird populations
and subsequently spread to humans. Our findings suggested that
emergence of new H5 sublineages with alpha-2,6 SA specificity caused a
subsequent increase in human H5N1 influenza virus infections in Egypt,
and provided data for understanding the virus's pandemic potential."

These conclusions are derived from phylogenetic analysis, _in vitro_
experiments with fixed tissue and cultured cells, and reverse genetic
constructs in laboratory mice. They clearly indicate that the
emergence of a new H5 sublineage with alpha-2,6 SA binding specificity
caused a subsequent increase in human H5N1 influenza virus infections
in Egypt. These genetic changes affect the transmissibility of avian
influenza A/(H5N1) virus from birds to humans, but do not on the basis
of the epidemiology in Egypt appear determine transmissibility of
infection among humans. - Mod.CP]

[The ProMED/HealthMap interactive map of Egypt is at:
<http://healthmap.org/r/008F

- Mod.JW]

Avian influenza - situation in Egypt - update 52
01.06.2011

The Ministry of Health of Egypt has announced a new confirmed case of human infection with avian influenza A (H5N1) virus.

The case is a 30 year old female from Amria District, Alexandria Governorate. She developed symptoms on 26 April and was hospitalized on 3 May. She was in a critical condition under artificial ventilation and died on 9 May. She received oseltamivir treatment at the time of hospitalization. Investigations into the source of infection indicate that the case had exposure to sick poultry suspected to have avian influenza. The case was confirmed by the Egyptian Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 144 cases confirmed to date in Egypt, 48 have been fatal.

AVIAN INFLUENZA, HUMAN (46): EGYPT
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 9 Jun 2011
Source: FluTrackers, UN Food & Agriculture Organisation (FAO) report
[edited]
<http://www.flutrackers.com/forum/showth ... p?p=411595>


One new fatal human case of A/H5N1 avian influenza virus infection
------------------------------------------------------------------
General information
Disease event ID: 163110
Reporting date: 8 Jun 2011
Observation date: 23 May 2011

Location
Region: Africa
Admin 1 (Country): Al Qahirah (Cairo) (Egypt)
Locality: Elzawy Alhamra
Lat/Long: 29.9955310461/31.6196065243
Coords quality: Centroid Admin1

Diagnosis
Status: confirmed
Disease: Highly pathogenic avian influenza
Serotype: H5N1
Source: FAO Field Officer

Species affected
An.Type: human
An.Class: human
Species: human
Cases: 1
Deaths: 1

Laboratory tests
Disease tested: Highly pathogenic avian influenza
Result: positive

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[In the absence of further information it must be presumed that this
is the 145th human case of avian influenza A/(H5N1) virus infection,
and the 49th fatality, recorded in Egypt since the beginning of the
outbreak in 2003. Confirmation by the Egyptian Health Ministry and WHO
is awaited. - Mod.CP]

[The HealthMap/ProMED-mail interactive map of Egypt can be seen at
<http://healthmap.org/r/0YDE>. - Sr.Tech.Ed.MJ]

Avian influenza - situation in Egypt - update 53
16.06.2011 - WHO

The Ministry of Health of Egypt has notified WHO of five cases of human infection with avian influenza A (H5N1) virus.

The first case is a 40 years old female from Aswan District, Aswan Governorate. She developed symptoms on 14 May, and was hospitalized. She completed the course of oseltamivir, recovered and was discharged.

The second case is a 21 years old pregnant female from Ashmoun District, Menofia Governorate. She developed symptoms on 21 May, was hospitalized and received oseltamivir. She died on 29 May.

The third case is a 31 years old male from Shobra Elkhima District, Qaliobia Governorate. He developed symptoms on 21 May, was hospitalized and received oseltamivir. He died on 5 June.

The fourth case is a 32 years old male from Elzawya District, Cairo Governorate. He developed symptoms on 23 May was hospitalized and received oseltamivir. He died on 2 June.

The fifth case is a 16 years old male from Ashmoon District, Menofia Governorate. He developed symptoms on 21 May was hospitalized and received oseltamivir. He was in a critical condition but he is recovering.

Investigations into the source of infection indicate that all the cases had exposure to poultry suspected to have avian influenza. The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 149 cases confirmed to date in Egypt, 51 have been fatal .