Wüstenschiff

AVIAN INFLUENZA, HUMAN (72): EGYPT, VIRULENCE
*********************************************
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: Sun 12 Apr 2009
Source: The Independent online [edited]
<http://www.independent.co.uk/news/scien ... 67526.html>

Infections in Egypt raise scientists' fears that the virus will be
spread by humans. 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
[2009], the government identified the bird-flu virus H5N1 as the
biggest threat facing the country, with the potential to kill up to
750 000 Britons.

The World Health Organization (WHO) 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 [2009], with 3 more reported last week, they have
almost all been in children under the age of 3, 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 [2009] 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 whether 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 1st 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 [12 Apr 2009] 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 damn 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 percent of those it infected could still cause hundreds of
millions of deaths around the world.

[Byline: Geoffrey Lean]

--
Communicated by:
Dr.med Martin Dirksen-Fischer
Hamburg, Germany
<MartinDirksenFischer@gmx.de>

[As of 5 Apr 2009, it remained true that there had been no deaths
among patients in Egypt with confirmed avian H5N1 influenza virus
infections since the resurgence of the illness in Egypt in late 2008.
11 of these 13 patients have been children 6 years of age or younger.
These data do indeed suggest that there may have been a reduction in
the virulence of the outbreak strain, and there is a perceived risk
of progression of the virus to less a virulent but more transmissible
form.

On the other hand, all the patients had exposure to diseased or dead
poultry, and they likely contracted infection from that source and
not from human carriers. Furthermore, there has been no evidence of
onward transmission of infection to family members.

Several of the children are still in critical condition, and all may
not survive. Another relevant factor in evaluation of the Egyptian
situation is the immediate resort to treatment with the influenza
virus neuraminidase inhibitor Tamiflu.

The proposed WHO study is an important initiative in attempts to
define properties of avian influenza virus that may convert it into a
human pathogen. - Mod.CP]

AVIAN INFLUENZA, HUMAN (73): EGYPT, VIRULENCE
***********************************************
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: Mon 13 Apr 2009
Source: Bloomberg News online [edited]
<http://www.bloomberg.com/apps/news?pid= ... mwbqDeHpvE>


Egypt asked the World Health Organization [WHO] to help investigate
an outbreak of bird flu after a dozen non-fatal cases of the disease
this year [2009] prompted speculation the virus may be becoming less
virulent. Two WHO doctors and a scientist will travel to Cairo later
this week at the request of Egypt's Ministry of Health, said Gregory
Hartl, a spokesman for the United Nations agency in Geneva, in an
interview today [13 Apr 2009]. The UN team will assist local
authorities to identify how the patients were infected with the H5N1
strain of avian influenza and whether there have been any significant
changes in disease patterns in the virus itself.

Scientists have been following H5N1 for more than a decade because of
concern it could spark a pandemic if it becomes as infectious for
humans as it is for poultry. A less lethal strain could be more
contagious because people would have longer to transmit it through
coughing and sneezing. None of the 12 Egyptian cases reported to the
WHO this year [2009] has been fatal.

These data do indeed suggest that there may have been a reduction in
the virulence of the outbreak strain, and there is a perceived risk
of progression of the virus to a less virulent but more transmissible
form, the International Society for Infectious Diseases said today
[13 Apr 2009] in an e-mail via its ProMED-mail program [see, "Avian
influenza, human (72): Egypt, virulence 20090412.1403"]. The survival
of H5N1 patients in Egypt also may reflect early treatment with
antiviral medicines, ProMED said.

At least 417 people in 15 countries have contracted the virus since
2003. Three of every 5 cases worldwide were fatal. Most cases were
caused by contact with infected poultry, such as children playing
with them or adults butchering them or plucking feathers, according
to WHO.

H5N1 is continuing to circulate in poultry in Egypt, though there is
no evidence so far of any significant changes in the virus, said
Joseph Domenech, chief veterinary officer with the Food and
Agriculture Organization [FAO]. The Rome-based UN agency has also
agreed to a request by Egypt's government to provide technical
assistance, Domenech said in an interview today [13 Apr 2009].

Egypt has the highest number of avian-flu cases outside Asia, with 63
cases reported to WHO since 2006, of which 23 were fatal. In
comparison, more than 80 percent of the 141 people reported to have
been infected in Indonesia died.

Roche Holding AG says its Tamiflu antiviral medicine can reduce the
severity and duration of flu symptoms if taken within 48 hours of the
onset of disease. Early treatment for H5N1 may improve survival, some
uncontrolled studies have shown.

[Byline: Jason Gale]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The participation of the FAO in the WHO-led investigation of the
current H5N1 epidemic situation in Egypt is a logical development. As
of today (13 Apr 2009), the 11 cases of avian H5N1 influenza virus
confirmed in 2009 (all children) remain alive. This is in marked
contrast to the period from 2006 to 2008 when 23 of 51 H5N1-confirmed
patients did not survive infection. This suggests that there may have
been a change in the virulence of the H5N1 virus circulating in Egypt
at the present time. While diminished virulence is clearly
advantageous for the Egyptian population, it is feared that reduction
in virulence may favor increased transmissibility of the virus, which
might have adverse consequences for the global population.

However, other factors such as the role of the age of the victims,
the absence of evidence of person-to-person transmission, and the
effectiveness of treatment protocols have still to be evaluated. An
update on the current situation is awaited. - Mod.CP]

AVIAN INFLUENZA, HUMAN (74): EGYPT, 64TH CASE SUSPECTED
*******************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[This report was scheduled for posting yesterday, 16 Apr
2009. ProMED-mail apologizes for the delay in posting and any
inconvenience this may have caused. - Mod.MPP]

[1]
Date: Wed 15 Apr 2009
Source: Agence France-Presse report [edited]
<http://news.yahoo.com/s/afp/20090415/wl ... thealthflu>


Egypt woman critically ill with bird flu
----------------------------------------
A 33-year-old woman has contracted bird flu, the 64th recorded case
since the 1st outbreak of the disease in Egypt in 2006, the health
ministry announced on Wednesday [15 Apr 2009]. The woman from the
Kafr el-Sheikh province of northern Egypt is in critical condition
and on an artificial respirator, state-run news agency MENA quoted a
health ministry official as saying. She 1st showed symptoms of flu
more than a week ago after being exposed to dead fowl thought to have
been carrying the disease, the official said.

Egypt has seen an increase in bird flu cases over the past month. The
World Health Organisation (WHO) called last month [March 2009] for an
investigation into why many of the victims have been young children.
A total of 23 people have died of bird flu in Egypt. Most of the
victims have been young girls or women, who are generally in charge
of looking after poultry in rural areas.

Egypt hosted an international conference on bird flu in October
[2008], when Washington pledged an additional 320 million dollars to
the fight against the disease amid fears it may yet escalate into a
global pandemic. The H5N1 strain of the virus that is most dangerous
to humans 1st emerged in Asia in 2003 and has since caused nearly 250
deaths, according to WHO figures. Scientists fear that a mutation of
the bird flu virus resulting in a strain easily transmitted among
humans could create a pandemic, potentially affecting up to one-fifth
of the world's population.

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

******
[2]
Date: Wed 15 Apr 2009
Source: Reuters News [edited]
<http://www.reuters.com/article/healthNe ... CI20090415>


Egyptian woman contracts bird flu
---------------------------------
A 33-year-old Egyptian woman has contracted the highly pathogenic
bird flu virus, the 4th case this month [April 2009], Egyptian state
news agency MENA said Wednesday [15 Apr 2009]. MENA said the woman
came from the northern province of Kafr el-Sheikh. Her case brings to
64 the number of confirmed cases of the H5N1 avian flu virus in
Egypt, which has been hit harder by bird flu than any other country
outside Asia. Health Ministry spokesman Abdel Rahman Shahine said the
woman had started to show symptoms on 7 Apr 2009 after coming into
contact with dead birds.

While H5N1 rarely infects people, experts say they fear it could
mutate into a form that people could easily pass to one another,
sparking a pandemic that could kill millions. Since 2003 the H5N1
avian influenza virus has infected at least 411 people in 15
countries and killed 254. It has killed or forced the culling of more
than 300 million birds in 61 countries in Asia, the Middle East,
Africa and Europe.

Some 23 Egyptians have died after contracting the virus. Most came
into contact with infected domestic birds in a country where roughly
5 million households depend on domestically raised poultry as a
significant source of food and income. The World Health Organization
has said that it was concerned some Egyptians may carry the bird flu
virus without showing symptoms, which could give it more of a chance
to mutate to a strain that spreads easily among humans.

[Byline: Will Rasmussen]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[If confirmed this case and the 59th case (a 38-year-old woman in the
governorate of Assiut) will be the only adult cases among the 12
reported in Egypt since the beginning of 2009.

A map of the governorates of Egypt can be accessed at
<http://en.wikipedia.org/wiki/Governorates_of_Egypt>. The governorate
[province] of Kafr el-Sheikh is located at 13 on this map. The
HealthMap/ProMED-mail interactive map of Egypt is available at
<http://healthmap.org/r/008G>. - Mod.CP]

Avian influenza - situation in Egypt - update 11
17.04.2009 - WHO

The Ministry of Health of Egypt has reported a new confirmed human case of avian influenza . The case is a 33 year old female from Kellin district, Kfr El Sheikh Governorate. Her symptoms began on 7 April and she was hospitalized at Kfr El Sheikh Fever Hospital on 15 April where she was started on oseltamivir the same day (15 April). She is in a critical condition. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 15 April. Investigations into the source of her infection indicate a history of close contact with dead and sick poultry prior to becoming ill. Of the 64 cases confirmed to date in Egypt, 23 have been fatal.

AVIAN INFLUENZA, HUMAN (76): EGYPT (CAIRO)
******************************************
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 17 Apr 2009
Source: DeepikaGlobal.com, Reuters report [edited]
<http://www.deepikaglobal.com/ENG4_sub.a ... code=35200>


A 25-year-old Egyptian woman has contracted the highly pathogenic
bird flu virus after coming into contact with infected birds, the
latest case in a growing spate of infections in Egypt, state media
said today [17 Apr 2009].

The new infection brings to 65 the number of bird flu cases in humans
in the most populous Arab country, which has been hit harder by bird
flu than any other country outside Asia.

The woman, from El-Marg on Cairo's outskirts, was in critical
condition on a ventilator after falling ill with a fever on 11 Apr
[2009]. She was being treated with the antiviral drug Tamiflu, state
news agency MENA reported.

While H5N1 avian influenza virus rarely infects people, experts say
they fear it could mutate into a form that people could easily pass
to one another, sparking a pandemic that could kill millions.

Since 2003, H5N1 has infected at least 411 people in 15 countries and
killed 254. It has killed or forced the culling of more than 300
million birds in 61 countries in Asia, the West Asia, Africa, and
Europe.

Egypt has seen a surge in cases in recent months, with 14 people
confirmed to have contracted this virus since the start of the year
compared to 7 in the same period last year [2008]. Most of the new
cases have been young children, a change from 2008.

Some 23 Egyptians have died after contracting the bird flu virus.

Most of those infected had come into contact with infected domestic
birds in a country where roughly 5 million households depend on
domestically raised poultry as a significant source of food and
income.

The World Health Organisation said this month [April 2009] it was
concerned some Egyptians may carry the bird flu virus without showing
symptoms, which could give it more of a chance to mutate to a strain
that spreads easily among humans. The issue will be the subject of an
Egyptian government study backed by WHO.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[A HealthMap/ProMED-mail interactive map of Egypt can be accessed at
<http://healthmap.org/r/009G>. - Mod.TY]

AVIAN INFLUENZA, HUMAN (77): EGYPT (KAFR EL-SHEIKH) 66TH CASE
*************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Sun 19 Apr 2009
Source: Thomson Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/LJ499966.htm>


Egyptian girl contracts bird flu
--------------------------------
An 18 month old Egyptian girl has contracted the highly pathogenic bird flu
virus after coming into contact with infected birds, the latest case in a
growing spate of infections in Egypt, state media said on Sunday [19 Apr
2009]. The new infection brings to 66 the number of bird flu cases in
humans in the most populous Arab country, which has been hit harder by bird
flu than any other country outside Asia.

Egypt has seen a surge in human cases in recent months, with 15 confirmed
since the start of the year [2009], compared with 7 cases between 1 Jan and
17 Apr 2008.

The girl, from the north Egyptian province of Kafr el-Sheikh, was being
treated with the antiviral drug Tamiflu (oseltamivir), state news agency
MENA reported, citing the health ministry.

While the H5N1 avian influenza virus rarely infects people, experts say
they fear it could mutate into a form that people could easily pass to one
another, sparking a pandemic that could kill millions. Since 2003, H5N1 has
infected at least 412 people in 15 countries and killed 254. It has killed
or forced the culling of more than 300 million birds in 61 countries in
Asia, the Middle East, Africa, and Europe.

Some 23 Egyptians have died after contracting the bird flu virus. Most of
those infected had come into contact with infected domestic birds in a
country where roughly 5 million households depend on domestically raised
poultry as a significant source of food and income.

WHO said this month [April 2009] it was concerned that some Egyptians may
carry the bird flu virus without showing symptoms and this could give the
virus more of a chance to mutate to a strain that spreads easily among humans.

[byline: Will Rasmussen]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[2]
Date: Sun 19 Apr 2009
Source: Egyptian Chronicles [edited]
<http://egyptianchronicles.blogspot.com/ ... se-in.html>


Another H5N1 human infection case in less than 72 hours
-------------------------------------------------------
The Ministry of Health has announced today [19 Apr 2009] that a year and
half old child is no. 66 in the H5N1 human infection roll in Egypt. It is
less than 48 hours from the announcement of case no. 65. The baby girl is
from a village in the Kafr El-Sheikh [governorate in the Delta region of
Egypt]. There have been several cases [reported] from Kafr El-Sheikh this
year [2009]. Al-Fayoum, Bahaira, and Kafr El-Sheikh are the top
governorates with the highest H5N1 infection rate. The baby girl referred
to in this report was admitted to hospital on 15 Apr 2009 and has been
treated with Tamiflu (oseltamivir) and remains in a stable condition.

[posted by Zeinobia]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[The 64th case, a 33 year old woman, was also a resident of the Nile Delta
governorate of Kafr el-Sheikh. All of the cases since the beginning of 2009
have been babies and young children, with the exception of the 2 preceding
adult cases. This 66th case restores the predominance of young children as
victims of avian H5N1 influenza virus infection.

A map of the governorates of Egypt can be accessed at
<http://en.wikipedia.org/wiki/Governorates_of_Egypt>. The governorate of
Kafr el-Sheikh is located at 13 on this map. The HealthMap/ProMED-mail
interactive map of Egypt is available at <http://healthmap.org/r/009S>. -
Mod.CP]

Avian influenza - situation in Egypt - update 12
21.04.2009 - WHO

The Ministry of Health of Egypt has reported two new confirmed human cases of avian influenza. 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. She is in a critical condition. Investigations into the source of her infection indicated close contact with sick poultry prior to becoming ill. The second case is 18-month old female from Kellin District, Kafr Elsheikh Governorate. Her symptoms began on 15 April and she was hospitalized at Kafr Elsheikh Fever Hospital on 18 April where she was started on oseltamivir on the same day of hospitalization. Her condition is stable. Investigations into the source of infection indicated close contact with dead and sick poultry prior to becoming ill. For both cases, infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory and subsequently confirmed by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3).

Of the 66 cases confirmed to date in Egypt, 23 have been fatal.

AVIAN INFLUENZA, HUMAN (79): EGYPT, 67TH CASE
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Tue 21 Apr 2009
Source: Bloomberg News [edited]
<http://www.bloomberg.com/apps/news?pid= ... Q9cmxVYmZw>


A 6 year old boy has died in Egypt after contracting avian influenza,
becoming the country's 24th human casualty of the disease since 2006, the
state-run Middle East News Agency reported today [21 Apr 2009]. The boy is
the 1st fatality attributed to the virus in Egypt this year [2009], the
news agency quoted Abdel-Rahman Shahine, a spokesman for the Health
Ministry, as saying. The boy had shown symptoms of the virus on 22 Mar 2009
after coming in contact with dead birds, Shahine said.

Egypt has the highest number of avian flu cases outside Asia, according to
the most recent data from the World Health Organization. With the newest
reports, the number of infected people there has reached 67. The Health
Ministry reported the 67th infection earlier today [21 Apr 2009], saying a
4 year old child has contracted the virus. He was in the hospital in what
was described as stable condition. He has received Tamiflu (oseltamivir)
treatment according to Shah.

Egypt has asked WHO to help investigate an outbreak of the so-called bird
flu after a dozen non-fatal cases of the disease this year [2009] prompted
speculation the virus may be becoming less virulent [and more
transmissible. - Mod.CP]

[byline: Alaa Shahine]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[2]
Date: Tue 21 Apr 2009
Source: Egyptian Chronicles [edited]
<http://egyptianchronicles.blogspot.com/ ... egypt.html>


The Ministry of Health has just announced that a 6 year old child is no. 24
in the H5N1 death toll. The boy died today [21 Apr 2009]. He was from
Shubra Kheima at Qalyubia [governorate]. He began to suffer from H5N1
symptoms on 22 Mar 2009 and was admitted to hospital on 28 Mar 2009. He was
given Tamiflu (oseltamivir) and he [remained] in critical condition till
the end.

This is not the end of H5N1 news today [21 Apr 2009]. The Ministry of
Health has announced too that a 4 year old child was infected by H5N1 in
Sohag [governorate], Upper Egypt. He is no. 67. He entered the hospital on
the 18 Apr 2009 and he has received Tamiflu treatment.

[posted by Zeinobia]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[The death of the young child in Qalyubia governorate is the 1st fatality
in the sequence of 16 cases recorded in Egypt since the beginning of 2009.
This death weakens the argument that the outbreak virus is less virulent
than in previous years.

A map of the governorates of Egypt can be accessed at
<http://en.wikipedia.org/wiki/Governorates_of_Egypt>. The governorate of
Sohag, the residence of the 67th case, is located at 24 on this map and the
governorate of Qalyubia at 20. The HealthMap/ProMED-mail interactive map of
Egypt is available at <http://healthmap.org/r/009Y>. - Mod.CP]

Avian influenza - situation in Egypt - update 13
23.04.2009 - WHO

The Ministry of Health of Egypt has reported a new confirmed human case of avian influenza . The case is a 4 year old male from Akhmim District, Sohag Governorate. His symptoms began on 18 April and he was hospitalized at Sohag Fever Hospital on 18 April where he was started on oseltamivir. He is in a stable condition. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 21 April and subsequently confirmed by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3). Investigations into the source of his infection indicate a history of close contact with dead and sick poultry prior to becoming ill. Of the 67 cases confirmed to date in Egypt, 23 have been fatal.

AVIAN INFLUENZA, HUMAN (80): EGYPT, 25TH FATALITY
*************************************************
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: Wed 22 Apr 2009
Source: Reuters (UK) News [edited]
<http://uk.reuters.com/article/americasC ... UKLM402988>


A 25 year old Egyptian woman has died of the H5N1 bird flu virus, the 25th
human fatality of the disease in Egypt, state news agency MENA said on
Wednesday [22 Apr 2009]. The woman, from Cairo, died of respiratory
failure, MENA reported. [See ProMED-mail posting Avian influenza, human
(76): Egypt (Cairo) 20090418.1472].

On Tuesday [21 Apr 2009] MENA reported a 6 year old boy had died from the
disease. He resided in Qalyubia [governorate] and was Egypt's 1st bird flu
fatality of 2009, MENA quoted a health ministry spokesman as saying. The
boy had been admitted to hospital in late March [2009]. [See ProMED-mail
posting Avian influenza, human (79): Egypt, 67th case 20090422.1517].

A 4 year old boy from Sohag [governorate] has contracted bird flu and was
in hospital. The boy was being treated with the antiviral drug Tamiflu. His
infection brought to 67 the number of bird flu cases in humans in the most
populous Arab country, which has been hit harder by bird flu than any other
country outside Asia. [See ProMED-mal posting Avian influenza, human (79):
Egypt, 67th case 20090422.1517].

Egypt has seen a surge in human cases in recent months, with 16 confirmed
since the start of the year [2009], compared to 7 cases between 1 Jan and
17 Apr last year [2008]. Most infected Egyptians had come into contact with
infected domestic birds in a country where roughly 5 million households
depend on domestically raised poultry as a significant source of food and
income. The World Health Organisation said this month [April 2009] it was
concerned some Egyptians may carry the bird flu virus without showing
symptoms and this could give the virus more of a chance to mutate to a
strain that spreads easily among humans.

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

[This is the 2nd fatality among the 16 cases recorded in Egypt since the
beginning of 2009. These 2 fatalities weaken the argument that the 2009
outbreak virus may be less virulent (and as a consequence more
transmissible) than the virus circulating in previous years when there were
higher mortalities. - Mod.CP]

AVIAN INFLUENZA, HUMAN (82): EGYPT (AL GHARBIYAH), 68TH CASE
************************************************************
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 24 Apr 2009
Source: Egyptian Chronicles [edited]
<http://egyptianchronicles.blogspot.com/ ... -h5n1.html>


Another woman infected by H5N1
------------------------------
The Ministry of Health has announced that a 34 year old woman from Tanta
[city, Al Gharbiyah governorate] in the Nile Delta is no. 68 in the H5N1
human infection toll in Egypt. The woman began to show symptoms on 21 Apr
2009 and she was admitted to hospital on the same day. She had contact with
infected domestic poultry. She is receiving Tamiflu (oseltamivir)
treatment. The ministry says that her condition is stable.

[byline: Zeinobia]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[A map of the governorates of Egypt can be accessed at
<http://en.wikipedia.org/wiki/Governorates_of_Egypt>. The governorate of Al
Gharbiyah is located at 10 on this map. The HealthMap/ProMED-mail
interactive map of Egypt is available at <http://healthmap.org/r/00ag>. -
Mod.CP]

Avian influenza - situation in Egypt - update 14
06.05.2009 - WHO

The Ministry of Health of Egypt has reported a new confirmed human case of avian influenza . The case is a 34 year old female from Tanta District, Gharbia Governorate. Her symptoms began on 21 April and she was hospitalized at Tanta Fever Hospital on 21 April where she was started on oseltamivir. She is in a stable condition. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 23 April and subsequently confirmed by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3). Investigations into the source of his infection indicate a history of close contact with dead and sick poultry prior to becoming ill. Of the 68 cases confirmed to date in Egypt, 23 have been fatal.

AVIAN INFLUENZA, HUMAN (86): EGYPT, AGE-SPECIFIC RATES
***********************************************
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 7 May 2009
Source: Eurosurveillance, Volume 14, Issue 18 [edited]
<http://www.eurosurveillance.org/ViewArt ... cleId=1919>


Age-specific infection and death rates for human A(H5N1) avian
influenza in Egypt. By J. P. Dudley, Science Applications
International Corporation, Modeling and Analysis Division, Rockville,
Maryland, United States
-----------------------------------------------
The age-specific infection and death profiles among confirmed human
cases of influenza A(H5N1) infection in Egypt differ markedly from
those recorded in other countries. The case fatality rate among human
H5N1 cases in Egypt is 34 percent, versus an average of 66 percent in
other countries. In Egypt, children younger than 10 years comprise 48
percent of reported cases, nearly twice the global average of
approximately 25 percent, and no H5N1 fatalities have been confirmed
among individuals in this age group as of 23 Apr 2009. Females
outnumber males among confirmed H5N1 cases by a factor of nearly 2:1,
and 90 percent of reported fatalities in Egypt have been females. The
evident age and sex biases in morbidity and mortality among H5N1
cases in Egypt are phenomena that warrant further investigation and analysis.

Introduction:
The 1st cases of human infection with avian influenza type A(H5N1)
were reported from Egypt in March 2006, and a cumulative total of 67
confirmed cases including 23 fatalities have been reported as of 23
Apr 2009 [1]. There are evident anomalies in the age distribution and
sex ratio of human mortality from influenza A(H5N1) in Egypt relative
to those reported from other countries that warrant detailed
investigation and analysis.

Methods:
Published information on human H5N1 cases in Egypt was analysed to
develop a 1st order comparative analysis of age-specific and
sex-specific infection and mortality patterns between human H5N1
cases in Egypt and those in other areas of the world. The age and
case history data of patients with confirmed influenza A(H5N1)
infection in Egypt used in this analysis were derived from reports
published by the United States Naval Medical Research Unit No. 3 in
Cairo, Egypt [2] and the World Health Organization (WHO), available
as of 23 Apr 2009 [1].

Results:
Human H5N1 cases in Egypt are most frequently reported among children
younger than 10 years, and approximately 80 percent of all reported
cases have occurred among individuals under the age of 30 years. In
Egypt, children under the age of 10 years comprise 48 percent of all
reported cases, nearly double the current global average of
approximately 25 percent [3]. A median age of 8 years has been
reported for human H5N1 cases in Egypt between March 2006 and March
2009 [2], versus a median age of 18 years for WHO-confirmed human
cases globally between November 2003 and November 2006 [4].

The age-specific infection and death profiles among confirmed human
A(H5N1) cases in Egypt differ markedly from those recorded in Asia
and Indonesia when compared to cumulative data for countries
worldwide other than Egypt, Nigeria, and Turkey [These data are
illustrated by 2 figures in the original text.]. The case fatality
rate from human H5N1 cases in Egypt confirmed as of 23 Apr 2009 is
only 34 percent (23 of 67), versus an average of 66 percent among
WHO-confirmed cases from all countries other than Egypt (234 of 354
cases as of 23 Apr 2009) [5].

Human mortality from H5N1 in Egypt is highly biased towards females
(90 percent: 21 females, 2 males), with confirmed mortality only
reported among individuals older than 9 years. Although the sex ratio
of cases in most countries is approximately 1:1, females outnumber
males among confirmed cases in Egypt by a factor of nearly 2:1 (43
females: 24 males). Although the average case fatality rate from H5N1
among children aged 0-9 years from all countries other than Egypt and
Turkey is 59 percent, no confirmed fatalities among 33 children in
this age cohort have been reported from Egypt as of 23 Apr 2009. A
similar pattern is evident for H5N1 cases in Turkey during January
2006; although 11 of 21 confirmed H5N1 cases in Turkey were children
in the age group 0-9 years, no confirmed fatalities were reported in
this age cohort [6].

Discussion:
There is increasing concern that undetected H5N1 cases may be
occurring in Egypt, given the evident anomalies in observed age-
specific and sex-specific case incidence and fatality rates. Although
there appears to be no compelling evidence for human-to-human
transmission of H5N1 in Egypt, family clusters have been observed in
Egypt, and H5N1 clusters involving highly probable human-to-human
transmission have been documented in China, Thailand, Viet Nam,
Indonesia, and Pakistan [7].

The most characteristic presentation of humans with fatal H5N1 virus
infections is severe lower respiratory disease accompanied by
hypercytokinaemia of the alveolar tissues. The pathology of most
fatal H5N1 cases resembles those of fatal human severe acute
respiratory syndrome (SARS) infections, and a suspected SARS case in
China during November 2003 was subsequently confirmed as a fatal H5N1 case [8].

The existing anomalies with regard to age and sex may be attributable
in part to the existence of undetected fatal or non-fatal atypical or
asymptomatic human H5N1 infections. Although human infections with
the H5N1 virus are typically associated with respiratory symptoms,
the clinical spectrum of H5N1 infections in humans is extremely
broad, and H5N1 virus has been recovered from lung, brain, large
intestine, small intestine, cerebrospinal fluid, kidney, spleen,
liver, pharynx, blood, and placental tissues [9]. Fatal atypical
human H5N1 infections involving only gastrointestinal and
neurological symptoms have been documented from patients in Viet Nam
and Thailand [10]. Asymptomatic human infections with H5N1 have been
reported from China, Viet Nam, Japan, Thailand, and Korea [11].

Clinically mild illness from highly pathogenic avian influenza (HPAI)
H5N1 virus infection has been reported from children in most
countries, but the early detection and treatment of possible cases
may be a factor in the overall lower case fatality rate reported for
H5N1 cases in Egypt. Although a median time of 4 days from symptom
onset to hospitalization has been reported for H5N1 cases worldwide
[4], nearly 50 percent of confirmed cases in Egypt are admitted to
hospitals within 24 hours after the 1st onset of symptoms, and
approximately 70 percent are hospitalized within 72 hours after
symptom onset [2].

Conclusions:
The evident age and sex biases in the incidence of infection and
mortality among H5N1 cases from Egypt are phenomena that have not
been fully explained and merit further in-depth investigation and
analysis. Further research is needed to understand the immediate and
long-term health risks of avian influenzas for human populations and
to identify those members of exposed populations who are at greatest
risk of infection and serious disease from avian influenza viruses.
Although most cases in Egypt can be linked to contact with diseased
poultry, increasing numbers of confirmed human H5N1 cases with no
evident history of direct exposure to diseased poultry or birds are
being reported from China and Indonesia. Efforts need to be made to
evaluate potential background rates of asymptomatic and mild cases of
human avian influenza in communities where human H5N1 clusters have
been documented and to evaluate potential instances of human-to-human
transmission of H5N1 in Egypt.

References:
(1) World Health Organization. Epidemic and Pandemic Alert and
Response (EPR). Disease outbreaks by country. Egypt. Geneva: World
Health Organization; 2009 Apr 23. Available from:
<http://www.who.int/csr/don/2009_04_23a/en/index.html>.
(2) United States Naval Medical Research Unit No. 3. Influenza
Activities Report. February-March 2009. Egypt. Available from:
<http://www.geis.fhp.osd.mil/GEIS/Survei ... h_2009.pdf>.
(3) World Health Organization Western Pacific Regional Office. Avian
Influenza A(H5N1) Cases by Age Group and Outcome. Geneva: World
Health Organization Western Pacific Regional Office; 2009 Mar 23.
Available from:
<http://www.wpro.who.int/NR/rdonlyres/FD ... Slide4.jpg>.
(4) Peiris JSM, de Jong MD, Guan Y. Avian influenza virus (H5N1): a
threat to human health. Clin Microbiol Rev. 2007;20(2):243-67. Available from:
<http://cmr.asm.org/cgi/content/full/20/ ... idemiology>.
(5) Epidemic and Pandemic Alert and Response (EPR). Cumulative Number
of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO.
Geneva: World Health Organization; 2009 Apr 23. Available from:
<http://www.who.int/csr/disease/avian_in ... index.html>.
(6) World Health Organization. Epidemic and Pandemic Alert and
Response (EPR). Disease outbreaks by country. Turkey. Available from:
<http://www.who.int/csr/don/2006_01_18/en/index.html>.
(7) Nicoll A. (Yet) another human A/H5N1 influenza case and cluster -
when should Europe be concerned? Euro Surveill.
2008;13(15):pii=18833. Available from:
<http://www.eurosurveillance.org/ViewArt ... leId=18833>.
(8 ) Zhu QY, Qin ED, Wang W, Yu J, Liu BH, Hu Y, et al. Fatal
infection with influenza A (H5N1) virus in China. New Engl J Med.
2006;354(25): 2731-2. Available from:
<http://content.nejm.org/cgi/content/full/354/25/2731>.
(9) Ng WF, To KF. Pathology of human H5N1 infection: new findings.
Lancet 2007;370(9593):1106-8.
(10) de Jong MD, Hien TT. Avian influenza A (H5N1). J Clin Virol.
2006;35(1):2-13. Available from:
<http://www.prbo.org/cms/docs/birdflu/de ... rology.pdf>.
(11) Dudley JP. Public health and epidemiological considerations for
avian influenza risk mapping and risk assessment. Ecology and Society
2008;13(2):21. Available from:
<http://www.ecologyandsociety.org/vol13/iss2/art21/>.

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

[The differences in the age-specific infection and death rates in
Egypt in comparison with the situation elsewhere among countries
affected by avian influenza A(H5N1) virus infection are striking and
need to be further elucidated. As stated by the author, efforts need
to be made to evaluate potential background rates of asymptomatic and
mild cases of avian A(H5N1) influenza in different economic
conditions and racial backgrounds. - Mod.CP]

AVIAN INFLUENZA, HUMAN (87): EGYPT (SOHAG) 69TH CASE
****************************************************
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: Sun 10 May 2009
Source: Reuters News [edited]
<http://www.reuters.com/article/europeCr ... USLA506331>


Egyptian girl contracts bird flu, 69th case
-------------------------------------------
A 5 year old Egyptian girl has contracted the highly pathogenic bird flu
virus after coming into contact with infected birds, the state news agency
MENA reported on Sunday [10 May 2009].

This case brings to 69 the number of people confirmed to have contracted
H5N1 avian influenza virus in Egypt, which has been hit harder than any
another country outside Asia. While the avian influenza virus rarely
infects people, experts say they fear it could mutate into a form people
could easily pass to one another, sparking a pandemic that could kill millions.

MENA, citing the Health Ministry, said the girl from Sohag province was
admitted to hospital on Saturday [9 May 2009]. It said she was being
treated with the antiviral drug Tamiflu (oseltamivir) and was in a stable
condition.

Some 26 Egyptians have died after contracting the virus. Most of those
infected had come into contact with infected domestic birds in a country
where roughly 5 million households depend on domestically raised poultry as
a significant source of food and income. Last month [April 2009], Egypt
ordered the culling of all the country's 300 000 to 400 000 pigs as a
precaution against the new H1N1 influenza strain, also known as swine flu.

The World Health Organization on Sunday [10 May 2009] reported 4379 people
in 29 countries have been infected by the new [H1N1] virus. No cases have
been reported in Egypt.

[byline: Edmund Blair]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[This 69th case conforms to the age-specific rate pattern, which
distinguishes cases of avian A (H5N1) influenza as discussed in the
Eurosurveillance article by Dr JP Dudley reproduced in the preceding
ProMED-mail post (Avian influenza, human (86): Egypt, age-specific rates
20090507.1708).

Sohag province (no. 24) can be located in the map of the governorates of
Egypt at <http://en.wikipedia.org/wiki/Governorates_of_Egypt>. The
HealthMap/ProMED-mail interactive map of Egypt is available at
<http://healthmap.org/r/00bO>. - Mod.CP]

AVIAN INFLUENZA, HUMAN (88 ): EGYPT (SHARKIYA), 70TH CASE
********************************************************
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 14 May 2009
Source: Reuters News [edited]
<http://www.reuters.com/article/africaCr ... USLE534551>


A 4 year old Egyptian boy has contracted the highly pathogenic H5N1 bird
flu virus, bringing to 70 the number of human avian flu cases in the most
populous Arab country, the state news agency MENA reported.

Egypt has been hit harder by the virus than any other country outside Asia
and has seen a surge of cases in recent weeks. Ten new human infections
have been reported since 1 Apr 2009, more than the country saw in all of
2008. The latest sufferer from the virus is from the Nile Delta province of
Sharkiya, MENA said.

The avian flu virus rarely infects people, but experts say they fear it
could mutate into a form that humans could easily pass to one another,
sparking a pandemic that could kill millions. Some 26 Egyptians have died
after contracting the virus. Most of those infected had come into contact
with infected domestic birds, in a country where 5 million households raise
poultry as a significant source of food and income.

MENA reported that the boy, believed to have contracted the virus from sick
household birds, had entered hospital suffering from a high fever and
showing flu symptoms. He was being treated with the anti-viral drug Tamiflu
[oseltamivir] and was in a stable condition, MENA added.

Last month [April 2009], Egypt ordered the culling of all the country's 300
000 to 400 000 pigs as a precaution against the new H1N1 influenza strain,
also known as swine flu, which has infected nearly 6000 people in more than
30 countries. The new virus has not been detected in Egypt so far.

Since 2003, the more deadly H5N1 bird flu virus has infected more than 400
people in 15 countries and killed more than 250. It has killed or forced
the culling of more than 300 million birds in 61 countries in Asia, the
Middle East, Africa and Europe.

[byline: Cynthia Johnston]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[This 70th case further conforms to the age-specific rate pattern, which
distinguishes cases of avian A (H5N1) influenza as discussed in the
Eurosurveillance article by Dr JP Dudley reproduced in a recent ProMED-mail
post (Avian influenza, human (86): Egypt, age-specific rates 20090507.1708).

Sharkiya province (no. 23) can be located in the map of the governorates of
Egypt at <http://en.wikipedia.org/wiki/Governorates_of_Egypt>. The
HealthMap/ProMED-mail interactive map of Egypt is available at
<http://healthmap.org/r/00bO>. - Mod.CP]