Egypt: A Paltry Poultry Vaccine

 

Photo Credit – FAO

 

 

# 6800

 

While the response of much of the world to outbreaks of highly pathogenic avian influenza (primarily H5N1) involves the immediate culling of all infected birds (and all birds in their vicinity), some countries rely instead on a combination of prophylactic poultry vaccination and strategic culling. 

 

Politically, and economically, it is easy to see why countries like Indonesia, Egypt, Vietnam, and China prefer to rely on vaccines.

 

Chickens and ducks are often raised in backyard or neighborhood coops, are the main source of protein for many families, and often represent a sizable portion of their wealth as well.

 

Ordering their destruction at the first sign of illness only encourages bird owners to hide or quickly sell their flocks, for fear of losing them entirely. In the past, we’ve seen angry confrontations between culling teams and poultry owners in places like India and Egypt.

 

Whether due to causation or coincidence, countries that rely primarily on a vaccination strategy seem to be the ones experiencing the most persistent bird flu problems.

 

Experts, like Professor C.A. Nidom, of the Institute of Tropical Disease, Airlangga University have warned in the past that the use of avian flu vaccines may only provide partial protection, allowing the virus to spread `silently’ through a flock (see Indonesia: Debate Over Poultry Vaccination).  

 

Similar warnings were expressed in early 2009 from Zhong Nanshan, a hero of the SARS outbreak and a highly respected respiratory disease specialist in China, who warned that vaccinated poultry can still become infected with the H5N1 virus.

 

Chinese expert issues new bird flu warning

www.chinaview.cn 2009-02-06 17:59:50

GUANGZHOU, Feb. 6 (Xinhua) -- A leading Chinese expert on respiratory diseases has warned the public to be aware that poultry can be infected with the bird flu virus but show no symptoms.

 

"Special attention should be paid to such animals, including those that have been vaccinated," said Zhong Nanshan.

 

"The existing vaccines can only reduce the amount of virus, rather than totally inactivating it," he said.

(Continue . . . )

 

And for years the OIE (World Organization For Animal Health) has warned that vaccination of poultry cannot be considered a long-term solution to combating the avian flu virus.

 

In Avian influenza and vaccination: what is the scientific recommendation?, the OIE reiterates their strong recommendation that humane culling be employed to control avian influenza, and advising that vaccines should only be used as a temporary measure.

 

While the OIE concedes that some nations may require the use of vaccines for `several years', they strongly urge that countries move away from that program and towards the more conventional culling policy.

 

They call this shift away from vaccines an `Exit Strategy’, a policy which China, Indonesia, Vietnam, and Egypt have shown no moves towards.

 

In the spring of 2010 we began to see reports of poultry vaccine failures in Vietnam due to the spread of a new clade (classified as clade 2.3.2.1), which led to this statement FAO Warns On Bird Flu.

 

With dozens of clades (and variants within clades) of the H5N1 virus in circulation, it is not surprising that vaccines that have been in use for several years are no longer protective.

 

Which brings us to a new study – conducted by the Virology department at St. Jude Children’s Research Hospital -  appearing in the journal Poultry Science, that looks at the effectiveness of six commercially available H5 poultry vaccines currently deployed in Egypt.

 

Of the 6 vaccines tested, only one (based on a locally acquired H5N1 seed virus) actually appears to offer protection.

 

 

Poult Sci. 2013 Jan;92(1):114-8. doi: 10.3382/ps.2012-02637.

Do commercial avian influenza H5 vaccines induce cross-reactive antibodies against contemporary H5N1 viruses in Egypt?

Kayali G, Kandeil A, El-Shesheny R, Kayed AS, Gomaa MR, Kutkat MA, Debeauchamp J, McKenzie PP, Webster RG, Webby RJ, Ali MA.

Abstract (reparagraphed for readability)

After emerging in Egypt in 2006, highly pathogenic avian influenza H5N1 viruses continued to cause outbreaks in Egyptian poultry and sporadic human infections. The strategy used by Egyptian authorities relied on vaccinating poultry, depopulating infected areas, and increasing awareness and biosecurity levels.

 

Despite those efforts, H5N1 became endemic, and vaccine-escape variants are thought to have emerged even though commercial poultry vaccines were protective in laboratory settings. We studied the cross-reactivity of 6 commercially available H5 poultry vaccines against recent H5N1 Egyptian isolates in a field setting in Egypt.

 

Only one vaccine based on an Egyptian H5N1 virus induced high cross-reactive antibody titers. Our results may be explained by the fact that the seed viruses in these vaccines are genetically distinct from H5N1 viruses currently circulating in Egypt.

 

In light of our findings, we recommend that the H5N1 prevention and control strategy in Egypt be updated and reinforced. Special consideration should be given to the vaccination strategy, and the use of vaccines based on currently circulating viruses is advisable.

 

The problem of mismatched poultry vaccines isn’t specific to Egypt, of course. 

 

Recently Hong Kong announced their intention to upgrade their existing vaccine (see New poultry vaccine to be introduced) by the end of 2012. Similarly, Vietnam is now testing a new H5N1 vaccine against the emerging  2.3.2.1 clade of the virus.

 

And over the past few weeks we’ve seen multiple reports of poultry (mostly duck) die offs in Indonesia (see VOA Report On The Indonesian Duck Die Off), concurrent with the recent arrival of clade 2.3.2.1, suggesting their vaccine may be faltering as well.

 

The debate over the merits of culling verses vaccination continues, but one point seems clear. For a poultry vaccination program to work, the vaccine must closely match the viruses locally in circulation.

 

Otherwise, the use of poorly matched vaccines has the potential to merely mask signs of infection in a flock, enabling the virus to spread silently, and possibly mutate further.

»» Read More

WHO: H5N1 Update

 

 

# 6791

 

The World Health Organization recently changed the way it reports on human infections with the H5N1 virus with the following notice.

 

Henceforward, WHO will publish information on human cases with H5N1 avian influenza infection on a monthly basis on the Influenza webpage.

 

Cases of human infection with H5N1 will only be reported on Disease Outbreak News for events that are unusual or associated with potential increased risks.

 

Today, we’ve an update that indicates two new infections (1 in Egypt, 1 in Indonesia ) have been reported since the November update (see Latest HAI Risk Assessment Summary 17 December 2012).

 

Based on previous years’ observations, an increase in reported H5N1 influenza events in poultry is expected for this time of year. Sporadic human cases reported this month in countries with known influenza A(H5N1) virus activity in poultry are within the expected range. No onward sustained human to human transmission was reported.

Public health risk assessment  of  avian  influenza  A(H5N1)  viruses:    The public health risk remains
unchanged. 

 

Neither of these two cases are exactly `news’, in that we saw an Indonesian MOH report on the 4 year-old last week, as well as an FAO report indicated a human case in Egypt.

 

As you can see from the chart above, increases in human infections with the H5N1 virus typically increase in the fall, and peak during the winter and spring.

 

This report also takes note of the H3N2v infection reported by the CDC (see FluView & A Novel Flu Case In Iowa) in November.  Since then, another case has been reported in Minnesota (see FluView Week 49).

The WHO report concludes by stating:

Overall public health risk assessment of the influenza A(H3N2)v viruses: Further human cases and small clusters may be expected as this virus is circulating in the swine population in the USA. Close monitoring of the situation is warranted.

Due to the nature of constant evolving of influenza viruses, WHO continues to stress the importance of
global monitoring of influenza viruses and recommends all Member States to strengthen routine
influenza surveillance.

 

For now, infections with variant swine flu viruses, and with avian influenza, remain sporadic and only rarely reported. 

»» Read More

Watching Egypt

 

UPDATED 9/18/12:  Sharon Sanders on FluTrackers has posted a notice from Egypt’s Undersecretary of Health stating that these three cases have tested negative.

# 6558

 

 

Overnight a number of Arabic-Language news reports have emerged from Egypt indicating that three brothers (ages 19,16, 9) from the village of Manshiet Galal are being tested for suspected `bird flu’.

 

Sharon Sanders at FluTrackers started a thread last night, with several of these news reports, and Laidback Al has produced a handy map of the location.

 

 

Meanwhile Crof, at Crofsblog, has prevailed upon an Arabic-speaking friend to translate one of the news reports – that increases its readability considerably over machine translations - which you’ll find at Egypt: Suspected H5N1 in three brothers.

 

We haven’t heard much out of Egypt this year, with the last confirmed H5N1 infection reported in early June (see WHO: Egypt Announces New H5N1 Case) – making Egypt’s 10th case of 2012.

 

Given the ongoing political and social turmoil in the Middle-East, it isn’t entirely clear how diligent surveillance and reporting on disease outbreaks like H5N1 are right now.

 

For now, these three cases reported today are just suspected cases, and it is often the case that suspected cases prove to have some other illness.

 

I’ll provide an update when we learn more.

»» Read More

WHO: Egypt Announces New H5N1 Case

 

 

 

# 6371

 

Although we don’t have a lot of details available with this report, the World Health Organization has posted a notification from the Egyptian Ministry of Health of their 10th H5N1 infection of 2012 – that of a 4 year-old girl from Kfr -Elsheikh governorate

 

Of note, this case occurred in late April, and the girl was treated and then released from the hospital on May 7th, but is only just now being reported.

 

This raises the question as to whether the child was suspected to have avian flu at the time of her hospitalization.

 

On rare occasions – such as we saw last January (see WHO Avian influenza - situation in Egypt – update) – H5N1 cases have only been identified after-the-fact through routine testing of flu virus samples collected from sentinel flu sites.

 

 

 

In any event, here is the WHO update:

 

Avian influenza – situation in Egypt – update

7 June 2012 - The Ministry of Health and Population of Egypt has notified WHO of a new case of human infection with avian influenza A(H5N1) virus.

 

The case is a four year-old female from Kfr -Elsheikh governorate. She developed symptoms on 25 April 2012, was admitted to a hospital on 26 April 2012 and received oseltamivir treatment upon admission. She was discharged from the hospital on 7 May 2012.

 

Investigations into the source of infection indicated that the case had exposure to backyard poultry.

The case was confirmed by the Central Public Health Laboratories and the Naval Medical Research Unit 3 (NAMRU-3), a WHO reference laboratory.

To date, a total of 168 cases have been confirmed in Egypt, of which 60 have been fatal.

 

Cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO

 

»» Read More

Laurie Garrett: Risks Of FMD & Bird Flu Destabilizing Egypt

Photo Credit – FAO

 

 

# 6325

 

From Laurie Garrett and Steven A. Cook an important story in The Atlantic this morning on the growing destabilization of Egypt due to the spread of FMD and Avian flu.

 

I’ll just step aside and invite you to read:

 

Egypt's Real Crisis: The Dual Epidemics Quietely Ravaging Public Health

International May 14 2012, 7:01 AM ET

A combination of avian flu and foot and mouth disease risk destroying the protein supply, eroding public trust, and further destabilizing the Arab world's most populous country . . .

(Continue . . . )

»» Read More

WHO: Egypt Reports Avian Flu Fatality

 

# 6277

 

 

The World Health Organization has posted a new update today on H5N1 in Egypt, with details on a 36 year old female patient who died on April 7th.

 

Although no explanation is provided, this patient was not hospitalized until a week into her illness. She died on the same day that she was admitted.

 

 

 

Avian influenza – situation in Egypt – update

12 April 2012 - The Ministry of Health and Population of Egypt has notified WHO of a new case of human infection with avian influenza A (H5N1) virus.

The case is a 36 year-old female from Giza governorate. She developed symptoms on 1 April 2012 and was admitted to a hospital on 7 April 2012 and died on the same day.

The case was confirmed by the Central Public Health Laboratories; a National Influenza Center of the WHO Global Influenza Surveillance Network.

Epidemiological investigations into the source of infection indicate that the case had exposure to backyard poultry.

 

Of the 167 cases confirmed to date in Egypt, 60 have been fatal.

 

 

The latest global tally of human H5N1 cases from the WHO show 23 confirmed H5N1 infections for 2012, and 14 fatalities.

 

»» Read More

WHO: Egypt Reports Another Bird Flu Fatality

 

 

# 6234

 

 

For the sixth time since the start of the year Egypt has reported a human H5N1 infection - and as in the case of two others this year from that nation - this one proved fatal.

 

This update from the World Health Organization’s GAR (Global Alert & Response) page.

 

 

Avian influenza – situation in Egypt – update

19 March 2012 - The Ministry of Health and Population of Egypt has notified WHO of a new cases of human infection with avian influenza A (H5N1) virus.

The case is a 40 year-old female from Dakahlia Governorate. She developed symptoms on 6 March 2012, was hospitalised on 12 March 2012. She was in critical condition and received oseltamivir upon admission. She died on 15 March 2012.

The case was laboratory confirmed by the Central Public Health Laboratories(NIC).

Investigations into the source of infection indicate that the case had exposure to sick backyard poultry.

Of the 164 cases confirmed to date in Egypt, 58 have been fatal.

 

 

Up until the `Arab Spring’ revolution of a year ago, we often caught wind of H5N1 cases in the press – sometimes days before the Ministry of Health would make an official announcement.

 

That happens far less often today, although the newshounds on the flu forums continue to scour the Arabic press, looking for reports.

 

While we’ve seen 19 confirmed cases from 6 countries already this year, bird flu remains very difficult for humans to contract. The concern is that the virus will mutate, and better adapt to humans, over time.

»» Read More

WHO: Egypt Announces Two New Bird Flu Cases

 

 

# 6180

 

The World Health Organization has posted a new update in their GAR (Global Alert & Response) system regarding two new H5N1 human infections in Egypt, both of which proved fatal.

These are the 4th and 5th H5N1 infections reported in Egypt this year and the first fatalities. A hat tip to Françoise Ramona on FluTrackers for posting this in the French forum.

 

 

Avian influenza – situation in Egypt – update

28 February 2012 - The Ministry of Health and Population of Egypt has notified WHO of two new cases of human infection with avian influenza A (H5N1) virus.

 

The first case is a thirty-two year old male from Behira governorate, in the Abo Elmatameer District. He developed symptoms on 16 February 2012 and was admitted to hospital on 21 February 2012 where he received oseltamivir treatment upon admission. He died on 28 February 2012.

 

The second case was a thirty seven year-old female from Kafr Elshihk governorate in the Kelleen District. She developed symptoms on 18 February 2012 and was admitted to hospital on 23 February 2012 where she received oseltamivir treatment upon admission. She died on 26 February 2012.

 

Preliminary investigations into both cases with regard to the source of infection indicate close contact with sick or deceased backyard poultry at the cases' respective residences.

 

Both cases were confirmed by the Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

 

Of the 163 cases confirmed to date in Egypt 57 have been fatal.

 

»» Read More

Egypt & Indonesia Confirm New H5N1 Cases

 

# 6170

 

 

This morning we’ve two reports of human infection from the H5N1 virus, one of which has proved fatal.

 

First stop, is Egypt, where the World Health Organization has announced their 3rd case of 2012, a 1 year-old girl from Gharbeia governorate who is recovering.

 

Avian influenza – situation in Egypt – update

24 February 2012 - The Ministry of Health and Population of Egypt has notified WHO of a new case of human infection with avian influenza A (H5N1) virus.‪

 

The case is a one year-old female from Gharbeia governorate. She developed symptoms on 14 February 2012 and was admitted to a hospital on 15 February 2012, where she received oseltamivir treatment upon admission. She is in good medical condition.

 

Epidemiological investigation into the source of infection is ongoing. Preliminary investigations indicate presence of backyard poultry in her area of residence.

 

The case was confirmed by the Central Public Health Laboratories; a National Influenza Center of the WHO Global Influenza Surveillance Network.

 

Of the 160 cases confirmed to date in Egypt, 55 have been fatal.

Meanwhile, the Indonesian Ministry of Health has posted a notice regarding the bird flu infection, and death, of a 12-year-old boy from Bali.

A hat tip to Gert van der Hoek on FluTrackers for the following link.

 

Development of Bird Flu Cases

February 24, 2012 | 1:33 pm

Ministry of Health through the Directorate General of Disease Control and Environmental Health, announced a new case of H5N1 have been confirmed by the Center for Basic Biomedical and Health Technology, Balitbangkes.

 

Case on behalf of DWM (male, 12 years) resident of Badung, Bali. Dated February 11, 2012 fever symptoms develop, see a doctor in private clinics and hospitals. On February 16, 2012 the case was being treated RS. Because of increased shortness, on February 20, 2012 the case was referred to the Referral Hospital Bird Flu, but eventually the case died on February 21, 2012.

 

Epidemiological investigations have been conducted in the home and neighborhood environment cases by the local Health Department with the results of risk factors is unclear.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news was broadcast on 186 cases with 154 deaths.

 

Director General of Disease Control and Environmental Health Yoga Aditama Prof.dr.Tjandra as the focal point of the International Health Regulations (IHR) has been informed about the case to the WHO.

 

This is the time of the year when we expect the greatest number of human infections from the H5N1 virus, and so the announcement of four cases this week is hardly unexpected or alarming.

 

The extremely high fatality rate in Indonesia continues (100% in 2012, 83% in 2011), while in Egypt this year, all known cases have survived. 

 

Last year, Egypt’s fatality rate was 38%.

 

The H5N1 virus remains poorly adapted to human physiology, and so far remains primarily a threat to poultry and wild birds.

That could change of course, as the dozens of strains and clades around the world continue to mutate and evolve. So we watch these cases with great interest, looking for any signs that the threat has changed.

»» Read More

WHO Updates H5N1 In Egypt & Indonesia

 

 

 

# 6084

 

The World Health Organization has posted updates on the Indonesian fatality I blogged about this morning (see Indonesian MOH Announces Bird Flu Fatality), along with two new cases of H5N1 infection in Egypt.

 

First, the Indonesian case where the girl is listed simply as a `family contact’ of case # 183.

 

Avian influenza – situation in Indonesia - update

19 January 2012 - The Ministry of Health of Indonesia has announced one new confirmed case of human infection with avian influenza A(H5N1) virus.

 

The case is a 5 year-old female from Jakarta Province. She was identified by a surveillance team during an investigation in the area on 7 January 2012 and was referred to a hospital. On 13 January 2012, she had breathing difficulties. Her condition deteriorated and she died on 16 January 2012.

 

Epidemiological investigation indicated that she was a family contact of case 183, and frequently had direct contact with the same pigeons as that case, and the same household environment.

 

Surveillance of other contacts has not identified further cases.

 

Of the 184 cases confirmed to date in Indonesia, 152 have been fatal.

 

 

Next stop, Egypt, where the MOH has reported two new cases.

 

Avian influenza - situation in Egypt - update

19 January 2012 - The Ministry of Health and Population of Egypt has notified WHO of two cases of human infection with avian influenza A (H5N1) virus.‪

 

The first case is a 2 year-old female from Cairo Governorate. She visited Helwan Fever Hospital as an outpatient on 30 October 2011 with symptoms of influenza-like-illness (ILI). The case was confirmed by RT-PCR at the Central Public Health Laboratory through periodic testing of samples collected from ILI outpatients from sentinel ILI surveillance sites.

 

The epidemiological team investigated the case after confirmation of the laboratory test. Retrospective investigation through data collected from her family identified a positive history of exposure to backyard poultry. Samples from the case have been sent to the US Naval Medical Research Unit No. 3 (NAMRU-3) for further sequencing.

 

The second case is a 31 year-old male from Fayium governorate. He developed symptoms on 1 January 2012, received oseltamivir on 14 January 2012 and is still hospitalised under the critical care unit. The case was confirmed by the Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network.

 

Epidemiological investigations into both the cases indicated that they had exposure to backyard poultry.

 

Of the 159 cases confirmed to date in Egypt, 55 have been fatal.

 

A bit unusually, the first case appears to have been treated as an outpatient, and was not hospitalized. Her infection was picked up later as part of a routine screening of samples collected from sentinel ILI surveillance sites.

 

Egypt has case fatality rate among known H5N1 cases  of about 35% - which is less than half that reported by Indonesia (82%). It is fair to assume that surveillance doesn’t pick up every case, so these numbers may be artificially inflated.

 

Whether the difference between these two regions is due to the varying strains that are circulating, more vigilant surveillance in Egypt, or differences in medical care is difficult to know.

 

This trend was particularly noticeable during the first half of 2009, when a string of about a dozen toddlers were found to have contracted what appeared to be a milder form of the H5N1 virus.

 

The CFR dropped (temporarily) to about 10%.

 

While a milder form of bird flu might sound like a good thing, several top virologists have warned that it might signal a better adaptation to human physiology.

 

Back in 2009, Dr. Robert Webster of St Jude Children’s Research Hospital and Dr. John Oxford of of Queen Mary, University of London – both expressed concern over the trend in Egypt (see Meanwhile, Back In Egypt . . .).

 

 

As these sporadic cases continue to trickle in, it is worth remembering that the world remains at Pre-pandemic Phase III on the H5N1 virus.  Which is why we continue to watch for signs that the virus is adapting better to humans.

 

»» Read More

WHO Updates: Bird Flu In China, Egypt

 

 

# 6053

 

The World Health Organization this morning has posted updates on China’s recent H5N1 fatality (see Shenzhen Bird Flu Suspect Dies) and the details on a new Egyptian fatality as well.

 

First, the Chinese case.

 

Avian influenza - situation in China - update 6

5 January 2012 - The Ministry of Health of China has notified WHO of a human case of avian influenza A (H5N1) virus infection.‪

 

The case is a 39-year-old male from Shenzhen, Guangdong Province. He developed symptoms on 21 December 2011 and was admitted to hospital on 25 December 2011. He was in critical condition and died on 31 December 2011. The case was laboratory diagnosed by Guangdong CDC on 30 December 2011 and confirmed by China CDC on 31 December 2011. Investigation into the source of infection is ongoing. Close contacts of the case are being monitored and to date all remain well.

 

Of the 41 cases confirmed to date in China, 27 have been fatal.

 

 

Next from Egypt, another case from late last year.

 

 

Avian influenza - situation in Egypt - update 60

 

5 January 2012 - The Ministry of Health and Population of Egypt has notified WHO of a case of human infection with avian influenza A (H5N1) virus.‪

 

The case is a 42 year-old male from Menofia Governorate. He developed symptoms on 16 December 2011 and was admitted to hospital on 21 December 2011, where he received oseltamivir treatment. He was in critical condition and died on 22 December 2011.

 

The case was confirmed by the Central Public Health Laboratories, a National Influenza Centre of the WHO Global Influenza Surveillance Network, on 24 December 2011.

 

Investigations into the source of infection indicated that the case had exposure to sick and dead backyard poultry.

 

Of the 157 cases confirmed to date in Egypt, 55 have been fatal.

 

 

Bird flu remains primarily a threat to poultry - as the virus remains poorly adapted to human physiology. Despite ample opportunities to cause illness in humans, the virus only causes rare, sporadic infections.

 

The concern, of course, is that over time that may change.  That the virus will mutate into a form that is easily acquired and passed on by humans.

 

And so we watch developments in places where the virus is endemic with particular interest.

»» Read More

WHO: Egypt Avian Flu Update # 58

 

 

# 6012

 

 

My thanks to Crof at Crofsblog for picking up on today’s update from the World Health Organization on two H5N1 cases earlier this month in Egypt, one of which was fatal.

 

 

Avian influenza - situation in Egypt - update 58

15 December 2011 - The Ministry of Health and Population of Egypt has notified WHO of two cases of human infection with avian influenza A (H5N1) virus.‬‪

 

The two cases are a mother and her young child from Dakahlia Governorate. Both developed symptoms on 26 November 2011.‬‪The mother was admitted to a Hospital on 1 December 2011 and received oseltamivir on admission. The child was hospitalised on 2 December 2011 and received oseltamivir on admission. The mother was 24 weeks pregnant. She died on 3 December 2011. The child is in stable condition.‬‪

 

Investigations into the source of infection indicate that both cases had exposure to sick and dead backyard poultry (chicken and turkeys).‬‪

 

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Centre of the WHO Global Influenza Surveillance Network, on 3 December 2011.‬‪

 

Of the 155 cases confirmed to date in Egypt, 53 have been fatal.‬‪

Bird flu remains primarily a threat to poultry - as the virus remains poorly adapted to human physiology – although there are signs that may be slowly changing (see PLoS: Human-Type H5N1 Receptor Binding In Egypt).

 

Despite ample opportunities to cause illness in humans, the virus only causes rare, sporadic infections.

 

The concern, of course, is that over time that may change.  That the virus will mutate into a form that is easily acquired and passed on by humans.

 

And so we watch developments in places where the virus is endemic with particular interest.

»» Read More

WHO: Egypt Reports New Bird Flu Case

 

 

# 5744

Photo Credit – Wikipedia.

Traditionally, reports of H5N1 infections generally decline during the summer months, pick up over the fall and winter, and peak in the Spring. This year has been running true-to-form, with only a handful of human cases reported over the past couple of months.

 

Egypt, which has seen the highest number of cases this year, today reported their 32nd case of 2011 to the World Health Organization. 

 

In this case, the patient was a 6 year-old girl from Behira governorate who fell ill on July 12th, but recovered and was discharged from the hospital on the 30th.

 

 

Avian influenza - situation in Egypt - update 55

9 August 2011 - The Ministry of Health of Egypt has notified WHO of one case of human infection with avian influenza A (H5N1) virus.

 

The case is a 6 years old female from Demnhoor district, Behira governorate. She developed symptoms on 1 2 July, and was hospitalized. She completed the course of oseltamivir, recovered and was discharged on 30 July .

 

Investigations into the source of infection indicate that the case had exposure to poultry suspected to have avian influenza.

 

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

 

Of the 151 cases confirmed to date in Egypt, 52 have been fatal.

 

 

Bird flu remains primarily a threat to poultry - as the virus remains poorly adapted to human physiology – although there are signs that may be slowly changing (see PLoS: Human-Type H5N1 Receptor Binding In Egypt).

 

Despite ample opportunities to cause illness in humans, the virus only causes rare, sporadic infections.

 

The concern, of course, is that over time that may change.  That the virus will mutate into a form that is easily acquired and passed on by humans.

 

And so we watch developments in places where the virus is endemic with particular interest.

»» Read More

Egypt Announces Another H5N1 Fatality

 

 

 

# 5642

 

Although bird flu cases generally decline during the warmer summer months, today’s announcement from the World Health Organization is the third such update this month, reporting a total of 7 cases reported since mid-May.

 

Also surprising are the number of fatal cases (5 of 7), and that all of the victims have been somewhat older than we have normally seen in Egypt, ranging in age from 16 to 40.

 

 

 

Avian influenza - situation in Egypt - update 54

22 June 2011 - The Ministry of Health of Egypt has notified WHO of a new case of human infection with avian influenza A (H5N1) virus.

 

The case is a 27 year-old male from Qena governorate, Deshna district. He developed symptoms on 5 June 2011, was hospitalized and was put on oseltamivir treatment on 13 June. He died on 14 June 2011.

 

Investigations into the source of infection indicate that the case had exposure to poultry suspected to have avian influenza.

 

The case was confirmed by the Egyptian sub-national laboratory for Influenza in Aswan and the Central Public Health Laboratories in Cairo, a National Influenza Centre of the WHO Global Influenza Surveillance Network.

 

Of the 150 cases confirmed to date in Egypt, 52 have been fatal.

 

 

It should be noted that the newshounds on the flu forums continue to track a small number of other – as yet unconfirmed – reported cases in Egypt.

 

Today’s report brings this year’s total to 31 cases and 12 fatalities.  

 

While human cases in the middle-east outside of Egypt have not been reported in many years, the lack of accurate testing, surveillance, and reporting in many of these nations is somewhat less reassuring.

 

Bird flu remains primarily a threat to poultry - as the virus remains poorly adapted to human physiology – although there are signs that may be slowly changing (see PLoS: Human-Type H5N1 Receptor Binding In Egypt).

 

Despite ample opportunities to cause illness in humans, the virus only causes rare, sporadic infections.

 

The `official’ number of cases that are reported each year - due to limitations in global testing, surveillance, and reporting - likely represent a subset of the actual number of infections.

 

The concern, of course, is that over time that may change.  That the virus will mutate into a form that is easily acquired and passed on by humans.

 

And so we watch developments in places where the virus is endemic with particular interest.

»» Read More

Egypt Reports 5 New H5N1 Cases, 3 Fatal

 

 

 

# 5632

 

Since the political revolution last winter, reports on human bird flu infections out of Egypt rarely appear in the Arabic Press. So for now, it is usually only through official notification to the World Health Organization or through an FAO report that we hear of them.

 

The last WHO report was on June 1st (see Indonesian & Egypt Report Bird Flu Cases) which reported on a single case from April, which marked the 25th case and 8th fatality in Egypt from the H5N1 virus in 2011.

 

Today the WHO released details on 5 more Egyptian H5N1 infections – three of which were fatal – all occurring in May.

 

 

Avian influenza - situation in Egypt - update 53

16 June 2011 - 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 .

 

 

Today’s report – whose most recent case was May 23rd – brings this year’s total to 30 cases and 11 fatalities.  Since the virus arrived in Egypt in 2006, only 2008 saw more confirmed cases (n=39).

 

Although bird flu infections occur elsewhere in the world (probably more often than we hear about), the pattern of human cases in Egypt has been troubling.

 

Unlike some Asian countries, where the virus has proved fatal in 80% of reported cases, the CFR (Case fatality ratio) in Egypt has ranged from 10% (2009) to 34% (2010).

 

This variability in virulence has sparked concerns that adaptive changes were taking place in the virus. 

 

Last month, in PLoS: Human-Type H5N1 Receptor Binding In Egypt we learned about research that found that among recent human infections in Egypt, viral isolates showed several new H5 sublineages had emerged with an increased affinity for (human) α2,6 SA receptor cells while still retaining their binding ability to (avian) α2,3 SA receptor cells.

 

Using reverse genetics, researchers identified the the amino acid mutations that produced this new receptor binding affinity (essentially, a single mutation at HA residue 192 or a double mutation at HA residues 129 and 151).

 

Researchers believe that the emergence of these new sublineages of H5N1 explains the increase in human cases in Egypt over the past three years.

 

Of course, there may very well be other – as yet unidentified -genetic changes that must occur before the virus can acquire human pandemic capability.

 

Something that could take years or even decades to evolve.

 

Or admittedly, might never happen.

 

But today’s announcement of five new cases in Egypt is a reminder that the H5N1 virus has not gone away.  It continues to circulate – primarily in birds - and on rare, occasion manages to infect humans as well.

 

Which is why the world remains at Pre-pandemic Phase III for the H5N1 virus.

 

»» Read More

Indonesian & Egypt Report Bird Flu Cases

 

 

# 5591

 

Two reports today.

 

First, the World Health Organization has details of a fresh bird flu case in Egypt.

 

Avian influenza - situation in Egypt - update 52

1 June 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.

 

 

This marks the 25th case and 8th fatality in Egypt from the H5N1 virus in 2011.

 

 

Next we get a report from Indonesia, a country where more than 8 out of 10 people treated for H5N1 infection have died.

 

Happy endings there are few and far between, nevertheless, we appear to have one today with this announcement by Depkes (The Indonesian Ministry of Health).

 

A big hat tip goes to Arkanoid Legent, one of the hardest working newshounds in Flublogia, for posting this report his site, along with the Flu Wiki and FluTrackers.

 

BIRD FLU PATIENT Heal

 

Indonesia : Bird Flu Patient Heals

KN (P, 1.2 years), North Jakarta residents who tested positive for H5N1 virus (bird flu) based on the results of Laboratory Research and Development Agency Ministry of Health, declared cured after being treated intensively in AI referral hospitals in North Jakarta. Until now KN conditions remain healthy.

 

KN started getting ill on 3 April 2011 with symptoms of fever, cough, diarrhea and shortness. The patient recovered from surveillance activities SARI (Severe acute Respiratory Infection), which is coordinated Balitbangkes. He referred to the hospital on 8 April 2011 and is getting treatment at the referral hospital care with a diagnosis Bronkhopneumoni.

 

To identify risk factors, we conducted an epidemiological investigation into the patient's house and surrounding environment. The strongest risk factor, a week before the ill patients were invited his father to the market near his house to buy free-range chicken and KN participated holding the chicken.

 

Tjandra Yoga Aditama as the focal point of IHR (International Health Reagulation) has informed also about the case to the WHO.

 

Today’s announcement from Depkes should put Indonesia’s confirmed totals to 178 cases and 146 fatalities (82% mortality rate).

 

Surveillance being sporadic, and laboratory test results sometimes unreliable, these numbers are subject to some debate.

 

Although we continue to see isolated human infections in Indonesia, Egypt, and around the world - for now H5N1 is primarily a threat to poultry.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities to cause illness in humans, only causes rare, sporadic infections.

 

The concern, of course, is that over time that may change.  That the virus will mutate into a form that is easily acquired and passed on by humans.

 

And so the world remains at Pre-pandemic Phase III on the H5N1 virus, and we continue to watch for signs that the virus is adapting to humans.

 

»» Read More

PLoS: Human-Type H5N1 Receptor Binding In Egypt

 

 

# 5579

 

 

The mantra over the past five years or so on H5N1 bird flu has been that:

 

The H5N1 virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections in humans.

 

 

H5N1 is generally a gastrointestinal malady in birds, and the virus is usually spread via infected feces. The virus binds preferentially to the kind of receptor cells commonly found in avian digestive and respiratory tracts; alpha 2,3 receptor cells.

 

Human influenzas, on the other hand, are adapted to bind to the kind of receptor cells that line the surfaces of the human respiratory system; alpha 2,6 receptor cells.

 

While not an absolute, flu viruses that bind to one type of receptor cell, tend not to bind well to the other.

 

This ability to bind to a specific type of cell has often been described as the host cell being a padlock, and the virus needing a specific key (determined by the genetics of the virus’s Receptor Binding Domain: RBD) to unlock it.

 

(A Very Simplified Illustration of RBDs)

 

 

Now humans do have some avian-like alpha 2,3 receptor cells, particularly deep in the lungs.

 

This has been suggested as the reason that - when on rare occasions humans contract H5N1 - it is usually a deep lung infection.

 

It has also been postulated that H5N1’s deeper lung infections may reduce human-to-human transmission, as sneezing is a less common symptom.

 

The concern is that over time, the H5N1 (or some other avian flu) virus might mutate in such a way as to be able to bind to human α2,6 receptor cells of the upper airway.

 

And while that may not be the only obstacle keeping the virus from becoming a pandemic strain, it does appear to be a major one.

 

Although only introduced to the region in 2006, Egypt has rapidly become a hotspot for avian flu (see this list of human cases maintained on FluTrackers). 

 

Unlike some Asian countries, where the virus has proved fatal in 80% of reported cases, the CFR (Case fatality ratio) in Egypt has ranged from 10% (2009) to 34% (2010).

 

This variability in virulence has sparked concerns that important changes were taking place in the virus. 

 

Which brings us to an open access research article (excerpts slightly reformatted for readability) appearing today in PLoS Pathogens called:

 

Acquisition of Human-Type Receptor Binding Specificity by New H5N1 Influenza Virus Sublineages during Their Emergence in Birds in Egypt

Yohei Watanabe, Madiha S. Ibrahim, Hany F. Ellakany, Norihito Kawashita, Rika Mizuike, Hiroaki Hiramatsu, Nogluk Sriwilaijaroen Tatsuya Takagi, Yasuo Suzuki, Kazuyoshi Ikuta

PLoS Pathog 7(5): e1002068.

doi:10.1371/journal.ppat.1002068

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% 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.

 

 

Since the entire research article is open access (and quite lengthy), I’ll not go into great detail on how they conducted this research here. 

 

Instead, we’ll focus on what all of this might mean.

 

While we tend to talk about the H5N1 virus as if it were a single, monolithic entity, in truth it is more akin to the mythical Hydra that is continually growing new heads.

 

The virus, as it spread from birds to other species and around the world, has evolved into a number of distinct genetic groupings called clades. As of 2009, the World Health Organization had classified the  H5N1 virus into 10 first order clades (0-9).

 

As  you can see from the chart below, while additional clades have been established over the past 10 years, the greatest diversity has been among the Clade 2 viruses.

 

 

 

Within each of these clades, the virus is continually evolving into subclades and sublineages. A few are biologically fit and manage to persist and spread, while others are not, and eventually die off.

 

Essentially H5N1 is a moving target; constantly changing, looking for an evolutionary advantage.

 

What the authors of today’s study found was that among recent human infections in Egypt, examination of viral isolates showed that several new H5 sublineages have emerged with an increased affinity for (human) α2,6 SA receptor cells while still retaining their binding ability to (avian) α2,3 SA receptor cells.

 

Using reverse genetics, they identified the the amino acid mutations that produced this new receptor binding affinity (essentially, a single mutation at HA residue 192 or a double mutation at HA residues 129 and 151).

 

They believe that the emergence of these new sublineages of H5N1 explains the increase in human cases in Egypt over the past three years.

 

Before anyone decides its time to head down to the bunker, it should be noted that this move towards greater `humanization’ of the H5N1 virus is far from complete.

 

The authors found `increased attachment and infectivity in the human lower respiratory tract, but not in the larynx.’

 

Many scientists believe the virus must learn to bind to, and replicate in, the upper airway of humans in order to transmit efficiently from human to human.

 

Something that hasn’t happened yet.

 

And there may very well be other – as yet unidentified -genetic changes that must occur before the virus can acquire human pandemic capability.

 

Something that could take years or even decades to evolve. Or admittedly, might never happen.

 

But today’s study is a not-so-gentle reminder that the H5N1 virus has not gone away, that it continues to try out new evolutionary tricks, and that it could still some day pose a pandemic threat to humanity.

 

Which is why the world remains at Pre-pandemic Phase III for the H5N1 virus.

 

»» Read More

Egypt: Two New Bird Flu Cases (1 Fatal)

 

 

# 5512

 

 

While I was away from my desk this morning Crof over at Crofsblog picked up on a new World Health Organization announcement of H5N1 in Egypt (see WHO: Two more Egyptian H5N1 cases, 1 death).

 

Today’s WHO announcement appears to catch up with the outstanding cases on the  Egyptian MOH website (as of Apr. 17th).

 

 

 

As you can see, since testing began in 2006, more than 12,000 suspected cases have been isolated and tested, but on 143 have tested positive.

 

 

 

Avian influenza - situation in Egypt - update 51

21 April 2011 - 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 .

»» Read More

WHO: Three Bird Flu Updates

 

 

# 5484

 

 

The World Health Organization has released updates on human H5N1 infections from three countries this morning.   Some of these are cases we’ve heard about earlier, but are only now being confirmed.

 

First stop, Bangladesh which appears to confirm a case I wrote about on March 16th (see Bangladesh: 2nd Bird Flu Case In Two Days).

 

 

Avian influenza - situation in Bangladesh - update

11 April 2011 - The Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh has confirmed a new case of human infection with avian influenza A(H5N1) virus.

 

The case is a 2 years old male from Kamalapur, Dhaka. He developed symptoms on 1 March. He visited the influenza sentinel surveillance site on 9 March where he was sampled. He completely recovered.

 

Detailed epidemiological investigation and contact follow up was conducted by a team from the Institute of Epidemiology Disease Control and Research (IEDCR), the International Centre for Diarrhoeal Disease Research, Bangladesh ( ICDDRB) and WHO Bangladesh, and no further cases were identified.

 

The investigation into the source of infection indicate that the case had exposure to sick poultry. Although the case is from the same locality as the previous case they had no direct contact with each other.

 

The case was confirmed as being infected with A(H5N1) by the Institute of Epidemiology Disease Control and Research (IEDCR).

 

 

 

Next stop, Cambodia which I reported on April 6th (see Cambodia: 4th Bird Flu Fatality Of 2011).

 

 

Avian influenza – situation in Cambodia - update 2

11 April 2011 - The Ministry of Health (MoH) of the Kingdom of Cambodia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

 

The case was an 11 year old girl from Steung Trang district, Kampong Cham Province. She developed symptoms on 22 March, was initially treated by local villagers with no effect and was admitted to a local hospital on 29 March. Further treatment at the local hospital was ineffective and she was referred to a regional hospital where she died within four hours of admission on 31 March.

 

There have been reports of poultry die off in her village. The girl is the fourteenth person in Cambodia to become infected with the H5N1 virus and the twelfth to die from complications of the disease. All four cases of H5N1 infections in humans in Cambodia this year have been fatal.

 

All contacts of the case have been tested and are negative for A/H5N1 influenza virus.

 

Last stop is Egypt, which has been very busy this year with human H5N1 cases.   Last week in Egypt: 4 New Bird Flu Cases,  I wrote:

 

The newshounds on FluTrackers are aware of several  more possible cases listed on the Egyptian Ministry of Health’s web page, although not yet confirmed to the WHO yet.

 

Today we get confirmation on 4 new cases.

 

Avian influenza - situation in Egypt - update 50

11 April 2011 - 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

 

It should be noted that as of April 8th the Egyptian Ministry of Health (MOH) website lists 142 total cases, and 47 fatalities. 

 

So at least one more case appears to be in the pipeline.

»» Read More

Egypt: 4 New Bird Flu Cases

 

# 5469

 

 

 

The World Health Organization has released their latest update (#49) on human infections by the H5N1 virus detected in Egypt. Four new cases have been added, bringing the total to 137 (with 45 fatalities).

 

Today’s announcement comes less than a week after the WHO announced 3 other cases (see Avian influenza - situation in Egypt - update 48).

 

 

Avian influenza - situation in Egypt - update 49

6 April 2011 - 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.

 

 

The newshounds on FluTrackers are aware of several  more possible cases listed on the Egyptian Ministry of Health’s web page, although not yet confirmed to the WHO yet.

»» Read More