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H5N1 Confirmed in Egypt
Recombinomics Commentary
January 17, 2007

A 27-year-old Egyptian woman tested positive for the bird flu virus, the official Middle East News Agency (MENA) quoted a Health Ministry official as saying on Wednesday.

The woman was identified as Warda Eidh Ahmed, the agency reported. She has been hospitalised since Jan. 13.

The above report describes the first confirmed case in Egypt in 2007.  Earlier this season there were four cases in Gharbiya.  Three of these cases were from the same extended family, and the HA sequence from two were recently released.

These two cases, like the October case, had M230I, a change adjacent to the receptor binding domain, that is found in all three human flu strains (H1N1, H3N2, and influenza B) and it creastes an exact match between H5N1 and
influenza B  at positions 226-230 (QSGRI).

Last season, the first confirmed human case in Egypt was not reported until mid-March.  This season human cases have been reported much earlier, and all have died.

Several human cases involving the Qinghai strain of H5N1 were reported in the region last season (Turkey, Iraq, Azerbaijan, Egypt, Djibouti).  The Egyptian cases are the first human cases reported this season, and the above cases suggest more will be reported in the near term.

The Gharbiya cluster included an additional change in the receptor binding domain, V223I, and such changes can affect transmission as well as the clinical course.  The 100% case fatality rate, which includes a failure to respond to Tamiflu treatment, remains a cause for concern.

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