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H5N1 In Israel?
The above comments from the Israeli Ministry of Health raise concerns that the H5N1 outbreak reported to the OIE is the Fujian strain of H5N1 (clade 2.3.2).
Clade 2.3.2 has been found previously in wild birds in Asia. It frequently appears at this time of year in wild birds in Hong Kong, but in 2008 it was found in South Korea, Japan, and Russia in the spring. The finding of the strain in whooper swans in Japan raised concerns that the H5N1 would spread to Mongolia and Russia over the summer.
Those concerns were realized when an outbreak of H5N1 in wild birds at Uves Lake in Mongolia on the border with Russia produced clade 2.3.2 sequences. The presence of clade 2.3.2 in wild birds in Russia and Mongolia led to concern that the Fujian strain would then spread to Europe, the Middle East, and Africa, as had happened to the Uvs Lake strain of the Qinghai Strain (clade 2.2.3).
The comments by the Health Ministry in Israel were remarkably similar to comments from South Korea when a soldier culler exhibited bird flu symptoms and was H5 positive. The Fujian strain was responsible for most human H5N1 cases in China. However, at the time the human Fujian cases had been clade 2.3.4. There was little reason to assume that clade 2.3.2 wouldn’t infect humans because human cases had been reported for clade 1 as well as clade 2.1, 2.2, and 2.3. Therefore, it was likely that all sub-clades of 2.3 would be able to infect humans. In South Korea the H5 virus was not isolated, so a formal report to WHO was not made and South Korea remains free of human H5N1 cases. However, in early 2009 China did report a human infection involving clade 2.3.2. However, this distinction between 2.3.2 and 2.3.4 was not widely reported, so the Israeli health ministry may still be assuming that the South Koreans comments on human infections by clade 2.3.2 may still be accurate.
However, clade 2.3.2 has produced at least one human infection in China, and clade 2.3.2 has never been reported outside of Asia. Thus, release of the sequences from the H5N1 outbreak in Israel would be useful.