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H5N1 Confirmed Case in Sharqiya Egypt
Recombinomics Commentary
February 16, 2007

The boy, 5-year-old Mohamed Ahmed Suleiman of Sharqiya province, was in a stable condition and being treated with Tamiflu. He tested positive for bird flu after developing a high fever on Wednesday, a health ministry statement said.

The patient described above is the second confirmed case in Egypt this week and the third case this month.  The two earlier cases were both in Fayyoum, south of Cairo, as was the first case this year, which was in Beni Suef.  The above case however, is in the Nile Delta, north of Cairo and to the east of Gharbiya, the location of the first four cases this season.

The eight confirmed cases this season are in marked contrast to last season, when the first reported human H5N1 case in Egypt was in March.  Last season 6 of 14 cases died.  This season, the first seven cases have all died.

The three cases in December were from the same family.  H5N1 sequence was generated for two of the family members, and the sequences had the Tamiflu resistance marker, N294S.  That marker was in both patients and was in samples collected two days after treatment as well as prior to treatment.  All four samples did not have detectable wild type H5N1, indicating the N294S did not develop because of Tamiflu treatment of the cluster members.

Although detection of N294S in Egypt has been limited to the Gharbiya cluster, the most recent fatality initially responded to Tamiflu treatment, but her condition subsequently deteriorated and she died Thursday night.  Similar short term improvement has been seen previously in H5N1 patients who develop Tamiflu resistance.

The samples collected thus far from patients in Egypt were from samples collected prior to Tamiflu treatment.  Therefore, if resistance developed de novo in the patient, or was present as a minor species initially, detection in samples collected early would be difficult.  Therefore, addition testing of samples collected after Tamiflu treatment had begun may identify resistance markers, which were initially present at levels below the detection limits.

The most recent case has been treated with Tamiflu within two days of developing symptoms.  Collection of early and late samples from this patient would also be useful.  The samples from the Nile Delta were more closely related to each other and the two patients from the Gharbiya cluster had N294S prior to Tamiflu treatment.

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