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Second H5N1 Bird Flu Fatality Confirmed In Egypt 

Recombinomics Commentary

March 22, 2006

The minister said: Fatma Mohamed Youssef - 30 years - the disease symptoms appeared on her and have been transferred from Al-Qalyubia hospital to Al Abasia. The minister pointed that the patient confirmed before her death that she was the intermixture of the birds that he raises in her house and that she was slaughtering her herself. And the minister pointed in the meeting yesterday to the appearance of a suspicion state in a new human injury in Al-Qalyubia on the citizen Fatma Khalil Ghmri and that it deposited Al Abasia's fevers to the note. And in Minya the national committee declared for the confrontation of the bird flu the appearance of the first human suspicion case in the preservation. The committee pointed to the detention of Aziz Mohamed - 30 years -'s emotions in the hospital of Beni Mazar fevers after the appearance of the injury symptoms on it. Also the hospital of Qina fevers received in the in the morning of Mohamed Hassan after the appearance of the disease symptoms on it. Taking samples took place from the patient earring and their sending to the central laboratories to the ministry.

And the national committee declared the isolation of children Omar Khaled Mostafa - 3 years - and Kholoud Mohamed Abdul Alim - 11 months - in the university hospital in Suhaj for the suspicion in their injury with the disease.

The above translation indicates a second H5N1 bird flu patient in Egypt has died.  She was among the first four suspect cases.  Media reports, and the above comments, indicate several additional suspect cases have been hospitalized.

These two deaths, coupled with the five confirmed deaths in Azerbaijan raise questions about the genetic composition of the Qinghai strains circulating in the area.  Prior to the cases in Turkey, there had been no confirmed human infections by the Qinghai strain of H5N1.  In Turkey sequences from the index case included HA S227N, a change that had been shown to increase efficiency for human receptors and decrease affinity for avian receptors.  This change was first reported in two H5N1 isolates from Hong Kong patients who had visited Fujian province in 2003.  However, those isolates were the Z+ genotype and differed significantly from the Qinghai strain.  Those isolates were collected using canine MDCK cells because such changes can be lost if the H5N1 is isolated in chicken eggs.

Media reports indicated that S227N was not found in the isolate from the sister of the index case, but it remains unclear if that isolate was collected on MDCK cells or chicken eggs.  Similarly, the sequence from the index case in Iraq also did not contain S227N, but details on isolation procedures are lacking.

More information on isolation procedures as well as sequence data on the latest human fatalities would be useful.  The sudden jump in human fatalities is a concern.  In Azerbaijan four of the five fatalities were related or neighbors, and the dates of deaths extended from February 23 to March 10, raising concerns of human-to-human transmission.  This cluster is close in time and location to large clusters in eastern Turkey in January, which point toward genetic changes in the H5N1 in circulation.

More information on the sequences from the current cases as well as updates on the hospitalized patients would be useful.

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