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Confirmed H5N1 Familial Cluster in Qena Egypt

Recombinomics Commentary
April 1, 2007

Rehab Mahmoud Helmi Abul Magd, and it reaches its age "6 years", she entered the hospital of Nag Hamadi fevers last Sunday and she suffers from a rise in the temperature after its mixing the birds.

Also the hospital of Nag Hamadi fevers yesterday detained, Ahmed Rehab's brother, and her uncle's wife, Mona Hashem, and its neighbour named Fouad, for their injury by symptoms similar to the bird flu.

Brother of case number 28
Date of reporting 30 March 2007
Gender: Male (Child)
Age: 4 years
Governorate: Qena

Clinical history: the patient was admitted to Qena fever Hospital on 29 March 2007, Treatment with Tamiflu started on March 29, 2007

The above description describes two confirmed siblings (6F and 4M) and the hospitalization of one or two family members and a neighbor, who have symptoms.  The index case was hospitalized on March 25 and the family members and neighbor were hospitalized on March 27.  The WHO report confirms a brother (4F) who was hospitalized on March 29.  Thus, in addition to the two confirmed cases, hospitalized four days apart, there are additional family members and a neighbor with symptoms.

US NAMRU-3 has sequenced the HA and NA from the index case, A/Egypt/2621/NAMRU-3/2007.  The sequences are similar to two confirmed cases from Beni Suef and Fayyoum.  Both earlier fatal cases had the same 3 BP deletion in HA as well as several additional shared polymorphisms inn bother HA and NA.  The HA sequence from the Fayyoum case, A/Egypt/1394/NAMRU-3/2007 had a mixed signal of the position encoding S227N, indicating the patient was infected with more than one H5N1.  It is not clear of the 3 BP deletion and the S227N were on the same HA sequence, or were on two different H5N1 sequences in the patient.  Because of the similarities between the Fayyoum HA and the Qena index case sequences, it is possible that S227N is also in the latest cluster, but not detected in the initial sequence.

Cloning of H5N1 from the Fayyoum and Qena case(s) would be useful.

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