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Ninth H5N1 Toddler in Egypt Increases Concerns
Recombinomics Commentary 20:31
April 1, 2009

A two-year-old Egyptian boy has contracted the highly pathogenic bird flu virus

The boy, from the province of Beheira in northern Egypt, was believed to have contracted the H5N1 virus after coming into contact with infected birds,

The boy was taken to hospital on Monday after he came down with a high fever while visiting extended family in another province.

The above comments describe the ninth toddler H5N1 confirmed in Egypt this year.  The only other case was an adult (38F), who was only symptomatic for four days.  The toddlers also appear to be infected with a mild version of H5n1.  Only one was listed as critical, and that case was over a month ago.  No confirmed cases have died this year.

Although the case fatality rate was low in the spring of 2007 (16/17 survived), the concentration of cases among toddlers is without precedent.  Prior to 2009, there were only six confirmed toddler cases over a three year period involving 51 cases.  The sudden jump in frequency from 12% to 90% this year is alarming.  These case are spread throughout the country (see updated map), and the concentration in toddlers raises concerns that the number of H5N1 cases is far higher than the 61 confirmed cases, and unconfirmed cases have generate a significant immunity among older residents.

To date over 6000 suspect patients have been hospitalized, but less than 1% are H5N1 confirmed.  If the low level of confirmation is linked to a low sensitivity, then the number of actual H5N1 could be concentrated in an at risk population and could offer protection.

Most of the testing in Egypt and elsewhere is limited to patients with known poultry contacts, which would limit the number of hospitalized and suspect patients.

A comprehensive survey of H5N1 antibodies in Egypt would be useful.

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