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In this study, we isolated H5N1 form
donkeys clinically affected with moderate respiratory distress
including cough, fever and serous nasal discharge. The course of the
disease was short (72h)
The above comments are from the paper “Isolation and characterization of highly pathogenic avian influenza virus subtype H5N1 from donkeys” and raise concerns that H5N1 may be silently spreading in mammals in Egypt. The HA and NA sequences from A/equine/Egypt/av1/2009 have been placed on deposit at Genbank and the HA sequence has the 3 BP deletion previously reported in mild cases in Egypt.
The milder cases were first noted in 2007 and then attracted considerable interest because of the large number of mild cases in young children in 2009. The sequences from these milder cases contained the 3 BP deletion, raising concerns that the deletion allowed for efficient spread of H5N1 in humans, which was largely undetected because of the mild nature of the infection.
The discovery of this H5N1 in mild infections of donkeys raises significant concerns. H5N1 has not been previously reported in equine previously, although its host range includes many mammalian species. The potential role of the 3 BP deletion raises concerns that H5N1 may be much more widespread in humans. The same deletion has been reported in clade 7 in China, raising additional concerns of human infections.
Like all countries, both Egypt and China have significant pH1N1 activity raising concerns of dual infections and recombination between H5N1 and H1N1.
The presence of H5N1 in mild efficiently transmitting disease in donkeys indicates surveillance in human populations as well as other mammalian species should be significantly enhanced and include humans without know exposures to poultry.