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Another Confirmed H5N1 Case in Nile Delta
Recombinomics Commentary 13:53
April 17, 2008
the child, Mahmoud Ibrahim Ramadan, comes from the Nile Delta province of Sharkia. He became infected after exposure to household birds.
He was taken to hospital on April 14 with bird-flu like symptoms including high temperature and breathing difficulties. He was treated with the anti-viral drug Tamiflu and was now in a stable condition.
The above comments describe another confirmed H5N1 case (2M) in Egypt in the past week. This case extends the pattern established over the past three years, which includes a jump in confirmed cases in the spring. It is the first case this season where pneumonia wasn’t mentioned, although the reporting is early.
New cases in Egypt are not a surprise. Recent sequence data from poultry in Egypt and Israel show a dramatic increase in the rate of evolution, including sequences with two receptor binding domain changes, V223I and M230I, as well as another subclade from vaccinated flocks. These sequences have a large number of non synonymous changes, including M230V.
In addition, full sequences from the Israeli isolate, which have an HA matching the vaccine resistant sequences are being released. These sequences have acquired polymorphism from the Uvs Lake strain of H5N1, which is throughout Europe and in the Middle East. In addition, the Israeli sequences have mammalian polymorphisms, most concentrated in PB2.
The rapid evolution will create challenges for effective vaccines in humans and birds. Japan has announced plans to begin vaccinations of first responders with a pre-pandemic vaccine and outbreaks in South Korea are at record levels. Sequences from these outbreaks are likely to appear in Egypt next season.
The rapid evolution of H5N1, especially associated with vaccinated poultry, remains a cause for concerns.
Recombinomics Paper at Nature Precedings