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H5N1 in Egypt Raises Pandemic Concerns
Recombinomics Commentary 14:58
May 12, 2009

A five-year-old Egyptian girl has contracted the highly pathogenic bird flu virus after coming into contact with infected birds, the state news agency MENA reported on Sunday.

The case brings to 69 the number of people confirmed to have contracted the H5N1 avian influenza virus in Egypt, which has been hit harder than any another country outside Asia.

The above comments describe the most recent confirmed H5N1 case in Egypt.  Although the pace of confirmed cases has slowed in Egypt, local media reports continue to detail the hospitalization of suspect cases, although less than 1% of hospitalized cases are PCR confirmed for H5N1.

The low confirmation rate, coupled with mild symptoms, has raised concerns of silent spread of H5N1.  The recent outbreak of swine H1N1 worldwide may allow the issue of H5N1 in asymptomatic cases, or those with lower viral loads, to be resolved.

In Egypt, H5N1 testing is limited to cases claiming poultry contact.  However, if a swine contact was required for H1N1 swine testing, the initial positives in the United States would have gone undetected because none of the confirmed cases had a swine contact.

The  H1N1 has led to enhance surveillance, although much of the testing has been limited to  travelers originating in North America.  However, the heightened awareness of H1N1 may lead to broader testing.  Seasonal H1N1 and H3N2, as well as swine H1N1 and avian H5N1 will all give a positive on an influenza A test.  Swine H1N1 and avian H5N1 however, will not sub-type with standard reagents, which are directed against human seasonal flu.

These swine H1N1 isolates are confirmed with additional tests that are specific for swine H1N1.  However, H5N1 will also test negative on the swine H1N1 test, which will signal another serotype (or evolution of the swine H1N1) and require additional testing.

Such testing may lead to the discovery of widespread H1N1 in local populations in Egypt.

Release of further analysis of non-typable influenza A positive samples in Egypt would be useful.

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