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Another H5N1 Case in Qena Egypt
Recombinomics Commentary
June 11, 2007

A four-year-old girl has contracted the bird flu virus in southern Egypt, the 36th case among humans in the Arab world's most populous country, the Health Ministry said on Monday.

Dina Ali Taghyan from Abu Diyab village in Qena province was admitted to hospital on Sunday with a high temperature, pneumonia and difficulty breathing, and had been exposed to birds suspected of having bird flu, the ministry said.

She was taken to a hospital in the capital Cairo and is in a stable condition under treatment, it added in a statement.

She is the second case in Egypt in two weeks after a lull of nearly two months.

The above comments describe a second H5N1 case in Qena in the past week. Media reports indicate the delay in treatment for the early case, 10F, may have contributed to the fatal clinical course.

NAMRU-3 has sequenced the HA and NA from the 10F, A/Egypt/4081-NAMRU3/2007.  The sequence clearly indicates the sequence is from southern Egypt.  The HA sequence is most like the earlier sequences from southern Egypt, but only six of the fourteen polymorphisms specific to the south were present, signaling significant divergence from the March / April sequences.  However, two of the six remaining polymorphisms were non-synonymous (N98D and T517I).  N98D is also in a cat isolate from Germany.  The NA sequence did not have G743A.

The earlier sequences from Aswan were very similar to each other, which makes the divergence in the recent sequence striking.  The 10F was the first child H5N1 fatality in Egypt.

The sequence of the most recent case will be of interest.  It is expected to be closely related to the earlier sequence, although a second southern sequence, containing a 3 BP deletion in HA was present in H5N1 from siblings in Qena isolates in March..

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