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Matches In Fatal 2011 Cases Raise Concerns
Although the cases were from two distinct governorates, and from cases that developed symptoms more than three weeks apart, all three sequences were virtually identical. Sequences for PA and NS were identical in all three patients. Five other genes (PB2, HA, NP, NA, MP) where identical in the two male patients, and the female sequence had one nucleotide difference in each of the five genes. The PB1 sequence was also closely related in all three cases and mapped on the same branch in phylogenetic analysis.
The near identity in all three cases (which would almost certainly be closely related to the child who was also H5N1 confirmed, raises concerns that H5N1 is evolving toward more efficient transmission in humans in Egypt. The adaptations had been noted previously, since all recent human cases have been from the same sub-clade, which has the 3 BP deletion in HA.
More information on relationships between these three cases, as well as sequences from 2012 H5N1 cases would be useful.