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Four Suspect H5N1 Patients Hospitalized in Suhaj Egypt
Recombinomics Commentary
November 16, 2006

The university hospital in Suhaj detained 3 children and a factor for the suspicion of their injury by the bird flu epidemic and they are Faten Ahmed Shawqi, its sister Manar and Shaimaa and their neighbour Mohamed Al Sayed "a worker" the child and the worker was injured by a pneumonia and a sharp descent in the heart and lost the awareness -

The above translation desscribes four suspect H5N1 bird flu patients hospitalized in central Egypt.  Two patients are already unconcious, and the cluster includes three siblings and a neighbor. 

Clusters in Egypt are cause for concern.  The HA from a recent fatality had M230I, which matches all three seasonal flu's (Influenza A H3N2 and H1N1 as well as Influenza B. The change creates five consecutive amino acids (QSGRI) that match the receptor binding domain of infleunza B, raising ocnerns of increased human-to-human transmission.

In addition, the Qinghai strain of H5N1 has PB2 E627K and recently released sequences from patients in Egypt earlier this year has S227N, as did two of the four isolates from Turkey.  Moreover, today's Nature paper describes two additional polymorphims, N186K and Q196R, which increase receptor binding and were found in patients in Azerbaijan and Iraq.  Those patients were also from clusters involving human-to-human transmission.

More information on these four patients would be useful.

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