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Poultry Deaths in Azerbaijan Raise H5N1 Survellance Concerns

Recombinomics Commentary
December 4,  2006

Mass death of birds was reported in Ganja, APA Western bureau reports. Over 20 poultry died simultaneously in different houses on December 2.

Rumors were spread that H5N1 virus caused the death of birds. State Veterinary Service Ganja Department Chief Hussein Abbasov denied it.
“State Veterinary Service holds monitoring twice a month. If there were bird flu virus, it would be found in wild birds first. The birds died of Newcastle and colibacilosis diseases,” he said.

The above denials of H5N1 in Azerbaijan are cause for concern.  Although there is monitoring of wild birds, most monitoring fails to detect H5N1 at early stages.  In Azerbaijan, H5N1 was first confirmed in February.  However there were multiple die-offs prior to the confirmation in February, when there were massive deaths on the shores of the Caspian Sea.

Last season H5N1 was initially detected in Romania and western Turkey in October and H5N1 in eastern Turkey was denied.  However, when patients began dying in early January, H5N1 was acknowledge in eastern Turkey in November and December.  Moreover, recently released sequences from teals in Egypt from December, 2005 included a Qinghai isolate.

Fatal H5N1 infections in Azerbaijan were confirmed in February of this year, but Azerbaijan monitor last season was poor.  The H5N1 in Egypt this season has a number of changes not found in last season, indicating H5N1 has arrived in the area again, although H5N1 has not been reported in Turkey or the Middle East this season, again raising serious concerns about monitoring and transparency in the area.

Although the bird sequences of H5N1 in Azerbaijan are still being withheld, the phylogenetic trees of isolates from last season were presented at a meeting in Italy in July.  These trees clearly showed that there were multiple introductions of H5N1 into Azerbaijan last season.  In the top branch (see top)  there is an isolate from a swan in Azerbaijan, A/swan/Azerbaijan/Av107-K3-2/06, which is the group that includes H5N1 from the only bird sequence released by Weybridge (from a turkey in Turkey collected in October, 2005).

Further down the tree (see bottom) are Azerbaijan isolates from a dog, A/dog/Azerbaijan/1413-6/06) and a fox, A/fox/Azerbaijan/1413-7/06. These are related to a chicken isolate from Azerbaijan, A/ck/Azerbaijan/Av107-K7-2/06.  Isolates from multiple countries in western Europe are represented in this group.  Another branch lower on the tree includes a number of isolates from Azerbaijan chickens, A/ck/Azerbaijan/Av776-2-7/06 as well as a swan, A/swan/Azerbaijan/Av107-K2-2/06, and isolates from Qinghai.  Although these sequences were collected in late 2005 / early 2006, only one bird sequence has been released by Weybridge.

Last week Weybridge released human sequences from Iraq and Azerbaijan.  Two of the Azerbaijan human H5N1 sequences have N186K, a change that has been shown to increase affinity for human receptors.  All six of the Iraq isolates have another change at the same position, N186S, and two isolates from Iraq also have Q196R, another change that increases affinity for human receptors and synergizes with S227N, which was in two of the four human isolates from eastern Turkey.  S227N has also been found in a human isoalte from Egypt, and this season the only confirmed human case in Egypt had M230I, which is found in all three human strains of influenza (H1N1, H3N2, influenza B) and creates are region (226-230) of identity (QSGRI) with influenza B, a strain that is efficiently transmitted from human-to-human.  Moreover, there have now been three suspect H5N1 clusters in Egypt, although these clusters have not been confirmed to be H5N1 positive.

Thus, the poultry deaths in Azerbaijan, suspect human cluster in Egypt, and confirmed H5N1 in one patient and multiple regions in Egypt raise concerns that H5N1 is transmitting unreported in the region.  Last season Azerbaijan had multiple introductions that lead to deaths of wild and domestic birds as well as mammals, including humans, a fox, and a dog.

The above discounting of H5N1 in dead poultry because H5N1 has not yet been reported in wild birds in the region is cause for concern, as is the hoarding of H5N1 bird, dog, and fox sequences by Weybridge from countries throughout the Middle East and Europe.

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