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H5N1 Confirmed in Two New Egyptian Patients
Recombinomics Commentary
December 23, 2006


The two Egyptians from the village of Hanut in the Gharbiya governorate contracted the disease after coming into contact with infected ducks they had been rearing in their homes, according to a ministry statement carried by the official MENA agency.

The above description of two confirmed H5N1 cases is cause for concern.  These two patients are from the same governate as the first confirmed case for this season. H5N1 from that case had many of the Egyptian associated polymorphisms seen in February 2006 human and bird isolates from Egypt.

However, the more recent isolate had several additional polymorphisms, including M230I, which is found in all human strains of influenza (H3N2, H1N1, and Influenza B).  Moreover, the new acquisition creates of region of identity (QSGRI) at positions 226-230 in Influenza B.

The earlier isolate also has many additionall polymorphisms that are found in isolates from Europe and western Africa, signaling additional recombination and acquisition of new polymorphisms circulating in the area,  Recent reports describe additional receptor binding domain changes which increase the affinity for human receptors, including S227N in Egypt and Turkey, N186K in Azerbaijan, and N186S and Q196R in Iraq.  Although these countries have not reported H5N1 this season, reports of H5N1 in Ukraine, Egypt, Sudan, and Nigeria signal new migration of H5N1 into the region, which has also been recently reported ion South Korea and southern Vietnam.  These new outbreaks signal migration of new H5N1 sequences into these regions.

Surveillance remains poor and transparency is becoming increasingly suspect.

Release of the recent sequence by US NAMRU3 has set an excellent example for this season.  Release of H5N1 from the two new cases as well as poultry and wild birds in the region by Egypt and neighbors would be useful.

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