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H5N1 Familial Cluster in Nile Delta Raises Concerns
Recombinomics Commentary
December 23, 2006

Tanta - Atef Deibis: The Ministry of Health laboratories revealed the injury of a young man "25 years" and his cousin 15 years with "my wedding procession" by the bird flu disease and have been transferred yesterday to the hospital of the Abbasid fevers and with them the sister of the first injured and who has been detained under the suspicion.

The Health Department by the western has detained in 17 December Farid Abdul Halim's victory 30 years and its brother Reda 25 years in "my wedding procession" fevers hospital and in 20 December detained their cousin Shafika Farid 15 years under the suspicion and taking samples took place from them for its sending to the ministry laboratories. Revealed yesterday due to the examination of conditions Reda Farid's injury and his cousin Shafika by the bird flu disease which led to causing a panic and the fear of citizens and especially after the detention of two new conditions took place in Tanta

The above translation indicates the two H5N1 confirmed cases are cousins and were hospitalized three days apart.  The index case (25M) was hospitalized December 17 and his cousin (15M) , hospitalized December 20 have confirmed H5N1.  The sister of the index case has also been hospitalized with symptoms.  There appear to be two more suspect cases hospitalized, indicating the three member familiar cluster may be part of a five member geographical cluster.

Clustering in the same Gharbiya govenorate as the earlier case is cause for concern. The current cluster as well as the initial case had linkages to ducks and the H5N1 from the first case had M230I.  This polymorphism is found in all three strains of human flu (H3N2, H1N1, and influenza B), all of which are efficiently transmitted human-to-human.  The earlier H5N1 is an exact match with positions 226-230 influenza B (QSGRI).  The first indication of efficient transmission is a familial cluster, as described in the translation above.

More details on condition of the sister and any relationship with the other two hospitalized patients would be useful (as would tesing and sequencing updates).

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