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Jordan Issues H5N1 Alert

Recombinomics Commentary
December 23, 2007

Jordan has raised its state of alert to its highest level for an outbreak of bird flu crossing over from Saudi Arabia, KUNA says.

The above alert by Jordan follows alerts in Egypt and Pakistan.  Egypt’s alert was linked to new H5N1 outbreaks in the Nile Delta, in spite of an active vaccination program.  Outbreaks have been reported in Giza, Sharqia, and Gharbiya (see satellite map).  These outbreaks are likely linked to migratory birds.  Egypt lies in the intersection of two major flyways and two years ago at this time the Qinghai clade 2.2 was found in a healthy teal in the Nile Delta.  Egypt has filed OIE reports on 922 outbreaks since February, 2006 (see satellite maps here, here, here, and here).

In addition to prior outbreaks in Egypt, Saudi Arabia has culled over 4 million birds due to outbreaks near Riyadh and regions southeast of Riyadh.

In addition, a suspect case was reported at the airport in Kuwait.  Earlier this year Kuwait had H5N1 outbreaks that led to the culling of over 1 million birds.  That outbreak involved the Uva Lake strain of H5N1.

Pakistan has also reported multiple poultry outbreaks in 2006 and 2007.  Although they have not released sequences of any H5N1 isolates, sequences from 2006 outbreaks in India and Afghanistan suggest the recent outbreaks in Pakistan have been the Uva Lake strain.  Neither Afghanistan nor India has released H5N1 sequences for outbreaks this year.  However, recently released sequences from South Korea from outbreaks a year ago are also the Uva Lake strain, as are sequences from multiple outbreaks in Germany over the summer and Krasnodar in the fall.  Reports on isolates in the Czech Republic, France, England, and northeastern Germany indicate all outbreaks are Uva Lake, which suggests the outbreaks in Poland, Romania, and Rostov will also be Uva Lake, which appears to have replaced earlier clades circulation in Europe and the Middle East in 2005 and 2006.

The likely Uva Lake strain in Pakistan has lead to the first reported human cases there.  Media reports indicate there are at least two familial clusters.  The largest appears to have been sustained from October 25 to December 6, representing the longest transmission chain reported to date, albeit in media reports rather than WHO updates, which have been withheld for an unprecedented time.  Most of the initial reports were confirmed in Pakistan over a week ago, and should have been independently confirmed in the NAMRU-3 mobile lab this week.  Samples have been sent to London.  The additional testing may be for sequencing, virus isolation, and/or receptor binding studies.  The collection of samples from patients after the start of oseltamivir (Tamiflu) treatment, may have limited local lab testing, as well as contact tracing.

In any event, the H5N1 that recently flew into Pakistan should now be circulating in the Middle East, which may have led to the outbreaks in Saudi Arabia and concerns by Jordan.  Saudi Arabia has denied confirmation of suspect H5N1 in cullers in Saudi Arabia.

Release of sequence data of H5N1 in the region, as well as WHO updates on the sustained transmission in Pakistan, would be useful.

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