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Third H5N1 Fatality in Gharbiya Cluster in Nile Delta
Recombinomics Commentary
December 27, 2006

Brick factory worker Rida Farid Abdel Halim was the third member of an extended family in the Nile Delta province of Gharbiyah to die of the disease, said Hassan el-Bushra, WHO regional adviser for communicable diseases surveillance.

The above comments indicate the case fatality rate in Egypt's Gharbiyah governate remains at 100%.  There have been four confirmed cases, who lived within 12 miles of each other, and all four have died.  The first case was hospitalized on September 30 and the sequence of the HA H5N1 was deposited at Genbank on October 13.  In addition to polymorphisms in H5N1 from Egyptian isolates from earlier cases, the isolate had a number of additional polymorphisms, acquired via recombination with other Qinghai isolates migrating through the region.

In addition, the isolate had M230I, which is found in all three human influenza strains, H1N1, H3N2, and influenza B.  The acquisition creates a region of identity in the receptor binding domain of influenza, QSGRI (positions 226-230).  This identity match with influenza B indicates that H5N1 need not change positions 226 and 228 to generate a receptor binding domain match with a human influenza strain that is efficiently transmitted human-to-human, since influenza B has that property with Q (glutamine) and G (glycine) at positions 226 and 228, respectively.

The presence of this change, or the conservation of the additional acquisitions would be of interest.  Release of the sequences from H5N1 from the current cluster of three fatal cases in the Gharbiyah governate would be useful.

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