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High H5N1 Case Fatality Rate in Egypt

Recombinomics Commentary 20:20
December 31, 2007

the ministry said a 50-years-old woman of Dumiyadh governorate, north of Cairo, died today as result of infection with the H5N1 virus

The above description of the fourth H5N1 fatality appears to match the third confirmed case (50F), who was admitted last week in critical condition.  If so, then four of the first five H5N1 cases in Egypt this season have died.  There was also a fatal suspect case who died over the weekend (see satellite map)..

This high death rate is similar to the rate at the beginning of last season, when the first seven confirmed cases died.  However, those seven cases died between the end on November, 2006 and mid-February, 2007, while the four recently confirmed fatalities were in the past week.  These fatality rates are markedly higher than the end of last season, when only one of seventeen cases died.

The return of a high case fatality rate may be linked to genetic changes in the H5N1.  Last season all cases infected H5N1 with M230I were fatal and M230I was in most of the early cases last year.

M230I and with V223I were also found in birds in Gharbiya and Beni Suef last year, so these polymorphisms may be in circulation.  The two receptor binding domain changes were among the newly acquired polymorphisms that were appended onto the Egyptian H5N1 background, which was also found in Israel, Gaza, and Djibouti.

However, the Uva Lake strain of H5N1 is also circulating widely in Europe and these sequences likely migrated into Egypt recently.  Thus far the only neighbor reporting recent H5N1 infections has been Saudi Arabia, although all confirmed cases have been in poultry.  Egypt has also had frequent poultry outbreaks, raising questions about the lack of reporting of H5N1 infections in neighboring countries.

Sequence information on the isolates in Saudi Arabia and Egypt would be useful.

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