# 618
According to the Regional Office for the Eastern Mediterranean (EMRO) of the WHO (World Health Organization), the 4 year-old boy diagnosed with H5N1 yesterday is the sibling of case # 28, a 6-year old girl who tested positive 5 days ago.
New Confirmed Human Case of Avian Influenza in Qena Governorate
Case number : 30
Brother of case number 28
Date of reporting 30 March 2007Gender: Male (Child)
Age: 4 years
Governorate: Qena
Occupation: Child
Specimens: Pharyngeal swabs and serum specimens. First samples were taken on the 29 March 2007. The first samples were tested positive for influenza A virus matrix, H5, and N1 genes in the Egyptian Central Public Health Laboratories on the 30th of March 2007.Date of onset of symptoms: 26 March 2007
Clinical history: the patient was admitted to Qena fever Hospital on 29 March 2007, Treatment with Tamiflu started on March 29, 2007
Prognosis: His condition is stable and still alive.
Exposure status: the sick child had a positive history of contact with dead birds one week before onset of symptoms, Throat swabs were taken from direct and indirect contacts. They are still under surveillance and healthy until this date.
For the past two days, there has been speculation that these two cases were related. The last names of both patients were similar (slightly different spellings in news accounts), and both came from Qena.
Case number : 28
Gender: Female (child)
Age: 6 years
Governorate: QenaOccupation: Child
Specimens: Pharyngeal swabs and serum specimens. First samples were taken on the 25 March 2007. The first samples were tested positive for influenza A virus matrix, H5, and N1 genes in the Egyptian Central Public Health Laboratories.
Date of onset of symptoms: 25 March 2007
Clinical history: the patient was admitted to Qena fever Hospital on 25 March 2007, treatment with Tamiflu started on March 25, 2007
Prognosis: Her condition is stable and still alive.
Exposure status: the sick child had a positive history of contact with dead birds since two days, throat swabs were taken from direct and indirect contacts. They are still under surveillance and healthy until this date.
It is curious that the second victim supposedly began showing symptoms on March 26th, but wasn't hospitalized until the 29th, even those his sister had been declared positively infected two days earlier.
Given that both reportedly children fell ill within days of each other, it is likely that both could have contracted the virus from the same source. That is, from infected birds.
Of course, it's impossible to know for sure.
Proving H2H (Human to Human) transmission is difficult, and the bar is always set high. If there is another reasonable explanation, such as a common exposure or onset of illness within a few days of each other, then H2H is generally dismissed.
In this case, unless there is something in the sequences to suggest otherwise, I doubt this one will be considered as such.
