# 5632
Since the political revolution last winter, reports on human bird flu infections out of Egypt rarely appear in the Arabic Press. So for now, it is usually only through official notification to the World Health Organization or through an FAO report that we hear of them.
The last WHO report was on June 1st (see Indonesian & Egypt Report Bird Flu Cases) which reported on a single case from April, which marked the 25th case and 8th fatality in Egypt from the H5N1 virus in 2011.
Today the WHO released details on 5 more Egyptian H5N1 infections – three of which were fatal – all occurring in May.
Avian influenza - situation in Egypt - update 53
16 June 2011 - The Ministry of Health of Egypt has notified WHO of five cases of human infection with avian influenza A (H5N1) virus.
The first case is a 40 years old female from Aswan District, Aswan Governorate. She developed symptoms on 14 May, and was hospitalized. She completed the course of oseltamivir, recovered and was discharged.
The second case is a 21 years old pregnant female from Ashmoun District, Menofia Governorate. She developed symptoms on 21 May, was hospitalized and received oseltamivir. She died on 29 May.
The third case is a 31 years old male from Shobra Elkhima District, Qaliobia Governorate. He developed symptoms on 21 May, was hospitalized and received oseltamivir. He died on 5 June.
The fourth case is a 32 years old male from Elzawya District, Cairo Governorate. He developed symptoms on 23 May was hospitalized and received oseltamivir. He died on 2 June.
The fifth case is a 16 years old male from Ashmoon District, Menofia Governorate. He developed symptoms on 21 May was hospitalized and received oseltamivir. He was in a critical condition but he is recovering.
Investigations into the source of infection indicate that all the cases had exposure to poultry suspected to have avian influenza.
The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.
Of the 149 cases confirmed to date in Egypt, 51 have been fatal .
Today’s report – whose most recent case was May 23rd – brings this year’s total to 30 cases and 11 fatalities. Since the virus arrived in Egypt in 2006, only 2008 saw more confirmed cases (n=39).
Although bird flu infections occur elsewhere in the world (probably more often than we hear about), the pattern of human cases in Egypt has been troubling.
Unlike some Asian countries, where the virus has proved fatal in 80% of reported cases, the CFR (Case fatality ratio) in Egypt has ranged from 10% (2009) to 34% (2010).
This variability in virulence has sparked concerns that adaptive changes were taking place in the virus.
Last month, in PLoS: Human-Type H5N1 Receptor Binding In Egypt we learned about research that found that among recent human infections in Egypt, viral isolates showed several new H5 sublineages had emerged with an increased affinity for (human) α2,6 SA receptor cells while still retaining their binding ability to (avian) α2,3 SA receptor cells.
Using reverse genetics, researchers identified the the amino acid mutations that produced this new receptor binding affinity (essentially, a single mutation at HA residue 192 or a double mutation at HA residues 129 and 151).
Researchers believe that the emergence of these new sublineages of H5N1 explains the increase in human cases in Egypt over the past three years.
Of course, there may very well be other – as yet unidentified -genetic changes that must occur before the virus can acquire human pandemic capability.
Something that could take years or even decades to evolve.
Or admittedly, might never happen.
But today’s announcement of five new cases in Egypt is a reminder that the H5N1 virus has not gone away. It continues to circulate – primarily in birds - and on rare, occasion manages to infect humans as well.
Which is why the world remains at Pre-pandemic Phase III for the H5N1 virus.
