- In the past week the number of confirmed and suspect
H5N1 cases has increased dramatically in Egypt (see satellite map). Following
a lull in cases over the summer and fall, the first
confirmed H5N1 fatality was reported a week ago, In contrast to the end
of last season, when one of seventeen infections were fatal, four
of the first five cases have died. The number of suspect cases has also
increased steadily in the past several days, including one fatal case in
- Two of the confirmed cases were in Menoufia,
which also has the largest concentration of suspect
cases. Included in this geographical cluster, is a familial
cluster of two (father and daughter). The concentration of the cases
in the same governorate suggests some or most of these cases represent
- In additional to the cluster in Menoufia, there is another
familial cluster in Port
Said involving a family of four, as well as a hospitalized health
- The dramatic rise in confirmed cases signals a more efficient
transmission of H5N1. These confirmed cases are supported by the suspect
cases, which represents a dramatic increase in cases. Last season there
was a spike
in cases in March, but those cases were mild and there were no reported
fatalities. In contrast, the current outbreak has a high frequency of reported
cases couple with a high case fatality rate.
- These combinations suggest the H5N1 has evolved
and acquired these two properties seen last season (frequent infections
and a high CFR). The combination of these two properties suggests evolution
- Release of sequences from poultry and human infections
is critical. It is unclear of the current H5N1 has an Egyptian genetic
background, which has evolved further, or represents a modified Uva Lake
sequence, which is widely circulating in Europe.
- In either case, the result is a dramatic increase in
fatal H5N1 infections in a region which has supported rapid H5N1 previously.
- More information on the suspect cases is critical.
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