Egyptian H5N1 Bird Flu
Fatalities Increase To Three
By Dr. Henry L. Niman, PhD
"It (was) declared here today the death of a girl that it is called Iman Mohamed Abdul Gawaad (16 years) in Ashmun center in Monoufia Governate affected by its injury with the bird flu disease in the third death state in Egypt since the beginning of the appearance of the disease. And an agency said the Middle East news are that the dead girl has transferred yesterday to the hospital in Ashmun where they were suffering from a rise a severe in the temperature and a narrow in the respiration and a sharp gastroenteritis and with its examination it became clear that it is injured with the bird flu disease in a stage a late. As it became clear that it was dealing with house birds injured with the bird flu virus and did not notify about them and their state deteriorated quickly until she was dead today."
The above translation describes the third reported H5N1 bird flu fatality in Egypt.  In this case, symptoms included "sharp gastroenteritis".  Two HA sequences from Egypt have been made public.  One was from a chicken and another from an earlier case who has been discharged from the hospital.  It is unclear if the sequences from more severe and fatal cases have differences.
As the number a H5N1 cases in Egypt rise, (11 have now been reported) concern about human cases in adjacent countries in the Middle East rise.  Moreover, birds from Egypt and western Africa will be migrating north through the Middle East and into Europe, which will likely spread the evolving H5N1 further.
Recent human cases in China have PB2 E627K, which should be in all Qinghai strain isolates, so minor changes in H5N1 in Egypt could have major changes on virulence and transmissibility to humans.
More sequences from human cases would be useful.  The index case in Turkey had one change in the receptor binding domain (S227N) and the recent case in Iraq has N186S near the receptor binding domain.  Similarly, the two HA sequences from Egypt have P239S.  Recent sequences from human cases China and Indonesia also have changes in or near the receptor binding domain, which provides more data showing easy adaptation by H5N1's infecting humans.  Therefore, more data from Egypt and release of the human sequences from Turkey would be useful
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