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Surge In Confirmed And
Suspect Cases In Egypt

Dr. Henry L. Niman
MAP 1-1-8
 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 Cairo.
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 H5N1 infections.
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 care worker.
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 via recombination.
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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