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What We All Must Understand:

  • “Any community that fails to prepare, with the expectation that the federal government or, for that matter, even the state government will come to their rescue at the final moment will be tragically wrong,” Michael Leavitt, Secretary of Health and Human Services

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7 entries categorized "Egypt : H5N1 News"

January 07, 2008

Egypt’s Poultry Vaccines

Discontent and finger pointing has been showing up in some of the translated articles out of Egypt about the poultry vaccine efficacy, quality, and proper administration, whether singly or a combination of the three factors. The al-Masry al-Youm article addresses the issue with a little more thoroughness.

New Conditions On Import Of Bird Flu Vaccines

By Metwalli Salem 8Jan08

Minister of Agriculture and Land Reclamation Amin Abaza unveiled that his ministry would prepare a study to determine the types of serums and vaccines the companies import from outside and set new conditions on private companies importing anti-bird flu vaccines.

He said the most important of these conditions is that the companies must be registered in the World Organization for Animal Health (OIE) and that the vaccine must be effective against the lethal H5N1 strain of bird flu in Egypt.

Commenting on the paper's yesterday exclusive report about the doubts over the validity of vaccines imported by these companies, the minister told al-Masry al-Youm that it is a scientific fact that the vaccine is not 100% effective against the disease, as its efficiency ranges between 75% and 90%, and that the circulation of vaccine is as important as the type of vaccine used in immunization, indicating that the ineffectiveness of vaccines imported from abroad is not in the interest of companies importing the vaccines.

He noted that about more than one billion anti-bird flu doses have been imported either by the state or the private sector since February 17, 2006. "All of these doses have been tested in the ministry's Institute of Veterinary Vaccines," he added.

Abaza stressed that all the vital safety regulations would be strictly applied and stringently enforced through the control of veterinary services affiliated with the General Authority for Veterinary Services, indicating that the increased number of infections in recent weeks were mainly attributable to the fact that many poultry farms are lax in applying vital safety standards, making them believe that they have entirely brought the virus under control.

Abaza accused some owners of farms where bird flu infections are reported of selling the remaining stock in the other coops in several provinces, contributing to the spread of the virus to other areas instead of culling all birds in all the farm's coops. He maintained that this behavior is a crime against citizens and the State.

 

This is certainly not a new issue, and unfortunately, it continues to crop up. The following piece is from an offering from December 2005:

Fake animal vaccines 'boosting bird flu risk'.

Source: Europe Intelligence Wire

Publication Date: 09-DEC-05

(From Western Daily Press)

Widespread use of ineffective and fake animal vaccines may be greatly increasing the threat of a human flu pandemic, a leading expert said yesterday.

WIDESPREAD use of ineffective and fake animal vaccines may be greatly increasing the threat of a human flu pandemic, a leading expert said yesterday.

Many vaccines given to poultry in bird flu hot-spots such as south-east Asia fail to control the virus, said Dr Robert Webster, from the World Health Organisation. As a result, even in apparently healthy birds, the virus is allowed to spread and evolve into new forms.

[snip]

Dr Webster, Director of the WHO Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds, said: "There are good vaccines and bad vaccines. Good vaccines reduce virus load; bad vaccines stop the signs of disease but the virus keeps replicating, spreading and evolving. The chickens look perfectly healthy but go on pumping out viruses for a long time.

"We have to ask the question, why are these animal influenza viruses showing so much antigenic drift? I would argue that contributing to this is the use of bad vaccines."

He said there was an urgent need for international standards to be applied to animal vaccines, as they are to those made for humans.

[snip]

Animal vaccines should also have minimum amounts of antigen, said Dr Webster. Poor quality veterinary vaccines are commonly used across the developing world, he said. Two major problem areas were China and Indonesia.

Government scientists in China produced some "excellent" high quality animal vaccines, said Dr Webster. But small regional factories were also making cheap, inferior vaccines that may contain no antigen at all. There was even one reported case of bottled water being sold as a vaccine.

Dr Webster pointed out that the problem was not new. An investigation into H5N1 outbreaks in Mexico in the 1990s found that only half the vaccines being given to poultry were effective
.

 

Some things one just has to learn the hard way. It appears the poultry vaccine is one of those things.

 

SZ

January 01, 2008

Egypt 01Jan08

This morning's roundup by Theresa42 at FluWiki offers us the following:

SUMMARY OF CONFIRMED AND SUSPECTED CASES IN EGYPT SINCE DEC 25

5 Confirmed cases / 4 deaths:

Oula Yunis Ali Mohamed (25F) - d. Dec 25, 2007 -- Beni Haroun, Beni Suwayf governorate
Attorh Hanim Ibrahim [aka Hanem Atwa Ibrahim] (50F) - d. Dec 31, 2007 -- Shatt `Ezbet el-Lahm, Damietta governorate
Nora Aboul Abbas Mohamed (21/22F) -- Barhim near Minuf city, Al Minufiyah
Fatma Fathi Mohamed (25F) - d. Dec 30, 2007 -- Dikirnis, Ad Daqahliyah governorate
Firdaus Mohamed Hadad (26F) - d. Dec 31, 2007 -- Al Minufiyah governorate

21 suspected cases reported in the last week / 1 death:

Beheira Governorate

Dec 30 - Mohamed Khalil Abdul Qawi (40M) - Ezbet "Notes", [Centre Kom Hamada] Kawm Hamadah

Al Minufiyah Governorate

Dec 30 - Nader Said Babylonian (5M) - Al Btanoun/Al Batanun

Dec 30 - Ahmad Abdulmohsen [aka Roqayya Ahmed Abdul Mohsen] (6M) - from a village "Tnbdi hamlet" ["Kafr Tunbdi"] in Shibin Al Kawm center Kafr Tambidi

Dec 31 - Abdul Rahman Ibrahim (57M)
Dec 31 - Abed Rabbo (50M?)
Dec 31 - Mohammad Ferdous (36M)

Jan 01 - Adel Mohamed Adel - from [Sers Al-Layan] Sirs al Layyanah

Jan 01 - Doaa - daughter of Adel Mohamed Adel

Jan 01 - Mohamed Said Abdul Rahman - from Barhim

Jan 01 - Karim Mohamed Fawzi - from Kafr Sheikh Khalil village in Shibin Al Kawm

Jan 01 - Hamida Abdul Hafiz Rizk - Aboukls village in the Martyrs

*Note that confirmed case Nora Aboul Abbas Mohamed above is also from Barhim, Al Minufiyah.

Amiriya north of Cairo:

Dec 31 - Salah Eddin Mohamed Ali (43M) - d. Dec 29

Alexandria:

Dec 31 - Faten (23F)

Port Said:

Dec 31 - Reza Abdalmugod Abdilkadir (25M) - husband of Radwan - "Satisfaction village in south of Port Said"
Dec 31 - Radwan - wife of Reza
Dec 31 - Mohammed (9M) - son of Reza & Radwan
Dec 31 - Rajab (5M) - son of Reza & Radwan

Ash Sharqiyah:

Jan 01:  Nabil Ahmed Mohamed (8M) - from the village of Hrbit belonging to Aboukbir center - has tested negative

Al Qalyubia:

Jan 01:  Safaa Mohamed Abdul Razek - nurse in the health unit - village of Al Alzm belonging to Shibin El Kanatar center

Al Gharbiyah:

Jan 01:  "34 years" policeman
Jan 01:  Huda Khaled (1M?)

 

Two of the suspect cases reported this morning (highlighted in red) are reported as a nurse and a police officer. Whether their infections have anything at all to do with their professions is not known at this time. However, anyone who works in a profession that requires close contact, such as a nurse, or as a police officer's often does, requires us to be alert to the possibility of contracting or spreading (or contracting and then spreading) the disease in the performance of those duties.

It is now well understood that the very people who come to our aid are also perfect communicable disease spreaders themselves. While we have long understood the role of health care professionals and their spreading germs from patient-to-patient, the role of first responders in viral spread is just becoming widely understood in light of pandemic planning.

 

I would be remiss if I failed to point out that most of the above cases are still suspect cases at this time. As the days pass we may find that most, if not all, of the above are not infections of H5N1. Until that time, the situation is worrisome.

 

SZ <gratitude to Theresa42 and the other Flubie Newshounds>

December 31, 2007

The Last Day of 2007

There is a quote that I am personally rather fond of:

"Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out, shouting '...holy shit...what a ride!'" – Anonymous

That handily sums up my 2007, so there is no need to bore anyone with details.

 

As is often said around the cyber flu community PanFlu (Pandemic Influenza) preparation and information gathering, as well as its dissemination, is a marathon, not a sprint. But someone failed to tell me that it was all up hill, occasionally with daunting headwind.

 

As I was considering the framing of this post it reminded me of an old song by Chicago, Does Anybody Really Know What Time It Is?

As I was walking down the street one day
A man came up to me and asked me what the time was that was
on my watch, yeah
And I said
Does anybody really know what time it is
I don't
Does anybody really care

What time does it read on the Pandemic Clock? Does anybody really know what time it is?

December has found us at a confluence of conflicting data-streams.

The first, WHO officials stating that progress has been made (which I fully agree with) and that H5N1 has slowed its frightful and inexorable march around the globe (which I fully agree with), and finally, that human cases had slowed in 2007—they had. The threat posed by H5N1 was not felt as acutely as in past years.

Second we have seen a veritable explosion (in comparison) of human cases during the month of December. Pakistan and Egypt are front and center with Indonesia the ever faithful and consistent handmaid.

 

Since human cases first appeared in Egypt they have had the "feel" of "different" to me and have engendered far more concern than the Indonesian cases, even though there are far more of them, and far more consistently deadly.

Theresa42 posted an update on the recent Egyptian cases along with what summary information currently available, since I would have no hope of doing half as well I will just use her great post from FluWiki. One of the important standouts of this data is the wide range of ages. Traditionally, the children and young women were victims, not so in Egypt. A change in victim's ages may indicate a change in the virus itself.

EGYPT - Detailed summary

SUMMARY OF CONFIRMED AND SUSPECTED CASES IN EGYPT SINCE DEC 25

5 confirmed cases / 4 deaths:

Oula Yunis Ali Mohamed (25F) - d. Dec 25, 2007

- from Beni Haroun village in Beni Suef governorate, south of Cairo
- admitted to Beni Suef hospital on Friday, Dec 21, with high fever, breathing problems and pneumonia
- diagnosed (test results came back) the day she died, Dec 25
- in contact with birds thought to be infected with bird flu
- relatives being checked/tested / mentioned in one article that her mother, specifically, was being tested
- brother of victim said that they went to one doctor who diagnosed bronchitis, but when she didn't get better they went to another doctor in a "special hospital" who sent her to the hospital in Beni Suef
- 39th case / 16th person to die of bf in Egypt

Attorh Hanim Ibrahim [aka Hanem Atwa Ibrahim] (50F) - d. Dec 31, 2007

- from Damietta governorate ("from Al Ngdi's land in the region of Ezbet meat in Damietta district")
- admitted to Damietta hospital on Monday, Dec 24 with high fever, breathing problems and pneumonia
- husband reports she began showing symptoms on Dec 24
- transferred to Cairo's Abbasiyah hospital
- reported on Dec 31st to be in critical condition
- in contact with birds thought to be infected with bird flu; husband reports that she keep poultry and that two days before she became ill, ten of her poultry had died
- husband and children tested and put under observation for 7 days
- 40th case

Nora Aboul Abbas Mohamed (21/22F)

- from "Center Worries" in Al Minufiyah governorate (also reported:  "from the belonging village of Barhim [Braheem], to Minuf center")
- admitted to Minuf hospital on Wednesday, Dec 26 with high fever and difficulty breathing
- transferred to Cairo's Abbasiyah hospital on Dec 27
- father reports that she began showing symptoms on the night of Dec 25 and that she had found dead poultry in her shop that morning
- reported on Dec 31st to be recovering in intensive care
- poultry seller, in contact with birds thought to be infected with bird flu
- family being tested
- 41st case

Fatma Fathi Mohamed (25F) - d. Dec 30, 2007

- from Daqahliya governorate
- admitted to local hospital on Dec 27 with high temperature and difficulty breathing; transferred to Mansoura hospital on Dec 29
- suspected of handling sick domestic birds
- 42th case / 17th person to die of bf in Egypt

Firdaus Mohamed Hadad (26F) - d. Dec 31, 2007

- from Al Minufiyah governorate
- hospitalized on Saturday, Dec 29
- high fever, difficulty breathing, pulmonary infection
- reportedly in contact with sick birds
- 18th death / 43rd case

12 suspected cases reported in the last week / 1 death:

Dec 30 -

Mohamed Khalil Abdul Qawi (40M) - Beheira governorate - reported Dec 30 - from the village of Ezbet Alhouci Bbrem Center Kom Hamada
Nader Said Babylonian (5M) - Al Minufiyah governorate - from the village "Alaptanon"
Ahmad Abdulmohsen (6M) - Al Minufiyah governorate - from the village "Kafr Tunbdi" at the centre of Shebin Mound

*Note that the two boys are from the same governorate as confirmed case Nora Aboul Abbas Mohamed above.

Dec 31 -

Amiriya north of Cairo:

Salah Eddin Mohamed Ali (43M) - d. Dec 29 - schoolteacher - had acute pneumonia - kept roof-top birds

Al Minufiyah:

Abdul Rahman Ibrahim (57M)
Abed Rabbo (50M?)
Mohammad Ferdous (36M)

Alexandria:

Faten (23F)

Port Said:

Reza Abdalmugod Abdilkadir (25M) - husband of Radwan
Radwan - wife of Reza
Mohammed (9M) - son of Reza & Radwan
Rajab (5M) - son of Reza & Radwan

 

So, the New Year will find us watching Egypt with intense interest, irrespective of the year-end assessments that want to tell us that H5N1 is less of a threat than it was at the beginning of 2007.

 

SZ

April 10, 2007

Egypt H5N1 Case #34 Update

News it hitting the Cyber Flu Community that Egypt's 34th human infection, Marianna Kameel Mikhail, died of her illness. According to my notes she entered the hospital on April 5th and if she died yesterday, the 9th, she lasted four days under treatment. Below is the source article and the translation of it that Dr Niman posted to FluTrackers.

 

توفيت أمس الطفلة مارينا ميخائيل‏(15 سنة‏), إثر إصابتها بمرض إنفلونزا الطيور‏, ليرتفع عدد المتوفين بالمرض إلي‏14 شخصا‏. وكانت الطفلة قد دخلت مستشفي الصدر بالعباسية الخميس الماضي أثر ارتفاع في درجة حرارتها عقب اختلاطها بطيور يشتبه في إصابتها بمرض إنفلونزا الطيور‏.(link to source article)

 

She died yesterday girl Marina Mikhail (15 years), following the presence of bird flu, raising the number of deaths the disease to 14 people. The girl had entered al-Sadr Abbassiya hospital last Thursday following a rise in the temperature following the sinking Batteur suspected in the presence of avian influenza.

 

She is older than the most recent survivors of human infection in Egypt, which showed a 100% recovery. There are three ready explanations for her rapid death that I can think of:

The sub-strain she contracted is the Tamiflu resistant strain that showed up in Egypt in Jan/Feb (see my previous entry for NAMRU-3's mention of it) or she started medical treatment too late, or she had an underlying medical condition. Hopefully we will be informed of the why, Egypt has been admirably transparent in their cases and information sharing, and hopefully we will not have to wait very long for the information.

 

I also feel a parent's grief. My thoughts are with Marianna's family at this tragic time in their life.

 

SZ

April 09, 2007

Egypt: 3 New Possible Cases

 

Three new possible cases of H5N1 human infection are being reported from one area in Egypt.  Thanks to Theresa42 and pugmom of FluWiki for translations of this new item.

Machine-translated from Arabic:

A detention 3 conditions to the suspicion of their injury by the bird flu in Dakahlia

April 8, 2007

Doctor Abdul Karim Ali Al Sayed the Ministry of Health deputy declared in Dakahlia a detention 3 conditions to the suspicion of their injury by the bird flu of the hospital of the triumphant [Mansoura] chest yesterday, And they:  Mohamed is Ragab Mohamed from the Tnbouha of Nabarouh center, and Mesbah Abu Mosallam Tawfik, and Ali Al Sayed Abdul Ati from Mahmoud's dead village in the triumphant [Mansoura] district, and taking samples took place from the suspect of their injury of its sending to the central laboratories, to make sure of the validity of their injury by the disease.

On the other side the firing squads [culling teams] carried out from the veterinary medicine, the health and the police in Dakahlia execution five thousand chickens in one of the farms related to the merchant Ali Sayed in Nusa region the sea belonging to Aga center after a death towards 1500 a chicken from it.

And the bodies concerned in Minya besieged the injury foci after the declaration of two human injuries in the past week in the cities of Minya and Beni Mazar, and they destroyed towards 2136 birds, and they closed 76 shops of the alive birds, and they seized 16 peddlers [street vendors], and they removed towards 49 [nests] I lived for the aviculture.

 

From Wikiepedia:

Al Mansurah (also spelled as Mansoura) (Arabic: المنصورة al-manūrah), with a population of 420,000. It is the capital of Ad Daqahliyah Governorate

Suspect Cases Names:

  1. Mohamed is Ragab Mohamed
  2. Mesbah Abu Mosallam Tawfik
  3. Ali Al Sayed Abdul Ati 

SZ

NAMRU-3 Letter to Microbe RE: Egypt H5N1

U.S. Naval Medical Research Unit No. 3 (NAMRU-3)sent in a letter to Microbe Magazine which they published in their March edition.  Thanks to Wulfgang for digging it up for us.

 

It is of interest because they are on the ground, doing the analysis of the submitted viral samples.  They are concerned enough to publicly state that they are concerned about the continued evolution of H5N1 in their area of responsibility.  The Webster et al. paper (PDF) mentioned may be found here.

 

We read with great interest the article by Webster et al. on the expanding range and behavior of H5N1 Avian Influenza (Microbe, December 2006, p. 559). They provide an outstanding description of how the viruses, originating in Southeast Asia, have migrated into Eurasia and the continued threat they pose to both birds and humans. One of the dramatic changes noted is the spread to Southwest Asia and Africa. The U.S. Naval Medical Research Unit No. 3 located in Cairo, Egypt, has been involved in monitoring the spread of H5N1 influenza to this region. We would like to add to the authors' arguments by commenting on this spread, as well as express our concern that our region may now be contributing to the continued evolution of influenza.

 

[snip]

 

Monitoring of migratory waterfowl in Egypt has revealed a number of avian influenza strains with components of viruses from different species and locations, including the mixing of European and Asian strains. Recently wild birds have been documented with H5N1 in Egypt. Retrospective analysis of a weak positive H5 from a live wild teal collected in November of 2005 revealed the Qinghai strain, as have several local birds (egret, pigeon) found dead during 2006.

 

In Nigeria, it has been demonstrated that there were multiple introductions of avian influenza into poultry. This is also suggested in Egypt. Human isolates in Egypt from October 2006 (GenBank #EF061116) indicated a new amino acid change in the HA receptor-binding domain when compared with viruses isolated between February and May. Isolates from December (GenBank  #EF200512) reveal two additional amino acid changes. Of further concern was a mutation observed in the neuraminidase gene (GenBank #EF222322 and #EF222323) which conferred resistance to oseltamivir as judged by a chemiluminescence neuraminidase inhibition assay (phenotypic analysis performed at the Centers for Disease Control and Prevention, Atlanta, Ga.). This is the first time this particular mutation has been observed in the Quinghai strain. Taken together, these data highlight the accumulation of multiple polymorphisms which could evolve into a pandemic strain. Information regarding the mutation in the neuraminidase gene can be found on the World Health Organization website (http://www.who.int/csr/disease/avian_influenza/en/index.html).

Africa is a region increasingly relying on poultry and is on the migratory pathways between H5N1 endemic regions. It is not surprising that evolution of virus is being observed here.

 

We agree with the authors of the Microbe article that H5N1 is changing in novel ways and is a continued threat. It now appears (for perhaps the first time) that the emergence of a pandemic strain could originate outside Southeast Asia. This paradigm shift further supports the need for continued global monitoring of influenza, especially in areas with high numbers of humans and domestic and wild birds living in close proximity.

 

Kenneth C. Earhart
Bruce R. Boynton
Magdi D. Saad
Marshall R. Monteville
U.S. Naval Medical Research Unit No. 3
Cairo, Egypt
Volume 2, Number 3, 2007 / Microbe Y 113


April 08, 2007

Egypt Case # 34

 

The 34th human case of H5N1 infection has been confirmed in Egypt.  Fifteen year old Marina Mikhail, her condition is listed as stable.  She lives in a district on the outskirts of Cairo in Shubra with an estimated population of between 4-5 million.  In some sections of the district population density reaches approximately 75,000 per square kilometer. 

Human infections in densely populated locations adds an extra level of concern.  Millions commute into and out of the Shubra district on a daily basis

 

News.com.au story

(Excerpt)

A 15-year-old girl in Cairo has been diagnosed with bird flu, the 34th person in Egypt to be infected with the disease, the health ministry says.

Marina Kamil Mikhail, from Cairo's Shubra district, was admitted to hospital on Thursday with high fever, health ministry spokesman Abdel Rahman Shahin said.

The girl, who had been in contact with domestic poultry, was treated with Tamiflu, he said, adding that the rest of her family is being tested for the disease.

Egypt's position on major bird migration routes and the widespread practice of keeping domestic fowl close to living quarters have given the Arab world's most populous nation the highest human death toll from avian flu outside Asia.

 

From TourEgypt.net… 

Geographically, the district covers North Cairo and extends from the railway bridge behind the Main train station in Ramsis Square, to the edge of Shubra Al Kheima at the far north of the capital. From East to West it covers the area between the Nile, and the railway line going north at Ahmed Helmy Street.

 

In the past, Shubra was much smaller, and more aristocratic. Now, it is home to millions of Egyptians in often-crowded conditions, most of whom belong to lower middle and lower classes.


SZ