Another Egyptian H5N1 case reported

Jun 11, 2007 (CIDRAP News) – A 4-year-old Egyptian girl was reported to have H5N1 avian influenza today, as the World Health Organization (WHO) confirmed that a 10-year-old girl from the same area died of the illness 2 days ago.

The Egyptian health ministry said the 4-year-old girl, from Qena governorate in southern Egypt, was hospitalized yesterday with fever and breathing difficulty, Reuters news service reported. Officials said she had been exposed to birds sick with suspected flu.

The 10-year-old girl, also from Qena, was listed in critical condition when her illness was reported Jun 8. The WHO said she fell ill Jun 1 and was hospitalized on the 6th. There was evidence that she had been exposed to dead birds, the agency said.

The two latest cases were the first in Egypt in about 2 months. The country had 16 cases earlier this year.

By the WHO's count, Egypt has had 35 cases with 15 deaths, for a case-fatality rate of about 43%. That compares with a fatality rate of 80% in Indonesia, the hardest-hit country, which has had 99 cases and 79 deaths.

The Reuters report said most Egyptian cases have occurred in the northern part of the country, but 10 of the past 12 cases have been in the hotter south.

Egyptian officials had expected the virus to be less active this summer, in line with the pattern set last year after the initial cases in February 2006, the story said.

In other developments, Vietnam's first H5N1 case-patient in a year and a half left the hospital today, according to another Reuters report.

The patient, a 30-year-old man, was hospitalized in Hanoi on May 15 after he helped slaughter chickens for a friend's wedding, the story noted. Doctors at the Bach Mai hospital said they treated him with the antiviral drug oseltamivir (Tamiflu) for 10 days instead of the standard 7 days, the report said.

Doctors also said the virus was found in the man's saliva, stomach, and feces, according to the story. A number of studies have reported gastrointestinal symptoms in H5N1 patients, and the WHO has said that H5N1 infection is more likely to involve diarrhea than ordinary flu is.

The Reuters report said a second Vietnamese patient, a slaughterhouse worker, is still being treated but is recovering well.

In Indonesia, meanwhile, officials said some poultry are getting H5N1 infections without showing signs of illness, complicating efforts to track the virus and protect humans.

"From our observations during 2007 we have found that chickens infected by bird flu have not been showing the usual symptoms," said Memed Zulkaraen, director of the agriculture ministry's avian flu campaign unit, according to an Agence France-Presse (AFP) report published today.

So far this year, 12,000 birds in Indonesia have died of avian flu or been culled, whereas last year about 1.75 million poultry died of the disease or were destroyed, said Musny Suatmodjo, animal health director at the agriculture ministry, according to a Reuters report today.

Bayu Krisnamurthi, chief of Indonesia's avian flu commission, expressed concern that healthy-looking poultry could shed the virus in their feces, increasing the risk of human cases, the story said.

Kisnamturthi said Indonesia has had some human cases in the absence of any sick or dead poultry in the area.

Last week Krisnamurthi expressed a suspicion that the H5N1 virus has mutated in a way that enables it to jump more easily from birds to humans. He said there were signs that humans could get infected with less intense exposure to sick birds than in the past.

See also:

Jun 11 WHO statement
http://www.who.int/csr/don/2007_06_11/en/index.html

Jun 6 CIDRAP News story "Indonesia suspects ominous H5N1 mutations"

Oct 11, 2005, CIDRAP News story "Experts cite differences between H5N1 and ordinary flu"

CIDRAP overview of the implications of avian influenza for human disease

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