EGYPT: UPDATE ON RECENT HUMAN AVIAN INFLUENZA CASES

1. (SBU) Summary. Scientists at NAMRU-3 conducted a
detailed examination of the H5N1 avian influenza virus
responsible for the deaths of three family members in late
December in the Gharbiya governorate (ref A). Early results
show that the virus has undergone mutations and acquired some
characteristics of mammalian strains. All of these mutations
have been seen before in swine or humans in other countries.
Though this is not/not a pandemic influenza virus and
scientists cannot say that these mutations are a step towards
creation of a pandemic virus, the changing face of avian
influenza in Egypt requires careful monitoring. NAMRU-3
continues to collaborate closely with GOE officials to survey
the virus in humans and the bird population. End Summary.



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MIXING AND RECOMBINATION IN EGYPT


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2. (SBU) Specimens from the most recent deaths suggest that
Egypt could be acting as a type of mixing bowl for diverse
strains of H5N1 originating from thousands of miles away.
The virus obtained from the thirty-nine year old Gharbiya
woman who succumbed to H5N1 in October (ref B) showed a
mutation not previously seen in Egypt. Two of the three
December cases in Gharbiya sequenced by NAMRU-3 showed that
same mutation, as well as two additional mutations. One of
these mutations is identical to another discovered in
Mongolia in 2005, which is on the migratory flyway with
Egypt. Crossed by two major flyways, millions of wild birds
pass through Egypt each autumn and spring, migrating between
Africa and Central Asia.



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THE CHANGING FACE OF AVIAN INFLUENZA


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3. (SBU) According to officials at NAMRU-3, sequencing of
the October and December cases shows that the virus is
acquiring changes which make it look more like a mammalian
virus. All three recent mutations have been seen before in
swine or humans in other countries. Though this is not/not a
pandemic virus and scientists cannot say that these mutations
are a step towards creation of a pandemic virus, the fact
that a single virus has acquired three mutations in three
months is cause for careful monitoring. The virus' ability to
acquire mammalian characteristics rapidly, in regions of the
viral genome that determine its infectivity, needs to be
carefully evaluated. In the most recent cases, there is no
evidence that the virus is efficiently transmitted from
person to person.



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MISSION RESPONSE


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4. (SBU) NAMRU-3 representatives are keeping officials from
the Ministry of Health and Population (MOHP), CDC, DOD
surveillance teams, and WHO in Geneva of the test results.
NAMRU-3 also submitted the virus sequences to Genbank, a NIH
genetic sequence databank; they will be accessible to the
public in a few days on their web site There is a high
likelihood that both the press and scientific community will
speculate about the meaning of the mutations. NAMRU is in
the process of sequencing the remainder of the viral genome
in all of these cases. In collaboration with Ministry of
Environment (MOE), NAMRU is continuing surveillance of wild
bird populations to detect any new viral strains entering
Egypt.
RICCIARDONE