Published Date: 2007-01-18 00:00:00
Subject: PRO/AH/EDR> Avian influenza, human (15): Egypt, drug resistance
Archive Number: 20070118.0238
AVIAN INFLUENZA, HUMAN (15): EGYPT, DRUG RESISTANCE
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In this update:
[1] Egypt: woman tests positive for H5N1 virus infection
[2] Egypt: drug resistant H5N1 strain isolated
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[1]
Date: Wed 17 Jan 2007
From: Mary Marshall <tropical.forestry@btinternet.com>
Source: Reuters Foundation AlertNet, Wed 17 Jan 2007 [edited]
<http://www.alertnet.org/thenews/newsdesk/L17812042.htm>
A 27 year old Egyptian woman tested positive for the deadly H5N1 bird flu
virus, a World Health Organization official said on Wed 17 Jan 20007. The
virus has claimed 10 lives in Egypt while 8 other positive cases recovered
since it first surfaced in Egyptian poultry in February [2006].
"Unfortunately, yes, there is a new case," said Hassan el-Bushra, regional
adviser for communicable diseases surveillance for WHO. He told Reuters
tests carried out by Egyptian authorities were positive for the H5N1 virus
and he was awaiting the results of a 2nd set of tests.
The official Middle East News Agency (MENA) identified the woman as Warda
Eid Ahmed from the province of Beni Suef south of the capital Cairo. The
agency quoted an Egyptian Health Ministry official as saying she has been
hospitalised since 13 Jan 2007 with a serious pulmonary inflammation.
--
ProMED-mail
<promed@promedmail.org>
[When confirmed officially by WHO, this will become the 19th human case of
H5N1 virus infection in Egypt. A map of the provinces of Egypt is available
at <http://www.un.org/Depts/Cartographic/map/profile/egypt.pdf>. - Mod.CP]
******
[2]
Date: Thu 18 Jan 2007
From: Mary Marshall <tropical.forestry@btinternet.com>
Source: New York Times, Thu 18 Jan 2007 [edited]
<http://www.nytimes.com/2007/01/18/world/africa/18flu.html?_r=1>
A strain of avian flu that is resistant to the antiviral drug oseltamivir
has been isolated from 2 family members in Egypt, the World Health
Organization (WHO) said yesterday. The development is potentially dangerous
because oseltamivir, commonly sold under the name Tamiflu, is the chief
weapon against the flu strain, H5N1, which many worry could mutate into a
strain that could set off a worldwide pandemic. WHO emphasized that it was
too early to tell whether the resistant strain had developed independently
in the 2 patients, who were both under treatment with the drug, or whether
they had picked it up from birds or from each other. The resistant strain
did not spread to anyone else, including a 3rd family member who also had
avian flu. "Given the information we have, we don't see any broad public
health implications," said Dick Thompson, a spokesman for the organization.
Mr Thompson was unsure which Egyptian cluster of flu infections the
patients were part of. But another source said it was one in Gharbiya
Province, roughly 50 miles north of Cairo, in which flu killed 3 people
last month [December 2006] in a 33-member family living in one compound.
Oseltamivir-resistant strains were found in 3 unrelated patients in Viet
Nam in 2005 but did not spread. The development "is not a big surprise, but
it certainly is disheartening," said Dr Anne Moscona, an expert on flu
treatment at Weill Cornell Medical College. The oseltamivir-resistant
strain in Egypt was susceptible to zanamir, which is sold as Relenza, and
to amantadine, which is from an older, cheaper, and easier-to-use class of
drugs but is not normally used as a 1st-line treatment because many avian
flu strains are resistant to it. The development, Dr Moscona said,
suggested that doctors might have to consider switching to a cocktail of
drugs as 1st-line treatment, as is done with AIDS medications and sometimes
with antibiotics.
Dr Andrew T Pavia, chairman of the pandemic influenza task force of the
Infectious Diseases Society of America, said it was theoretically possible
that resistant strains of the flu had developed simultaneously in 2 related
patients, especially if they were very sick and had been treated with doses
of oseltamivir that were too low. But if one transmitted it to the other,
"it would be very worrisome," he said, because previous resistant strains
had been very weak at infecting new victims.
Scientists do not know exactly which mutations or how many of them would
make the avian flu virus more dangerous, but they have some clues. The
virus now circulating in birds does not attach easily to cells inside human
noses or throats. It reproduces more slowly at human temperatures than at
bird temperatures, which are slightly higher. It does not detach easily
from cells to infect new ones, and it is usually killed by oseltamivir.
Scientists are keeping an eye on the genes that code for those aspects of
the virus -- for example, the shape of the spikes on its outer coating,
where it binds to cells.
If an oseltamivir-resistant strain spreads, it will complicate the public
health response. Governments have been stockpiling oseltamivir, not
zanamir. Zanamir is more expensive and also harder to use and to ship,
because it is typically sold not as a pill but as a powder that comes in an
inhaler resembling a small hockey puck. An intravenous form exists but has
not been approved for use in some countries, including the United States,
Dr Moscona said.
[byline: Donald G McNeil Jr]
--
Mary Marshall
<tropical.forestry@btinternet.com>
[The co-resistance of this isolate to both oseltamivir and zanamir is not
unexpected, since both drugs target the same viral protein (the
neuraminidase), although strains resistant to one of these inhibitors only
have been isolated elsewhere. Simultaneous resistance to amantadine,
however, which targets the M2 protein (a membrane protein functioning as an
ion channel), is unusual and suggests indiscriminate use of these drugs in
treatment of influenza patients. - Mod.CP]
See Also
Avian influenza, human (13): Egypt, Indonesia 20070115.01982004
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Avian influenza A (H5N1) virus, drug resistance (02) 20040127.0316
Avian influenza A (H5N1) virus, drug resistance 20040125.0298
.................cp/pg/sh
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