15 June 2009

Monday

Egypt Reports 20^th Case of Novel Influenza A (H1N1= ), and Remains the Only Nation in Africa wi= th Lab-Confirmed Cases

As of this morning the World Health Organization (WHO) Eastern Mediterranean Region has report= ed an ongoing increase to 20 lab-confirmed cases in Egypt of the novel Influenza = A (H1N1) virus. Daily updates can be found at: http://www.emro.who.int/csr/h1n1= /

No other African nations have reported any lab-confirmed cases, according to the websites for the two WHO regions in Africa: this East= ern Mediterranean Region Office (EMRO) and the 46-nation African Regional Office (AFRO): http:= //www.afro.who.int/ddc/influenzaa/index.html

On Sunday, June 1= 4, the WHO EMRO Influenza A (H1N1) website “highlights” section summarized three cases reported by the Min= istry of Health of Egypt on June 13^th. These three patients were travelers to Egypt. = The first was a 45 year-old Columbian woman who flew from Columbia to Frankfurt, Germany and then to Cairo<= /st1:City> on June 10^th. Her symptoms did not start until June 12 while vis= iting the Egyptian Museum. Fortunately, a physician a= t this Museum suggested she go to a hospital for evaluation.

A second case was= a 7 year-old boy who flew with his mother from Minnesota (USA) to London and then to Egypt on June 7. He was diagnosed i= n the governorate of Alexandria. His brother was diagnosed with the= same novel virus (case 12 in Egypt). Of note, the mother reported that the child was evaluated by a physician in= the USA on June 5 for influenza-like illness, told he had the novel Influenza A (H1N1) virus, and treated with the inhaled neuramini= dase inhibitor “Relenza” (zanamivir).

The third case wa= s an 8 year-old Egyptian-Canadian boy who flew from Canada to Egypt= on June 12 and was “detected by the quarantine staff at the airport”.

All three of these patients were reported to be in stable condition while receiving the oral neuraminidase drug “Tamiflu” (oseltamivir), in a referral hospi= tal.

Today, the American University<= /st1:PlaceType> of Cairo (AUC) dormitory in the Zamalek area of Cairo, where several American students = had been diagnosed with this novel influenza virus, is scheduled to reopen.

The latest update from the WHO African Regional Office reports that there are still zero lab-confirmed cases in the 46 nations in this part of the continent. The following information is poste= d on their website summarizing key actions at the Regional office in Brazzaviull= e, as well as in Zimbabwe= , Gabon, and Burkina Faso. http://www.afro.= who.int/ddc/influenzaa/index.html

“All countries in the region have activated their national emergency preparedness and contingency response plans

A crisis management team has been put in place by the Regional Director at the regional office (Brazzaville) and the sub regional levels (Intercountry Sup= port teams in Harare, Zimbabwe, Gabon and Burkina Faso)) to work closely with countries to boost their disease surveillance to ensure that any suspected = case of Influenza A H1N1 is detected early.

Stockpiles of relevant medicines have been dispatched to all countries in the region as well as mapping laboratory and human resources capability at country and regional levels to enable WHO to support Member States to respond rapidly to any suspected outbreaks.”

In sum, currently= there is no reported community-level transmission of this novel Influenza A (H1N1) virus anywhere in Afri= ca. Increased surveillance and vigilan= ce is warranted now across all of Africa, not only in Egypt, for cases of this new virus. There is no biological= ly plausible reason to assume that this virus will not spread in Africa as it = has in the Americas, Europ= e, and Asia.

In addition, incr= eased surveillance for avian flu H5N1, and other avian flu viruses (e.g., H7, H9,= and H10) should be considered. Continued animal-to-human cases of Influenza A (H5N1) have been reported in Egypt during the first six mo= nths of this year. Such increased surveillance would help to monitor for, and gu= ide responses to, any reassortment between an avian flu virus and the novel “swine flu” Influenza A (H1N1) virus= .

Daniel R. Lucey, MD, MPH

EROne Institutes, Department of Emergency Medicine<= /o:p>

Washingt= on Hospital Center

Adjunct Professor of Microbiology and Immunology

Georgeto= wn University Medical Center, Washington, DC

Website for this posting: www.BePast.org

e-mail: DRL23@Georgetonw.edu