Continuous circulation of influenza A(H5N1) virus among poultry in Egypt has created an epicenter in which the viruses evolve into newer subclades and continue to cause disease in humans. To detect influenza viruses in Egypt, since 2009 we have actively surveyed various regions and poultry production sectors. From August 2010 through January 2013, >11,000 swab samples were collected; 10% were positive by matrix gene reverse transcription PCR. During this period, subtype H9N2 viruses emerged, cocirculated with subtype H5N1 viruses, and frequently co-infected the same avian host. Genetic and antigenic analyses of viruses revealed that influenza A(H5N1) clade 2.2.1 viruses are dominant and that all subtype H9N2 viruses are G1-like. Cocirculation of different subtypes poses concern for potential reassortment. Avian influenza continues to threaten public and animal health in Egypt, and continuous surveillance for avian influenza virus is needed. In 2008, highly pathogenic avian influenza (HPAI) A(H5N1) virus became enzootic among poultry in Egypt, and the country became an epicenter for virus activity. As the established viruses drifted over time, viral genetic and antigenic diversity was generated. During 2010–2011, subclade 2.2.1 viruses (direct-drift progeny of the initially introduced virus) and 22.214.171.124 viruses (which might have emerged because of vaccine pressure) were cocirculating among poultry in Egypt. These subclades differed genetically and antigenically, hence complicating control efforts, especially vaccination. Subclade 2.2.1 viruses, commonly isolated from backyard flocks that are not vaccinated, caused all of the human cases in Egypt; from 2006 through September 2013, the toll rose to 173 cases and 63 deaths. Subclade 126.96.36.199 viruses were more prevalent on commercial farms, where vaccines are more frequently used.
Furthermore, recent reports have indicated that very few mutations are needed for subtype H5N1 to become transmissible among ferrets, the best mammalian model of human influenza infection. In Egypt, a subtype H5N1 virus was found to have 2 of the 4 mutations needed to gain the transmissibility function, thereby underlying the need and urgency for surveillance among poultry. The Nile Delta region of Egypt was also identified as an area where substantial reassortment of influenza viruses can take place. As a further complication, in 2011, subtype H9N2 viruses were detected in poultry from areas in Egypt where subtype H5N1 viruses circulate. Since 2009, we have been conducting systematic, active surveillance of avian influenza virus (AIV) among poultry in Egypt; the same locations are sampled over time, regardless of whether a clinical outbreak of disease is present. We previously reported that the threat of HPAI (H5N1) virus is widespread beyond rural areas and that the commercial sector is a key reservoir for virus transmission. Here we provide an update on the changing epizootiology and genetic features of AIV in Egypt and report co-infection of poultry in Egypt with influenza virus subtypes H5N1 and H9N2.
http://wwwnc.cdc.gov/eid/ Emerging Infectious Diseases
April 29, 2014
http://wwwnc.cdc.gov/eid/article/20/4/13-1295_article.htm Original web page at Emerging Infectious Diseases