Recombinomics Commentary 17:44
April 8, 2009

Both boys had contact with sick/dead poultry prior to the illness onset.

Close contacts of both boys have been identified and none has shown symptoms of the infection.

The above comments from the latest WHO update represent glaring commission by omission.  The update claims “contact with sick/dead poultry”, but fails to give results of testing of such poultry.  The SAIDR site, which has poultry results through April 3 does not include any confirmed poultry cases in the proximity (see updated map) of the Beheira cluster.

Moreover, the above comments imply that neither confirmed case has transmitted H5N1 to any contact, yet the update fails to mention that the two confirmed cases live “in adjacent houses”, and are cousins.

The four day gap in disease onset dates leaves little doubt that the index case infected his cousin, who lives text door.  This toddler to toddler transmission is cause for concern, because both cases had mild H5N1, including the index case, who began oseltamivir treatment after the recommended 48 hours after disease onset.

These mild bird flu cases in Egypt are not new, and were cause for concern in 2007, when children between the ages of 3-10 rapidly recovered and were infected with H5N1 sequences that were virtually identical and signaled extensive human to human transmission because the cases with identical H5N1 sequences were not epidemiologically linked.

Although WHO has recently acknowledged concern for silent transmission of H5N1, the above commissions by omission of an obvious case of human to human transmission raises serious pandemic concerns about WHO’s ability to analyze scientific data and transparently present results of such analysis.