101st Death in Indonesia

The World Health Organization (WHO) has confirmed the death of a 32-year-old Indonesian man identified as N, from the H5N1 strain of avian influenza. The man was a resident of Tangerang district.

Indonesia MoH reports on 4 new cases

There seems to be more information on each case and the circumstances around the infection. Hopefully we'll continue to see improvements on reporting of cases

All 4 cases are around Jakarta and Tangerang.

"Entering last week in January 2008, there are 4 more AI cases, based on RT ? PCR (Real Time Polimerase Chain Reaction) test in laboratories of National Institute of Health Research & Development (Balitbangkes) MOH and Eijkman Molecular Biological Institute. Those 4 cases are Nas (Tangerang District, Banten), MIY (Depok, West Java), and Res and Vir (both from East Jakarta).

Since the first case found in mid July 2005, number of AI cases in Indonesia by January 28, 2008 reaches 124 cases with 100 of them dead. The Case Fatality Rate (CFR) is 80.6%.
This latest information is received by Center for Public Communication from AI Post, DG of Diseases Control & Environmental Health MOH, January 28, 2008.

Nas (m, 32 years), a fried chicken seller who lives at Medistrania Regency, Sukamulya Village, Cikupa Sub District, Tangerang District, Banten, started getting ill on January 17, 2008 with symptoms of headache, stomachache, difficulty in breathing and fever. On January 24, he was hospitalized at Bakti Asih Hospital, Tangerang, and two days later referred to Persahabatan Hospital. Now, he is still getting treatment in ICU. One of his neighbor, living 500 meter from his house, raises 12 pigeons.
MIY (m, 9.5 years), a student who lived at Pancoran Mas, Depok, West Java, started getting ill on January 16, 2008 with symptoms of difficulty inbreathing and high temperature (37.8oC). After getting treatment at Sentra Medika Hospital, Cimanggis on January 23, 2008, he was referred to Sulianti Saroso Infection Center on January 27, 2008. The risk factor is still observed.
Res (f, 31 years), who lives in Duren Sawit, East Jakarta, starts getting ill on January 18, 2008. She was hospitalized at Harum Hospital on January 22, 2008 with symptoms of cough. Four days later, she was referred to Persahabatan Hospital, East Jakarta with symptoms of high temperature, cough and headache. Today, she is still getting treatment there and put on a ventilator. Based on an observation, some could be the risk factors, suc as chicken farming 100 meter from her house and chicken slaughter 500 meter from her house. In addition, on January 15, 2008, she went to a bird market.

Vir (f, 23 years), who lived in Pulogebang, East Jakarta, started getting ill on January 19, 2008 with symptoms of fever and difficulty in breathing. On January 24, she was hospitalized at Ananda Hospital, Bekasi and referred to Sulianti Saroso Infection Center two days later and then died on January 27, 2008. by now, the risk factor is still investigated."

http://www.depkes.go.id/en/2901fo.htm

Cambodian study hints at subclinical H5N1 cases

A study by the Pasteur Institute of Cambodia shows some cases of H5N1 in humans that most likely mild or subclinical and went unreported in a previous outbreak. The study was presented last week at the international avian flu conference in Bangkok


"The Cambodian researchers tested 674 people in two villages who were exposed to the virus and found that seven of them, all between the ages of 4 and 18, had antibodies signaling previous infection, according to a Jan 24 Bloomberg News report. The finding contrasts with previous serologic studies of people in areas affected by H5N1 outbreaks. A review published Jan 16 in the New England Journal of Medicine (NEJM) said the few serologic studies since 2003 of people with potential exposure to H5N1 suggest that asymptomatic or mild cases are rare. The studies involved people living with backyard poultry, workers in live-bird markets, and healthcare workers.

More cases of mild disease might suggest that the virus is improving its ability to spread among humans, while becoming less virulent. Based on the current global count of 353 cases with 221 deaths, the case-fatality rate is almost 63%.

The median age of the seven people who had antibodies was 12 years, compared with 27 years for those who had no antibodies, the story said. Vong and colleagues had conducted a similar study of 351 Cambodian villagers in 2005 and found that none had antibodies to the virus. The study was published in Emerging Infectious Diseases in 2006.

Malik Peiris, a microbiology professor at the University of Hong Kong, told Bloomberg that the latest study supports findings from the 1997 H5N1 outbreak in Hong Kong, in which human cases were first reported. The virus infected 18 people, 6 of whom died. Peiris said children were less severely affected than adults and had a better survival rate, Bloomberg reported.
"Most of the children diagnosed in Hong Kong in 1997 had a very mild course of infection; they basically had a mild flu-like illness and they recovered,"
Peiris was quoted as saying. "I don't think there is any evidence to say the situation has changed."

This is a very important study, but too soon to draw conclusions. It is worrisome though.

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jan2508bangkok-jw.html

Vietnam confirms 2nd H5N1 death in 2008

BBC Monitoring Asia Pacific - Political
Supplied by BBC Worldwide Monitoring
January 24, 2008 Thursday
Vietnam confirms second death from bird flu in 2008
Text of report in English by Vietnamese news agency VNA website

"The head of Vietnam's health preventive watchdog on 23 January confirmed that a man from northern Tuyen Quang province has died of bird flu. The victim was 32 years old from the Cao Lan ethnic minority group in Son Duong district, Tuyen Quang province, Dr Nguyen Huy Nga, Head of the Health Preventive Department of the Health Ministry said, adding that he is the second victim in the country since the beginning of this year. Earlier, a four year-old kid from Chieng Khoa commune, Moc Chau district, northern mountainous Son La province died at the central paediatrics hospital in Hanoi.

"The two H5N1victims are all related to dead fowl," Dr Nga emphasised after he had received the results of sample tests provided by the Central Hygiene and Epidemiology Institute."

Indonesia confirms 99th & 100th human deaths and more cases

"In Indonesia, the H5N1 bird flu virus killed a 9-year-old boy and a 20-year-old woman from the outskirts of Jakarta, said Joko Suyono of the National Bird Flu Center. The boy fell ill Jan. 16 and died Sunday in Jakarta after testing positive, Suyono said. The woman developed symptoms Jan. 19 and died in a hospital. Two other Indonesians in their 30s, who also tested positive, were being treated in the capital, Suyono said.Indonesia has recorded nearly half of the 222 human deaths from bird flu detected worldwide since the virus began decimating poultry stocks in late 2003."

http://ap.google.com/article/ALeqM5h4z_Ugpa0UYwp7CmJNz0feyeHGbQD8UEUK800

WHO establishes database for virus sharing

WHO has launched a new electronic database that records all virus samples countries have contributed to the agency since November 2007

"It also will list which other vaccine companies or laboratories around the world
receive them. The system, currently available on the WHO's Web site and still
being developed, notes which countries donated the viruses, test results, and
other information.As of yesterday, the database had 46 entries for viruses collected from around the world. The most recent virus in the database, for example, was a sample
collected by a laboratory in the United Arab Emirates from a falcon infected
with bird flu that the database indicates was shared this month with the St.
Jude Children's Research Hospital in Memphis, Tennessee."

This is an important step forward, not only for transparency and the ongoing debate about virus sharing and vaccines, but also as a step forward in harnessing mass collaboration to fight flu.


http://online.wsj.com/article/SB120111686934510627.html?mod=dist_smartbrief

India: Overwhelmed labs and a plan to expand

As H5N1 engulfs half of West Bengal, the nation's only lab testing samples of suspected H5N1 has been overwhelmed, receiving hundreds of samples from dead birds each week.

"'It has been decided to build several new laboratories especially in view of the bird flu situation now," Santanu Kumar Bandyopadhyay, India's animal husbandry commissioner told Reuters late on Tuesday.'

"To begin with, at least six laboratories are being built which will be of biosafety level-3 (BSL-3), or clinical and diagnostic facilities that work with potentially lethal agents."

It is not immediatley clear when these new labs will be operational.

H5N1 continues to spread in West Bengal state as veterinary workers are joined by other volunteers in the area to begin culling infected flocks. Nine of West Bengal's 19 districts are now reporting H5N1 among flocks. Culling targets, previously set at 2 million, are likely to be raised. At the moment, the daily goal would have 600 teams culling 300,000 birds each day.

Full story: http://in.reuters.com/article/topNews/idINIndia-31541220080123

New human cases in Vietnam and Indonesia

Indonesia has reported its 120th human case of H5N1. This time, instead of being a villager, poultry vendor, child, etc, the case involves a sales executive.

"A 30-year-old man from Tangerang has been confirmed as the latest case of bird flu in the country. The sales executive at an automotive company, identified only as GR, was initially treated at Honoris Hospital in Tangerang on Jan. 18 and referred to Persahabatan Hospital two days later. He was sent to the hospital with a fever, cough, breathing difficulties, a decreasing white blood cell level, a reduced blood platelet count and symptoms of pneumonia. "

Meanwhile, 3 children in West Java have been hospitalized with suspected H5N1 after mass poultry die offs in their village

http://www.thejakartapost.com/detailheadlines.asp?fileid=20080123.B08&irec=7

A new human case looks likely in Vietnam

"Bird flu may have killed a 32-year-old Vietnamese man in a northern province where the virus has been found in poultry, state-run media and a government report said on Tuesday.
The man died at a Hanoi hospital of pneumonia earlier this month, two days after he had been taken in from Tuyen Quang province, the hospital's deputy director Nguyen Hong Ha was quoted by the online VTC News newspaper (www.vtc.vn) as saying.
The man fell ill on Jan. 16 after eating chicken which had died of unknown cause. Dead chicken and white-winged ducks were also found near his house, the newspaper quoted a relative as saying."

http://africa.reuters.com/commodities/news/usnHAN286150.html

Concerns mount over spread of H5N1 in India's West Bengal

West Bengal, home to 24 million people, India's most densely populated state, is now also home to the largest H5N1 outbreak among poultry in the nation. After spreading to 7 of West Bengal's 19 districts, officials fear that they may not be able to get ahead of the disease's spread.

Officials feared that five Bengalis had contracted the deadly strain, but fortunately none have tested positive for H5N1.

Authorities have put a plan in action to cull 2 million infected and exposed poultry to prevent the strain from spreading to other districts and states. However, progress has been slow because health workers are showing up late to work and villagers, expressing anger at the government for not fulling informing them of the dangers of bird flu, have been resistant. So far, only 150,000 birds have been culled.

In neighboring Bangladesh, where 26 of 64 districts are experiencing poultry outbreaks, health workers continue culling but have not gotten control of the outbreak yet.

Full Story: http://www.alertnet.org/thenews/newsdesk/SP262379.htm

The InSTEDD launch: A new blog with pandemic flu topics and disease surveillance

The InSTEDD Project launched it's website and new blog this past week. A branch off of the Google philanthropy arm, InSTEDD is, " all about humanitarian collaboration through technology innovation. We are looking carefully at the problems faced by those involved in disease tracking and disaster response, and we're moving forward in focused ways to help them."

The have blog where they're already talking about models of disease transmission and pandemic preparedness. Looks like it will be a good resource

http://www.instedd.org/blogs

New outbreaks and cases around the world

To consolidate some news on outbreaks from around the world

97th Death in Indonesia

An 8 year old boy from Tangerang became the 97th H5N1 death in Indonesia

http://www.reuters.com/article/latestCrisis/idUSJAK3368

Iran is just now reporting on it's first H5N1 outbreak in poultry, though it occured in Dember.

"The outbreak was in Mazandaran province on the Caspian Sea, the OIE said. It said investigations are under way to trace the source of the infection and its "probable spread."

http://www.iht.com/articles/ap/2008/01/18/africa/ME-GEN-Iran-Bird-Flu.php

Ukraine is reporting it's first H5N1 outbreak since June 2006

http://www.kyivpost.com/bn/28197/

Fourth Swan Tests Positive for H5N1 in England

"The deadly H5N1 strain of avian influenza was detected in a fourth dead swan in southwest England, the U.K. environment ministry said, six days after the outbreak of the disease was first reported.

The ministry said Jan. 10 that three dead mute swans were found with the virus. The outbreak occurred at Abbotsbury Swannery, a reserve near Chesil Beach in Dorset.

'Another mute swan collected on 11 January as part of wild bird surveillance from the same area has tested positive'' for H5N1, the Department for Environment, Food and Rural Affairs said today in an e-mailed statement.' There is currently no evidence to suggest widespread disease in the wild-bird population.''

It's the first outbreak in the U.K. this year, and only the fourth time the disease has been found in the country, after two outbreaks at poultry farms in Suffolk, eastern England, in 2007 and detection of the strain in a dead swan in Scotland in 2006.

After the latest outbreak, the government set up a 3- kilometer (2-mile) control area and a 10-kilometer monitoring area around the site, banning gatherings of domestic birds and requiring bird-keepers to isolate their flocks from wild fowl.

'Enhanced surveillance is taking place and poultry keepers in the area are reminded to remain vigilant and report any signs of disease immediately,' the ministry said today. 'There is no evidence of disease in domestic birds.'"

Article retrieved from: http://www.bloomberg.com/apps/news?pid=20601102&sid=aZVP.dmNo5MA&refer=uk

Continued Outbreak in India's West Bengal State

The Indian state of West Bengal, which borders Bangladesh, has been experiencing continued bird-to-bird transmission of the H5N1 avian influenza strain for the past few weeks. Bangladesh has also been experiencing continued outbreaks among wild and domestic birds, causing the deaths of more than 300,000 birds in the last year.

"More than 35,000 chickens and other poultry have died in and around Margram village in West Bengal state's Birbhum district over the last couple of weeks, officials have said."

"A second outbreak has been detected in the district of South Dinajpur, also in West Bengal but not neighbouring the other outbreak, said Anisur Rahaman, state minister for animal resources."

Animal and human health officials have set up a 3km quarantine and have begun culling birds within the area and monitoring anyone that has come in contact with the birds for influenza-like illnesses. To date, no human cases have been reported in India.

The border between Bangladesh and West Bengal has been sealed until the outbreak is under control.

Full story: http://www.reuters.com/article/middleeastCrisis/idUSDEL54419

New H5N1 Case, and Death, in Indonesia

A 16-year-old Indonesian girl died of H5N1 on Tuesday, bringing Indonesia's death toll to 96 out of 118 cases.

The young girl died January 15 after a week and a half of treatment at a hospital in East Jakarta. Health officials say she contracted the deadly virus two weeks ago after eating half-boiled eggs from infected chickens in her home. Many of them had died from the virus days earlier. Two separate lab tests confirmed she died of H5N1.

Full Story via H5N1 blog: http://www.chinadaily.com.cn/world/2008-01/15/content_6396468.htm

Pandemic Influenza Contingency

For more information, please visit the following links... www.un-influenza.org/objective_6 www.un-influenza.org/objective_7 ...or simply email us at PIC@un.org.

Indonesia's death toll climbs to 95

"The 32-year-old woman from Tangerang died at her home last Thursday after her family had taken her out of a hospital where she had been receiving treatment a day before, said Suharda Ningrum of the health ministry's bird flu centre..."She bought a live chicken and some eggs from a market and cooked them," Ningrum said, adding there were also chickens living in her backyard."

Meanwhile, the teenager with H5N1 is in stable condition but requires a respirator to breathe

http://www.reuters.com/article/asiaCrisis/idUSJAK24547

Outbreak in Bangladesh & large poultry die off in India

Outbreaks of H5N1 in poultry killed 500 chickens in the Moulavibazar district, about 250 km (155 miles) from the capital. That brings the total to 71 affected farms in 22 out of 64 districts

http://www.reuters.com/article/europeCrisis/idUSDHA39331

Meanwhile, 25,000 birds have died near the India-Bangladesh border (around Margram). Tests have yet to confirm whether or not the die off was caused by H5N1

http://www.hindustantimes.com/StoryPage/StoryPage.aspx?id=9ff2aca7-db22-4ed0-a3b7-97ff357a20dc&MatchID1=4633&TeamID1=5&TeamID2=10&MatchType1=1&SeriesID1=1167&MatchID2=4617&TeamID3=3&TeamID4=4&MatchType2=1&SeriesID2=1163&PrimaryID=4633&Headline=25%2c000%20birds%20die%2c%20avian%20flu%20scare

China's latest human case is a result of "close contact"

"Health authorities confirmed here on Thursday that the latest human case of bird flu in the eastern province of Jiangsu, which involved a 52-year-old father, came from close contact with his infected son and not a viral mutation.

The World Health Organization has warned that the virus that causes the illness -- if given sufficient opportunity -- would mutate into a form that is highly infectious and easily transmissible from person to person. Such a change could start a global outbreak. However, this case -- although it involved the disease apparently passing from one person to another -- does not exactly fit the profile of an infectious human-to-human outbreak, and it has remained something of a puzzle.

"It has no biological features for human-to-human transmission," said Mao Qun'an, Health Ministry spokesman. An epidemiological investigation showed the father was infected through close contact with his son, he said.

The cases took place in the provincial capital, Nanjing. The son, 24, and the first to be infected, died on Dec. 2. The father was later confirmed to be infected with the H5N1 virus, which causes bird flu. At the time, the ministry said experts had found that the virus that infected the son had originated with poultry and had not mutated. But it remained unclear how the son was infected in the first place, as neither man had any known contact with dead poultry -- the primary known source of the ailment for humans. "

http://news.xinhuanet.com/english/2008-01/10/content_7398344.htm

117th human case in Indonesia

Indonesia records it's 117th human case this week, but thankfully the patient is possibly doing better. The case is a 16 year old girl living outside of Jakarta. It seems she became ill after eating eggs after a poultry die off in her neighborhood.

http://www.alertnet.org/thenews/newsdesk/JAK100248.htm

Though the number of cases coming out of Indonesia is disturbing, It worries me that most cases are being reported around Jakarta. Residents around Jakarta would most likely have better access to information about AI, better trained local health and animal health workers and be subject to more information campaigns about AI. Are they just better equipped to identify and report the disease than other areas? How many cases are we not catching elsewhere?

New guidelines from WHO on ethics during a pandemic

It's always good to see new pandemic preparedness tools come out - WHO now has "Ethical considerations in developing a public health response to pandemic influenza"

A whole range of sticky topics, from quarantine to allocating scarce resources, would be issues during a pandemic and it's best to think through them ahead of time.

This is a great reference tool for NGOs or civil society groups interested in doing advocacy work at the national level to follow best practices during a pandemic

http://www.who.int/csr/resources/publications/WHO_CDS_EPR_GIP_2007_2/en/index.html

A further breakthrough in understanding the flu virus receptors

"PARIS (AFP) — Scientists on Sunday said they had figured out how influenza viruses carried by birds latch on to humans, a discovery that may open the way to a vaccine against not just deadly avian flu but against all flu types.

There are many strains of flu virus, but only a few have succeeded in crossing the species barrier from animals to humans.

Strains known as H1 and H3 are the most common, and are especially efficient in attacking cells in the upper reaches of the respiratory system. Variants of the H5 virus, by contrast, usually remain confined to wild or domesticated fowl....

The findings, published in the British journal Nature, overhaul scientific understanding of how viruses attach themselves to cells inside human lungs.

Researchers have long known that whether an influenza strain infects humans depends on the ability of a protein on the surface of the virus, called hemagglutinin, to bind to a sugar receptor in the respiratory tract.

In humans, these receptors are known as alpha 2-6, whereas their counterparts in birds are known as alpha 2-3.

Up to now, scientists believed it was a genetic switch in the virus that allowed it to bind to human rather than bird receptors, thus making the much-feared "species jump" possible.

But the study, led by Massachusetts Institute of Technology (MIT) professor Ram Sasisekharan, says that the big factor is the shape of the sugar receptors in human lung cells.

The human alpha 2-6 receptors come in two shapes, one broadly resembling an umbrella, and the other a cone. To infect humans, flu viruses must bind to the umbrella-shaped receptors, the researchers found.

"This work enables researchers to look at flu viruses in an entirely new way," said Jeremy Berg, director of the National Institute for General Medical Sciences, which funded the research.

At the very least, the new discovery will help scientists rapidly identify strains that may develop the capacity to attack human respiratory systems.

"Now that we know what we are looking for, this could help us not only monitor the bird flu virus, but it can aid in the development of potentially improved therapeutic interventions for both avian and seasonal flu," said Sasisekharan."

http://afp.google.com/article/ALeqM5jzFyxed_6I9VGtNVbzIKrrFItA-A

New Vaccine Targets Influenza A Viruses

"An influenza vaccine that could help to protect against a possible flu pandemic has achieved positive results in early trials, say UK researchers.

The vaccine known as ACAM-FLU-A, made by the biotechnology company Acambis, targets all strains of influenza A, the type responsible for a pandemic.
Preliminary results from phase one clinical trials involving 79 volunteers have shown that the vaccine is well tolerated and immunogenic.
In a parallel study, the researchers also tested whether the vaccine could offer protection against avian flu.
Using ferrets, which are commonly used in flu research because they are susceptible to human and bird flu, they found that 70 per cent of those that were vaccinated were protected against the H5N1 virus."

Retrieved from: http://www.healthcarerepublic.com/news/PHARMACIST/775013/Flu-vaccine-achieves-positive-results-offers-pandemic-hope/

Poultry die from H5N1 in petting zoo in Israel

A disturbing story from Israel News...

"The Haifa District Physician, Prof. Shmuel Rishpon, confirmed Thursday that a deadly strain of the bird flu virus has infected chickens at a petting zoo in a Binyamina kindergarten.

Earlier Thursday morning 18 of the 25 chickens in the kindergarten's petting zoo, were found dead.
"The virus was identified as H5N1 bird flue," said Rishpon, adding that humans that contract this strain have only a 50% survival rate.

Rishpon commended the kindergarten teacher for her decision not to discard the dead chickens but rather to call a veterinarian, who sent samples of the poultry's blood to the Health Ministry for further testing.

"The kindergarten staff has been given preventive medicines and as far as we know, none of the children or their parents came in contact with the birds.

"The virus can only be transmitted by direct contact," he added. "We have alerted the hospitals in the area to look out for any children or adults coming in with bird flu-like symptoms."


http://www.ynetnews.com/articles/0,7340,L-3489988,00.html

Who gets vaccines during a pandemic? CIDRAP says protect the supply chain

Now that many countries have some semblance of plan in place related to a pandemic, whether it's preparing for a pandemic or policies and procedures during a pandemic, many experts are looking to the non-health related consequences of a severe pandemic, especially with regards to the economy and availability of goods and services

Around the world, businesses rely on a "just in time" supply chain, which would be extremely vulnerable to disruptions. Therefore, in a recent four page commentary on the guidance the US Govt is providing on vaccine allocation, the experts at CIDRAP are strongly urging that the government focus on critical products and services (such as electricity) and vaccinate those workers over even children.

"We recommend:

• Continued efforts should be made to identify and quantify personnel
  essential for maintaining critical product and service supply chains, on
  both US soil and abroad.
• Continued efforts should be made to identify goods and products that are
  critical to the US.
• Personnel critical to maintaining these supply chains should have priority
  over the general population, including children."

http://www.cidrap.umn.edu/cidrap/files/13/hhsvaccpriority.pdf

More outbreaks in Vietnam and Myanmar

After the first human case reported in November, outbreaks in birds continue in Myanmar - this time in a village in Shan State’s Mongphyat Township in eastern Burma.

http://www.irrawaddy.org/article.php?art_id=9780

Meanwhile, further outbreaks occuring in geese in Southern Vietnam

http://www.chinapost.com.tw/health/2008/01/03/137464/Bird%2Dflu.htm

Continued Culling and Outbreaks in Vietnam and Bangladesh

Vietnam is experiencing additional outbreaks of H5N1 among poultry in Tra Vinh Province, which is in the Mekong Delta Region in the South (on the opposite side of the country from the recent human case)

http://www.thanhniennews.com/healthy/?catid=8&newsid=34670

Meanwhile in Bangladesh, another 20,000 birds were culled after an outbreak in Mirpur, which is just outside the capital

http://www.voanews.com/english/2008-01-01-voa15.cfm

Egypt has Fourth H5N1 Dealth in One Week

From Daily News Egypt

" The Ministry of Health reported Monday the death of a fourth bird flu case in less than a week, bringing the total of bird flu deaths in Egypt to 19 and the number of Egyptian cases overall to 43. Hanem Atwa Ibrahim, 50, from Damietta north of Cairo, died late on Monday in a hospital in the capital, Al-Ahram daily reported.Atwa was admitted to the hospital on Dec. 24 and had been in critical condition ever since.According to local press reports, five other patients suspected of carrying the virus are held in the custody of three different hospitals in Menufiya.

Minister of Health Hatem Al-Gabaly told the press that people’s negligence is the main reason behind the spread of the virus. He blames the public for not following the preventive measures to fight it.Earlier this week three other deaths were reported.Menufiya resident Fardous Mohamed Hadad, 36, died Monday Dec. 31 in the hospital where she was admitted two days earlier with a high fever and difficulty breathing, ministry spokesman Abdel Rahman Shahin said in a statement carried by the official Mena news agency. On Sunday Dec. 26, Fatma Fathi Mohammed, 25, from the Nile Delta province of Daqahliya died of the disease just days after the death of Ola Yunes Ali.

The World Health Organization (WHO) said earlier this year that countries around the world had improved in their resistance to bird flu, but the situation remains critical in Egypt and Indonesia where the risk of the H5N1 virus mutating into a major human threat remains high."

http://www.dailystaregypt.com/article.aspx?ArticleID=11089

I've heard many officals, including David Nabarro, speak about the gains we are making in many countries in controlling H5N1, but that we're losing the battle in a few key places - especially Egypt, Indonesia & Nigeria. I would also add Bangladesh to that list...