Egyptian bird flu mutations suggest antiviral resistance

Mutations in the bird flu virus have been found in two people in Egypt, in a form that might be resistant to the medication most commonly used to treat the deadly disease, according to laboratory tests approved by WHO.

The mutations in the H5N1 virus strain were not drastic enough to make the virus infectious enough to spark a pandemic, said officials with the World Health Organisation.

But more such mutations could ultimately prompt scientists to rethink current treatment strategies.

Samples taken from two bird flu patients in Egypt – a 16-year-old girl and her 26-year-old uncle – were not as responsive as regular H5N1 viruses to Tamiflu, a drug also know as oseltamivir that is used to treat the disease, WHO officials said.

The girl and her uncle died in late December, as well as the man’s 35-year-old sister, though she has not yet been confirmed as having had H5N1.

The three – who lived together in Gharbiyah province, 50 miles north-west of Cairo – fell ill within days of one another after being exposed to sick ducks.

“Based on the information we have, we can’t yet rule out human-to-human transmission,” said Dr Fred Hayden, a WHO bird flu and antivirals expert. “We need to better understand the dynamics of this outbreak.”

Though people have passed the virus on to other people in the past, such infections are rare, and most patients have been infected by direct contact with sick birds.

Scientists fear, however, that the virus could mutate into a form more easily passed between people, which could spark a flu pandemic.

The drug-resistant strains found in Egypt likely developed after the patients were taken to hospital and treated with Tamiflu, with the virus responding directly to the drug, Hayden said.

It was not proven, however, that that was the case, and a more worrying scenario would be if drug-resistant strains were already circulating among birds.

Though Tamiflu remains the drug of choice to treat H5N1, experts may have to consider other options if they find more resistant viruses.

Because flu viruses evolve constantly, mutations are only worrisome if they are linked to the virus’ transmissibility, lethality or drug susceptibility.

“What the resistance tests look for are markers associated with antiviral resistance,” though finding the markers did not necessarily mean Tamiflu would not work, said Dr Angus Nicoll, flu director at the European Centre for Disease Prevention and Control.

Hayden said the mutations found in Egypt were different from Tamiflu-resistant H5N1 viruses found in patients two years ago in Vietnam. The Vietnamese strains were definitely resistant to Tamiflu, whereas the Egyptian viruses have only proven they are not as susceptible to the drug, he said.

Tamiflu-resistant viruses such as those found in Vietnam are often treatable with an older, less expensive class of antivirals, known as amantadanes. Some bird flu virus strains from Indonesia and China have also proven susceptible to amantadanes.

H5N1 first hit Egypt last year, and has since infected 19 people, 10 of whom have died.

The latest case came to light this morning.

The reports, citing health authorities, said that a housewife from Beni Suef, about 60 miles south of Cairo, tested positive for the avian flu strain and was admitted to hospital for treatment.

The Middle East News Agency did not say how the woman contracted the virus.

Most people get it through contact with infected birds which they raise at home, or while slaughtering or cleaning chicken.

Meanwhile, three other bird flu cases in humans were suspected in the eastern province of Ismailiya and the southern city of Sohag, while three other provinces have declared a state of emergency after new bird flu cases were detected in domestic fowl, reported the independent al-Masri al-Youm daily.

Since the H5N1 outbreak first began in late 2003, it has decimated the Asian poultry industry and infected at least 265 people worldwide, 159 of whom have died, according to WHO.