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PostPosted: Wed Sep 02, 2009 12:31 pm 
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wotan wrote:
If I am reading the (confusing) trail correctly, one of the three mentioned is the case posted yesterday with a denial from Egypt (no Nile puns intended). However, if we *are* infact seeing some cases returning from Saudia Arabia and Egypt with H1N1/H5N1 coinfection, what are we really looking for?

1. The two may not exchange genetic material?
2. They may reassort and produce a totally new virus of unknown subtype (doesn't have to be H1N1 OR H5N1)? This has potential ramifications on the vaccine.
3. A recombination even may occur in one or both viruses? This could result in little change to either (H1N1 not becoming even more lethal, H5N1 not becoming H2H). Or dramatic changes to either or both. Such changes may or may not impact the vaccine, depending on the nature of the change(s) and what ultimately emerges.

Dr. Niman, can you provide some insight on what you would be looking for and what outcome(s) you think might be most likely?

I will have a commentary up shortly. There are THREE cases. which would mean co-TRANSMISSION.

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PostPosted: Wed Sep 02, 2009 12:32 pm 
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He replied to this already in the Egypt thread. Maybe we should combine these.

Quote:
gjs0708 wrote:
H5N1/H1N1 VIRUS CO-INFECTION - EGYPT: ex SAUDI ARABIA, SUSPECTED,
REQUEST FOR INFORMATION

Is this another false scare?

http://www.promedmail.org/pls/otn/f?p=2 ... 1000,79041

I suspect this is H1N1 co-infections (swine and seasonal).


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PostPosted: Wed Sep 02, 2009 12:39 pm 
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gjs0708 wrote:
He replied to this already in the Egypt thread. Maybe we should combine these.

Quote:
gjs0708 wrote:
H5N1/H1N1 VIRUS CO-INFECTION - EGYPT: ex SAUDI ARABIA, SUSPECTED,
REQUEST FOR INFORMATION

Is this another false scare?

http://www.promedmail.org/pls/otn/f?p=2 ... 1000,79041

I suspect this is H1N1 co-infections (swine and seasonal).

Yesterday there was one case that was denied. It wasn't clear if the other two cases were dual infections, or something else.
Today, there seems to be three cases and WHO is investigating (not denying), suggesting that the co-infections / co-transmisison in Suadi Arabia is real, which would be a VERY big concern.

I actually expected H5N1 to be discovered in humans due to enhanced surveillance, but I did not expect co-circulating / co-transmitting H1N1/H5N1, which is much worse if it is coming from Saudi Arabia, because pilgrims will rapidly spread this combo worldwide.

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PostPosted: Wed Sep 02, 2009 12:48 pm 
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If I'm understanding what's being said here correctly, there may be evidence of 3 patients who've been co-infected with both H5N1 and pandemic H1N1 -AND- possibly some evidence (because of the multiple cases) of CO-TRANSMISSION -- that is, infected cases are passing on both viruses strains together -- to others? If so, WHOA :worried: :swoon:


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PostPosted: Wed Sep 02, 2009 12:50 pm 
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MKey1 wrote:
If I'm understanding what's being said here correctly, there may be evidence of 3 patients who've been co-infected with both H5N1 and pandemic H1N1 -AND- possibly some evidence (because of the multiple cases) of CO-TRANSMISSION -- that is, infected cases are passing on both viruses strains together -- to others? If so, WHOA :worried: :swoon:


How many pilgrims will have close contact with poultry?

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PostPosted: Wed Sep 02, 2009 12:55 pm 
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wotan wrote:
MKey1 wrote:
If I'm understanding what's being said here correctly, there may be evidence of 3 patients who've been co-infected with both H5N1 and pandemic H1N1 -AND- possibly some evidence (because of the multiple cases) of CO-TRANSMISSION -- that is, infected cases are passing on both viruses strains together -- to others? If so, WHOA :worried: :swoon:


How many pilgrims will have close contact with poultry?

It three patients have H1N1 and H5N1 it is H2H co-transmission (no poultry required).

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PostPosted: Wed Sep 02, 2009 12:58 pm 
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MKey1 wrote:
If I'm understanding what's being said here correctly, there may be evidence of 3 patients who've been co-infected with both H5N1 and pandemic H1N1 -AND- possibly some evidence (because of the multiple cases) of CO-TRANSMISSION -- that is, infected cases are passing on both viruses strains together -- to others? If so, WHOA :worried: :swoon:

Right now the real issue is the virological status of the three patients. If the co-infect is swine and seasonal H1N1, that is a concnern, but less of a concern that swine H1N1 and H5N1. However, in either case, if all three patients have the same combo, it is H2H co-transmission.

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PostPosted: Wed Sep 02, 2009 1:00 pm 
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Dr. Niman or others,
When will we "know" for sure it is H2H transmission.....I sure hope this is not correct :(


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PostPosted: Wed Sep 02, 2009 1:01 pm 
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This may be the third time you see this post, but the two previous tries have not shown a post.

This type of situation occurred previously. However, it turned out to be a ProMED mistranslation. We need to make certain the translation is correct before moving forward with the possibilities.


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PostPosted: Wed Sep 02, 2009 1:03 pm 
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SonicHappyHourAddict wrote:
Dr. Niman or others,
When will we "know" for sure it is H2H transmission.....I sure hope this is not correct :(

There is virtually no doubt that it is H2H. The real question is what is transmitting (swine H1N1, swine and seasonal H1N1, or swine H1N1 and H5N1).

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