Emerging Infectious Disease ISSN: 1080-6059

Microevolution of Highly Pathogenic Avian Influenza A(H5N1) Viruses Isolated from Humans, Egypt, 2007–2011

Mary Younan¹, Mee Kian Poh¹, Emad Elassal¹, Todd Davis, Pierre Rivailler, Amanda L. Balish, Natosha Simpson, Joyce Jones, Varough Deyde, Rosette Loughlin, Ije Perry, Larisa Gubareva, Maha A. ElBadry, Shaun Truelove, Anne M. Gaynor, Emad Mohareb, Magdy Amin, Claire Cornelius, Guillermo Pimentel, Kenneth Earhart, Amel Naguib, Ahmed S. Abdelghani, Samir Refaey, Alexander I. Klimov, Ruben O. Donis

, and Amr Kandeel

Author affiliations: Author affiliations: US Naval Medical Research Unit No.3, Cairo, Egypt (M. Younan, E. Elassal, M.A. ElBadry, S. Truelove, A.M. Gaynor, E. Mohareb, C. Cornelius, G. Pimentel, K. Earhart); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.K. Poh, T. Davis, P. Rivailler, A.L. Balish, N. Simpson, J. Jones, V. Deyde, R. Loughlin, I. Perry, L. Gubareva, A.I. Klimov, R.O. Donis); Cairo University, Cairo (M. Amin); Ministry of Health and Population, Cairo (A. Naguib, A.S. Abdelghani, S. Refaey, A. Kandeel)

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Figure 2

Geographic distribution of humans with highly pathogenic avian influenza A(H5N1) virus infection yielding clade 2.2.1 isolates, Egypt, 2007–2011. Each case is shown within the governorate that reported the case; however, locations within governorate territories are arbitrary and do not represent exact coordinates. White circles indicate the 59 confirmed cases from this study with fully sequenced viral genomes; numbers are the corresponding World Health Organization case numbers. Black dots indic

Figure 2. . . Geographic distribution of humans with highly pathogenic avian influenza A(H5N1) virus infection yielding clade 2.2.1 isolates, Egypt, 2007–2011. Each case is shown within the governorate that reported the case; however, locations within governorate territories are arbitrary and do not represent exact coordinates. White circles indicate the 59 confirmed cases from this study with fully sequenced viral genomes; numbers are the corresponding World Health Organization case numbers. Black dots indicate confirmed cases. Cases include 25 from 2007 and 8 from 2008 (A); 39 from 2009 (B); 29 from 2010 (C); and 39 from 2011 (D).

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¹These authors contributed equally to this article.

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