Egypt is seeing no let-up in its steady flow of H5N1 avian influenza infections, with 10 more reported over the past few days, and the virus recently killed an Indonesian father and son, according to official and media reports.

The Egyptian cases are part of an unprecedented, sustained wave of H5N1 activities that has been under way since November, vaulting the country to the top of the list for most cases. The cases from Indonesia appear to be the first reported this year in that country.

Three of the new cases from Egypt, two of them fatal, were noted in separate governorate health department reports, and seven are part of a compilation from the United Nations Food and Agriculture Organization (FAO).

At least 2 Egyptian cases fatal

The three patients described in the health department reports are a 1-year-old child from Asyut governorate, a 27-year-old woman from Asyut who was hospitalized and died in Sohag governorate, and a 52-year-old woman who died from her infection on Mar 29 in Port Said, according to reports translated and posted on Mar 28 and Mar 29 by *******, an infectious disease news message board.

Few details, however, are known about the FAO case entries, other than the locations and that they are human H5N1 cases. Three of the cases in that group appear to be from Sharqia governorate, with one each from Beheira, Dakahlia, Faiyum, and Menofia governorates.

It has been difficult to pinpoint exactly how many cases have been reported in Egypt so far this year, because some of the official reports don't match or have inconsistent information in them. *******' case list, based on its tracking of official notifications and statements, puts the total at 128 cases this year, 28 of them fatal.

The most recent update on cases reported to the World Health Organization (WHO) through Mar 17 put the total at 116 cases, 36 of them fatal.

Egypt's health ministry invited a group of global experts to be part of a mission earlier this month to assess the current situation. They presented their findings to Egypt's health ministry at the conclusion of their visit, but so far no details are known about the team's recommendations.

Initial lab investigations of H5N1 viruses from people and birds in Egypt haven't identified any major genetic changes, and a report in early March from the WHO on global avian influenza activity said the increase likely stems from a variety of factors, including increased H5N1 circulation in poultry, gaps in public awareness, and potential seasonal factors related to the cold weather.

Indonesian family had visited farm

An Indonesian health ministry official said H5N1 infections have been confirmed in a father and son from Tangerang in Banten province, according to a Mar 27 Jakarta Globe report. The two were hospitalized in separate facilities with severe flulike illness symptoms.

The father died on Mar 24, and his son died 2 days later. Another media report said the father was 40 years old and that his son was 2 years old.

Antara, Indonesia's state media, said the two, along with other family members, had visited a relative in Bogor who owns a small poultry farm and that sudden poultry deaths had occurred during their stay. How or where the two were infected hasn't been confirmed.

The ministry health official said so far other family members—a woman and a child—have tested negative for the virus.

If confirmed by the WHO, the two new cases would lift Indonesia's total to 199 cases and its number of deaths to 167. According to the WHO's latest global flu total on Mar 3, Egypt has the most H5N1 infections—292—but Indonesia still has the highest number of deaths from the disease: 165, compared with 99 in Egypt.