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Indonesia Human Cases - April 9, 2008 - 20th June 2008
No, it means that panic residents threw away dead chicken into the small river/ditch before reporting the case to the authority. The carcasses were taken again from the river later and be burnt and buried.
Reaction of "The Regional People's Representative Council" (DPRD) on the news on Tini Suhartini. They support the actions undertaken by Regional Lifestock Service and Regional Health Service.
The commission B supported Dispeterpan and Dinkes Prevention efforts of the Spread of Bird Flu
The case of the death NY Tini Suhartini (54), the patient who was expected suspect bird flu (Avian Influenza-AI) and was stated positive H5, received attention seius from DPRD Sumedang, West Java.
Moreover, DPRD supported Peternakan Service efforts and fisheries (Peterpan) and the Kesehatan Service (Dinkes).
That was raised by Drs Minan Sukarnan, MBA, Chairman Komisi B to the Passage, on Wednesday (21-5).
He said, the B Commission has peeked casualties's family in the Babakan Asem Village, Desa Ranjeng, Kecamatan Cisitu, just recently.
Mentioned, in his observation, his side indeed still was seeing the existence of the kept poultry that was released.
In fact, in accordance with the suggestion from the Peterpan Service so that all the poultries in the location of the patient suspect bird flu so that dikarantina.
According to Minan, DPRD joined in concerned after hearing the existence produced by the Hall of Pelelitian Kesehatan Dinkes West Java, that stated the positive patient H5 AI.
Indeed still ought to be expected, but anticipation must continue to be carried out.
And if enabling depopulation against the poultry in the Asem Round
apparently must be carried out, he said.
Because of this, if evidently the Peterpan Service must carry out the extermination -deppulasi - the poultry there, DPRD would mensupport him.
Yes was supported by us to the best of these efforts to kebakan together, he stated.
Acknowledged, results terkahir on the sample of the throat liquid and the sample of the deceased's blood NY Tini Suhartini, at this time still was done by the inspection in the Peneletian Hall and the Development of the Department of Health Health in Jakarta.
If indeed the death of the chicken suddenly and in a mass fashion, happened again kenapan not depopulation yes was carried out, he said.
Besides this, the B Commission supported also efforts that were carried out by the Kesehatan Service rank that apart from did monitoring and took the sample of the virgin from the sides that once physical contact deang casualties.
We indeed still were waiting for results of the laboratory inspection of the end.
But we made a plea to Dinkes to continue to carry out the monitoring in the field so as when being gotten perekembangan other against casualties's family, for example, as early as possible could be detected and carried out penecegahan in order to not spread, he said.
Minan hoped, the community's participation could be realised through mengkarantina his property poultry was their respective.
Although must didepopulasi, was hoped for could the birth of the awareness of the community because of being related to the safety of the poultry and the health of humankind.
Another H5N1 Cluster Denied in Indonesia
Recombinomics Commentary 12:36
May 21, 2008
According to Mahbud, last May 1 Rizki complained was sick. "His body was hot." Hands, fingertips and foot very blue, said the father. Fortune was carried to the Yakriza Clinic, Tanah Kusir. "His diagnosis typhus."
A legacy of Rizki, Istiqomah showed the similar sign. Appetite descended, the tip of the finger turned blue and breathless. Isti could be treated two nights in the Gandaria Hospital afterwards were given by reconciliation to the Persahabatan Hospital, Rawamangun. Love, medical help could not rescue the life of the girl.
Priyanti, the team's member of the control doctor of Persahabatan Hospital bird flu, said, Istiqomah positive was affected by bird flu. The girl suffered hot was accompanied by the cough and breathless. The "photograph toraks him also showed the sign" of "pneumonia," said Priyanti.
At this time RS Persahabatan was also treating Alamsyah, 26 years, the older brother Istiqomah.
"Gandaria still could not be classified as cluster bird flu because of his incident just had one case and casualties that was ascertained positive also only one person," Togi words.
The above translation describes another H5N1 cluster that has been denied in Indonesia due to a mis-diagnosis and a false negative. The index case died with bird flu symptoms, including cyanosis in extremities. However, he was diagnosed as having typhus and not considered a bird flu case. His sister had similar symptoms, including cyanosis in extremities, but she was lab confirmed as H5N1 positive. Recent reports indicate the H5N1 was confirmed by a second lab, so she is an official case. A third sibling was hospitalized with symptoms, but declared H5N1 negative.
The cluster was then declared as a non-cluster because only one of the three siblings was confirmed. This denial is the third in the last four confirmed cases in Indonesia. In the earlier cases, one cluster involved a relative who died with respiratory problems, while the index case for the other cluster was mis-diagnoses with dengue fever. The diagnosis of dengue fever was questioned in media reports, but a mis-diagnosis was denied. The denial was accepted without question in a Promed commentary.
These denials of clusters has extended an under reporting trend that is widespread, but the denial of three cluster out of the last four confirmed cases is an H5N1 record. In the 1918 pandemic the most frequent mis-diagnosis were dengue fever, typhoid, and cholera. Indonesia has previous mis-diagnosed patients with dengue fever and typhus previous, which were subsequently lab confirmed as H5N1. However, the specific denials of obvious clusters are new.
In addition to the cluster denials, confirmation of cases is also delayed. One case described in local media has not been confirmed, and there is a cluster of five family members with symptoms, but typhus has again been mentioned, even though birds in the neighborhood died suddenly.
The increase in cluster denials in Indonesia is a cause of increasing concern.
(...)
These denials of clusters has extended an under reporting trend that is widespread, but the denial of three cluster out of the last four confirmed cases is an H5N1 record. In the 1918 pandemic the most frequent mis-diagnosis were dengue fever, typhoid, and cholera. Indonesia has previous mis-diagnosed patients with dengue fever and typhus previous, which were subsequently lab confirmed as H5N1. However, the specific denials of obvious clusters are new.
(...)
In early '900 no laboratory diagnostics existed and perhaps today misdiagnosis could help to take a certain time from the authorities perspective.
I think Indonesian physicians are well skilled - at least in the most part of advanced hospitals - and they also deserve to be recognized an hard work at the centre of a storm.
Dealy in laboratory tests' confirmations are probably due to external factors, no directly controlled by medical staff.
IOH
"..The nonspecific clinical presentation of influenza A (H5N1) disease has often resulted in misdiagnosis of subsequently confirmed cases (Table 3); influenza A (H5N1) virus infection has been suspected in only a small number of patients. Health care staff should include influenza A (H5N1) virus infection in the differential diagnosis for patients who present with epidemiologic risk factors and unusual courses of illness, especially rapidly progressing pneumonia (see Fig. 2 of the Supplementary Appendix). "
From the above supplementary appendix -
"...Note that initial manifestations of H5N1 illness may be nonspecific or atypical
(e.g. fever with or without diarrhoea)..."
<sup>
</sup>
"..The nonspecific clinical presentation of influenza A (H5N1) disease has often resulted in misdiagnosis of subsequently confirmed cases (Table 3); influenza A (H5N1) virus infection has been suspected in only a small number of patients. Health care staff should include influenza A (H5N1) virus infection in the differential diagnosis for patients who present with epidemiologic risk factors and unusual courses of illness, especially rapidly progressing pneumonia (see Fig. 2 of the Supplementary Appendix). "
From the above supplementary appendix -
"...Note that initial manifestations of H5N1 illness may be nonspecific or atypical
(e.g. fever with or without diarrhoea)..."
<SUP>
</SUP>
I think that a medical worker in an imaginary Jakartan hospital while he / she is visiting a patient with GIT symptoms, fever, chest RX images, haemorrhages passes in reviews in his/her mind other cases seen previously and avian influenza may be at top of the list, notwithstanding scientific or medical literature descriptions.
I think that a hand may be tend to these heroic individuals and no doubt into their honesty and professional skill should be cast.
I think Dr. Niman is making a fair point.
I have no idea what the front-line HCWs conditions are like but I am sure you are correct in that they are doing a valiant job in difficult conditions. But there is a difference in saying nothing, and letting the results speak for themselves, and the head of the Ethnic Group of Dinas Kesehatan Southern Jakarta Togi Asman making 'a this is not a cluster' comment. If there is an attempt to spin this in anyway then this is 'cause for concern' (all copyrights acknowledged).
-snip-
All 5 people that suspected infected virus Avian Influensa (H5N1) that are Asdar, 8 tahun, Andika Saputra (1,3), Sarminda (10), Nuraminah (4) as well as Dg Sholeh (53).
Side RS already take sample blood medical patient in order that was researched. "We not yet can determine what all five medical patients that infected flu burung or not," words doctor Musawarah that treat all five patients those.
Menurut Dewaty mother Asdar her child enter RS because fever that high temperature reach 38 degrees celciau. After given medicine not descend, she also carry her child to RS. "We still to guard results exam laboratorium," said Dewaty.
-snip-
KOMNAS FBPI updated their website with 1 more bird flu victim listed.
In total 135.
However as far as I know 134 were confirmed? # 135 probably would TS/ Tini Suhartini from West Java, not confirmed by Dep of Health or by Komnas FBPI.
TS was confirmed positive through local PCR test from West Java lab.
Compared to the list in post # 191, we see 1 more in West Java (TS?) and 1 more in Jakarta District ( Isq).
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