Indonesia Human Cases - April 9, 2008 - 20th June 2008

[HenryN]

Re: Indonesia Human Cases - April 9, 2008+

Two die as Indonesia resumes bird flu reporting--WHO



"The minister has told WHO they will not continue to share publicly whenever there is a new case but they will inform the WHO in conformity with IHR," David Heymann, WHO assistant director-general for health security and environment, told Reuters by telephone.

"We anticipate that promise will be honoured," he said.

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http://www.alertnet.org/thenews/newsdesk/L19830123.htm

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Indonesia has clearly decided to cover-up the clusters and the WHO updates support these efforts. The claims that relatives of H5N1 confirmed cases died of "lung inflammation", dengue fever, and typhus are nonsense, and WHO knows that these diagnosis are not believeable.

[Giuseppe]

Re: Indonesia Human Cases - April 9, 2008+

Indonesia has clearly decided to cover-up the clusters and the WHO updates support these efforts. The claims that relatives of H5N1 confirmed cases died of "lung inflammation", dengue fever, and typhus are nonsense, and WHO knows that these diagnosis are not believeable.

And they seem to accept the attempt of media censorship for Indonesians.
But, what will be the policy of the WHO? They update or not their web site? It seems a bit paradoxical statement.

[HenryN]

Re: Indonesia Human Cases - April 9, 2008+

And they seem to accept the attempt of media censorship for Indonesians.
But, what will be the policy of the WHO? They update or not their web site? It seems a bit paradoxical statement.

Yes, that is true. In the past WHO has issued a situation update as soon as the case is confirmed. Thus, the case(s) from May clearly did not meet the IHR requirement of immediate (24-48 hour) notification of human H5N1 to WHO. Similarly, the June case was said to have been positive in the AP report of June 5, so notification of that case to WHO was also delayed.

[Commonground]

Re: Indonesia Human Cases - April 9, 2008+

Maybe they (WHO) should put something to that effect on their website, as so many people/organizations, etc. are relying on their efficient updates.

[HenryN]

Re: Indonesia Human Cases - April 9, 2008+

Commentary

http://www.recombinomics.com/News/06190805/WHO_Oversight_Failure.html

[sharon sanders]

Re: Indonesia Human Cases - April 9, 2008+

Indonesia has clearly decided to cover-up the clusters and the WHO updates support these efforts. The claims that relatives of H5N1 confirmed cases died of "lung inflammation", dengue fever, and typhus are nonsense, and WHO knows that these diagnosis are not believeable.

Of course, we can not claim to know what WHO "knows" or that Indonesia is "covering up" clusters.

What is occurring now is speculation surrounding the current and past H5N1 status in Indonesia.

This is a result of incomplete and delayed epidemiological surveys of reported and suspected human cases.

As long as pertinent information is not readily available, for whatever reason, the world will speculate and act on that speculation regarding Indonesia's disease status.

It is extremely important that all countries conduct proper surveillance, testing, and reporting of their "bird flu" status.

In fact, this reporting should exceed the requirements of the UN, WHO, OIE, FAO, and other alphabets.

What we need here is frankness. Tell it like it is.

Hiding the problem will make it worse.

For all of us.

[HenryN]

Re: Indonesia Human Cases - April 9, 2008+

Of course, we can not claim to know what WHO "knows" or that Indonesia is "covering up" clusters.

What is occurring now is speculation surrounding the current and past H5N1 status in Indonesia.

This is a result of incomplete and delayed epidemiological surveys of reported and suspected human cases.

As long as pertinent information is not readily available, for whatever reason, the world will speculate and act on that speculation regarding Indonesia's disease status.

It is extremely important that all countries conduct proper surveillance, testing, and reporting of their "bird flu" status.

In fact, this reporting should exceed the requirements of the UN, WHO, OIE, FAO, and other alphabets.

What we need here is frankness. Tell it like it is.

Hiding the problem will make it worse.

For all of us.

WHO monitors news and the two clusters reported by wire services are clearly known to WHO. The "dengue fever" case was questioned by international media reporters and denied by Kadum. The denial was also published in ProMED, which is also monitored by WHO (and in some cases written by former WHO employees). The more recent cluster was also extensively covered in media reports, and the index case had the same cyanosis as reported for the confirmed cases. WHO employees are trained to investigate infectious disease and the two clusters could not be clearer. WHO has chosen to NOT report these associated cases in their updates, which speaks volumes. It is pretty clear what WHO does and doesn't know.

[sharon sanders]

Re: Indonesia Human Cases - April 9, 2008+

I agree that all reporting should exceed current minimal standards. Full disclosure is warranted for all parties.

[Commonground]

Re: Indonesia Human Cases - April 9, 2008+

from Commentary:

Moreover, three of the last five confirmed cases in Indonesia were part of three distinct familial clusters. In each case a relative died with bird flu symptoms within days of the death of the confirmed case, yet these associated cases were said to be due to ?lung inflammation", dengue fever, and typhus. None of these diagnosis is credible, since H5N1 has been confirmed in a contact in each cluster.

I could not agree more. In today's confirmation of Istimqomah (16), he often treated Ahmad Rizki (his brother). Rizki's onset of symptoms were 5/1. He died on 5/4. Diagnosed with typhus. Now, Istimqomah's symptoms began on 5/6, and died on 5/14. confirmed H5N1. In addition, their older brother, Alamsyah (24) was admitted on 5/13, brought home on 5/15.

It is not credible, because you would have to then logically conclude that Rizki just happened to contract typhus at the same time his brother contracted H5N1.

In the case of Agus Youhadi (15); whom passed away 1 hour after the arrival to RSHS Bandung Sadikin, his symptoms began on 3/19. He passed away on 3/26. His younger brother, Dea Putra (6) died not long before Agus Youhadi, and was diagnosed with DBD.

So two brothers dying within one week, one contracting DBD, and one contracting H5N1, to me, is not credible.

In March we had Alifa/Anisa who was confirmed. Adm: 3/24. She survived. Her younger brother did not. He was admitted on 3/11. Was diagnosed with DBD. The nurse that treated him, Etriani was also admitted on 3/30. She was there for quite a while, but diagnosed with DBD. So we would have to conclude that it was a coincidence.

[Giuseppe]

Re: Indonesia Human Cases - April 9, 2008+

From Alertnet newswire, post #330:

''Indonesian authorities were still trying to confirm a suspect 111th bird flu death, he added. (...)''

Another confirmation is anticipated.

[sharon sanders]

Re: Indonesia Human Cases - April 9, 2008+

H5N1 can present as pneumonia, denque, upper respiratory illnesses, and typhoid in Indonesia.

Update on Avian Influenza A (H5N1) Virus Infection in Humans

<!-- AUTHOR_DISPLAY --> Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus

http://www.flutrackers.com/forum/showthread.php?t=51845

[Giuseppe]

Re: Indonesia Human Cases - April 9, 2008+

H5N1 can present as pneumonia, denque, upper respiratory illnesses, and typhoid in Indonesia.

Update on Avian Influenza A (H5N1) Virus Infection in Humans

<!-- AUTHOR_DISPLAY -->Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus

http://www.flutrackers.com/forum/showthread.php?t=51845

Yes. But in Indonesia more than 80&#37; of the case's presentation were influenza-like illness, pneumonia and severe influenza. It is not impossible to accept the reality of co-morbidity in some of recent cases. Don't restrict your view, people!
In fact Indonesian live amidst endemic Dengue Fever (and Dengue Haemorrhagic Fever), Malaria, Tubercolosis, severe malnoutrition conditions, viral hepatitis, infectious gastroenteric diseases... Nothing new, since the early cases of bird flu in humans presented with GI symptoms, septic shock with hemorrhages.
Again, nothing precludes to co-morbid presentation of human birdflu infections.

[Farmer]

Re: Indonesia Human Cases - April 9, 2008+

From WHO's Avian Influenza FAQ page

http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/index.html#drugs

- snip-
What are the most important warning signals that a pandemic is about to start?

The most important warning signal comes when clusters of patients with clinical symptoms of influenza, closely related in time and place, are detected, as this suggests human-to-human transmission is taking place. For similar reasons, the detection of cases in health workers caring for H5N1 patients would suggest human-to-human transmission. Detection of such events should be followed by immediate field investigation of every possible case to confirm the diagnosis, identify the source, and determine whether human-to-human transmission is occurring.

Studies of viruses, conducted by specialized WHO reference laboratories, can corroborate field investigations by spotting genetic and other changes in the virus indicative of an improved ability to infect humans. This is why WHO repeatedly asks affected countries to share viruses with the international research community.

Question: Given this newly evolving culture of obfuscation, how is the Pandemic Alert Level even remotely meaningful anymore?

[HenryN]

Re: Indonesia Human Cases - April 9, 2008+

From Alertnet newswire, post #330:

''Indonesian authorities were still trying to confirm a suspect 111th bird flu death, he added. (...)''

Another confirmation is anticipated.

Probably the 54F, who was lab confirmed locally.

[HenryN]

Re: Indonesia Human Cases - April 9, 2008+

From WHO's Avian Influenza FAQ page

http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/index.html#drugs

- snip-
What are the most important warning signals that a pandemic is about to start?

The most important warning signal comes when clusters of patients with clinical symptoms of influenza, closely related in time and place, are detected, as this suggests human-to-human transmission is taking place. For similar reasons, the detection of cases in health workers caring for H5N1 patients would suggest human-to-human transmission. Detection of such events should be followed by immediate field investigation of every possible case to confirm the diagnosis, identify the source, and determine whether human-to-human transmission is occurring.

Studies of viruses, conducted by specialized WHO reference laboratories, can corroborate field investigations by spotting genetic and other changes in the virus indicative of an improved ability to infect humans. This is why WHO repeatedly asks affected countries to share viruses with the international research community.

Question: Given this newly evolving culture of obfuscation, how is the Pandemic Alert Level even remotely meaningful anymore?

When the UN regulations were revised, WHO was given more power to investigate diseases like avian influenza (which could cross international borders). They were allowed to send and receive e-mails from apprpriate contacts to investigate suspected outbreaks.

WHO has control over situation updates, which list confirmed cases. The two clusters in March were in the same WHO update. If the fatal "lung inflammation" of a relative was mentioned in associated with the one confirmed case, and fatal dengue fever was listed for the brother of the second confirmed case, and fatal typhus was listed with the confirmed case in the latest update, it would be quite clear to most of the casual observers who look at situation updates that there was some highly suspect activity happening in Indonesia.

The deaths of the relatives are not at issue, although the cause of death is.

WHO needs to start sending shots across the bow, or they will know less and less, as countries try to hide more and more.