Indonesia Human Cases - May 17, 2006

[Sally Furniss]

WHO says 5 more Indonesians have died of bird flu

JAKARTA (AP): The World Health Organization on Wednesday confirmed that five more people have died of the H5N1 strain of bird flu in Indonesia, raising the total number of human fatalities in the archipelago to 30.

Four of the deaths were on the North Sumatra province while one was in the country's second largest city, Surabaya, on East Java, an official said.

Indonesia last year overtook Thailand to tally the second highest number of fatal cases in the world after Vietnam.

The virus has infected poultry populations in 27 of 33 provinces, including easternmost Papua, and the government has come under fire for refusing to carry out mass culls in infected areas.

http://www.thejakartapost.com/detaillgen.asp?fileid=20060517113458&irec=0

Are these another 5 deaths, I am losing count

[Sally Furniss]

Re: Indonesia BF - 5/16/06

JAKARTA, May 17 (Reuters) - An outbreak of H5N1 bird flu involving up to eight members of a family in Indonesia's North Sumatra province is not a case of human-to-human transmission, a Health Ministry official said on Wednesday.

Concern has been growing about the case in which six of the eight have already died. Local tests showed five members of the cluster were positive for the bird flu virus and tests were being carried out on the remaining three.

"The spread was through risk factors from poultry or other animals. There is no proof of human to human," Nyoman Kandun, director-general of disease control, told Reuters.

"The world is watching us. We are not being hasty," he added.

He said authorities were still trying to identify the source of the virus in the cluster case in Kubu Simbelang village in Karo regency, about 50 km (30 miles) south of the North Sumatran city of Medan.

Some reports have suggested chicken manure used as fertiliser might be the link, but there has been no confirmation of this. Infected birds can excrete large amounts of the H5N1 virus and this can be one way it can spread to birds, and people.

The World Health Organisation has sent a team to the area. The agency said it is on alert for signs that the virus is mutating into one that can be easily transmitted between people, a development that could signal the start of a pandemic in which millions could die.

Such a mutation could occur anywhere there is bird flu, the WHO says.

Experts have said in the past that possible bird flu cluster cases among family members do not mean the virus is necessarily mutating. It could be caused by the close contact normal in families.

There have been a number of such examples in Vietnam and Thailand, a WHO spokeswoman said in Geneva earlier this week.

The Indonesian Health Ministry has said blood samples of the five family members who had tested positive locally had been sent to a WHO-affiliated laboratory in Hong Kong for confirmation. Local tests are not considered definitive.

Bird flu has killed 115 people worldwide, the majority in east Asia, since reappearing in 2003. Virtually all the victims caught the disease from poultry.

The WHO has confirmed 25 deaths in Indonesia from the H5N1 virus, the second highest number after Vietnam, which has confirmed 42 deaths.

The virus is endemic in much of Indonesia, and on Tuesday a senior Agriculture Ministry official said H5N1 had been detected for the first time in poultry in remote eastern Papua province.

http://www.alertnet.org/thenews/newsdesk/JAK321517.htm

[AlaskaDenise]

Re: Indonesia - Family in Karo suspected of having bf

Kasus Cluster Flu Burung Kian Besar



JAKARTA -- Kasus flu burung di Kabupaten Karo, Sumatra Utara, merupakan kasus cluster keenam di Indonesia. ''Ini adalah cluster baru dan yang terbesar,'' kata Direktur Pengendalian Penyakit dan Penyehatan Lingkungan, Departemen Kesehatan, I Nyoman Kandun, di Jakarta, Senin (15/5).

Kasus cluster dengan delapan orang yang terinfeksi, menunjukkan kasus cluster makin besar dari waktu ke waktu. ''Sehingga kita harus makin waspada,'' kata dr Tjandra Yoga Aditama SpP(K) DTM&H MARS dari Departemen Pulmonologi dan Kedokteran Respirasi FKUI/RS Persahabatan, Jakarta di Jakarta, Ahad (14/5).

Namun, menurut Kandun, hingga kini belum ada bukti yang menunjukkan adanya penularan virus dari manusia ke manusia ke manusia. Untuk mengetahui ada-tidaknya penularan dari manusia ke manusia, kata dr Tjandra, perlu dilakukan dua hal.

a. Surveilans epidemiologik. Untuk mengetahui kemungkinan penularan dari orang ke orang dan tidak ada riwayat penularan dari sumber yang sama. Contoh yang paling mudah adalah tertularnya 30-an petugas RS di Singapura oleh seorang pasien SARS tahun 2003 yang lalu, yang disebut sebagai superspreader.

b. Penelitian virologi. Untuk mengetahui ada-tidaknya virus baru yang merupakan semacam 'merger' antara virus flu burung dan virus flu manusia. Kalau belum sepenuhnya 'merger', setidaknya ditemukan virus yang bagian dalamnya adalah H5N1 dan bagian luarnya adalah H1N1, misalnya.

Menurut dr Tjandra, kini Indonesia dalam stadium tiga, yaitu hanya ada penularan antara manusia terbatas atau pada keluarga dekat saja. Untuk sampai disebut dalam stadium empat, kata dr Yoga, stadium empat ditandai dengan sekitar 25 orang yang tertular.

Selanjutnya ia mengemukakan hal yang baru dalam penemuan ilmiah virus flu burung adalah ditemukannya reseptor virus flu burung di manusia ternyata ada di paru bagian dalam, yang disebut alveoli. Hal inilah yang menyebabkan dua hal:
1. Kerusakan parunya cepat dan luas.
2. Belum adanya penularan antarmanusia di masyarakat, karena kalau reseptor virus itu jauh di dalam paru, maka tentu tidak mudah terbatukkan ke luar dan menulari orang lain.

Di pihak lain, reseptor virus flu manusia ternyata ada di saluran napas atas, sehingga keluhannya banyak yang sakit tenggorokan dan mudah menular ke orang lain. ''Tetapi, nanti mungkin saja kalau virus flu burung dan virus flu manusia sudah 'merger', maka resptornya ada di saluran napas atas dan bawah. Artinya, mudah tertular dan sekaligus juga dapat menyebabkan radang di paru (pneumonia) yang luas,'' ungkap dr Tjandra. n
http://www.republika.co.id/koran_det...8253&kat_id=13

Translation by my nephew Omar (Indonesian/American):

Clusters of Bird Flu Cases Increasing

JAKARTA – A case of bird flu in the Kabupaten (District) of Karo, Sumatra Utara is the sixth cluster case in Indonesia. “This is the newest and largest cluster to date,” said Director of Disease Control and Environmental Health, Health Department, I Nyoman Kandun, in Jakarta on Monday the 15th of May.

This cluster case, with eight people infected, demonstrates an increase in cluster size over time. “We must be more vigilant,” said Dr. Tjandra Yoga Aditama SpP(K) DTM&H MARS from the Department of Pulmonology and Respiratory Medicine at FKUI/RS Persahabatan (hospital) in Jakarta, Ahad on the 14th of May.

However, according to Kandun, there has not been any evidence demonstrating a spread of the virus from human to human. To detect such transmission, Dr. Tjandra says, two procedures need to be implemented.

a. Epidemiological surveillance, to detect the possible transmission of the virus from human to human with no history of infection from the same source, a simple example being the infection of approximately thirty Singaporean hospital workers by a SARS patient in 2003, who was known as a superspreader.

b. Virology research, to detect new viruses formed from a merging of bird flu and its human equivalent. If a full merger has not taken place, hybrid viruses which formed internally of H5N1 and externally of H1N1 may be found, for example.

According to Dr. Tjandra, Indonesia is now in the third stage, consisting of limited human transmission, normally between family members. To be considered in the fourth stage, said Dr. Yoga, there must be 25 confirmed cases of the virus.

Continuing, he explained a new discovery was made regarding the receptors for bird flu in human lungs, which are located within the alveoli of the internal lung structure. The location of these receptors directly contributes to the following symptoms:
1. Rapid, widespread damage within the lungs.
2. No discernible human transmission risk, for the deep location of these receptors contributes to the difficulty of disease spreading through the air.

On the other hand, human flu virus receptors it appears are located in the upper respiratory tract, leading to many complaints of sore throats and the easy spread of the virus. “But, when the human flu virus and the bird flu virus have merged, both sets of receptors will be affected. This means that it will easily spread and cause widespread inflammation of the lungs, also known as pneumonia,” said Dr. Tjandra.

.

[Sally Furniss]

Re: Indonesia BF - 5/16/06

WHO confirms six bird flu cases in Indonesia
JAKARTA, May 17 (Reuters) - The World Health Organisation confirmed six more human cases of bird flu infections in Indonesia on Wednesday, including five members of a family whose case has triggered fears of human-to-human transmission.

"There are six confirmations. One from Surabaya and five from Medan. One from Medan is still alive," said Sari Setiogi, the WHO's Indonesia spokeswoman.

An outbreak of H5N1 bird flu involving up to eight members of a family at Medan in North Sumatra province has worried health agencies around the world but a Health Ministry official said on Wednesday it was not a case of human-to-human transmission.

"The spread was through risk factors from poultry or other animals. There is no proof of human to human," Nyoman Kandun, director-general of disease control, told Reuters.

http://www.alertnet.org/thenews/newsdesk/SP44506.htm

[Sally Furniss]

Re: Indonesia - Family in Karo suspected of having bf

Great stuff AD. Please pass our thanks on to Omar.

According to Dr. Tjandra, Indonesia is now in the third stage, consisting of limited human transmission, normally between family members. To be considered in the fourth stage, said Dr. Yoga, there must be 25 confirmed cases of the virus.

I guess this means the virus must be passed on 25 times before stage 4 is considered. And it must be exactly the same strain. So WHO have to test all 25 cases to make sure it was passed between them.

[HenryN]

Re: Indonesia BF - 5/17/06

Commentary at

http://www.recombinomics.com/News/05170601/H5N1_Indonesia_WHO.html

[HenryN]

Re: Indonesia BF - 5/17/06

H5N1 spread among people not ruled out in Indonesia
17 May 2006 10:40:08 GMT
Source: Reuters
HONG KONG, May 17 (Reuters) -" Health experts are
investigating how several members of a family in
Indonesia's North Sumatra province contracted the H5N1
bird flu virus and are not ruling out the possibility
of human-to-human transmission.
Clusters of human infections are worrying as they
indicate that the virus, which has killed 115 people
worldwide since late 2003, might be mutating into a
form that is easily transmissible among humans. That,
experts say, could spark a pandemic in which millions
might die.
Samples taken from six members of the family were sent
to a WHO-affiliated laboratory in Hong Kong and five
tested positive for H5N1. Results of the sixth were
still pending.
According to the World Health Organisation and experts
familiar with the case, the family -- which raised a
small number of pigs and had chickens, ducks and geese
in the neighbourhood -- held a barbecue on April 29
when they ate pork and chicken.
The first person to fall ill was a 37-year-old woman,
and two of her sons, her brother, sister, niece and
nephew later fell sick. Except for the woman's
brother, everyone has since died.
Contrary to earlier reports from the Indonesian
government that eight members of the family were
infected, the WHO says the eighth person, a woman, had
fever for only a day and is now well. Local tests
showed she was not infected with H5N1.
Samples taken from 11 pigs, four geese, four ducks and
an unspecified number of chickens in Kubu Simbelang
village in Karo regency, where the family lived, have
also turned up negative for H5N1, but experts are not
ruling anything out.
"The possibility that they may have been infected by
the same source is still there," said Sari Setiogi,
the WHO spokeswoman in Indonesia. More animal samples
will be collected for local tests.
CLUSTERS DRAW SUSPICION
"Any time we have a cluster, it raises the suspicion
that human-to-human transmission may have occurred. We
don't rule out either way ... it is too early to make
any conclusion because investigations are still going
on," Setiogi said.
More than 15 people attended the barbecue, but there
were no signs of any spread beyond this cluster of
seven, she said.
There have been a few other probable cases of
human-to-human transmission of the virus in Hong Kong
and Thailand in the past, possibly due to prolonged
and very close contact, although these have never
spread beyond the initial clusters.
But Indonesia's Health Ministry said the cluster in
Sumatra was not a case of human-to-human transmission.

"The spread was through risk factors from poultry or
other animals. There is no proof of human-to-human,"
Nyoman Kandun, director-general of disease control,
told Reuters.
But an Indonesian agriculture official who declined to
be identified said animal tests have not shed any
light.
"There is a big question mark. Blood samples from all
kinds of animals from chickens, ducks, geese, birds,
pigs, cats and do gs turned out negative so far.
Manure has also been checked. The result is negative,"
the Jakarta-based official said.
In Hong Kong, microbiologists tasked with decoding the
genomic sequence of the six virus samples cautioned
against making any quick conclusion either way. Guan
Yi, who heads the laboratory decoding the samples,
said the long time lag of nine days between the first
and last victims showing symptoms of the disease was
unusual.
The 37-year-old woman fell ill on April 27, while one
of her sons and her sister -- the last ones to fall
sick -- felt the first symptoms on May 5. The WHO
recommends that an incubation period of seven days be
used for field investigations.
"If they were all infected by the same source, their
onset time (of illness) would have been closer, but
that is not the case ... The later cases may involve
the possibility of human-to-human transmission," Guan
told Reuters.
"They may have infected one another ... but we have no
evidence. This needs to be investigated by the
locals."
Some reports say chicken manure used as fertiliser
might be the link. Infected birds can excrete large
amounts of the virus and birds and people can be
infected this way.
"This could be one likely infection source," Guan
added.

http://www.swissinfo.org/eng/interna...=1147863230000

[HenryN]

Re: Indonesia BF - 5/17/06

Commentary at

http://www.recombinomics.com/News/05170602/H5N1_Indonesia_Evidence.html

[emmysue]

Re: Indonesia BF - 5/17/06

http://in.today.reuters.com/news/newsArticle.aspx?type=worldNews&storyID=2006-05-17T171409Z_01_NOOTR_RTRJONC_0_India-249731-1.xml&archived=False

JAKARTA (Reuters) - A 12-year-old Indonesian boy died of bird flu four days ago in Jakarta's eastern suburb of Bekasi, a health ministry official said on Wednesday, citing the results of local tests.

Blood samples have been sent to a World Health Organisation-affiliated laboratory in Hong Kong for confirmation, spokeswoman Lily Sulistyowati said. Local tests are not considered definitive.

"We are waiting for the WHO report. It is still being studied" whether the victim had contact with poultry, she said.

If confirmed by WHO, the boy would be Indonesia's 31th death from the H5N1 virus, which is endemic in poultry in the world's fourth most populous nation.

Contact with infected birds is the most common means of transmission of the bird flu virus in humans.

So far, the WHO has confirmed 30 human deaths from the virus in Indonesia. Scientists fear H5N1 could mutate and spread easily from person to person, triggering a pandemic.

Earlier on Wednesday, the WHO confirmed six more human cases of bird flu infections in Indonesia, including five members of a family whose case has triggered fears of human-to-human transmission. The boy's death is a separate case and is not part of the six WHO-confirmed infections.

[sharon sanders]

Re: Indonesia BF - 5/17/06

Thanks Emmysue.

[GaudiaRay]

Re: Indonesia BF - 5/17/06

Commentary at

http://www.recombinomics.com/News/05..._Evidence.html

Evidence for Human Transmission of H5N1 in Indonesian Cluster

Recombinomics Commentary
May 17, 2006

According to the World Health Organisation and experts familiar with the case, the family -- which raised a small number of pigs and had chickens, ducks and geese in the neighbourhood -- held a barbecue on April 29 when they ate pork and chicken.

The first person to fall ill was a 37-year-old woman, and two of her sons, her brother, sister, niece and nephew later fell sick. Except for the woman's brother, everyone has since died.

The above comments provide additional evidence for human-to-human transmission of H5N1in the Medan cluster. Local media reports indicate the mother developed symptoms on April 27, two days prior to the gathering. The mother was locally hospitalized and died May 4. The other family members developed symptoms around the time of her death and were hospitalized May 5. The first fatality was May 9, flowed by deaths on May 10, 12, 13, 14. This bimodal distribution of disease onset dates is common for familial clusters, and supports a mechanism of human-to-human transmission.

The size of the cluster (7 or 8) and number of fatalities (6) are the largest reported to date in Indonesia and raise concerns that the H5N1 transmission to humans is becoming more efficient. A similar increase in Turkey was linked to a change in the receptor binding domain (S227N) and similar changes in Indonesia are cause for concern. The only human HA sequence from Indonesia has a new glycosylation site and a novel cleavage site, but the sequence is from a fatality from last July.

More human sequences, including the current cluster, would be useful and sequences sequestered by WHO should be released immediately.

Media Link

Map

[HenryN]

Re: Indonesia BF - 5/17/06

Liputan6.com, Hong Kong: results of the laboratory of the World of the Health Body (WHO) in Hong Kong, just recently decisive five from eight cases of the assumption of bird flu in the Karo Land, North Sumatra positive was infected by the virus avian sub-type influenza H5N1.
One of them was experienced by the patient was named Jonnes Ginting that up to now still is undergoing the maintenance in special isolation space of the Public Hospital Saint Elizabeth, Medan, North Sumatra [read: wanted to drink Coffee, Jonnes Ginting Again bolted].
These positive results were known after WHO checked the sample of blood and the saliva of eight bird flu casualties in the Karo Land.
Beforehand results of the inspection the laboratory of the Health and the Namru laboratory of the Body of the Department's Research And Development (Naval Medical Research the Unit) in Jakarta also pointed out five positive patients terjangkit bird flu.
This case was cluster sixth and biggest in Indonesia [read: Cluster in the Karo Land that most Big].
As for eight cases of bird flu that happened in the Karo Land for the last ten day claimed six fatalities.
While several patients, including Jonnes Ginting and Obviously Borung Ginting still were treated in RSU Saint Elizabeth.
However up to now results of the sample inspection of blood and the Clear saliva of Boru are not yet known.

http://www.liputan6.com/view/3,122997,1,0,1147874844.html

(BOG/Coverage 6 SCTV)
</pre>

[DB]

Re: Indonesia BF - 5/17/06

"According to Dr. Tjandra, Indonesia is now in the third stage, consisting of limited human transmission, normally between family members. To be considered in the fourth stage, said Dr. Yoga, there must be 25 confirmed cases of the virus."

This statement is incorrect and I suggest Dr. Yoga go back and read the requirements again. They are pretty straight forward.

http://www.cdc.gov/flu/pandemic/phases.htm

Phase 3: Human infection(s) with a new subtype but no human-to-human spread, or at most rare instances of spread to a close contact.

Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 3 allows for "rare instances" of spreading TO A close contact. I repeat TO A, as in 1, close contact. There is NO mention of clusters in Phase 3.

Everyone got that, Phase 3 does not mention anything about clusters.

Phase 4 however does. To be in Phase 4 you need only 1 cluster with limited human-to-human transmission which is highly localized.

You DO NOT need clusters of 25.
You DO NOT need two clusters of eight.

Once again the pandemic phases are ignored or changed when they are reached.

[GaudiaRay]

Indonesian incapacity to reason once again surfaces

As some point, the Indonesian intelligencia will find it less painful to look objectively and think rationally than it is to offen sensibilities. It's coming.

Currently, their position is now:> ... according to Kandun, there has not been any evidence demonstrating a spread of the virus from human to human.

>To detect such transmission, Dr. Tjandra says, two procedures need to be implemented.

>a. Epidemiological surveillance, to detect the possible transmission of the virus from human to human with no history of infection from the same source, a simple example being the infection of approximately thirty Singaporean hospital workers by a SARS patient in 2003, who was known as a superspreader.

>b. Virology research, to detect new viruses formed from a merging of bird flu and its human equivalent. If a full merger has not taken place, hybrid viruses which formed internally of H5N1 and externally of H1N1 may be found, for example.

Firstly, "b." has nothing to do with deducing transmission of H5N1 other than at a possible but extreme evolutionary edge which itself is probably irrelevant to the evolution towards pandemic.

Secondly, surveillance has not a whit to do with bimodality. In this case 9 days are reported by YiGuan and recognized earlier than this pronouncement by many in this newsgroup.

Indonesia repeatedly imo proves itself a highly likely candidate for being among the first with a unique clade and with extensive, negative consequences of pandemia.

[HenryN]

Re: Indonesia BF - 5/17/06

Commentary at

http://www.recombinomics.com/News/05170603/H5N1_Bekasi_Grow.html