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  • Indonesia: Human Cases 20 June 2008 to 8 October 2008

    Indonesia confirms 2 recent avian flu deaths

    Robert Roos News Editor

    Jun 19, 2008 (CIDRAP News) – The World Health Organization (WHO) said today that Indonesia has officially notified it of two recent fatal human cases of H5N1 avian influenza that were reported previously by the news media.
    The reporting to the WHO of the cases in a 16-year-girl and a 34-year-old woman comes 2 weeks after Health Minister Siti Fadilah Supari said Indonesia would stop announcing cases as they occur and instead list them only at longer intervals, perhaps as long as 6 months. The comments raised questions about the government's compliance with the International Health Regulations (IHR), which call for countries to promptly report human cases of avian flu and certain other diseases to the WHO.
    David Heymann of the WHO drew a distinction between Indonesia's public announcements of H5N1 cases and its reports to the WHO, according to a Reuters report published today.
    "The minister [Supari] 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," said Heymann, who is the WHO's assistant director-general for health security and environment.
    Heymann told Reuters the WHO encourages all governments to provide information freely to their populations, but it is their decision.
    Today's WHO statement, citing information from the Indonesian health ministry, said the 16-year-old girl was from South Jakarta and fell ill on May 7; she was hospitalized May 12 and died 2 days later. There was evidence that she had been exposed to sick and dead poultry, the agency said.
    Supari had reported the girl's case to the Associated Press (AP) 2 weeks ago but had described her as a 15-year-old.
    The WHO said the 34-year-old woman was from Tangerang district, west of Jakarta. She became ill May 26 and died Jun 3 after a day in a hospital. An investigation into the source of her exposure was continuing.
    The AP on Jun 13 had reported that a 34-year-old woman named Susi Lisnawati had died of avian flu on Jun 3. Several government officials who requested anonymity had confirmed the case, but the government had not informed the woman's husband that she had the virus, according to the story.
    The two latest cases raise the WHO's H5N1 count for Indonesia, the hardest-hit country, to 135 cases with 110 deaths. The global count has reached 385 cases, including 243 deaths.
    Heymann told Reuters that Indonesian authorities were trying to confirm another suspected H5N1 case that was fatal.
    According to Reuters, another WHO official said the agency has a good relationship with Indonesia, despite the country's reluctance to share H5N1 virus isolates. Indonesia is seeking guarantees that it will receive a supply of any vaccines developed from the isolates it provides.
    "There is a strong working relationship between the WHO country office and the government," John Rainford, a WHO spokesman in Geneva, told Reuters. "Even if there is a conflict on issues like virus-sharing, it hasn't eroded the ability to carry out joint investigations."
    A WHO official who requested anonymity told CIDRAP News this week that the agency had been aware of recent H5N1 cases in Indonesia despite the delay in receiving official notification.
    Speaking before the latest case confirmations, the official said, "The fact that you don't yet have official notification of any cases doesn't mean there isn't unofficial awareness." He said the two recent cases didn't change WHO experts' assessment of the risk posed by the virus.
    If the cases had signaled more of a threat, the information would have been handled differently, he suggested. "If we were dealing with something much more serious, I think there would be a very, very different approach by all involved in getting the information. If you had a cluster of something behaving in an unusual fashion, the pressure to share it would be very high."
    See also:
    Jun 13 CIDRAP News story "Indonesian government mum as AP reports H5N1 case"


    Jun 5 CIDRAP News story "Indonesia quits offering prompt notice of H5N1 cases"


  • #2
    Re: Indonesia Human Cases - April 9, 2008+

    Two Die From Bird Flu In Indonesia; Death Toll At 110 - WHO




    DOW JONES NEWSWIRES
    Indonesia's death toll from the bird flu has risen to 110 from two more confirmed deaths, the World Health Organization said, two weeks after the Southeast Asian archipelago said it would no longer announce human fatalities.
    The WHO, in a statement from its Geneva headquarters Thursday, said a 16-year old girl from Jakarta died in May from exposure to sick poultry. Earlier this month, a 34-year-old woman from Java's Banten province died this month. The cases appear unrelated, the organization said.
    Indonesia accounts for around half of the world's fatalities from the H5N1 strain of avian influenza.
    Health Minister Siti Fadilah Supari said earlier this month it would no longer announce deaths from the virus, saying it was unnecessary.

    (END) Dow Jones Newswires 06-19-082147ET Copyright (c) 2008 Dow Jones & Company, Inc.</PRE>
    </PRE>
    http://www.nasdaq.com/aspxcontent/Ne...ternational.na</PRE>

    Comment


    • #3
      Re: Indonesia Human Cases - April 9, 2008+

      H5N1: Lost in transition
      Emmy Fitri, The Jakarta Post, Jakarta

      It seems like deja vu. In the past, Indonesians saw the New Order government in constant denial over touchy issues like the number of people with HIV/AIDS, deaths caused by the disease and, most importantly, what the government was doing to address the problem.

      When AIDS becomes widespread it is heavily stigmatized. And the public does not seem to be moved by campaigns for preventive measures, and there is a very strong tendency to cover up the reality. As the old saying goes, the chickens come home to roost. Now we have to deal with the results of mistakes that we made in the past.
      These days, the chickens are running again, and we are reverting to past patterns in facing bird flu.
      After withholding bird flu virus samples from the World Health Organization, which earned her special mention as a national hero, Health Minister Siti Fadillah Supari has decided to withhold information on deaths caused by the virus -- H5N1 -- as part of a new policy to improve the image of the country hardest hit by the disease.
      And what we get is confusion. We've lost the death count. It could be 109, 200 or more.
      No one knows for sure how many people have died of this disease or where the virus has hit? Moreover, do not expect to learn what abilities the virus has developed because it is free-ranging, unobserved, on the loose, or let loose.
      Officials at the Health Ministry are also in the dark. "We're not supplied with updates on bird flu cases in humans anymore. Try tomorrow, I can ask around," a ministry official replied last week to a query on the latest death toll.
      Even worse, the usual standardized procedure for treating a suspected case of bird flu reportedly has not been performed since the minister decided no longer to publicize human cases of bird flu. The procedure includes placing the suspected patient in an isolation room during treatment, requiring doctors and nurses to wear protective masks and gloves and the distribution of antiviral drugs to close family members of the patient. In the past, suspected bird flu patients were not charged a rupiah for treatment, medicine and even for coffins if they did not survive.
      When cases were still publicized months ago, even for one case officials would rush to the neighborhood where the suspect lived, examine people and give oseltamivir medication as a preventative measure. The local animal husbandry agency too would deploy officials to check birds in the area to determine the source of the virus.
      If there were infected chickens, standard procedure was to perform a selective cull. The public would know what to do next if there were these aforementioned activities in their neighborhood thanks to media reports and aggressive campaigns by health agencies and their partner organizations.
      Before the minister started holding back information, the media (and the public) could just call a hotline number at the ministry designated for providing updates on bird flu cases in humans. The media then would pick up the updates to keep a record of the virus.
      These days, no one seems to know about bird flu cases. But a case in Bitung brought to the surface by The Associated Press confirmed the absence of previously standard procedures. The news report centered on a 34-year-old woman from Bitung who died after showing symptoms similar to those of bird flu. The woman's family was left confused because they were never informed of the cause of her death because no examination was ever conducted on her.
      The Associated Press also reported that the minister herself promised she would announce bird flu deaths as cumulative data, probably several times a year. One reason the minister decided to do this was that she didn't want "people to be preoccupied with the death toll and turn away from the efforts that have been done by her ministry".
      Worldwide, the virus has killed 241 people, with half that tally coming from Indonesia.
      It's public knowledge that although bird flu was originally a poultry disease, experts fear someday it will gain the ability easily to move from person to person, sparking a pandemic.
      Isn't it the government's duty to make available information that is needed by the public? The new law on freedom of information grounds such demand. Collective learning on how to keep a clean environment, not to touch sick birds and important hygienic practices can be learned from cases reported in the media. Changing people's behavior cannot be done overnight, it takes time, even longer in a country whose media is still madly in love with sensational news.
      Bird flu deaths are not criminal cases in that investigators have to withhold some facts as they pursue their investigation.
      The country should be embarrassed that bird flu is still claiming lives despite the campaigns and other efforts. Holding back information on deaths will not help improve anybody's image, doing just the opposite.
      But when the policy to hide information from the public comes from the minister herself, we can only hope that somehow it is all part of a sound plan to contain bird flu, although that looks very unlikely.

      The writer is a journalist at The Jakarta Post



      to aurora

      Comment


      • #4
        Re: Indonesia Human Cases - April 9, 2008+

        Originally posted by Commonground View Post
        Laidback Al, it doesn't look like HAN/Mohammad Andika lived very far from Istiqomah.
        http://maps.google.com/maps/ms?ie=UT...b303931c324e44

        Probably less than a mile. See map of the location of a number of human H5N1 cases in and around the Jakarta area.
        Attached Files

        Comment


        • #5
          Re: Indonesia Human Cases - April 9, 2008+

          machinetranslated

          Press release Department of Health

          See also this press release from Dep of Health summarised here: http://www.flutrackers.com/forum/sho...&postcount=268

          More or less the same; one important addition: confirmation on 2 bird flu victims. The Jakarta 15 yo girl I (no reference to her sibling(s), possibly contaminated too by H5N1) and the 34 yo woman from Bintung (AP report)
          posted here: http://www.flutrackers.com/forum/sho...&postcount=271




          Information of the Bird Flu Situation till June 19 2008


          19 Jun 2008

          Was based on the inspection virologis with the genetic analysis method (genetic sequencing) by the Penelitian Dan Pengembangan Kesehatan Body (Balitbangkes) the Department of Health and the Biologi Molekuler Eijkman Agency in Jakarta, till at this time the Bird Flu virus that attacked humankind still continue to H5N1.

          Therefore, the spread of the Bird Flu virus in Indonesia still from the poultry to humankind.

          Karana, the community was appealed to to avoid contact with the poultry that was sick or died suddenly and the most polluted environment the waste of the poultry.

          Did not maintain the poultry in the settlement environment.
          If having the poultry that was sick or died in the environment around, immediately was reported to RT/RW Chairman local.

          The community was also asked always to carry out the behaviour of the clean and healthy life (PHBS), maintained the cleanliness of the environment as well as guarded against the sign of Flu, because often the delay of the patient looked for the medical service enlarged the risk of the death.

          That was sent by Dr. I Nyoman Kandun, MPH, Dirjen of the Control of the Illness and Sanitation of Lingkungan Department of Health was linked with the development of the control of Bird Flu.

          The positive case of Bird Flu showed the decline 50&#37; compared to the case of Bird Flu in May 2007 as well as the decline that was sharp that is 88.8% compared to the case of Bird Flu in May 2006.

          During 2008 (in January now), cumulatively the positive case of bird flu was based on the Litbangkes inspection of the Body laboratory and the Biologi Molekuler Eijkman Agency was recorded by 18 cases, including 2 last cases in May that is IST (F, 15 years) from Jakarta and SS (F, 34 years) from Tangerang.

          Comment


          • #6
            Re: Indonesia Human Cases - April 9, 2008+

            Post #3:

            When cases were still publicized months ago, even for one case officials would rush to the neighborhood where the suspect lived, examine people and give oseltamivir medication as a preventative measure. The local animal husbandry agency too would deploy officials to check birds in the area to determine the source of the virus.
            If there were infected chickens, standard procedure was to perform a selective cull. The public would know what to do next if there were these aforementioned activities in their neighborhood thanks to media reports and aggressive campaigns by health agencies and their partner organizations.
            Before the minister started holding back information, the media (and the public) could just call a hotline number at the ministry designated for providing updates on bird flu cases in humans. The media then would pick up the updates to keep a record of the virus.
            These days, no one seems to know about bird flu cases. But a case in Bitung brought to the surface by The Associated Press confirmed the absence of previously standard procedures. The news report centered on a 34-year-old woman from Bitung who died after showing symptoms similar to those of bird flu. The woman's family was left confused because they were never informed of the cause of her death because no examination was ever conducted on her.
            This is the most scariest post I have read in a while......

            Comment


            • #7
              Re: Indonesia Human Cases - April 9, 2008+

              Bird flu mistaken as dengue, typhoid in Indonesia

              By Tan Ee Lyn

              KUALA LUMPUR, June 20 (Reuters) - Some cases of human bird flu in Indonesia have been variously misdiagnosed as dengue fever and typhoid, resulting in the late administration of drugs, a leading doctor in the country said on Friday.

              Indonesia has had the highest number of human H5N1 cases in the world and while mortality rates are around 60 percent in other places, the figure is highest, or at 81 percent, in Indonesia.

              Sardikin Giriputro, director of the Sulianti Saroso Infectious Disease Hospital in Indonesia, told an infectious disease conference in Kuala Lumpur that misdiagnoses and the late administration of drugs were partially responsible for the high mortality rates.

              "It (H5N1) is misdiagnosed initially as dengue, bacterial pneumonia, typhoid and upper respiratory tract infection because of similar clinical features (symptoms)," Giriputro said.

              Indonesia has had 135 confirmed human H5N1 cases from late 2003 to May 2008 and 110 resulted in deaths. The country reported two more confirmed cases this week, but these were not reflected in Giriputro's figures.

              Oseltamivir, otherwise known by its brand Tamiflu, is considered the drug of choice against bird flu and Giriputro said fatalities mounted the later the drug was administered.

              The survival rate was very high when Tamiflu was given less than 2 days after the onset of symptoms, but that plunged the later the drug was given.

              "It's best if given less than 24 or 36 hours after the onset of symptoms," he told Reuters later.

              While rapid test kits are now used to diagnose the disease in animals, Giriputro said these tools were much less reliable in people.

              "It depends on the viral load (in samples taken from patients)," he said, adding that test results could turn out negative even if the person was infected with H5N1, simply because there was not enough virus in samples taken.

              In a bid to reduce the death rate, the Indonesian government has begun distributing Tamiflu to health centres in areas where H5N1 cases have occurred.

              "When doctors see influenza-like illnesses and where there is evidence of contact with sick poultry, then they give Tamiflu (without waiting for laboratory results),"
              Giriputro said.

              While H5N1 remains essentially a disease among birds, experts have warned for years now that it could trigger a pandemic, killing millions of people, if it ever manages to become easily transmitted among humans.

              Thomson Reuters empowers professionals with cutting-edge technology solutions informed by industry-leading content and expertise.

              Comment


              • #8
                Re: Indonesia Human Cases - April 9, 2008+

                Who reads the Jakarta Post?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
                <o:p></o:p>
                I thought Emmy Fitri's 'H5N1: Lost in transition' was excellent and definitely very scary - but in a good way. This opinion piece needs to be read, not by us, but by lots of Indonesians and is this what happens with Jakarta Post Op-Eds? Is it English Language only or is the same article produced in Indonesian and who would get to see it?<o:p></o:p>
                <o:p></o:p>
                Earlier in the thread Florida1 posted a table showing initial H5N1 diagnosis in <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:country-region><st1:place>Indonesia</st1:place></st1:country-region> & <st1:country-region><st1:place>Thailand</st1:place></st1:country-region> but I found the options/categories confusing. As a layman it seemed to me 3 of the 5 were descriptions of causative agents (Typhus, Dengue & Influenza) and the other 2 were descriptions of symptoms (Pneumonia & <st1:stockticker>URT</st1:stockticker> infection) and as such were not mutually exclusive. I don’t mean to be etiologically pedantic but even in a relatively well resourced environment, like my GP's practice, most infectious diseases are not tested for but treated based on syndrome. <o:p></o:p>
                Hit it with antibiotics and if they have no effect you have 'a viral infection'. <o:p></o:p>
                Only if your immune system is loosing the battle does it get escalated to a serious attempt to pin down the causative agent by species. <o:p></o:p>

                Comment


                • #9
                  Indonesia Human Cases 20th June 2008 +

                  Previous Thread
                  Last edited by sharon sanders; June 20, 2008, 06:01 AM. Reason: fixed link

                  Comment


                  • #10
                    Re: Indonesia Human Cases 20th June 2008 +

                    Bandung, West Java

                    The 3 yo girl RN in Bandung Hospital was tested negative for bird flu; she became conscious again, but is still critical and on the ventilator.

                    New suspect case admitted, with clinical signs of bird flu.


                    RN Negatif Infected by Bird Flu Virus

                    Friday, June 20, 2008

                    Bandung - Results of the blood test were expected by bird flu, the RN (3 thn) from Subang West Java was stated by the negative terjangkit the bird flu virus.

                    Although his condition gradually improved but the RN did not yet pass the critical period.

                    She continued to be treated in Poinciana Tree space of RSHS Bandung.

                    The RN awareness, on Friday (19 -6) the morning has begun to be restored.
                    Although for his breathing still was helped the ventilator.


                    Apart from the RN, RSHS Bandung also received was expected just SE bird flu (26) from Batu Bandung.

                    According to Chairman Tim of the Control of Bird Flu of RSHS Bandung, Dr. Hadi Yusuf, the patient SE in a manner the story of the health did not have clear contact with the poultry died.

                    But clinically, showed the sign was expected by bird flu, like the acute inflammation, the high fever as well as the decline in the awareness of the para-lungs.

                    Until this we continued observation, said Hadi Yusuf, on Friday (19 -6).

                    Pikiran-rakyat.com - Media Jawa Barat, Media Nasional, Media Bandung, Indonesia dan Dunia Terkini Hari Ini, Update Harian Terbaru Fakta Terpercaya Terlengkap Politik, Ekonomi, Travel, Teknologi, Otomotif, Bola

                    Comment


                    • #11
                      Re: Indonesia Human Cases 20th June 2008 +

                      More from Bandung Hospital. Although other initials are mentioned, it seems possible we are talking about the same "suspect" patient menitioned in the previous post. It seems odd the patient is in the special bird flu isolation space, and at the same time the doctor says "he is not stated suspect bird flu, we must wait for lab tests".

                      Edit: confirmation of negative test for the little girl RN. Note: no diagnose is mentioned, this is not uncommon.

                      Buahbatu Resident Suspect Bird Flu

                      The Hasan Sadikin hospital (RSHS) Bandung came back the arrival of the patient suspect bird flu.

                      The male patient had the initials FP (27), the resident Street ***
                      RT *** Kel. Jatisari, Kec. Buahbatu, Kab. Bandung arrived in RSHS on Wednesday (18 -6 struck 21. 30 WIB.

                      Till yesterday, that was relevant still received the intensive maintenance in Isolasi Flamboyan Space.

                      The team leader the Handling and the Control of the Case of RSHS Bird Flu, Dr. Hadi Yusuf said, the patient at this time was not yet stated as suspect bird flu.

                      To be stated suspect bird flu, still was waiting for results of the laboratory inspection, although at this time FP was placed in the special room of the patient suspect bird flu.

                      The condition for the patient at this time was not yet categorised as suspect bird flu.

                      If seeing his condition, the stage inpatient under investigation.


                      We were still being waiting for results of the laboratory, the possibility of results has been tomorrow (today, red) or the day after tomorrow (tomorrow, red), said Hadi.

                      Said, the condition for the patient was not too critical so as the team of the doctor might not install the ventilator.

                      The patient was not installed the ventilator, only oxygen as respiratory aids, he added.

                      When being touched on about the possibility of contact between the patient and the poultry, Hadi admitted to not yet pocketing certain information.

                      Negative

                      In the meantime, on Saturday (14 - 6) then, RSHS also treated the patient suspect bird flu that still pre-schoolers had the initials R (2 years and 7 months) from Subang.According to the Team Leader the Handling and Penanggulanan Kasus of Khusus Anak Bird Flu the child in RSHS, Dr. Djatnika Setiabudi, the patient's situation that came from Subang this has improved.

                      Was based on results of the laboratory, for the time being results of the negative.

                      Comment


                      • #12
                        Re: Indonesia Human Cases 20th June 2008 +

                        Originally posted by JJackson View Post
                        Who reads the Jakarta Post?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
                        <o:p></o:p>
                        I thought Emmy Fitri's 'H5N1: Lost in transition' was excellent and definitely very scary - but in a good way. This opinion piece needs to be read, not by us, but by lots of Indonesians and is this what happens with Jakarta Post Op-Eds? Is it English Language only or is the same article produced in Indonesian and who would get to see it?<o:p></o:p>
                        <o:p></o:p>
                        Earlier in the thread Florida1 posted a table showing initial H5N1 diagnosis in <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:country-region><st1:place>Indonesia</st1:place></st1:country-region> & <st1:country-region><st1:place>Thailand</st1:place></st1:country-region> but I found the options/categories confusing. As a layman it seemed to me 3 of the 5 were descriptions of causative agents (Typhus, Dengue & Influenza) and the other 2 were descriptions of symptoms (Pneumonia & <st1:stockticker>URT</st1:stockticker> infection) and as such were not mutually exclusive. I don?t mean to be etiologically pedantic but even in a relatively well resourced environment, like my GP's practice, most infectious diseases are not tested for but treated based on syndrome. <o:p></o:p>
                        Hit it with antibiotics and if they have no effect you have 'a viral infection'. <o:p></o:p>
                        Only if your immune system is loosing the battle does it get escalated to a serious attempt to pin down the causative agent by species. <o:p></o:p>
                        As far as I know, the Jakarta Post is only printed in English.

                        Comment


                        • #13
                          Re: Indonesia Human Cases 20th June 2008 +

                          Post #3:

                          Was based on results of the laboratory, for the time being results of the negative.
                          For the time being? Waiting for another test result?

                          Comment


                          • #14
                            Re: Indonesia Human Cases 20th June 2008 +

                            "Was based on results of the laboratory, for the time being results of the negative."

                            This is the testresult for the little girl RN, she was tested negative.

                            Comment


                            • #15
                              Re: Indonesia Human Cases 20th June 2008 +

                              AVIAN INFLUENZA, HUMAN (54): INDONESIA
                              ****************************************
                              A ProMED-mail post
                              <http://www.promedmail.org>
                              ProMED-mail is a program of the
                              International Society for Infectious Diseases
                              <http://www.isid.org>

                              Date: Thu 19 Jun 2008
                              Source: Reuters Health [edited]
                              <http://www.reutershealth.com/en/index.html>


                              The Indonesian health ministry has reported 2 deaths from bird flu in
                              recent weeks, easing concerns about whether Jakarta would share
                              information about the disease, the World Health Organisation (WHO)
                              said on Thursday [19 Jun 2008]. Indonesia has had more human H5N1
                              infections than any other country, with 110 deaths out of 135 cases.
                              [It is unclear whether the 2 deaths announced below are included in
                              this figure or are additional. - Mod.CP]

                              The latest infections are the 1st since Health Minister Siti Fadillah
                              Supari said 2 weeks ago that Jakarta had changed its policy on
                              reporting human cases and would only announce the death toll every 6
                              months [see ProMED-mail posting: Avian influenza, human (51):
                              Indonesia, new policy 20080606.1811. - Mod.CP]. The WHO, a United
                              Nations agency, has been seeking clarification on her remarks, which
                              appeared to run counter to international health regulations requiring
                              the WHO's 193 member states to report human cases of bird flu within
                              24 hours. "We've had reassurances they are going to comply with the
                              international health regulations," WHO spokesman in Geneva John
                              Rainford told Reuters on Thursday [19 Jun 2008].

                              The WHO, in a statement reporting information from the Indonesian
                              health ministry, said that a 16-year-old girl from South Jakarta died
                              on 14 May 2008 and a 34-year-old woman from Banten province died on 3
                              Jun 2008. Investigation into the girl's death indicate she was
                              exposed to sick and dead poultry, which carry the H5N1 virus, while
                              investigations into the source of the 2nd woman's infection are
                              continuing, according to the WHO statement.

                              There have been 385 human bird flu infections, including 243
                              fatalities in 15 countries worldwide since 2003, it says.

                              Indonesia has maintained its decision not to share bird flu samples
                              with WHO laboratories, saying it wants guarantees from richer nations
                              and drug makers that poor countries would get access to affordable
                              vaccines developed from their samples. International health experts
                              say it is vital to have access to samples of the constantly-mutating
                              virus, which they fear could change into a form spreading more easily
                              among humans and sweep the world in months, killing millions of
                              people. "There is a strong working relationship between the WHO
                              country office and the government. Even if there is a conflict on
                              issues like virus-sharing, it hasn't eroded the ability to carry out
                              joint investigations," Rainford said.

                              --
                              Communicated by:
                              ProMED-mail <promed@promedmail.org>

                              [As a consequence of the delayed announcement of these 2 deaths, the
                              current total number of avian H5N1 influenza cases and deaths in
                              Indonesia is unclear. Clarification is awaited. - Mod.CP]

                              [see also:
                              Avian influenza, human (51): Indonesia, new policy 20080606.1811
                              Avian influenza, human (50): Bangladesh, WHO 20080529.1740
                              Avian influenza, human (49): Bangladesh, WHO 20080525.1718
                              Avian influenza, human (48): Bangladesh 20080523.1704
                              Avian influenza, human (47): Indonesia, susp 20080514.1623
                              Avian influenza, human (46): Japan, Egypt WHO 20080418.1389
                              Avian influenza, human (45): Egypt, Japan 20080416.1370
                              Avian influenza, human (44): Egypt 20080411.1332
                              Avian influenza, human (43): China, Egypt WHO 20080408.1292
                              Avian influenza, human (42): Egypt, Indonesia 20080406.1257
                              Avian influenza, human (41): Indonesia, Pakistan, WHO 20080404.1235
                              Avian influenza, human (40): Indonesia 20080331.1193
                              Avian influenza, human (39): Indonesia, Viet Nam (WHO) 20080319.1060
                              Avian influenza, human (38): Viet Nam 20080317.1041
                              Avian influenza, human (37): Egypt, WHO 20080313.1010]
                              .................................................. .....cp/msp/dk

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