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Indonesia: The Latest Human Suspected & Confirmed Cases January 29 + April 6, 2009
Re: Indonesia: The Latest Human Suspected & Confirmed Cases January 29 +
And let me extend my thanks, and congratulations, to the newshounds as well. I quite honestly couldn't do what I do, without your tireless efforts.
Thank you.
All medical discussions are for educational purposes. I am not a doctor, just a retired paramedic. Nothing I post should be construed as specific medical advice. If you have a medical problem, see your physician.
"...Mike Coston, who authors the Avian Flu Diary blog, provided a round-up today of additional details about the four cases, based on information that he and flu reporters at the FluWiki and FluTrackers blog sites have gleaned over the past several weeks from Indonesian media reports and other online sources...."
Yes! You have my deep appreciation for taking a complicated news item and helping to make it into digestible pieces for so many news items. This one, in particular was very confusing today. Again, I found myself using your AFD blog as a source of information for my list serve. -k
Re: Indonesia: The Latest Human Suspected & Confirmed Cases January 29 +
dbg at PFI raises the possibilities that the identity of fourth individual that died from H5N1 as noted by the MOH on Feb 11 could be Nafisah, a 43 year old woman who died on Jan 17 in West Jarkarta. Nafisah is first noted in this post with other follow up posts. http://www.flutrackers.com/forum/sho...&postcount=449
The province in which the fourth case occurred may have been misreported by Bayu Krisnamurthi, chief of the National Bird Flu Commission, in post #220 above. Uncertainty abounds, because initially, the announcement in mid February suggested that three of these deaths occurred in West Java and one in DKI Jakarta. See: http://www.flutrackers.com/forum/sho...5&postcount=99
Indonesian H5N1 Cluster and Case Reports Raise Concerns
Recombinomics Commentary 20:18 March 3, 2009
Head of Unicef for the East Java, Bali, NTB, and NTT, Jinung D Kritanto added, Unicef continues to actively participate in prevention efforts to the spread of bird flu. Basic steps are carried out the program within the community to continue cautious spread of the virus is vicious. "We just want to add that local governments in the area of concern that the traditional market becek.Sebab, the spread of bird flu virus is more easily in humid areas and tarnish," he said.
He explains, according to the Ministry of Health of RI 2005-2009, the number of people with bird flu reached 145 inhabitants and 119 patients declared dead.
The above translation is from a media report dated February 11, 2009, indicating that the four confirmed cases being widely reported today had died and had been confirmed in early February. Indeed, media reports on three of the four cases describe their deaths in January. The fourth case, from Bekasi, is not identified in earlier media reports, but inclusion in the above translation suggest that she also died in late January or early February. The translation also strongly suggests that WHO was aware of these confirmed cases weeks ago, yet has still not issued a situation update, more than a month after they died.
When Indonesia announced their news blackout on confirmed cases, WHO offered assurances on timely updates. International Health Regulations require notification within 24-48 hours of confirmation and previously WHO had issued updates within a day or two of the death or discharge of confirmed cases. If Indonesia is abiding by these regulations, then WHO is withholding the data for weeks or months after they are notified. Ironically, when WHO offered its assurances last year, they noted that the Indonesian confirmed cases were not part of a cluster. Yet the news blackout came after the third cluster was confirmed. In each cluster the index died, but was diagnosed with something other than H5N1 (lung inflammation, dengue fever, or typhus) and when a family member was H5N1 confirmed, the misdiagnosis was not upgraded, so the official case count underrepresented both cases in clusters.
This undercount continues today. On Java the past 16 confirmed cases have been fatal. A case fatality rate of 100% signals an under-representation of infected cases that recover. In the latest confirmed cases from Bogor, two siblings died (see updated map). However, a third sibling who survived refused testing. Similarly, three paramedics affiliated with the hospital that treated the confirmed fatality in Surabaya developed symptoms and were in critical condition. At the end of last month they were still hospitalized and unconfirmed, but the likely three cases would create another cluster that included surviving contacts of an H5N1 confirmed case.
These latest likely clusters raise concerns that the H5N1 in Indonesia is evolving toward an H5N1 that is more efficiently spread to humans. The recent WHO report on H5N1 vaccine targets included an HA phylogenetic tree with four isolates from Indonesian patients. These isolates continued to evolve away from this initial 2005 isolate from Tangerang, and raise concerns that vaccines directed against the 2005 isolate will offer limited protection. Moreover, the continued evolution raises concerns of receptor binding domain changes leading to more efficient transmission. Recent H1N1 seasonal flu isolates have had a number of changes in or around the receptor binding domain near position 190 (H3 numbering), including A193T. A193T is in all published clade 2B H1N1 isolates this season which have the Tamiflu resistant polymorphism, H274Y. Moreover A193T was associated with the spread of adamantane resistant S31N in H1N1 clade 2C, and S193F was linked to the spread of S31N in H3N2. Therefore, changes in this area of H5N1 in Indonesia would be a cause for concern.
Thus, the continuing rapid evolution of H5N1 in Indonesia, coupled with frequent larger H5N1 clusters continues to increase pandemic concerns, while the level of WHO transparency on cases and clusters declines.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Re: Indonesia: The Latest Human Suspected & Confirmed Cases January 29 +
Four people die of bird flu in Indonesia
There have been 4 deaths from avian flu in Indonesia since January, increasing the country?s total fatalities caused by the virus to 117 out of 143 people infected.
The news was confirmed by the head of Indonesia?s national bird flu commission, Bayu Krisnamurthi, on March 3.
Indonesia has encountered many obstacles in its efforts to stop the spread of the virus, across its vast territory, the traditional way of raising chickens in the backyard and the public?s refusal to obey guidelines issued by the provincial administration on how to stop the virus spreading have all contributed to the current epidemic.
"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Re: Indonesia: The Latest Human Suspected & Confirmed Cases January 29 +
google translation
Hospital doctor Annisa argue Blood Sample Taken
Wednesday, March 04, 2009 | 14:35 WIB
TEMPO Interactive, Jakarta: Rumah Sakit Annisa Cikarang, Bekasi regency, West Java, stressed that the two paramedics and a doctor that the blood sample was taken Thursday after handling bird flu patients presumed non-medical staff from their party.
"They were not our doctors, but the Sentra Medika medical clinic," said dr Annisa Noor, Director of Hospital Annisa, told Tempo.
Edition, such as the Tempo be Tuesday, from S, of L, and Mantri A blood sample taken the Penanggulangan National Bird Flu. The goal is, to a laboratory for testing to check the occurrence of transmission of bird flu victims to the medical team. This information is obtained from the Head of Disease Control and Environmental Health Office Penyehatan Kabupaten Bekasi Rudi Ruhdiat, Monday (2 / 3).
Head of Service of Hospital Annisa Rina, did not claim to provide any information related to the status of a doctor and two paramedics that. He also disputed the telephone that the patient A, 8 years, treated only in the ordinary space is not space insulation.
Head of Disease Control and Environmental Health Office Penyehatan Kabupaten Bekasi Rudi Ruhdiat that give wrong information. "This error information," he said.
According to Rudi, before referred to the Hospital Annisa, a patient had been treated the way the clinic and Kartika Sentra Medika Medika. Sentra Medika in clinic, he was treated S dr, dr L, paramedics and A. "Officials in the two medical clinics that allegedly involved close contact with the patient dies," he said.
The hospital of Annisa Bantah Doctor Diambil Sampel Darah On Wednesday, March 04 2009 | 14:35 of WIB The Interaktif TIME, Bekasi: the Annisa Cikarang Hospital, Kabupaten Bekasi, West Java, stressed that two doctors and an official who were taken the sample of his blood of Ahad then after handling the patient was expected by bird flu not the medical official from their side. "They not our doctor, but the medical official" of the "Medika centres clinic," said Dr Noor Annisa, Director Rumah Sakit Annisa, to the Time.
As being reported the edition Time last Tuesday, Dr S, Dr L, and the Official A were taken the sample of his blood of the Penanggulangan Nasional Body of Bird Flu. The aim is, for the laboratory test in order to checks the occurrence of the transmission of bird flu from casualties to this medical team. This information was obtained from the Head of the Pengendalian Field of the Illness and Lingkungan Dinas Kesehatan Sanitation of the Bekasi Regency of Rudi Ruhdiat, on Monday (2/3).
The head of the Rumah Sakit Annisa Service Dr Rina, admitted to not giving information anything related the status of two doctors and an official. He also denied it explained through the telephone that the patient A, 8 years, was only treated in normal space not isolation space.
The head of the Pengendalian Field of the Illness and Lingkungan Dinas Kesehatan Sanitation of the Bekasi Regency of Rudi Ruhdiat admitted to be wrong gave information. "This the information mistake," he said. According to Rudi, before being reconciled to the Annisa Hospital, the patient A could be treated the road in the Medika centres clinic and Kartika Medika. In the Medika centres clinic, he was treated by Dr S, Dr L, and the official A. "Petugas medical in two clinics so that it was suspected was involved in contact was close to the patient died," he said.
dbg at PFI raises the possibilities that the identity of fourth individual that died from H5N1 as noted by the MOH on Feb 11 could be Nafisah, a 43 year old woman who died on Jan 17 in West Jarkarta. Nafisah is first noted in this post with other follow up posts. http://www.flutrackers.com/forum/sho...&postcount=449
The province in which the fourth case occurred may have been misreported by Bayu Krisnamurthi, chief of the National Bird Flu Commission, in post #220 above. Uncertainty abounds, because initially, the announcement in mid February suggested that three of these deaths occurred in West Java and one in DKI Jakarta. See: http://www.flutrackers.com/forum/sho...5&postcount=99
Three of the four confirmed cases are unambiguous and all three died in January, consistent with their inclusion in the UNICEF press conference on February 11.
The unambiguous cases are fatalities, which are those most likely to be confirmed, especially if no other cause is mentioned in the local media. The number of such cases is fairly limited and traditionally match the confirmed cases.
I think it is safe to assume that the milder cases are not reported/tested properly and are rarely confirmed. The past 16 confirmed cases on Java, going back to the cluster in February, 2008 have all been fatal.
Re: Indonesia: The Latest Human Suspected & Confirmed Cases January 29 +
Lab results (Regional Lab West Java) regarding the samples of the deceased Andri (from Kampung Kandang, Desa Sukaraya, Bekasi) are expected tomorrow (thursday).
BANDUNG - MI: Animal Husbandry Jawa Barat (West Java) is still examining the causes of death of Andri Ruhiyat, 30, of Kampung Kandang, Sukaraya Village, Bekasi, is exposed to the virus suspected of bird flu.
Head of Animal Husbandry Koesmayadi Tatang Jabar said his side will determine whether the death of Andri at a hospital in East Jakarta, Monday (2 / 3), exposed to the virus-positive bird flu (avian influenza) is not.
"We are waiting the results of research on blood samples of the victim in the Public Health Laboratory Jabar," he said, Wednesday (4 / 3).
In addition, he said, he has also been
take a blood sample in birds near the victim's house, on Tuesday (3 / 3), while doing it. "It's likely tomorrow (Thursday, 5 / 3) already have the results," he said.
To anticipate the merebaknya the virus to other areas, he has to give the vaccine to the poultry in the village sekitaran residence of the victim. This year Animal Husbandry Jabar target of a bird flu vaccine to poultry ekor 7,195,000.
According Koemayadi, Bekasi region is the region that every year was bird flu. However, the spread of the virus in that region caused by traffic poultry. (EM/OL-01)
Re: Indonesia: The Latest Human Suspected & Confirmed Cases January 29 +
Andri Ruhiyat, 30, of Kampung Kandang
Head of Animal Husbandry Koesmayadi Tatang Jabar said his side will determine whether the death of Andri at a hospital in East Jakarta, Monday (2 / 3), exposed to the virus-positive bird flu (avian influenza) is not.
We have a problem here in Bekasi. They are currently observing 33 residents/medical personnel, and someone just died. This is a new case.
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-k
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