Indonesia Reporting Human Cases of H5N1 Controversy

[rymich13]

Re: Indonesia says it will no longer formally announce bird flu deaths

This is so bad for the worlds health, because what if the virus makes the jump to humans and we do not know it until it's too late, cutting into critical time to make vaccines and other measures to help stop the spread of the disease.

[sharon sanders]

Re: Indonesia says it will no longer formally announce bird flu deaths

I would like to thank the news analysts who search, translate, and report the news daily:

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I may add more names. I reviewed the sites but I may have inadvertently omitted someone. For that I apologize in advance and I will promptly correct this post.

[Giuseppe]

Re: Indonesia says it will no longer formally announce bird flu deaths

This is so bad for the worlds health, because what if the virus makes the jump to humans and we do not know it until it's too late, cutting into critical time to make vaccines and other measures to help stop the spread of the disease.

One could hope in hidden channels of information, that exists in certain forms between some countries, for rapid exchange of critical information about natural disaster, man-made disaster, etc.

These kind of hotlines represent sometimes the only way to communicate for a number of countries, also when the freedom of press is limited or absent.

In addition, military communicate with its counterparts in a same way, and Indonesia and USA I think are allied in more fronts.

Are we sure that the Indonesian govt move is a real surprise for all?

[gsgs]

Re: Indonesia says it will no longer formally announce bird flu deaths

reminds me to the secret databases

those who get the info and keep it secret may be
critisized later.
OTOH, they probably only get the info because
they promise to keep it secret

[Commonground]

Re: Indonesia says it will no longer formally announce bird flu deaths

June 6, 2008
Indon health minister silent on bird flu toll

JAKARTA - INDONESIAN Health Minister Siti Fadilah Supari refused on Friday to say how many Indonesians had died of bird flu.
She also insisted it was no longer necessary to announce the toll on a case-by-case basis.

'Publicly announcing the toll every time a victim dies brings no benefit at all to efforts to contain the virus,' she said, without confirming a media report that a 15-year-old girl had become Indonesia's 109th bird flu victim.

The minister said she had decided to end the practice of publicly updating the national toll with every new death, and the names of victims would no longer be released to protect the families.

'We will announce the toll periodically, every three months or so,' she said.

Earlier this year Ms Supari closed a 24-hour information centre which provided confirmation of new human cases of avian influenza and stopped the ministry's practice of emailing bird flu alerts to journalists.

The last toll published by the World Health Organisation (WHO) says there have been 108 deaths from bird flu in Indonesia since 2005, out of 133 cases.

That is almost half of the world toll of 241.

WHO officials in Jakarta and Geneva refused to discuss the minister's comments, saying only that there had been no communication on the matter from the Indonesian health ministry.
-snip-

http://www.straitstimes.com/Latest%2BNews/Asia/STIStory_245019.html

[tropical]

Re: Indonesia says it will no longer formally announce bird flu deaths

I agree with Ironorehopper and gsgs,
that's an media-only move, probably.

Some of the many other inter-estabs prof./spec. links probably got official reports from there which are quoted classified, not for the media.

[HenryN]

Re: Indonesia says it will no longer formally announce bird flu deaths

June 6, 2008
Indon health minister silent on bird flu toll

JAKARTA - INDONESIAN Health Minister Siti Fadilah Supari refused on Friday to say how many Indonesians had died of bird flu.
She also insisted it was no longer necessary to announce the toll on a case-by-case basis.

'Publicly announcing the toll every time a victim dies brings no benefit at all to efforts to contain the virus,' she said, without confirming a media report that a 15-year-old girl had become Indonesia's 109th bird flu victim.

The minister said she had decided to end the practice of publicly updating the national toll with every new death, and the names of victims would no longer be released to protect the families.

'We will announce the toll periodically, every three months or so,' she said.

Earlier this year Ms Supari closed a 24-hour information centre which provided confirmation of new human cases of avian influenza and stopped the ministry's practice of emailing bird flu alerts to journalists.

The last toll published by the World Health Organisation (WHO) says there have been 108 deaths from bird flu in Indonesia since 2005, out of 133 cases.

That is almost half of the world toll of 241.

WHO officials in Jakarta and Geneva refused to discuss the minister's comments, saying only that there had been no communication on the matter from the Indonesian health ministry.
-snip-
http://www.straitstimes.com/Latest%2...ry_245019.html

Earlier this year Ms Supari closed a 24-hour information centre which provided confirmation of new human cases of avian influenza and stopped the ministry's practice of emailing bird flu alerts to journalists. -- PHOTO: AP

[tropical]

Re: Indonesia says it will no longer formally announce bird flu deaths

I saw the WHO officials text line.

Still:
"Some of the many other inter-estabs prof./spec./corp.s links probably got unofficial reports from there which are quoted classified, not for the media."

Where goes the Baxter agreement folks ...

[Gert van der Hoek]

Re: Indonesia says it will no longer formally announce bird flu deaths

Indonesia's bird flu reporting policy draws (f)ire

Fri 6 Jun 2008,

By Olivia Rondonuwu

JAKARTA, June 6 (Reuters) - Indonesia's decision to report bird flu cases in humans only every six months, rather than immediately, is irresponsible and could lead to delays in containing outbreaks of the disease, a scientist said on Friday.

Health Minister Siti Fadillah Supari, who has clashed with the international community and United States over her handling of health issues, on Thursday said her ministry had changed its policy and would only report cases every six months.

She did not say whether that reporting policy also included the World Health Organisation (WHO). But a health ministry official said on Friday that the ministry had not decided yet whether it would report to the WHO every one, two, or three months.

"It's a drawback," said Gusti Ngurah Mahardika, a bird flu researcher at Bali's Udayana University.

"It's an obligation (to report) not only every day, but every minute if there's a new development. If they only report to WHO every six months, it will be too late to recognise if there's a new development towards a pandemic."

WHO officials in Geneva said they are still seeking confirmation of the new policy.

With 108 confirmed human fatalities from bird flu, Indonesia has the highest toll of any nation. Since the virus resurfaced in Asia in late 2003, it has killed 241 people in a dozen countries, according to the WHO.

Supari has attracted criticism from the international community for her stance on sharing bird flu samples.

Officials in Indonesia have said they want to ensure equal access to any vaccines that are made against bird flu, but U.S. Health Secretary Michael Leavitt said in April after visiting Jakarta that Indonesia also wanted payments.

The United States and Indonesia are also locked in a dispute over the future of a U.S. naval lab in Jakarta, mainly over virus transfers and the number of U.S. staff allowed to have diplomatic status.

International health experts say it is vital to have access to samples of the constantly mutating H5N1 virus, which they fear could change into a form easily transmissible among humans and sweep the world in months, killing millions of people.

"We are obliged to report to WHO, we are also obliged to report it to the public," said Nyoman Kandun, director-general of communicable diseases at the health ministry, adding that the new policy was meant as a better way to "package" the information.

Indonesia so far has maintained its decision not to share bird flu samples, saying it wants guarantees from richer nations and drugmakers that poor countries would get access to affordable vaccines developed from their samples. (Reporting by Olivia Rondonuwu; Editing by Sara Webb and David Fogarty)

http://africa.reuters.com/commodities/news/usnJAK308549.html

[HenryN]

Re: Indonesia says it will no longer formally announce bird flu deaths

[ATTACH]2489[/ATTACH]
http://www.who.int/gb/ebwha/pdf_file.../A58_55-en.pdf

Obviously I have not quite got the chart readable but it can be found as Annex 2 at the link to the IHR(2005)

I also wrote something more general on the IHR and WHO 2 years ago which can be found here http://www.flutrackers.com/forum/showthread.php?t=66555

Active link

http://www.who.int/gb/ebwha/pdf_files/WHA58/A58_55-en.pdf

4. At the local community level and/or primary public health response level
The capacities:
(a) to detect events involving disease or death above expected levels for the particular time
and place in all areas within the territory of the State Party; and
(b) to report all available essential information immediately to the appropriate level of healthcare
response. At the community level, reporting shall be to local community health-care
institutions or the appropriate health personnel. At the primary public health response level,
reporting shall be to the intermediate or national response level, depending on organizational
structures. For the purposes of this Annex, essential information includes the following: clinical
descriptions, laboratory results, sources and type of risk, numbers of human cases and deaths,
conditions affecting the spread of the disease and the health measures employed; and
(c) to implement preliminary control measures immediately.
5. At the intermediate public health response levels
The capacities:
(a) to confirm the status of reported events and to support or implement additional control
measures; and
(b) to assess reported events immediately and, if found urgent, to report all essential
information to the national level. For the purposes of this Annex, the criteria for urgent events

Annex 1 A58/55
43

include serious public health impact and/or unusual or unexpected nature with high potential for
spread.
6. At the national level

Assessment and notification

. The capacities:
(a) to assess all reports of urgent events within 48 hours; and
(b) to notify WHO immediately through the National IHR Focal Point when the assessment
indicates the event is notifiable pursuant to paragraph 1 of Article 6 and Annex 2 and to inform

WHO as required pursuant to Article 7 and paragraph 2 of Article 9.

[Commonground]

Re: Indonesia says it will no longer formally announce bird flu deaths

Indonesia to announce bird flu deaths biannually

Posted By BY HELEN BRANSWELL, THE CANADIAN PRESS

Indonesia's health minister said Thursday her country would no longer report H5N1 avian flu deaths as they happen, but will share a revised death toll every six months -- a threatened policy change experts said would put the country in violation of a key international health treaty.

The International Health Regulations, a treaty to which Indonesia is a signatory, requires prompt reporting of cases of diseases that have been designated as global health threats. SARS, polio, smallpox and human cases of avian influenza infection are specified under the treaty.

Indonesian Health Minister Siti Fadilah Supari -- whose country has lost the most people to H5N1 -- signalled the change Thursday.

http://www.orilliapacket.com/ArticleDisplay.aspx?e=1061998

[HenryN]

Re: Indonesia says it will no longer formally announce bird flu deaths

ANNEX 2
DECISION INSTRUMENT FOR THE ASSESSMENT AND NOTIFICATION OF EVENTS THAT
MAY CONSTITUTE A PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN
OR OR

Events detected by national surveillance system (see Annex 1)

A case of the following
diseases is unusual or
unexpected and may
have serious public
health impact, and thus

shall be notified

a, b:

-

Smallpox

-

Poliomyelitis due to

wild-type
poliovirus
-

Human influenza

caused by a new
subtype
-

Severe acute

respiratory

syndrome (SARS)

EVENT SHALL BE NOTIFIED TO WHO UNDER THE INTERNATIONAL HEALTH

REGULATIONS

[HenryN]

Re: Indonesia says it will no longer formally announce bird flu deaths

Commentary

http://www.recombinomics.com/News/06060801/H5N1_Indo_H2H_Failures.html

[HenryN]

Re: Indonesia says it will no longer formally announce bird flu deaths

The Reader (not verified) — Fri, 06/06/2008 - 8:0

http://www.thejakartapost.com/news/2...for-birds.html

For the Birds

The Jakarta Post , Jakarta | Fri, 05/23/2008 7:38 PM | Cover Story
As citizens of the country hardest hit by avian influenza, Indonesians are inundated with messages about the disease. Increasingly it appears that bird flu is joining the list of other serious and persistent ailments, such as dengue fever, TB and HIV/AIDS that have to be controlled from the ground up. Emmy Fitri reports.
Homemaker Yuli Rosmalia is confident she knows the ins and outs of bird flu – “who doesn’t these days?” -- from the relentless public information blitz on TV and in print media.
As she talks, the 30-something occasionally uses the English term of avian influenza, a knowledge gained from reading up on the disease. <o:p></o:p>
“For sure, it has nothing to do with eating chicken. People get sick when they have contact with dead chickens. That’s why I never want to keep chickens in my backyard,” she says.
It was a typical afternoon in her low-income residential neighborhood in <st1:place>East Jakarta</st1:place>, located near a military complex. Yuli sat with four other mothers, feeding their children. The restless youngsters scampered off in their bare feet across a vacant lot, crossing paths with a hen and her chicks that pecked up fallen crumbs of food from the children. <o:p></o:p>
“We know whose chickens they are,” says Ibu Sapto, another one of the mothers.<o:p></o:p>
“They’re owned by a retired Army soldier. He has chickens that are not caged so they range freely during the day, and doves that are kept in a cage in front of his house.” <o:p></o:p>
“She (Rosmalia) already complained to sub-district officials about the birds. I don’t think the officials dared to say a word to him, that’s why they are still there,” she adds, to the laughter of the others. <o:p></o:p>
Although the sub-district head was not available for comment, an official said he knew about a resident who owned free-ranging chickens nearby -- a crime according to a <st1:city><st1:place>Jakarta</st1:place></st1:city> administration bylaw on poultry containment issued last year under then governor Sutiyoso. <o:p></o:p>
“[b]ut we have repeatedly asked the owner to cage the chickens and keep the cage clean. Maybe he thought they’re just chickens so why make a fuss. Typical,” the official says.<o:p></o:p>
Second only to neighboring Banten, <st1:city><st1:place>Jakarta</st1:place></st1:city> accounts for almost half of the total human fatalities from bird flu in the national tally, which, as of April 20, stood at 107. The capital is home to densely populated slums and low-income kampongs marked by poor sanitation. Compounding the problem is that many residents keep small backyard farms to help make ends meet. <o:p></o:p>
Yuli’s apparent knowledge of bird flu transmission while allowing her children to play in a potential danger zone is a contradiction. However, she and her friends are probably typical of most Indonesians when it comes to the disease. Knowledge does not instantly change lifestyles and risky behavior.
As Richard Fielding, associate professor of medical psychology at the <st1:place><st1:placetype>University</st1:placetype> of <st1:placename>Hong Kong</st1:placename></st1:place>, said last year, varying perceptions among people about backyard farming and the sale of live chickens explain why it is difficult to draw up a single set of rules about what is healthy. <o:p></o:p>
His colleague, translational public health expert Gabriel M. Leung, also points out that densely populated Asia, where animals and people live in close proximity and some of the world’s most virulent epidemics began, will continue to be a hotbed of disease. For bird flu, much of the problem stems from traditional methods of rearing poultry. <o:p></o:p>
Regulating the poultry industry – from factory-style farming to backyard operations – is imperative but no guarantee for resolving issues arising from the complex nature of the industry. Chicken and other poultry products remain the number one affordable animal-based protein source for most of the population here. <o:p></o:p>
Bird flu, caused by the H5N1 virus, is endemic in a tropical, agricultural country like <st1:country-region><st1:place>Indonesia</st1:place></st1:country-region>, where poor sanitation is the norm, especially in rural areas. Almost all of the 33 provinces in the country have reported outbreaks of avian influenza, and short of the drastic and unfeasible step of culling entire poultry populations, the virus will remain endemic in domesticated birds. <o:p></o:p>
Chief executive of National Commission for Avian Influenza and Pandemic Preparedness, Bayu Krisnamurthi, contends it is not possible to stamp out the disease from the country completely. <o:p></o:p>
“There is no history in other countries of complete success in eradicating this disease. This continues with diseases we face today, like TB or dengue. Diseases that we have to deal with in our daily lives.” <o:p></o:p>
Facing myriad problems in many sectors, <st1:country-region><st1:place>Indonesia</st1:place></st1:country-region>, according to Bayu, has shown great effort in dealing with avian influenza.<o:p></o:p>
“Preparedness is the key because the virus has been with us all along and is going to hover around us. It’s literally in our hands to stop it from catching us,” he says, referring to the commission’s slogan about the importance of hand washing to prevent the spread of infection. <o:p></o:p>
“And we all are now, not only <st1:country-region><st1:place>Indonesia</st1:place></st1:country-region> but the world, in the learning process while preparing for the worst from this virus. What we need to do is to prevent bird flu from becoming a pandemic.” <o:p></o:p>
The fact that most people who have died of bird flu came from low to middle-income families fuels the assumption bird flu “picked” its victims, based on poor lifestyle, an unhealthy environment and lack of access to information. The doubters point out that the first person to die of H5N1 in the country, a Tangerang resident in 2005, was from an affluent background.<o:p></o:p>
“That remains a big question,” says Tjandra Yoga Aditama, the former director of <st1:place><st1:placename>Persahabatan</st1:placename> <st1:placetype>Hospital</st1:placetype></st1:place> and now the Health Ministry’s director for infectious diseases. “It’s hard to trace back the contact history of a patient and identify the source of infection because we live in this vast, mobile community, like <st1:city><st1:place>Jakarta</st1:place></st1:city>, Tangerang and <st1:city><st1:place>Bogor</st1:place></st1:city>. They’re interlinked.”<o:p></o:p>
The problem is that this first death is just one of many question marks hanging over the disease.<o:p></o:p>
“There is still more to learn about this disease. Clinicians, doctors and hospitals are learning too because it’s something new,” Tjandra says.<o:p></o:p>
In the much-feared worst-case scenario, avian influenza would spiral into a full-fledged pandemic. Scientists have always said that no country can ever be truly primed to respond to a pandemic, especially in this age of international air travel where diseases can spread between continents in days.<o:p></o:p>
So, many people keep their fingers crossed, hoping that the ugly historical examples of the 1918 Spanish flu pandemic, 1968 Hong Kong pandemic and 2000 SARS outbreak will not be repeated on a greater scale.<o:p></o:p>
Preventing that from happening starts in the home, with simple, basic hygienic practices. Yuli and her friends already know that – now they just have to start putting it into practice.<o:p></o:p>

[HenryN]

Re: Indonesia says it will no longer formally announce bird flu deaths

AVIAN INFLUENZA, HUMAN (51): INDONESIA, NEW POLICY
**************************************************
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 5 Jun 2008
Source: CIDRAP News [abbreviated and edited]
<http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun0508indonesia-br.html>


Indonesia quits offering prompt notice of H5N1 cases
----------------------------------------------------
Indonesia's health minister said today [5 Jun 2008] the government
has stopped the practice of promptly notifying global health
officials each time it confirms a human H5N1 avian influenza case or
death, a move some say will likely hamper efforts to monitor the
world's pandemic risk level.

Health Minister Siti Fadilah Supari today confirmed that a
15-year-old girl from Jakarta tested positive for H5N1 avian
influenza on 13 May 2008 and died the next day, according to a report
from the Associated Press (AP). Indonesia's National Committee for
Avian Influenza Control and Pandemic Influenza had previously listed
the case as confirmed on its Web site, but the information is
apparently no longer listed [see comment below].

The WHO, which typically confirms cases when it receives
notifications from health ministries or test results from its
collaborating laboratories, has not yet confirmed Indonesia's most
recent case and has not commented on Supari's decision to stop
sending out H5N1 case notifications. The WHO last confirmed, on 30
Apr 2008, an Indonesian H5N1 case, in a 3-year-old boy who died on 23
Apr 2008.

Supari told the AP that the health ministry would not send out H5N1
case confirmations until after they have been reported in the media.
However, Reuters reported today that the ministry will announce the
death toll from the H5N1 virus only every 6 months.

"How does it help us to announce these deaths?" Supari told the AP.
"We want to focus now on positive steps and achievements made by the
government in fighting bird flu." She told Reuters that announcements
of H5N1 deaths are sometimes misunderstood. "It's OK not to announce
it. Sometimes they only give hurtful comments instead of helping,"
she said without further explanation. Indonesia has been hit hardest
of any country by the H5N1 virus. According to the WHO's most recent
count, the country has had 133 cases and 108 deaths.

The country's refusal to share timely reports of human H5N1 cases is
the latest in a series of controversies that began when Indonesia
stopped sharing its H5N1 isolates in early 2007 to protest what it
views as a lack of access to affordable H5N1 therapies and vaccines.
The WHO has held several meetings to resolve the virus sharing
issues, but so far no agreements have been reached.

Sharon Sanders, editor-in-chief of FluTrackers, a well-known Web
message board that focuses on avian flu developments, told CIDRAP
News that Indonesia's decision to delay H5N1 notifications will
obscure what is happening there, which negatively affects the world's
ability to prepare for a pandemic. She said Indonesia's news blackout
would likely have the opposite effect from what the government
apparently intends. "Now, there will be intense speculation and
generation of rumors surrounding suspicious deaths that have similar
symptoms to H5N1 infections," Sanders said. "False rumors of an H5N1
outbreak have the potential to be even more economically devastating
than a government-confirmed outbreak." Sanders said media reports
coming out of Indonesia are generally reliable, but have some
drawbacks. "In many instances, reported suspicious human cases have
little or no follow up, so we are left with gaps in our total
picture," she said.

[Byline: Lisa Schnirring]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>
& ProMED Rapporteur Mary Marshall

[The WHO table of the cumulative number of confirmed human cases of
avian influenza A/(H5N1), last updated on 28 May 2008, records 133
cases and 108 deaths in Indonesia [see:
<http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_05_28/en/index.html>].
The death of the 15-year-old girl described in the 2nd paragraph of
the above report would raise the case total to 134 and the number of
deaths to 109, if confirmed independently.

It is not clear, however, whether this case is one of the 2 suspected
cases described in ProMED-mail on 14 May 2008 (see: Avian influenza,
human (47): Indonesia, susp 20080514.1623). In this posting it was
reported that: "A 16-year-old girl died 4 days after being admitted
to the Persahabatan Hospital in the Indonesian capital on 8 May 2008
with laboratory test later confirming she had the avian flu virus.
10 days before her death, her 15-year-old brother died after a brief
treatment at another hospital with symptoms similar to bird flu." The
cause of death of the 15-year-old could not be confirmed because no
blood sample had been taken. It is possible therefore that the death
toll may now be at least 110. - Mod.CP]

[see also:
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/ejp/jw
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