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**Gert van der Hoek** · April 26, 2010, 04:26 PM

Re: Indonesia - Riau - 3 toddlers suspected to have bird flu

Some snips from Riau Pos:

April 26 2010

Whereas for three toddlers and one citizen who allegedly contracted the bird flu virus has been in intensive care in the Community Health Centre and his condition has gradually recovered.

''We are still doing observations, whether the victim is experiencing a high fever accompanied by cough and headache and pain in their bodies, whether the bird flu virus or not,''said Hartini.

While from Efriadi description (34), one Lalang Village residents say, before he and his son had a fever heat. After several of his chickens, and chickens that died suddenly neighboring lots. But he did not expect the dead chickens was due to bird flu, so he did not report the incident to the Health Center Sungaiapit.

-------------------------------

While the victims are suspected bird flu suspect, Budiman expect, so that officers can perform diagnostics Puskesman of the victims. If that condition does not allow the victim should be immediately referred to Arifin Achmad Hospital in Riau. That victims do not be late in the handle.

Comment: it looks like standard procedure. If people have bird flu symptoms possibly related to H5N1 positive poultry they are put on Tamiflu.

If the health of the patients doesn't improve in 3 days, they will be send to a dedicated "bird flu hospital", where samples of blood and mucus will be taken.

**Gert van der Hoek** · April 27, 2010, 04:39 AM

Re: Indonesia - Riau - 3 toddlers suspected to have bird flu

From Bird Flu Information Corner:

Sungaiapit, Riau ::: Four locals possibly contracting bird flu virus

Posted by Ida on April 27, 2010

Sungaiapit, Riau ? Hundreds of chickens in Desa Lalang, Kecamatan Sungaiapit, Riau Province found to have suddenly died within these few days. Further rapid test done by Livestock, Fishery and Agriculture Service of Siak to dead chickens showed positive bird flu (H5N1) infection. Four residents of RT/RW 03/05 Dusun 2 Desa Lalang, were reported to have fever following to the incident.

Patients are three children and an adult, named Muhammad Sandika Putra (3.9), Jumiati (3.6), Zurahmah (3.4) and Efriadi (34). Head of Sungaiapit public health center, dr Hartini mentioned patients showed signs such as fever, coughing, headache and muscle pain. They had received intensive treatment in Sugaiapit public health center and had been improved, she said.

In mean time, patients are still under observation.

Source: Indonesia local newspaper, Metro Riau. http://metroriau.com/read-1635-2010-...lu-burung.html

http://birdflucorner.wordpress.com/

**Shiloh** · April 29, 2010, 06:53 AM

Indonesia - Sungaiapit, Riau: Bird flu in poultry and 9 suspected human cases

Source: http://www.riaupos.com/berita.php?ac...&id=6286&kat=7

Kasus Flu Burung di Sungai Apit Mulai Meluas
29 April 2010

Google translation:

Bird Flu Case in Spreads Starting Apit River
29 April 2010
12 clicks Tell a Friend

Reports Abu Kasim, Sungaiapit abukasim@riaupos.com
CASE Sungaiapit bird flu in the district began to expand, since the unknown Saturday (24 / 4) and then, only one village namely Lalang Village.

In the village of hundreds of birds died suddenly had a positive infected bird flu virus (AI) and until Tuesday (27 / 4), extends to two villages and one village ie village of Parit I / II and Hope Village and Village Sungaiapit. Even human sacrifice which was initially only four people have grown to nine people, two of whom, since Monday (26 / 4) are already in the reconciliations in hospitals Arifin Achmad Pekanbaru.

To anticipate that the bird flu virus that has been declared fositif it so do not spread to other villages and the nearest in Siak district, District Health Office of Siak and Riau Province and the Department of Animal Husbandry, Fisheries and Agriculture (Distanakan) Siak made rapid strides , specifically provides counseling and understanding to people in his village of bird flu.

There''are referred to Arifin Achmad Hospital, two people, while the other victims still being treated in their own homes. Because of their victims are not treated in Puskesman and we continue to conduct monitoring in the field,''firmly Kadiskes Siak Ir H Budiman Shafari MKes to Riau Pos, Tuesday (27 / 4) in Siak.

It is said Budiman, until now the victims are still suspected of bird flu and has not been positive, it's just been tested positive for avian bird flu virus. For handling in the field, his side has to take fluid samples of victims and also provide tamiflu drug.

While in the field, health workers from Distanakan Siak drh Romi Setiadi, after getting reports from health centers that mention Sungaiapit there are several villages in the district was attacked by bird flu, directly into the field and conduct an examination of dead birds by using the rapid test.

One Family Attacked muntaber
Meanwhile, still in Sungaiapit, a family of diarrhea disease. Even in the event that one of the victims must be stretched his life, because he could not bear the pain and ran out fluid.

Diarrhea diseases that attacked a family who is located at RT 03/RW 05, Bay Village Mosque, occurred Saturday (25 / 4) then. Each family was named Parlautan (36) husband, Rubiati (32) wife, Andri (11) children, Defianti (10) children and Almunawir (6) children.

They had admitted to the PHC Sungaiapit, but due to diarrhea diseases and diarrhea (vomiting faeces) can not be arrested again, making the child victim named Defiani (10) died while on his way to get intensive treatment at the Hospital of Pekanbaru.

Parlautan (36) as Head of the Family (KK) when approached by reporters, Wednesday (28 / 4) said the events that have claimed the lives of her daughter Defianti begins on Saturday (24 / 4) and, as usual, his son Andrew who was sitting in class V and Defianti who sit in fourth grade, went to SDN 014 Bay Mosque.

But he said again, when she was studying, her two children to vomit, then by the teacher and the child is sent home delivered by a friend. After that her two children seek treatment at Pustu Bay Village Mosque and the midwife suggested that she and her family were referred to PHC Sungaiapit.

Against the incident, staff Sungaiapit Health Center, Dr. Adrian Hidayat moment met reporters on Wednesday (28 / 4) said, patients with diarrhea or diarrhea and vomiting are dying due to run out of fluids in his body. Cause of the diarrhea and vomiting, the Department of Health has taken samples of water and food in consumption by Parlautan family. The sample fluid''we have taken, and allegations while they sekulaurga affected muntaber,''he said curtly. (RNL)

**sharon sanders** · April 29, 2010, 07:45 AM

Re: Indonesia - Sungaiapit, Riau: Bird flu in poultry and 9 suspected human cases

Even human sacrifice which was initially only four people have grown to nine people, two of whom, since Monday (26 / 4) are already in the reconciliations in hospitals Arifin Achmad Pekanbaru.

**Laidback Al** · April 29, 2010, 09:52 AM

Re: Indonesia - Sungaiapit, Riau: Bird flu in poultry and 9 suspected human cases

Current summary
<o:p> </o:p>
Poultry died and tested positive for H5N1 starting on April 24 in Lalang village (Desa Lalang). By April 27, more poultry were infected in at least two more villages, Parit I/II (Desa Parit I/II) and <st1:place w:st="on"><st1:placename w:st="on">Hope</st1:placename> <st1:placename w:st="on">Village</st1:placename></st1:place> (Desa Harapan), and apparently elsewhere in the district (Kelurahan Sungai Apit). (post # 5)
<o:p> </o:p>
As of April 26 (post #1 and #2) three children and one adult are suspected of being infected with H5N1 from the <st1:place w:st="on"><st1:placetype w:st="on">village</st1:placetype> of <st1:placename w:st="on">Lalang</st1:placename></st1:place>. By April 27, four other individuals from Lalang are also suspected to be infected with H5N1. Two of the nine suspected cases are being treated in the hospital and remainder apparently given Tamiflu and are being treated at home.
<o:p> </o:p>
Meanwhile, elsewhere in the subdistrict (Kecamatan Sungai Apit) in ?Bay Village Mosque? (Desa Teluk Masjid), a family of five people was stricken with diarrhea and vomiting on April 25. One of the children, a 10 year old, died (uncertain on the date of death). This is a separate incident and does not seems to be related to possible H5N1 infection.

General location map showing Lalang village in Siak Regency, Riau Province.

<o:p> </o:p>

**Gert van der Hoek** · April 29, 2010, 11:26 PM

Re: Indonesia - Sungaiapit, Riau: Bird flu in poultry and 9 suspected human cases

Sungaiapit, Riau ::: Bird flu spreads to other villages

Posted by Ida on April 30, 2010

Sungaiapit, Riau ? Bird flu H5N1 had spread to Desa Parit I/II, Desa Harapan and Kelurahan Sungaiapit since it was firstly identified in Desa Lalang.

Until now, bird flu infected human suspect has reached nine victims. Two of them are now being treated at Arifin Achmad hospital in Pekanbaru, while others are refused to be hospitalized.

Based on the investigation of Health Service and Livestock Service of Kabupaten Siak, so far dead chickens had been tested positive bird flu H5N1. Furthermore, Health Service had collected patient?s liquid samples for further test and treated patients with Tamiflu.

Source: Indonesia local newspaper. Riau Pos.

http://www.riaupos.com/berita.php?act=full&id=6286&kat=7

http://birdflucorner.wordpress.com/

**Treyfish** · April 30, 2010, 10:45 AM

Re: Indonesia - Sungaiapit, Riau: Bird flu in poultry and 9 suspected human cases

Friday, 30 April 2010 19:40
Positive Joice, Arifin Achmad Hospital Patients Hospitalized third suspect bird flu

Joice toddlers tested positive Efeline died from bird flu. Sementa currently three residents in the provincial hospital Siak Arifin Achmad for allegedly infected by H5N1 virus.

Riauterkini-Pekanbaru-suspect case of bird flu, Arifin Achmad Hospital has treated this weekend hikes. After a toddler, child Sidomulyo resident Street, Padang Keluruhan headdress, District Senapelan, named Joice Efeline Pekanbaru City died Wednesday (28/4/10) and ascertained from the virus or the H5N1 strain of avian enfluenza, now there were three patients who origin in Siak Regency should be treated in isolation space suspect bird flu patients.

"To Joyce Efeline we can and certainly a positive laboratory result of bird flu," said Chairman of the Bird Flu Prevention Team Arifin Achmad Pekanbaru Hospital Saad Azizman to riauterkini in Pekanbaru, on Friday (30/4/10).

While about three patients Siak origin who is now hospitalized in isolation room is a mother named Siti Fatimah (40) and his son, Anggi (14) and neighbor Diva Amandasari (8). All three residents Apit River, Siak.

All three enter simultaneously at dawn earlier. Previously handled at the Emergency Unit (ICU), but because his body temperature reached 38 degrees Celsius, and then referred to were isolated in a special space suspect bird flu patients.

"Now all three conditions began to improve. His temperature began to decrease and his lung condition is stable, "explained Azizman

.***( mad)

http://www.riauterkini.com/sosial.php?arr=29284

**Gert van der Hoek** · May 1, 2010, 04:58 AM

Re: Indonesia - Riau: Child dies of H5N1, 9? suspected human cases

From Bird Flu Information Corner

Sungaiapit, Riau ::: Deceased girl tests positive H5N1, three others under intensive care

Posted by Ida on May 1, 2010

Pekanbaru ? A four-year-old girl, Joice Evelyn, resident of Jalan Sidomulyo, Kelurahan Padangbulan, Kecamatan Senapelan, Kota Pekanbaru has been confirmed to have died of bird flu (H5N1) virus.

?We have received the laboratory result of Joice Evelyn and it was evidently positive bird flu,? said Head of Bird Flu Control Team of Arifin Achmad hospital, dr Azizman Saad.

Meanwhile, Arifin Achmad hospital is currently treating three other bird flu suspect patients, a woman, Siti Fatimah (40) and her daughter, Anggi (14), and their neighbor, Diva Amanadasari (8). They are resided in Sungai Apit Kabupaten Siak.

They were admitted to hospital at the same time and placed in bird flu isolation unit because of fever up to 38℃.

?Now they are in stable condition. Temperature is falling and lung condition is good,? said Azizman.

Source: Indonesia local newspaper, Riau Terkini. http://www.riauterkini.com/sosial.php?arr=29284

**Gert van der Hoek** · May 2, 2010, 04:28 PM

Re: Indonesia - Riau: Child dies of H5N1, 9? suspected human cases

From ProMED

AVIAN INFLUENZA, HUMAN (35): INDONESIA (RIAU)
*******************************************

Date: Sat 1 May 2010
Source: Bird Flu Information Corner [edited]

http://birdflucorner.wordpress.com/2010/05/01/sungaiapit-riau-deceased-girl-tested-positive-h5n1-three-others-under-intensive-care/

A 4-year-old girl, a resident of Jalan Sidomulyo, Kelurahan
Padangbulan, Kecamatan Senapelan, Kota Pekanbaru has been confirmed
to have died of avian influenza (H5N1) virus infection. "We have
received the laboratory result for this patient, and it was evidently
positive for avian influenza (H5N1) virus infection," said Head of
the Bird Flu Control Team of Arifin Achmad hospital, Dr Azizman Saad.

Meanwhile, Arifin Achmad hospital is currently treating 3 other bird
flu suspect patients, a 40-year-old woman, her 14-year-old daughter,
and an 8-year-old neighbor. They reside in Sungai Apit Kabupaten Siak.

They were admitted to hospital at the same time and placed in a bird
flu isolation unit because of fever up to 38 C. "Now they are in
stable condition. Temperature is falling and lung condition is good,"
said Azizman.

(Source of report: an Indonesia local newspaper, Riau Terkini.
http://www.riauterkini.com/sosial.php?arr=29284).

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[If this human case of avian influenza (H5N1) virus infection is
subsequently authenticated by a World Health Organisation reference
laboratory, it will rank as the 2nd confirmed case in Indonesia since
the beginning of 2010 and the 164th case overall.
See: http://www.who.int/csr/disease/avian.../en/index.html.
Both of the 2010 cases have had a fatal outcome.

http://www.promedmail.org/pls/otn/f?p=2400:1001:438883047634262::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82532

**Gert van der Hoek** · May 3, 2010, 01:51 AM

Re: Indonesia - Riau: Child dies of H5N1, 9? suspected human cases

Monday, May 3, 2010

Condition improved, three suspect bird flu patients allowed to go home

Three suspected bird flu patients in hospitals Arifin Achmad Pekanbaru condition improved. This afternoon, they were allowed to go home.

Riauterkini-Pekanbaru-Avian Flu Response Team Leader for Hospital Arifin Achmad Pekanbaru
Saad revealed encouraging Azizman pekembangan against three suspected flu patients
origin of birds Pakning River, Siak. All three conditions are steadily improving, even
to say healthy.

"The clinical condition of the three continues to improve. Now it's healthy, "said Azizman time
talked with riauterkini, Monday (3/5/10).

Azizman described, these three patients, each Siti Fatimah (40) and his son, Anggi
(14) and neighbor Diva Amandasari (8), when his temperature is normal now, ie 36 degrees
celsius. Likewise with her breathing. Everything was normal.

Because his condition had improved in kliniks, then grant permission to third Azizman
patients to go home. "If nothing changes, later in the day all three had to come home," he said.

Although he has allowed to go home, but Azizman not yet dared to make sure that all three
not infected or H5N1 avian influenza virus. "We are still awaiting results of laboratory tests
Jakarta, may be tomorrow they come, "he explained.

404 Not Found

http://www.riauterkini.com/sosial.php?arr=29304

Senin, 3 Mei 2010

Membaik, 3 Pasien Suspek Flu Burung Diizinkan Pulang

Tiga pasien suspek flu burung di RSUD Arifin Achmad Pekanbaru kondisinya membaik. Siang ini, mereka diizinkan pulang.

Riauterkini-PEKANBARU- Ketua Tim Penanggulangan Flu Burung RSUD Arifin Achmad Pekanbaru, Azizman Saad mengungkapkan pekembangan menggembirakan terhadap tiga pasien suspek flu burung asal Sungai Pakning, Kabupaten Siak. Ketiganya kondisinya terus membaik, bahkan sudah bisa dikatakan sehat.

?Secara kliniks kondisi ketiganya terus membaik. Sekarang sudah sehat,? ujar Azizman saat berbincang dengan riauterkini, Senin (3/5/10).

Dijelaskan Azizman, ketiga pasien tersebut, masing-masing Siti Fatimah (40) dan anaknya, Anggi (14) dan tetangganya Diva Amandasari (8), saat kini suhu badannya sudah normal, yakni 36 derajat celsius. Demikian juga dengan nafasnya. Semua sudah normal.

Karena kondisinya secara kliniks sudah membaik, maka Azizman memberikan izin kepada ketiga pasien untuk pulang. ?Kalau tidak ada perubahan, siang nanti ketiganya sudah bisa pulang,? tuturnya.

Meskipun telah mengizinkan pulang, namun Azizman belum berani memastikan bahwa ketiganya tidak terinveksi virus avian influenza atau H5N1. ?Kita masih menunggu hasil uji laboratorium dari Jakarta, kemungkinan besok baru tiba,? demikian penjelasannya.

**Giuseppe** · May 3, 2010, 03:38 AM

Re: Indonesia - Riau: Child dies of H5N1, 9? suspected human cases

Indonesia, Girl dies from bird flu (Straits Times, May 3, 2010, edited)

[Source: Straits Times, <cite cite="http://www.straitstimes.com/BreakingNews/SEAsia/Story/STIStory_522005.html">Girl dies from bird flu</cite>. Edited.]

May 3, 2010

Girl dies from bird flu

JAKARTA

A FOUR-YEAR-OLD Indonesian girl has died from the H5N1 bird flu virus and three other people in the area - who did not have contact with the child - are being tested for the virus, an official said on Monday.

With a death toll to date of 136, Indonesia has the highest number of deaths from the virus of any country globally.

The girl, who lived in Pekanbaru, Sumatra, died on Wednesday, said Mr Azizman Saad, the head of bird flu unit at Arifin Achmad hospital. The three others - a mother, her seven-year-old child and a five-year-old girl who live in Siak district, north-east of Pekanbaru - were admitted to hospital on Friday.

The Arifin Achmad hospital in Pekanbaru, Sumatra, is waiting for lab results for the three patients to see whether they have been infected with the same virus.

Mr Saad said local health officials had found the three had been in direct contact with dead chickens before they suffered from high fever.

'They all have similar symptoms and they all have touched dead chickens,' Mr Saad said, adding that many dead chickens had been found in the area. 'Maybe they were contaminated by the same source,' he said.

The World Health Organisation (WHO) on its website put the death toll for H5N1 virus for Indonesia at 135, but a Health Ministry spokesman said the ministry will update the WHO with the recent death.

-- REUTERS
-
-----

**Gert van der Hoek** · May 3, 2010, 11:50 AM

Re: Indonesia - Riau: Child dies of H5N1, 9? suspected human cases

Pekanbaru ::: Three bird flu suspects recovered

Posted by Ida on May 4, 2010

Pekanbaru ? Three bird flu suspect patients from Sungai Pakning, Kabupaten Siak had been recovered, said Dr Azizman Saad, Head of Bird Flu Control Team of Arifin Achmad hospital, Pekanbaru.

Those patients, Siti Fatimah (40) and her daughter Anggi (14) and their neighbor Diva Amandasari (8) showed normal breathing rate, and temperature 36℃. Because they were clinically healthy, Azizman allowed them to return home.

However, whether those patients had contracted bird flu H5N1 or not, is still unclear. ?We?re waiting the laboratory result from Jakarta to be issued tomorrow,? said Azizman.

Source: Indonesia local newspaper, Riau Terkini.

404 Not Found

http://www.riauterkini.com/sosial.php?arr=29304

http://birdflucorner.wordpress.com/

**alert** · June 9, 2010, 01:10 PM

Pekanbaru: 4 year-old girl is H5N1 fatality with no poultry contact - possibly not a recent case

http://info-flu.blogspot.com/2010/06/catatan-khusus-recent-bird-flu-death.html

Recent bird flu death shows signs of complacency

Arie Rukmantara

This is about risk. Our public health risk. When news broke out several weeks ago about a series of avian influenza outbreaks in poultry and humans in Riau, I expected series of tough measures would be launched by either the province health authority or by the central government.

My high expectation came mainly because Indonesia has to keep its reputation. Last year, the country?s senior officials announced that bird flu was under control, cases and fatalities had been cut, and the nationwide campaign ?Tanggap Flu Burung? was touted as one of Indonesia?s success story in controlling zoonotic diseases.

I was right. Both provincial health and animal health offices moved quickly and caught a dozen of suspected cases two districts: Pekanbaru and Siak. All those people were tested negative for of H5N1, but one.

A 4-year-old girl, a resident of Riau?s capitol of Pekanbaru, tested positive for avian influenza. She passed away about a week after she succumbed to the deadly disease.

But that was it. A day after she passed away, everybody went back to their business as usual. No further outbreak response measures were seen on the ground. Her death was just another puff in our collective memory. Another number to be added to the country?s bird flu toll.

Yes it is just one little girl. But, it always starts with one. One human case, one fatality and then leads to another. It took one Indonesian died of bird flu in 2005, and?voila! We ended up recording more than 160 confirmed cases with more than 10 family clusters. We inked a record of being the country with most bird flu human fatalities and confirmed cases in the world.

It took only one chicken died of H5N1 in 2003, and look at now?tens of millions of poultry in 31 out of 33 of Indonesia?s provinces had died of bird flu, disturbing the economy and putting many lives at grave risk.

If we consider this ?one? Riau toddler as just another digit we are set to be doomed. Most of us, Indonesians, claim to be religious right? Well religion says, ?The death of an innocent equals the death of humanity.?

Why do we have to pay serious attention to this particular ?one?? Because news reports quoted the patients? doctor as saying, ?risk factor has yet to be found.?

What is that mean? Well, I am neither a medical doctor nor a trained veterinarian, but my interpretation is: it means local health workers and veterinarians fail to locate or detect the source of the infection, or simply put, they have no idea how this girl contracted the virulent bug.

I have gone to the ?ground zero? and gathered some information. Local media reports said there was no poultry kept around in the patient?s home tested positive for H5N1. The patient?s family do not even kept a single poultry. Meanwhile, official report says, the Riau animal health officers have checked everything, from chickens? feces to soil around her home only to find nothing related to virus? exposure.

The girl?s case raises a mystery that needs to be solved.

To my knowledge, there are few options to solve the mystery. One, thorough scientific studies have to be carried out immediately to unveil the mystery. Studies by animal health experts, or virologists or microbiologists should be commissioned to find out what the risk factors are. Is it the air she breathe, the water she drinks, or the environment she lives in? Could the virus transmit from other medium besides poultry? Is it still the same virus strain or has it evolved, or in the experts? term, has it ?mutated??

Two, an investigation by human health experts or epidemiologists should also be carried out to find out when, where, why, and how this innocent young girl got the fatal disease. Was it when she travelled to neighboring villages, or when she goes to the mall? And why her?

We need to have these questions answered because I, and most of Indonesians, would love to be convinced that our health authority is still able to keep the virus check. I would sleep better at night knowing that I am in good hands.

And as for the government, provincial and central, unraveling the mystery of the girl?s death may save their faces because it will fulfill the elements of risk communications.

Within the family of risk communications, World Health Organization introduces a quick response communication method that relies on trust, early announcement, transparency, knowing what the public thinks, and drawing plan of actions in the brink of an outbreak. It is called the Outbreak Communications.

Finding out of what killed the Riau toddler would cement trust. Trust that the health authority is capable of protecting its citizens by looking into details of what exactly took the girl?s life.

The consequences of losing the public's trust can be severe in health, economic and political terms. The less people trust those who are supposed to protect them, the more afraid the public will be. This would bar them from following future government?s instructions.

On this aspect, the Riau administration and the government have failed. The mother of the patient had publicized her distrust to the province?s health system. She has defied the prognosis that her daughter got bird flu because she kept no chickens at home. She accused the doctor treating her daughter of being incapable to recognize her daughter?s illness immediately.

According to WHO guidance on Outbreak Communications, the parameters of trust are established in the outbreak's first official announcement. The central government announced the case almost a week after the girl died, leaving the girls? parents and the public in Riau baffled, wondering what exactly happened to the girl.

Should the government like to maintain the public?s trust, the announcement should come earlier, furthermore, it should be real time. Just like when it was back in 2005 to mid 2008, before the former Health Minister Siti Fadillah Supari halted the media-friendly policy, arguing that announcing cases instantly would bring no benefit to the public. I do not have a clear idea of why the present Minister Endang R. Sedyaningsih, a leading bird flu and well known public health expert, sustains such an erroneous policy.

Understanding what the public thinks is another critical factor to build an effective outbreak communication. It has been decades the government officials claim they know what the public wants, but they lie.

So how do you know public perception during an outbreak? There is only one way, go to the field and find out. I had experienced going to several locations that recorded fresh bird flu outbreaks along with an integrated rapid response team consisting of health officers and veterinarians. The procedure is I would stay out of ?ring one?, where the outbreaks took place to keep me from ruining the ?crime scenes? and give space to the epidemiological detectives to do their job.

Along with members of the Indonesia University Student Forum for Bird Flu Response (Forum Mahasiswa Indonesia Tanggap Flu Burung), outbreak communications team would go door to door, doing quick surveys, finding out publics perceptions to help us understand what they think. Some people perceive bird flu is a preventable disease, some said it is part of bioterrorism, and some raise a theory that it is God?s punishment to human beings for the sins they have committed.

These results came in no surprise. Even an American M.D. published a book entitled The Great Bird Flu Hoax in 2006, saying that bird flu is way too exaggerated.

Knowing what the public thinks would be beneficial to ensure prevention messages. It would be very difficult to change pre-existing beliefs unless we know what they are.

And it is nearly impossible to design successful messages that bridge the gap between the expert and the public without knowing what the public thinks.

The last menu in an outbreak communications: planning. The decisions and actions of public health officials have effect on trust and public risk perception. Only when they announce what they are going to do with the unsolved case of the Riau toddler, then the public will rest.

I acknowledge the heavy loads of both health workers and veterinarians have to bear. Besides bird flu, they have to deal with hundreds of other emerging and reemerging diseases, thanks to poor sanitation, people?s unhealthy behaviors, and climate change. All the above suggested measures could be seen as additional burden for them. But hey, I got news for you officials?health crisis is not only your business, it everybody?s.

Although the bird flu control national committee had been dissolved, the Riau provincial bird flu control committee exists up to this date. The 2007 Riau Gubernatorial Decree on Avian Influenza Control stipulates that the mandate of the team?consisting of 46 multi sector members, including the military, police, and NGOs?expires only in 2011.

Both doctors and veterinarians should never feel lonely. You should notify the committee members, push the panic button, and mobilize the whole entourage. Solve the mystery, build trust, and ensure us that you are protecting your people with all your heart and soul.

Riau is the one of the richest and the most developed provinces in Indonesia. Please set an example, teach us how to cope with outbreaks and public health crisis. We know you can, you have the resources to do it.

Because if you fail. I got news for you. We are still in a pandemic. The H1N1 pandemic is not over yet. The virus has killed more than 18,000 people around the world, including Indonesians. And the number keeps on soaring.

In addition, the chance of H1N1 influenza strain to mix with H5N1, or as health experts say ?reassort?, remains wide open. And when they do, God only knows what will happen. Health experts already warned us that the impacts may be ugly.

Past pandemics warned us to remain vigilance no matter how greener is the grass in the other side of the fence, no matter how sexier political and economic news were.

The 1918 pandemic, hit the Netherland Indie, the former Indonesia, when our great grandparents celebrated the birth of the first parliament Volksraad, where some of the country?s top leaders finally have the chance to speak their minds officially. Meanwhile, the rest of the world was busy paying attention to World War I.

The 1957 pandemic killed some of Indonesians, when the nation was in shock of the news on a possible coup by military generals, who drove their tanks to the state palace, demanding essential role in politics.

The 1968 pandemic quietly slaughtering some of our grandparents at the same time they were expecting the birth of a new government called the New Order, after the 1965 bloody communist coup tore the country apart.

But our brain works like a data bank, there is never too many things to process, as long as we pay attention to the many lessons we can learn from history.

Or else, as historians put it,? those who fail to learn from history are doomed to repeat it.?

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Arie Rukmantara is a freelance environmental health writer and a risk communication consultant.

**alert** · June 9, 2010, 01:11 PM

Re: Pekanbaru: 4 year-old girl is H5N1 fatality with no poultry contact - possibly not a recent case

I believe, based on the details in the above story, that the case is question is the one in this thread:

Indonesia - Riau: Child dies of H5N1, 9? suspected human cases - FluTrackers News and Information

http://www.flutrackers.com/forum/showthread.php?t=145676