Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

[Susie]

Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

http://news.antara.co.id/en/seenws/?id=13714


A 25-year old nurse identified by her initials as `Ci` is currently being treated at the Hasan Sadikin Hospital here for bird flu-like symptoms.
Ci was admitted to the hospital which has been treating a number of bird flu patients on Thursday evening (June 1).

"When she arrived at this hospital last night, her body temperature was very high, namely 39.6 Celsius degrees but now it has decreased to 37 Celsius degrees," Hadi Jusuf, head of the bird flu medical treatment unit of the hospital, said here on Friday.

The hospital was planning to send the patient`s blood sample to the laboratory of the Health Development and Research Body in Jakarta on Friday.

The result of the laboratory test is expected to come within the next three days, he said.

"We could not confirm whether she is positive of having been infected by avian influenza virus or not, although she had earlier have contacts with siblings, 18-year old Ad and 10-year old Ai, who died of bird flu virus recently," he said.

The ailing nurse has never had contact with poultry, but she had treated the sibling when being treated at Ujungberung Hospital, where Ci works as a nurse.

If she is confirmed of being infected by bird flu virus, it would be the first case of human-to-human transmission of the virus, he said.

Meanwhile, the UN World Health Organization (WHO) recently announced that international health investigators were finding no evidence that efficient transmission of the highly pathogenic avian influenza virus has emerged from a family cluster of cases in Indonesia`s North Sumatra.

The H5N1 virus has caused 127 deaths in 224 cases worldwide since it was detected in humans in late 2003. In all but a handful of cases, humans have become infected through direct contact with ailing birds, their feces or blood.
Indonesia has detected 48 cases of H5N1, 31 of those appearing since January, and ending in 36 fatalities. (*)

[HenryN]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

Commentary at

http://www.recombinomics.com/News/06020602/H5N1_Bandung_HCW.html

[Auburn Boy]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

Commentary at

http://www.recombinomics.com/News/06...ndung_HCW.html

This looks like one case that we need to pay very close attention to.

One of the red flag warnings that has been preached about is transmission of the virus to Health Care Workers. The patient in question, a nurse in Bandung doesn't seem to have any connection to poultry contact. The only factor in her case seems to be the contact with several previous H5N1 positive patients.

[hawkeye]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

How would her case be any different than those detailed by the WHO listed at this thread?

http://www.flutrackers.com/forum/showthread.php?t=6700

-hawkeye

[Auburn Boy]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

How would her case be any different than those detailed by the WHO listed at this thread?

http://www.flutrackers.com/forum/showthread.php?t=6700

-hawkeye

Most suspected clusters have been among family members. There is speculation that there is some genetic propensity among those family members that makes them particularrly susceptible to H2H, that non-family members do not have.

The case of a non-family HCW being infected can show one of several things. First, it can discredit the family genetics issue. Second it can indicate a more effective H2H transmission, allowing infection through more casual contact.

HCWs are typically better protected against casual transmission. E.g., masks, working in cleaner environment, more hand washing, etc., etc.. Therefore, transmission to an HCW would be of MAJOR import.

I don't recall any other HCW who had been confirmed of having been infected while treating an H5N1 patient.

[ukcz]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

I don't recall any other HCW who had been confirmed of having been infected while treating an H5N1 patient.

There is that famous doctor in Vietnam who got sick, but only mildly, but tested positive to H5N1. He treated a lot of the H5N1 cases in the country and they couldn't find another source other than the more serious cases he was treating. (As featured on the UK 'Panorama' TV program some time ago I believe.)

[hawkeye]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

Good points Auburn. However, I don't know how well protected HCWs are in Indonesia.

[Auburn Boy]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

Good points Auburn. However, I don't know how well protected HCWs are in Indonesia.

Agreed, I've seen some pretty suspicious pictures of HCWs in Indonesia looking a little less than bio-secure..,

But there are references on how health care workers fare with respect to H5N1 inspections. Google it and you'll find at least this:

http://www.journals.uchicago.edu/JID...439659295Guest

[LMonty]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

which cluster was she exposed to? the large one that Nature reports has a higher viral load in nose/throat?

[Theresa42]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

which cluster was she exposed to? the large one that Nature reports has a higher viral load in nose/throat?

No. She was treating the brother and sister who died ealier in the week(?)/last week(?) -- they were treated in Bandung which is on Java -- the Big Cluster with the higher viral load in nose/throat is on Sumatra.

This is the cluster the nurse has been exposed to:

http://www.flutrackers.com/forum/showpost.php?p=14780&postcount=2

(It's hard to keep track of Indonesia, I know. I'm just starting to work it out myself!)

[Mellie]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

Could folks in that cluster also have a higher than usual viral load in the nose and throat but no one has checked for that yet???

[Sonny]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

I wonder if she has children? if so, will they receive Tamiflu and isolation?

Hopefully they caught this case early enough, I'm sure she knew how important early treatment is.
So Tamiflu treatment would have been started very soon after start of symptoms.
ie within 48hr of sympyoms.

If she tests BF neg, would she be released that same day?

[Theresa42]

Re: Nurse with bird flu-like symptoms hospitalized in Bandung, W Java

Could folks in that cluster also have a higher than usual viral load in the nose and throat but no one has checked for that yet???

Could have. Definitely a possibility.

[Theresa42]

A little more on the Pamulang cluster / more details on the nurse

toggletext-ed from Indonesian:

Kluster Bird Flu happened in Pamulang
June 03, 2006
Jakarta, (PR). -

The Incident kluster bird flu happened in the Pamulang territory, Tangerang, after Y (7) that was treated in RS Fatmawati Jakarta, died on Thursday night (1/6). The Y death, happened following his [her] older brother, T (10), that died three the previous day.

Health Minister Siti Fadilah Supari, on Friday early afternoon (2/6) in Jakarta, confirmed, Y died as a result of being infected by the bird flu virus. Menkes made a plea so that the neighbour that close to casualties's house, that suffered the sign of flu and demamagar immediately asked for Tamiflu to the Health Service.

"His brother has been positive bird flu. That his older brother could not be taken the sample of his blood," said Menkes Siti Fadilah Supari.

In the meantime, the Chairman Tim the Control of Bird Flu of RSHS Bandung, Dr. Hadi Jusuf said, the situation C of the patient's public (25) the nurse RSUD Ujungberung was good enough. Results x-rayed also did not point out the existence of pneumonia. "Not there is breathless and painful the chest." Hb, leucocytes, and trombosit him in the normal situation. But, because he [she] had contact with the positive patient bird flu, was handled by us as suspect bird flu, he said.

Menkes said that the incident in Pamulang was kluster although small scale.

Menkes mentioned, Y [Yohana] began to suffer the fever was accompanied by the cough and breathless on May 26 2006. Y was brought to the Hospital of Fatmawati Southern Jakarta on May 30 2006 around struck 16.00 WIB.

After seeing the sign of pneumonia in the photograph x-rayed the Fatmawati patient of the Hospital side then reconciled the patient to the Sulianti Saroso Infection Hospital on June 1 2006 but the patient died when arriving in the hospital that dituju.

The official of the Command Post KLB the Department's Bird Flu of the Health, Dr. Nadhirin explained in and around the Y residence environment was gotten by several risk factors that the possibility became the source of the spread of the bird flu virus that infected the small girl.

Nadhirin said behind casualties's house was gotten the chicken coop and several the previous day the chicken belonging to casualties's family died. "In the environment of casualties's residence also was gotten the chicken abattoir and on May 28 2006 several chickens in the RT environment the place of casualties and the family him was kept also dying," he added.

Tamiflu giving

Officially the West Javanese Health permitted the use of the tablet oseltamivir (Tamiflu) for the official of the health with two criteria. "For the official of the health, especially in the handling of bird flu, we made the agreement that the Tamiflu use for the prevention might, with the hot criterion on 39 Celsius levels and contact with suspect bird flu," said Kasubdin developed environmental Sanitation of Dinkes West Java, Dr. Fatimah Resmiati.

The agreement was carried out because of the existence of confusion between the official of the health pascaada him suspect bird flu from the nurse's circle that was suffered by C, that at this time was treated in RSHS. Tamiflu limited was used for suspect bird flu and was not justified for the prevention.

The section head the Health of the Bandung City, Dr. Gunadi Sukma Binekas, asked for the official of the health in the community health centre and the hospital in order to apply universal prevention efforts, especially in handling the infection patient. Dinkes also was open for the community health centre or RSUD that will ask for the Tamiflu addition.

In the meantime, C (25) beforehand, took part in treating the patient AT (10) and the AS (18) that was stated positive was infected by the bird flu virus and died on Tuesday (23/5). Before being reconciled to RSHS, the two patients could receive help in RSUD Ujungberung. As far as this is concerned, according to Dr. Hadi, the patient C did not have the story of contact with the poultry was sick or the poultry died.

http://www.pikiran-rakyat.com/cetak/2006/062006/03/0105.htm

[Theresa42]

Local tests negative for Indonesian nurse who treated bird flu patients

Local tests negative for Indonesian nurse who treated bird flu patients
June 04, 2006

JAKARTA (AP): Local tests have come back negative for an Indonesian nurse who fell ill after treating two siblings infected with bird flu, amid a surge in deaths from the virus.

"Thank God, the result came back negative," Hariadi Wibisono, a senior Health Ministry official said on Sunday.

He said specimens would be sent to a World Health Organization-approved laboratory in Hong Kong for confirmation.

The 25-year-old nurse was isolated and given the antiviral drug Tamiflu when she developed a fever and other flu-like symptoms. She fell ill about 10 days after treating a 10-year-old girl and her 18-year-old brother from West Java province, who died hours apart last month of bird flu.

She is improving and will likely be released this week after finishing the full course of Tamiflu, said Dr. Hadi Jusuf of Hasan Sadikin Hospital in Bandung, where the nurse is being treated.

The nurse's case initially raised concerns that the H5N1 virus may have passed to her from the siblings, but Wibisono said it now appears that she was instead suffering from a seasonal flu.

There have been 36 WHO-confirmed human bird flu deaths in month.

On Friday, health officials said local tests found a 7-year-old girl from the outskirts of Jakarta had died from the virus.

Specimens have been sent to the WHO laboratory for confirmation.

The girl's 10-year-old brother died three days earlier with similar symptoms, but no samples were taken before he was buried.

Last month, six members of a family also died of bird flu and a seventh fell ill in the largest family cluster reported since the virus began ripping through Asian poultry stocks in late 2003.

An eighth member of the family in the farming village of Kubu Simbelang in North Sumatra province was buried before samples were collected, but WHO considers her part of the cluster of cases.

Experts have not found any link between the relatives and infected birds, which has led them to suspect human-to-human transmission. But no one outside the group of blood relatives has fallen ill and experts say the virus has not mutated.

Bird flu has killed at least 127 people worldwide since late 2003. It is difficult for humans to catch, but experts fear the virus could mutate into a form more easily transmissible between humans, potentially sparking a pandemic. So far, most human caseshave been linked to contact with infected birds.

Indonesia trails only Vietnam, where 42 people have died, in the number of bird flu deaths.

http://www.thejakartapost.com/detaillgen.asp?fileid=20060604115925&irec=2