Indonesia Reporting Human Cases of H5N1 Controversy

[Gert van der Hoek]

Indonesia says it will no longer formally announce bird flu deaths


Thursday, June 5, 2008

By ROBIN McDOWELL, AP

JAKARTA, Indonesia -- A 15-year-old girl died of bird flu last month, becoming Indonesia's 109th victim, but the government decided to keep the news quiet. It is part of a new policy aimed at improving the image of the nation hardest hit by the disease.

"How does it help us to announce these deaths?" Heath Minister Siti Fadilah Supari said Thursday, after confirming that the girl from southern Jakarta tested positive on May 13 and died one day later. "We want to focus now on positive steps and achievements made by the government in fighting bird flu."


Indonesia's decision could aggravate the World Health Organization, which waits to update its official tally of Indonesia's bird flu deaths until after they are formally announced by the government. The toll on its Web site stood at 108 on Thursday - accounting for nearly half the 241 recorded fatalities worldwide.


The country's health minister has clashed with WHO over bird flu before.


Supari stopped sharing bird flu samples with the global body in January 2007 after learning that some coveted data about the virus was being kept in a private database at a U.S. government laboratory in Los Alamos, New Mexico, and made accessible to only a handful of researchers.


She worried that pharmaceutical companies would use her country's viruses to make vaccines that were ultimately unaffordable for developing countries. She has called for the creation of a global stockpile of lifesaving drugs, price tiering or other multinational benefit-sharing programs.


At present, all of Indonesia's virus samples are kept at a Health Ministry laboratory. DNA sequencing - used for risk assessment, diagnosis and to signal possible mutations - is carried out by scientists at the nearby Eijkman Institute.


"We have the capability to do this ourselves," Supari said.


So far, the virus remains hard for people to catch. Most of the world's 388 recorded human cases fell ill after contact with infected birds. But scientists have been closely monitoring the H5N1 virus, fearing it could potentially mutate into a form that spreads easily among people, possibly sparking a pandemic.


Until recently, Indonesia's government announced bird flu deaths by e-mail and provided an almost 24-hour information center for confirmations.


It gradually abandoned that practice several months ago, often burying news of deaths on the ministry's Web site.


The latest policy shift means no posting will be made until deaths have already been reported in the media, said Supari, who wants the focus now to be on improvements made in fighting the H5N1 virus nationwide.


She said only 18 people have been infected in the first six months of 2008, compared to 27 during the same period in 2007 and 35 in 2006 - something she attributed to improved surveillance and public awareness.


But the U.N. Food and Agriculture Organization issued a critical statement in March, saying Indonesia's efforts to control the disease in poultry are failing.

The H5N1 virus is entrenched in 31 of the country's 33 provinces and will continue to kill humans until it can be controlled in birds, it said.

http://www.chinapost.com.tw/print/159731.htm

[sharon sanders]

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

This is not in the best interest of world public health.

[Commonground]

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

This news truly has me very concerned. Very concerned. Now - I don't know how to watch for an outbreak. So you've got a Country where it is endemic in the poultry. A highly congested population. Ratio of birds to people pretty tight. Health Minister refuses to cooperate with samples. Now refuses to announce bf deaths. So, we (the world) are getting no cooperation what so ever out of this Country. They are endangering the rest of the world. What does each Country do in response to this?

So we had that family of 5 all with symptoms. We had AR who died without testing, and a confirmed sister. We have a 54 year old who died, and the community was all tested, and they continue to survey the poultry, We have another boy, 15 who died, confirmed postive, and his brother died not long before that, but was diagnosed with DBD. We currently have a Mother (48) and Daughter (25) with symptoms. We have a 12 year old who died late March, positive. We have poultry who are not responding to the vaccine. We have cats testing positive in West Sumatra. Cats dying suddenly without cause in Central Java. In Solo, we had a confirmed case 4/23, and another current entry on 5/30.

How else can I try to watch Indonesia? What other things should I be looking for?

[sharon sanders]

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

I agree that this is a very serious situation. As this is the country with the highest reported number of cases of H5N1, we should all be concerned.

FluTrackers will continue to search and publish information that we find about the "bird flu" situation in Indonesia.

I would like to thank all of the news analysts here at FluTrackers and on all the bird flu sites for their diligence. Now these people, who are volunteers from around the world, are the only source of information outside of Indonesia for relevant and pertinent data.

History will be the judge of the actions of various officials, governments, individuals, and corporations. I think we should remember that the Indonesian people are not responsible for the decisions of their government. They are citizens who are living day to day as best they can - just like all of us.

[Gert van der Hoek]

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

Indonesia changes policy on reporting bird flu deaths

05 Jun 2008 13:45:42 GMT

Source: Reuters

JAKARTA, June 5 (Reuters) - Indonesia has changed its policy on reporting bird flu cases and will only announce the death toll from the disease every six months, the health minister said on Thursday.

Indonesia has the highest toll of any nation with 108 confirmed human fatalities. Since the virus resurfaced in Asia in late 2003, it has killed 240 people in a dozen countries, the World Health Organisation says.

"We will not announce every single new bird flu death because sometimes it is misunderstood," Siti Fadillah Supari told Reuters, adding it was unethical to announce the identity of the victims.

"It's OK not to announce it. Sometimes they only give hurtful comments instead of helping," she said, without elaborating.

The country will update new bird flu deaths every six months, instead of announcing every fatality each time, Supari said.

She declined to comment on media reports of a 109th death last month.

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.

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. (Reporting by Olivia Rondonuwu, writing by Fitri Wulandari, editing by Sugita Katyal)

http://www.alertnet.org/thenews/newsdesk/JAK227573.htm

[Laidback Al]

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

To me the questions is - Will they also now stop reporting confirmed cases, survived or not, to WHO in a timely fashion?

[gsgs]

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

to me another question is : is this induced by current developemts,
are there some new cases/clusters which they don't want to report ?

[Giuseppe]

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

To me the questions is - Will they also now stop reporting confirmed cases, survived or not, to WHO in a timely fashion?

And IHR? What's international health regulations rule in this case? How can independent media sources help to track and report possible human cases even in informal way to UN agencies?

Clearly, it is time to apply IHR.

[Gert van der Hoek]

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

And IHR? What's international health regulations rule in this case? How can independent media sources help to track and report possible human cases even in informal way to UN agencies?

Clearly, it is time to apply IHR.

Indonesia wants positive H5N1 news. A bone for the dogs from time to time. They seem to do the same thing as China, India, Bangla, Egypt, Nigeria, .....

IHR applied there ?


..

[Giuseppe]

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

Indonesia wants positive H5N1 news. A bone for the dogs from time to time. They seem to do the same thing as China, India, Bangla, Egypt, Nigeria, .....

IHR applied there ?


..

I think a communication channel between China and other neighbors exists (sse for example the words at the end of all of Chinese updates: ''Authorities of HK SAR, Macau SAR, Taiwan, Japan, Korea and other countries were informed of the case(s)...'' This channel is one of the tools of IHR, also used for other diseases recently detected in certain locations (ie: chikungunya and haemorrhagic fever in Italy last year, the WHO was informed under IHR rule.)

[JJackson]

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

Article 6 Notification
1. Each State Party shall assess events occurring within its territory by using the decision
instrument in Annex 2. Each State Party shall notify WHO, by the most efficient means of
communication available, by way of the National IHR Focal Point, and within 24 hours of assessment
of public health information, of all events which may constitute a public health emergency of
international concern within its territory in accordance with the decision instrument, as well as any
health measure implemented in response to those events. If the notification received by WHO involves
the competency of the International Atomic Energy Agency (IAEA), WHO shall immediately notify
the IAEA.
2. Following a notification, a State Party shall continue to communicate to WHO timely, accurate
and sufficiently detailed public health information available to it on the notified event, where possible
including case definitions, laboratory results, source and type of the risk, number of cases and deaths,
conditions affecting the spread of the disease and the health measures employed; and report, when
necessary, the difficulties faced and support needed in responding to the potential public health

emergency of international concern.

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

[Commonground]

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

Indonesia stops announcing bird flu deaths on case-by-case basis
Excerpt:
At present, all of Indonesia's virus samples are kept at a Health Ministry laboratory. DNA sequencing _ used for risk assessment, diagnosis and to signal possible mutations _ is carried out by scientists at the nearby Eijkman Institute.
?We have the capability to do this ourselves,? Supari said.

Until recently, the government announced bird flu deaths by e-mail and provided an almost 24-hour information center for confirmations. It gradually abandoned that practice several months ago, often burying news of deaths on the ministry's Web site.
Supari wants the news now to focus on improvements made by the government in fighting the H5N1 virus.
She says 18 people have been infected in the first six months of 2008, down from 27 during the same period in 2007 and 35 in 2006 _ something she attributed to improved surveillance and public awareness.
But the U.N. Food and Agriculture Organization issued a critical statement in March, saying Indonesia's efforts to control the disease in poultry are failing. The H5N1 virus is entrenched in 31 of the country's 33 provinces and will continue to kill humans until it can be controlled in birds, it said.
Associated Press reporter Zakki Hakim contributed to this report.

http://www.pr-inside.com/indonesia-stops-announcing-bird-flu-r627231.htm

[Gert van der Hoek]

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

WHO concerned by Indonesia's plan to announce bird flu deaths sporadically


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 as notifiable diseases under the treaty.

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

"We will not announce every single new bird flu death because sometimes it is misunderstood," Supari told Reuters.

"How does it help us to announce these deaths?" she asked in an interview with The Associated Press.

The World Health Organization said it had not received official notification of the change in policy, but is seeking clarification of the minister's remarks.

But experts on international law and public health worried about where Indonesia is heading in terms of international co-operation with the effort to conduct surveillance for influenza viruses that pose a pandemic threat.

"If Indonesia thinks that this is going to be better for their economic interests to be less transparent with information about H5N1, that's a long-term recipe for disaster," said international law expert David Fidler, director of the Center on American and Global Security at Indiana University.

"This is not a good development. It worries me."

Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, also raised concerns.

"This is a very slippery slope that flies in the face of good public health," he said from Minneapolis.

"And lessons around SARS should have been very instructive to countries in Asia about what happens when you do not have full disclosure of public health events in your country."

WHO spokesperson John Rainford said the Geneva-based health agency is seeking further information from Jakarta. "We want to confirm whether or not what's been reported in the press is in fact a change in Indonesian policy," he said from Geneva.

But if Indonesia does plan to carry through on Supuri's statement, the country would be violation of the International Health Regulations, he said.

"It would be, I think, the position of any signatory to the IHR, 193 states... including Indonesia that this is a notifiable illness and that there are duties and obligations under that to report that detail," Rainford said from Geneva.

"But again, this is speculation if we don't have confirmation of that. But if in fact it was the case, yes, that would be a cause of serious concern."

Since late 2003, there have been 383 confirmed human cases of H5N1 infection in 15 countries and 241 of those people - or 63 per cent - have died.

But Indonesia's death rate is substantially higher, 81 per cent. The country has recorded 133 human cases and 108 deaths since July 2005.

http://canadianpress.google.com/article/ALeqM5jxI0CeytjqvYzs_Tr72swbqY6omQ

[Treyfish]

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

The WHO Indo BF page, last updated in '06 <TABLE cellSpacing=0 cellPadding=4 width="100%" bgColor=#e0ebf5 border=0><TBODY><TR><TD></TD><TD></TD><TD width="100%">

</TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD height=1></TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD bgColor=#7da7d9 height=16> </TD></TR></TBODY></TABLE><TABLE class=text10 cellSpacing=0 cellPadding=4 width="100%" border=0><TBODY><TR><TD width="50%" bgColor=#e0ebf5><SCRIPT style="FONT-SIZE: 10px; COLOR: #336699; FONT-FAMILY: Verdana"><!--now=new Date();dy=now.getDay();dd=now.getDate();mm=now.get Month();yy=now.getFullYear();mn="Jan";if(mm==1)mn= "Feb";if(mm==2)mn="Mar";if(mm==3)mn="Apr";if(mm==4 )mn="May";if(mm==5)mn="Jun";if(mm==6)mn="Jul";if(m m==7)mn="Aug";if(mm==8)mn="Sep";if(mm==9)mn="Oct"; if(mm==10)mn="Nov";if(mm==11)mn="Dec";dn="Sunday"; if(dy==1)dn="Monday";if(dy==2)dn="Tuesday";if(dy== 3)dn="Wednesday";if(dy==4)dn="Thursday";if(dy==5)d n="Friday";if(dy==6)dn="Saturday";document.write(d n+", "+dd+" "+mn+" "+yy);Stamp = new Date();var Hours;var Mins;var Time;Hours = Stamp.getHours();if (Hours >= 12) {Time = " PM";}else {Time = " AM";}if (Hours > 12) {Hours -= 12;}if (Hours == 0) {Hours = 12;}Mins = Stamp.getMinutes();if (Mins < 10) {Mins = "0" + Mins;}document.write(' ' + Hours + ":" + Mins + Time + '');//--></SCRIPT>Thursday, 5 Jun 2008 6:18 PM</TD></TR></TBODY></TABLE><TABLE cellSpacing=0 cellPadding=10 width="100%" bgColor=#e0ebf5 border=0><TBODY><TR><TD>AVIAN INFLUENZA CURRENT SITUATION UPDATE </TD></TR></TBODY></TABLE>
<TABLE class=tulisan cellSpacing=1 cellPadding=5 width="100%" align=center border=0><TBODY><TR><TD bgColor=#ffffff>23 June 2006 , 04:56:58 PM
Avian influenza ? situation in Indonesia ? update 20
The Ministry of Health in Indonesia has confirmed the country?s 51st case of human infection with the H5N1 avian influenza virus... http://www.who.or.id/ind/php/current_situation.php</TD></TR></TBODY></TABLE>
Here is the current WHO Indo front page http://www.who.or.id/eng/index.asp

[Sally Furniss]

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

Indonesia quits offering prompt notice of H5N1 cases

Lisa Schnirring Staff Writer

Jun 5, 2008 (CIDRAP News) – Indonesia's health minister said today 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 May 13 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.

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's last confirmed an Indonesian H5N1 case, in a 3-year old boy who died on Apr 23, on Apr 30.

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."

Established in early 2006, FluTrackers monitors avian flu developments in several languages from several sources and hosts international discussion forums and resource lists.

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.

Indonesia's avian flu news blackout might increase traffic to online avian flu communities, such as FluTrackers and FluWiki, because they translate and analyze Indonesian newspaper reports, blogs, newscasts, and other sources, Sanders said.

"FluTrackers will continue to publish what we can; however, we rely on the local sources in Indonesia," she said. "Since the national government is imposing restrictions on when they confirm human deaths, we are watching for other restrictions such as suppression of the local news media to develop."

See also:

WHO global H5N1 case count

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun0508indonesia-br.html