Indonesia Reporting Human Cases of H5N1 Controversy

[HenryN]

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

AVIAN INFLUENZA, HUMAN (51): INDONESIA, NEW POLICY


[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]

The above Promed commentary is curious. Usually Promed readily excludes unconfirmed cases, even when they are obvious bird flu cases because they belong to an H5N1 positive cluster. The commentary fails to note that the death of the brother was attributed to typhus,

http://www.recombinomics.com/News/05...r_Another.html

just as the cluster preceding the one above was attributed to dengue fever.

http://www.recombinomics.com/News/03...er_Denial.html

The same Promed commentator accepted the dengue diagnosis and noted that the obvious H5N1 cluster was therefore not a cluster.
The news blackout may have served as an epiphany for H5N1 commentators at Promed (especially CP).

[HenryN]

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

Commentary

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

[JJackson]

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

The International Health Regulations 2005 revision (IHR (2005)) is the legal document signed by Nation States which forms the authority for the WHO. It is an improvement on the IHR(1968) in that it requires more from the member states by way of reporting but is still too weak for my liking in that the Countries that negotiated it were unwilling to accept any independent verification of their compliance to its requirements or sanction should they fail to comply.

I posted earlier in the thread Article 6 and Annex 2 from the IHR(2005) but did not explain their significance an omission Dr. Niman partially rectified but I would like to try and make clearer. The point being - I would argue - that Indonesia’s new position is in clear violation of its obligations under IHR(2005) and for the reasons outlined above and expanded on in the old commentary linked to in the earlier post.

Articles 1 to 5 are mainly concerned in requiring each country to set up internal monitoring systems, commensurate with their level of wealth and development, which should funnel information to a central collection point. This Focal Point is then required to be register as the countries interface with WHO and to supply certain information. Which brings us to Article 6 which covers 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

As is usually the case with these UN documents the interesting bit is in an Annex which we are immediately referred to. Annex 2 is a decision tree
IHR1.jpg


Novel influenza virus is specifically listed in the first box which has a direct line to the Notify box at the bottom so it is difficult to see how it could be argued that a human H5N1 infection – fatal or otherwise – is not a mandatory notification.


capture.jpg
So having passed the Annex B test we return to Article 6 text which then obliges notification to the WHO via the Focal Point within 24hrs. It further requires notification of “any health measure implemented in response to those events” and “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”

While I am not a lawyer (second only to philosophers – and possibly politicians - in their ability to prove black is white) a plain text reading would seem to show Indonesia in clear breach should they continue on this path. The problem is - unlike common law – international laws (with the exception of commercial laws) seldom include any meaningful sanctions for non-compliance by Nation State signatories.

We have only our own governments to blame.

[Commonground]

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

Indonesia's bird flu policy draws criticism

June 07 2008 at 10:32AM
By Olivia Rondonuwu

Jakarta - 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.

http://www.iol.co.za/index.php?click...130913&set_id=

[Commonground]

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

How is it that Supari has an interview with the AP, and I can't find any articles within Indonesia on it, or anything on it from about 4 links in China? Also, CNN.com did not pick it up.

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

http://news.guelphmercury.com/Wire/article/337046

Edited: CBS News & Reuters picked it up. I'm still looking to see who else did.

[sharon sanders]

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

Thank you to everyone on FluTrackers for your moderate response to this volatile issue.

Of course we are concerned about the comments that indicate Indonesia may not report the H5N1 status inside that country in a timely manner.

It is not good for Indonesia. It is not good for world public health. Indonesia has opened the box for rumours and suspicions to flourish regarding the "bird flu" situation there.

What we can do in a positive way is to continue to work with our various contacts there on the ground, search the media for reports, and support the Indonesian people.

Would any of us want to trade places in this case?

How would we want to be treated by the world?

There are many repressed peoples in this world. Many do not have enough food and water for each day. They live in states where basic freedoms are denied. They live in "hot zones" where conflict is constant.

What is the world's response? Ignore it and it will go away. It is not my problem.

Well, these problems are coming to all of us in the form of disease.

There are no borders for disease. We can run but we can not hide.

If we continue to turn our eyes and our spirits from our brothers in need, we will pay the price.

I urge compassion and support for all humanity. All peoples. All cultures.

If we can help the people of Indonesia, lets do it. If they need anti-virals, we need to send as much as we can. We can not be detoured by a government or government leader that we do not agree with.

All for one, one for all.

[AlaskaDenise]

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

Commentary

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

Commentary

Delay and Denial Control of Indonesia H5N1 Clusters
Recombinomics Commentary 04:13
June 7, 2008

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

The above discussion from today’s ProMED commentary on the new Indonesian policy on delaying announcements of H5N1 fatalities is curious. Usually ProMED excludes any suspect H5N1 which are not lab confirmed, even when the unconfirmed case is in a fatal H5N1 confirmed familial cluster. The announcement by Indonesia may have served as an epiphany for ProMED commentator.

The preceding Indonesia cluster was quite similar. The fatality of the index case was mis-diagnosed as dengue fever and the death was quickly followed by an H5N1 confirmed death in a sibling. That cluster was picked up by wire services and when director general of communicable diseases, Nyoman Kandun, was specifically asked about the cluster, the incorrect dengue fever diagnosis was used to deny the cluster, and this denial was accepted and supported by the same commentator cited above.

The latest comments are a step in the right direction, but the commentary above fails to note that the brother was diagnosed with typhus. Thus, the delay in reporting the case above has already created confusion regarding the diagnosis of the fatal infection in the index case. The commentary also fails to note that the time gap between the index case and the confirmed cases in each cluster supports human to human transmission.

The time gap was also present in the cluster confirmed on the same day as the earlier cluster. That cluster was not picked up by the wire services, but a relative of the confirmed case had died of respiratory disease just prior to the death of the H5N1 confirmed case.

Thus, there are three recent clusters. In each cluster the index cases dies and the cause of death is mis-diagnosed (respiratory disease, dengue fever, and typhus), while the relative then dies of lab confirmed H5N1,

It seems likely that this series of denied clusters may have contributed to the decision to delay H5N1 reporting and reduce transparency. The delay in reporting is in violation of the International Health Regulations, which added H5N1 to the reportable disease list, which requires immediate notification of human H5N1 cases. These regulations were revised in 2005 to increase transparency and give WHO the authority to investigate suspect cases, even without direct participation of host country agencies.

The rapidly deteriorating situation in Indonesia indicates it is time for the WHO to exercise its newly acquired options.


.

[Commonground]

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

[Article from Boxun]

To improve the country's image in Indonesia will not release bird flu death
(Boxun - June 6, 2008 reprint)

Source: Lianhe Zaobao
Indonesia last month, a 15-year-old girl became the first 109 people died of bird flu, the Ministry of Health decided not to announce the news. This is for Indonesia to improve the image of the avian flu and a heavy blow to most of the measures taken by.

Health Minister Siti said: "We announced this news on what benefits? we have to fully take active measures, while stressing that the Government's achievements in bird flu prevention and control. "

She also confirmed that the South Jakarta that the girl last month on the 13th was identified infection with the H5N1 virus, died the next day.

Will be dissatisfied with the WHO

Indonesian decision may anger the United Nations World Health Organization. WHO waiting for Indonesia officially announced the news to amend the Indonesian human bird flu deaths in the figures. WHO Web site as of yesterday the Indonesian bird flu death toll is 108, accounting for 241 deaths of the world for nearly half.

Siti had the problem of avian influenza with the WHO and conflict.

Last year in January, heard a U.S. official in the collections of some laboratory bird flu virus samples after the news, she refused to share with the WHO medical profession was seen as treasures of the bird flu virus samples.

She was concerned that pharmaceutical companies use the Indonesian virus samples vaccine research and development, leading to the developing countries can not afford to buy expensive price of the vaccine. She called for the establishment of the global bird flu vaccine, developed at the top limit or States Liyijunzhan plan.

At present, all Indonesian bird flu virus samples are stored in a laboratory in the Ministry of Health, from the vicinity of Aijie Man Institute scientists detected deoxyribonucleic acid (DNA) of the gene sequencing.

Siti said: "We have the ability to detect."

Before this, the Ministry of Health notified by e-mail bird flu death cases, confirmed that the news of the Information Center also operate almost 24 hours. A few months ago, the Ministry of Health gradually abolish the practice of mixing in the deaths of news, web publishers.

She said that the first half of this year, only 18 people infected with the virus, while the previous year and the first half of the first half of last year, respectively 35 and 27.

Of the 33 provinces in Indonesia, there are 31 provinces bird flu. UN Food and Agriculture Organization in March issued a statement criticizing the Indonesian poultry in bird flu prevention and control work has failed. (Boxun.com)
http://64.233.179.104/translate_c?hl...06061634.shtml

[Laidback Al]

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

Before this, the Ministry of Health notified by e-mail bird flu death cases, confirmed that the news of the Information Center also operate almost 24 hours. A few months ago, the Ministry of Health gradually abolish the practice of mixing in the deaths of news, web publishers.

She said that the first half of this year, only 18 people infected with the virus, while the previous year and the first half of the first half of last year, respectively 35 and 27.

It should be pointed out that only 16 of these individuals have actually been reported by WHO.

http://www.who.int/csr/disease/avian.../en/index.html

The last confirmed case from Indonesia was reported on April 30, 2008.

http://www.who.int/csr/don/2008_04_30/en/index.html

The news articles suggest that deaths from H5N1 will not be reported in a timely fashion. It will be interesting to see if Indonesia reports any survivors from H5N1 infections in a timely fashion.

[Commonground]

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

[Also, this is what I have come up with as far as "source of infection" for the confirmed cases in 2008 up until April 29th]:

I count 14 confirmed cases of H5N1 in humans in 2008, in Indonesia.
"Source of Infection is under investigation" = 8 times
"Poultry died in the neighborhood" = 3 times
"visited a wet market recently" = 1 time
"victim lived in close proximity to a wet market/slaughter house" = 2 times

Quote:
Avian influenza ? situation in Indonesia ? update 41
2 April 2008
The Ministry of Health of Indonesia has announced three new cases of human H5N1 avian influenza infection. The cases are not linked epidemiologically. The first is a 15-year-old male student from Subang District, West Java Province who developed symptoms on 19 March, was hospitalized on 22 March and died on 26 March .

The second case is an 11-year-old female student from Bekasi City, West Java Province who developed symptoms on 19 March, was hospitalized on 23 March and died on 28 March.

The third case is a 21-month-old female from Bukit Tinggi, West Sumatra Province who developed symptoms on 17 March, and was hospitalized on 22 March. She is presently recovering in hospital.

The source of infection for all three cases is still under investigation.



Quote:
Avian influenza ? situation in Indonesia ? update 40
21 February 2008
The second case is a 3-year-old boy from South Jakarta District, Jakarta Province who developed symptoms on 3 February, was hospitalized on 10 February and died on15 February. The investigation team found that chickens & a pet bird had died in the neighborhood in the two weeks prior to the case?s onset of symptoms.


Quote:
Avian influenza ? situation in Indonesia ? update 39
12 February 2008
The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 15-year-old female from West Jakarta, Jakarta Province developed symptoms on 2 February, was hospitalized on 8 February and is currently in hospital in a critical condition. The case is the daughter of a previously confirmed case, the 38-year-old female from West Jakarta, Jakarta Province who developed symptoms on 23 January.

Investigations into the source of her infection are ongoing. However, she was exposed to her sick mother on 27-28 January and spent time in a neighbourbood where chickens and other birds were found.


Quote:
Avian influenza ? situation in Indonesia ? update 38
5 February 2008

The Ministry of Health of Indonesia has announced two new cases of human H5N1 avian influenza infection. The first is a 29-year-old female from Tangerang City, Banten Province who developed symptoms on 22 January, was hospitalized on 28 January and died on 2 February. Investigations into the source of her infection are ongoing .

The second case is a 38-year-old female from West Jakarta, Jakarta Province who developed symptoms on 23 January 2008, was hospitalized on 26 January and is currently in hospital in a critical condition. Investigations into the source of her infection are ongoing.


Quote:
Avian influenza ? situation in Indonesia ? update 35
29 January 2008

The Ministry of Health in Indonesia has confirmed an additional four cases of human infection with the H5N1 avian influenza virus. Two of these cases were fatal. There is no evidence of an epidemiological link between the cases.

The first case, a 31-year-old female from East Jakarta, Jakarta Province, developed symptoms on 18 January, was hospitalized on 22 January and is currently in hospital. The investigation indicated that she visited a wet market where live poultry are sold three days prior to symptom onset.

The second case, a 9-year-old male from Depok Municipality, West Java, developed symptoms on 16 January, was hospitalized on 23 January and died on 27 January. Investigations into the source of his infection indicate that the case lived next door to a wet market where live poultry are sold.

The third case, a 32-year-old male from Tangerang Municipality, Banten Province, developed symptoms on 17 January, was hospitalized on 24 January and is currently in hospital. Investigations into the source of his infection are ongoing.

The fourth case, a 23-year-old female from East Jakarta, Jakarta Province, developed symptoms on 19 January, was hospitalized on 24 January and died on 27 January. Investigations into the source of her infection are ongoing.



Quote:
Avian influenza ? situation in Indonesia ? update 33
23 January 2008

The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 30-year-old male from Tangerang District, Banten Province developed symptoms on 13 January 2008, was hospitalized on 19 January and is currently in hospital. Investigations into the source of his infection are ongoing.

Of the 120 cases confirmed to date in Indonesia, 97 have been fatal.



Quote:
Avian influenza ? situation in Indonesia ? update 32
21 January 2008

The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. An 8-year-old male from Tangerang District, Banten Province developed symptoms on 7 January 2008, was hospitalized on 16 January and died in an AI referral hospital on 18 January. Investigations into the source of his infection are ongoing, however initial reports indicate the case lived in close proximity to a chicken slaughter house.


Quote:
Avian influenza ? situation in Indonesia ? update 29
11 January 2008

The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 16-year-old female from West Java Province developed symptoms on 30 December 2007, was hospitalized on 4 January 2008 and is currently in hospital. Investigations found a history of deaths in chickens in the case?s neighborhood in the two weeks preceding her onset of symptoms.


http://www.who.int/csr/don/archive/country/idn/en/

[Shiloh]

Indonesia says it will no longer formally announce bird flu deaths

Source: http://canadianpress.google.com/arti...IRggemVMdfp-QA

WHO says Indonesia has given assurances it will report bird flu cases

TORONTO ? A senior official of the World Health Organization says the global health agency has been assured Indonesia will continue to report human cases of, and deaths from, H5N1 avian flu as they occur.

The WHO had sought clarification from Indonesia after Health Minister Siti Fadilah Supari said last week that her country would in future only report H5N1 deaths sporadically, perhaps at six month intervals.

The suggestion was met with dismay and with warnings that Indonesia would be in violation of the International Health Regulations if Supari carries through on her threat.

That international treaty requires prompt reporting of cases of diseases such as H5N1 that have been designated as global health threats. Indonesia is a signatory to the treaty.

"We've received official notice at our WHO office in Jakarta that the minister will continue - as she has been - notifying WHO on confirmed infections under the International Health Regulations," Dr. David Heymann, assistant director general for health security and environment, said from Geneva.

"She's been clear ... that she has no intention of not conforming to the International Health Regulations. She knows what they are. She's been told what those regulations require."

Despite the assurances, it seems Indonesia may not have formally notified the WHO yet of an H5N1 death that occurred nearly a month ago.

In an interview with the Associated Press last week, Supari revealed that a teenage girl died on May 14, but the government decided not to announce her death right away.

"How does it help us to announce these deaths?" she asked in the interview.

The most recent death Indonesia reported to the WHO occurred on April 23. As of Thursday, the WHO's official case count for Indonesia was 108 deaths out of 133 confirmed cases - the highest toll of any country afflicted with the H5N1 virus.

Heymann said the WHO's country office in Jakarta may have been notified Thursday of the death and was putting the information through channels. But if that's not the case, the WHO will be asking questions.

"If that was a confirmed case, we will have to work to understand what went wrong" in the notification process, he said.

The International Health Regulations stipulate that countries must report new H5N1 cases within 24 hours of confirmation and must report important related information, such as deaths, in a timely manner.

The WHO needs the information to make an assessment of the risk the event poses. Changes in the H5N1 death rate, for instance, could signal that the virus has mutated and experts would want to study sample viruses to look for what triggered the shift.

Indonesia has been enmeshed in a dispute with the WHO for more than a year, refusing to allow outside scientists to study sample viruses until it receives assurance it will get a share of any vaccine produced from Indonesian viruses.

[Gert van der Hoek]

Re: Indonesia Reporting Human Cases of H5N1 Controversy

Indonesia's new bird flu policy on reporting deaths leads to confusion, anger


2008-06-13


BITUNG, Indonesia (AP) - Ali Usman's wife died of bird flu 10 days ago, but he still has not been officially notified by the government. Desperate for information, he scours the newspapers, which until last month aggressively wrote about deaths in the country hardest hit by the disease, but finds nothing.

That's because of a new government policy to no longer publicize individual bird flu cases immediately _ an attempt to shift media attention that politicians say focuses too heavily on deaths instead of successes.
From now on, fatalities will be announced in clusters, perhaps just a few times a year.

The news blackout worries health experts and has left government officials and people living in areas worst affected by the virus confused and frustrated.

It took The Associated Press a week to track down and confirm the June 3 death of Usman's wife, Susi Lisnawati, which raised the country's toll to 110.

Though she was suffering from classic symptoms of the disease _ breathing difficulties, coughing and high fever _ she was not kept in isolation during her two days of hospitalization or otherwise treated as a suspected bird flu patient, her husband said.

She also was given a traditional Muslim burial, her body washed and shrouded by barehanded family members, before being placed in the ground without a casket, he said.

?I'm terribly scared, I need to know what the test results were,? said Usman, a 44-year-old tailor with three sons. ?The government should be intensifying public awareness.

Indonesia, which has tallied more human deaths than any other country, is seen as a potential hot spot for a pandemic because of its high density of people and large number of backyard chickens. The virus remains hard for people to catch, but experts fear it could mutate into a form easily transmitted between humans, potentially killing millions across the globe.

The World Health Organization, which has been engaged in a bitter dispute with Indonesia since early 2007 over the sharing of virus samples, said Health Minister Siti Fadilah Supari promised to keep it informed about new deaths and did not appear to be violating international health regulations with her new policy.

?Indonesia has agreed to continue notifications to WHO .... they have never said they would not do that,? said David Heymann, the U.N. agency's top flu expert, adding that it does not matter if it takes several weeks to publicize the country's official toll ?as long as the virus is known about and handled properly.

Still, the lack of transparency has forced health workers, scientists and residents to rely on word of mouth and raised fears that deaths could be covered up _ especially since the government has been exclusively responsible for carrying out genetic sequencing of H5N1 viruses needed for diagnosis and risk assessment since its standoff with WHO.

Next-of-kin are still shown official test results almost immediately and Usman's case appeared to be an aberration.

But when asked for an explanation, Health Ministry spokeswoman Lily Sulistyowati said test results had come back negative and would be delivered to the family within days.

A senior ministry official, speaking on condition of anonymity because the issue has become so politically sensitive, later confirmed the tests were positive.

Four other health workers agreed, some after double-checking with the National Institute for Health Research and Development, the government laboratory that is responsible for confirmations but no longer speaks to the media.

Neighbors too were confused after seeing bird flu investigators visit Usman's house, taking blood samples from family members and handing out the antiflu drug Tamiflu, but only to his youngest son and a child living next door. Residents were asked if they had backyard fowl.

Gusti Ngurah Mahardika, a virologist at Udayana University on Bali island, said the new policy on announcements was a setback. ?People will become complacent about bird flu and its threat.

http://www.pr-inside.com/print641928.htm

[Readymom]

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

[snip].

All for one, one for all.

Yes, Florida1 ... the children. All the children. We must keep pressing ahead for them! -k

[sharon sanders]

Re: Indonesia Reporting Human Cases of H5N1 Controversy

Thank you to AP for investigating this case....



Indonesian government mum as AP reports H5N1 case

Robert Roos News Editor

Jun 13, 2008 (CIDRAP News) ? An Indonesian woman died of H5N1 avian influenza 10 days ago, but her case has not yet been publicly confirmed by the government, which is continuing to withhold information about avian flu cases, the Associated Press (AP) reported today.
The news came on the heels of the word from a World Health Organization (WHO) official that Indonesia has promised to keep the agency informed of human cases and deaths, as it is obligated to do under the International Health Regulations (IHR). The WHO official's comments appeared to contradict statements last week from Indonesia's health minister.
On Jun 5, Health Minister Siti Fadilah Supari said the government would no longer report human H5N1 cases and deaths promptly to the WHO. Different news accounts said she planned to report cases after they were reported in the news media or only at 6-month intervals. Supari said she wanted to focus attention on the country's successes in fighting avian flu.
Today's AP story says that a 34-year-old woman named Susi Lisnawati died of avian flu Jun 3. Speaking anonymously, a senior health ministry official and four other health workers confirmed the case to the AP. But the government had not yet notified Lisnawati's husband, Ali Usman, that she had the virus, according to the story, which came from Bitung, a city near the northeastern tip of Sulawesi island.
The case has not been reported in the local news media, and it took the AP a week to track down and confirm it, the report said.
The case apparently raises Indonesia's H5N1 death toll to 110, out of a total of 135 cases. The WHO's tally for Indonesia stands at 133 cases with 108 deaths; the agency has not yet included Lisnawati and a 15-year-old girl whose case was announced by Supari just last week, though she had died May 14.
Dr. David Heymann, the WHO's assistant director general for health security and environment, said yesterday that Indonesia had assured the agency it would continue reporting avian flu cases, according to a Canadian Press (CP) report published yesterday.
"We've received official notice at our WHO office in Jakarta that the minister will continue?as she has been?notifying WHO on confirmed infections under the International Health Regulations," Heymann told CP.
"She's been clear . . . that she has no intention of not conforming to the International Health Regulations," he said. "She knows what they are. She's been told what those regulations require."
Today's AP story carried similar comments from Heymann. But according to the AP account, Heymann said it doesn't matter if it takes several weeks for the government to report cases, "as long as the virus is known about and handled properly." He also said it did not appear that Indonesia was flouting the IHR.
Under the IHR?agreed to by all WHO member countries?governments are required to quickly report cases of diseases labeled as global health threats. Novel influenza strains are among the diseases that countries are specifically obligated to report.
Indonesia has been at odds with the WHO since early 2007, when Supari announced the government would no longer send H5N1 virus samples to the agency. The country wants guarantees that it will receive a supply of any vaccine derived from the isolates it supplies. The WHO has relied for decades on free sharing of flu viruses in its effort to identify new strains, develop vaccines, and monitor drug resistance.
See also:
Jun 5 CIDRAP News story "Indonesia quits offering prompt notice of H5N1 cases"
WHO's H5N1 case count
Information on the International Health Regulations
http://www.who.int/csr/ihr/prepare/en/index.html
Jun 15, 2007, CIDRAP News story "New global disease-control rules take effect"



http://www.cidrap.umn.edu/cidrap/con...n1308indo.html

[Gert van der Hoek]

Re: Indonesia Reporting Human Cases of H5N1 Controversy

The Jakarta Post now also has the AP story.

This is added by Jakarta Post:

This is not the first time Indonesia's handling of bird flu has raised eyebrows.

Supari, the health minister, got widespread attention - and some praise - when she bucked the WHO's 60-year-old virus sharing system in January 2007, saying it was unfair to developing nations. She's worried pharmaceutical companies will use her country's virus strain to make pandemic vaccines that are ultimately unaffordable to her own people.

But by refusing to share virus samples, Supari is making it almost impossible for international scientists to make sure the virus isn't morphing into a more dangerous form.

Supari defended her new policy on reporting deaths last week, saying the focus now should be on positive steps taken by the government to combat bird flu. She pointed to a "declining trend" in cases, with at least 18 people infected in the first six months of 2008, down from 27 during the same period in 2007 and 35 in 2006. (*)

http://www.thejakartapost.com/news/2...ion-anger.html