Indonesia: Human Cases 8 Oct 2008 - January 28, 2009

[Commonground]

Re: Indonesia: Human Cases 8 Oct 2008 +

13 residents have been returned

[This article gives some much needed information on the relationships of the 17 cases.
Ruslan (almost his whole family suspected of contracting bird flu)

Irwan (6) son
Three Nephews (all preschool)

Continue to be treated, have to ascertain if infected with bird flu:
Ruslan parent-in-law (father/mother in-law): Juhani
Rusian brother-in law: Saleha
2 neighhbors

?Ruslan also informed his two neighbours just was put into RSUP Wahidin Sudirohusodo as suspect bird flu. ?
(this is not clear enough to determine if it is the same 2 neighbors mentioned above)]


Suspect Flu Burung di Tangki Jangang
Sabtu, 22-11-08 | 16:02 | 22
As many as 13 from 17 residents of the Jangang Tank, Kelurahan Sudiang, of Kecamatan Biringkanaya, that beforehand it was suspected contracted bird flu finally had been returned. Was based on results of the laboratory inspection, was not found by the existence of the bird flu virus in the sample of their blood. Ruslan, one of the residents that almost all of his family was stamped suspect bird flu felt grateful.

On last Saturday, his son who was named Irwan, 6 years, as well as his three nephews that still pre-schoolers were allowed to return to the house.

Beforehand, 5 other residents have also been allowed to return to his house was their respective.

However the Ruslan parent-in-law was named Juhani, his brother-in-law of Saleha, as well as his two neighbours still continue to was in RSUP Wahidin Sudirohusodo in order to ascertains the four of them also not terjangkit bird flu. "Possibly they will go in the near future out," said Ruslan.

Ruslan admitted to since the beginning of himself being convinced the size family not terjangkit the deadly illness. He suspected the medical official from the Sudiang Community Health Centre too much was on the alert when diagnosing the illness that was suffered by his family's member.

At this time, the condition for the family's Ruslan member who could be treated has begun to improve. Only, Ruslan regretted the shortage of attention of local government apparatus. "Our family's ten days were treated, there were not even one of the local government apparatus that came," said Ruslan. Ruslan also informed his two neighbours just was put into RSUP Wahidin Sudirohusodo as suspect bird flu. The "sample" of "their blood was still being researched," he stated.

[Commonground]

Re: Indonesia: Human Cases 8 Oct 2008 +

Post #269:
[here we go again....]

In the meantime, Dr Azisman that treated this child stressed, NW quite positive suffered the bird flu illness.

vs.:

Officially Kesehatan Terima Laporan Sementara, the Kesehatan Service of the Riau Province through the Sub- Dinas Head the Health service and the Nutrient drg Burhanudin Agung named his side still could not confirm whether NW positive bird flu or not because the sample of the patient's blood was still being checked the central laboratory.

[Anne]

Re: Indonesia: Human Cases 8 Oct 2008 +

do somebody remember a test made by the CDC or WHO, one year ago or 2 : one provided known strains of influenza, of which H5N1, at well trained laboratories.
One asked them to identify the strains
There were errors. ( false negative and false positive ) : only 75 % of the strains were well identified.
I do not find the study again .
Is the Makassar laboratory well trained for H5N1 detection ?

[Commonground]

Re: Indonesia: Human Cases 8 Oct 2008 +

Post #271
I'm trying to figure this out here....I should have 4 remaining in the hospital, out of the 17. I think this is correct? Feedback welcome.

Grandparents:
Juhani (50) - stayed

Children:
Dg Nginga (mother). Husband: Rizal/Ruslan
Saleha (12) - stayed

Grandchildren:
Nurul Awaliah (3) - stayed
Nurfadillah (4 mos) - home 11/14
Salman (6/4) - stayed


Parent:
Jufri (30)

Children:
firdaus (6) home 11/20
fauzi (3 mos) - home 11/20
Ahmad Hidayat - older brother, not admitted.


Neighbors (or related??)
Sibblings
Ilham (2) - stayed
Ikbal (6) - stayed

Excerpts from Ruslan, one of the residents that almost all of his family:

As many as 13 from 17 residents finally had been returned.

On last Saturday, his son who was named Irwan, 6 years, as well as his three nephews that still pre-schoolers were allowed to return to the house.

Beforehand, 5 other residents have also been allowed to return to his house

Ruslan parent-in-law was named Juhani, his brother-in-law of Saleha, as well as his two neighbours still continue to was in RSUP Wahidin Sudirohusodo

Ruslan also informed his two neighbours just was put into RSUP Wahidin Sudirohusodo as suspect bird flu.

[Commonground]

Re: Indonesia: Human Cases 8 Oct 2008 +

If my list is accurate, some of the one's that stayed, are the ones that arrived first on 11/12. I'm also wondering now if the brother of the mother, and the grandparent were not the caregivers??

Here's my information on the ones that stayed:
Nurul Awaliah/Andia (3) (entered 08:00) (1st one sick)
Salman (6/4) (entered 08:00) Symptom onset: 11/10 (?)
Saleha (12) (entered 12:00)
Johani/Yohani (50) (entered 12:00)

Ikbal (6) (adm: 11/18) sibbling to Ilham (2)
Iiham (2) (adm: 11/13)

Karmila (4) (adm: 11/18)

[sharon sanders]

Re: Indonesia: Human Cases 8 Oct 2008 +

Thanks Commonground for the list. I think it is accurate. Maybe the first suspected patients started tami later in their treatment, since they were not suspected at the time of disease onset, than the other suspected patients so they are having a harder time recovering?

[Giuseppe]

Re: Indonesia: Human Cases 8 Oct 2008 +

An overview of recent evaluation of H5N1 testing capabilities is available at http://www.flutrackers.com/forum/showthread.php?t=85335

[Commonground]

Re: Indonesia: Human Cases 8 Oct 2008 +

An overview of recent evaluation of H5N1 testing capabilities is available at http://www.flutrackers.com/forum/showthread.php?t=85335

Can anyone give a summary in laymens terms of the above study? I don't have time to read it, and I'm not sure I would understand it when I was through......thanks in advance.

[Anne]

Re: Indonesia: Human Cases 8 Oct 2008 +

http://www.who.int/wer/2008/wer8345.pdf

Could be an explanation.. thank you very much IRO..

IRO could explain better than me, CG , what I can say approximatively :
Laboratories with training to detection , have improved their diagnosis and PCR could give false positive and false negative. It's not 100 % exact .
RT PCR is better than PCR.
False positives exists : the most frequent false-positive results reported were for influenza A virus subtype H5.



panels
The 4 panels consisted of coded samples containing
RNA at different concentrations from 5 strains representing
different genetic clades (1 and 2) of infl uenza
A(H5N1) viruses, A(H1N1) viruses and A(H3N2) viruses.
Samples that contained no virus were also included.
Details of the composition of the panels are shown in
Table 1.

( some laboratories detected "virus" , in a negatif sample, with no virus )

Comparison of laboratories? performance
on all panels
During a 2-year period from 2007 to 2008, the proportion of participants with entirely correct results increased from 65% to 77%, whereas the proportion of participants with incorrect H5 subtyping fell from 23%
to 12% and false-positive results fell from 14% to 6%
(Table 4).
False-positive results for negative samples remained
at <10% from panel 2 onward.
Of the 868 tests performed on negative samples (panel 1, 128 tests; panel
2, 332 tests; panel 3, 190 tests; panel 4, 218 tests),

32 (3.7%) tests were false-positives; the most frequent
false-positive results reported were for influenza A virus
subtype H5 (Table 5).


Factors affecting performance
There was considerable variation in the PCR protocols
applied by participants. Because of the multitude of test procedures used by a small number of participants, a meaningful statistical analysis to determine whether individual protocol is significantly better than others was not possible. However, we have compared and analysed
the use of in-house methods versus commercial
kits, and the use of conventional PCR versus real-time
PCR.Analysis showed that in 2 of 3 panels, laboratories using
real-time PCR for >1 test to detect the H5 gene demonstrated
signifi cantly better overall performance than
laboratories using only conventional PCR (panel 2,
P=0.002; panel 3, P=0.006) (Table 7).

snip
Although it is statistically impossible to
determine whether 1 set of PCR primers and probes
produced significantly better results than others, overall
analysis shows that no difference in performance was
observed between the use of in-house methods and
commercial kits.
Detecting influenza A virus in a clinical sample is a
complex, multistep procedure. Each laboratory should
have its own testing strategy using optimized protocols
for different target genes. The design of the primers and
probes alone may not explain why participants failed
to detect H5 samples, since base mismatch in some
primer and probe sets would still be able to detect all
H5 samples (data not shown). Optimization of the PCR
reaction seems to be a more important factor: this
could explain why performance among laboratories
varied even though they were using the same sources
of PCR primers and probes.

[Commonground]

Re: Indonesia: Human Cases 8 Oct 2008 +

Thanks Anne.

[Anne]

Re: Indonesia: Human Cases 8 Oct 2008 +

http://www.fkm-unhas.ac.id/index.php

makassar university .. kesehatan.
I don't see if it 's a big " medical "center.

[gsgs]

Re: Indonesia: Human Cases 8 Oct 2008 +

thanks for the positives/negatives statistics.

Did they report, they had PCR positives ? How many ?
I can't find a source

[Anne]

Re: Indonesia: Human Cases 8 Oct 2008 +

Hi gsgs, I know you like statistics .. more stats in WHO's pdf ( must thanks Ironorehopper.. )

PCR in this article.. "was done"..

http://www.tempointeraktif.com/hg/nusa/2008/11/13/brk,20081113-145843,id.html

Keluhan dan gejala 17 pasien itu adalah batuk, demam, dan sesak nafas. Mengunggu hasil pemeriksaan lanjutan dari sampel darah pasien suspect ini, sementara mereka diisolasi diruang perawatan Pakis. Pemeriksaan sampel darah dengan menggunakan Polymerase Chain Reaction (PCR) dilakukan di laboratorium Universitas Hasanuddin (Unhas) dan dikirim ke Depkes, dimana membutuhkan waktu sekitar 2 hari untuk mengetahui hasilnya.

<table id="texttable"><tbody><tr valign="top"><td id="sourcecell"><script>_SetupBidi('source');</script>
</td><td id="gap">
</td><td class="almost_half_cell">17 complaints and symptoms of the patient is coughing, fever, and shortness of breath. Mengunggu the results of further blood sample from the suspect patient is, while they affect treatment diisolasi fern. Examination of blood samples using the Polymerase Chain Reaction (PCR) is done in the laboratory Hasanuddin University (Unhas) and sent to the Ministry of Finance, which takes about 2 days to know the results.
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http://www.southeastasiantimes.com/

17 in Makassar hospital with suspected bird flu
From News Reports:
Jakarta, November 15: The Wahidin Sudirohusodo General Hospital in Makassar, South Sulawesi, has admitted 17 patients with suspected bird flu in two days, reports The Jakarta Post.
The patients, mostly children, presented with symptoms of the disease, such as a high fever, cough and respiratory difficulties, the newspaper quoted hospital spokesman Andi Kurnia Bintang as saying.
All were from Makassar’s Biringkanaya district.
Initial tests of the first seven patients indicated the presence of the H5N1 avian virus.
The hospital was now awaiting confirmation of the results from blood tests done by the Micro Laboratory of the Hasanuddin University Medical School, he said.
The hospital’s senior emergency unit officer Wasis Udaya said of the other ten: “They showed symptoms of bird flu, such as a high fever and respiratory problems, but we are still waiting for the results of the rapid tests, thorax photos and blood tests.”
The hospital had set aside 11 beds for potential bird-flu patients but has had to increase the number.

[Shiloh]

Re: Indonesia: Human Cases 8 Oct 2008 +

Source: http://www.fajar.co.id/index.php?act=news&id=54609
Sabtu, 22-11-08 | 16:02 | 102
13 Warga Sudah Dipulangkan
Suspect Flu Burung di Tangki Jangang
Laporan: Akbar Hamdan

Machine translation:
On Saturday, 22-11-08 | 16:02 of | 102 13 residents already Dipulangkan Suspect Bird Flu in the Jangang Tank The report: Great Hamdan

MAKASSAR -- As Many As 13 from 17 residents of the Jangang Tank, Kelurahan Sudiang, of Kecamatan Biringkanaya, that beforehand it was suspected contracted bird flu finally had been returned.

Was based on results of the laboratory inspection, was not found by the existence of the bird flu virus in the sample of their blood.

Ruslan, one of the residents that almost all of his family was stamped suspect bird flu felt grateful. On last Saturday, his son who was named Irwan, 6 years, as well as his three nephews that still pre-schoolers were allowed to return to the house.

Beforehand, 5 other residents have also been allowed to return to his house was their respective.

However the Ruslan parent-in-law was named Juhani, his brother-in-law of Saleha, as well as his two neighbours still continue to was in RSUP Wahidin Sudirohusodo in order to ascertains the four of them also not terjangkit bird flu. "Possibly they will go in the near future out," said Ruslan.

Ruslan admitted to since the beginning of himself being convinced the size family not terjangkit the deadly illness. He suspected the medical official from the Sudiang Community Health Centre too much was on the alert when diagnosing the illness that was suffered by his family's member.

At this time, the condition for the family's Ruslan member who could be treated has begun to improve. Only, Ruslan regretted the shortage of attention of local government apparatus.

"Our family's ten days were treated, there were not even one of the local government apparatus that came," said Ruslan.

Ruslan also informed his two neighbours just was put into RSUP Wahidin Sudirohusodo as suspect bird flu. The "sample" of "their blood was still being researched," he stated. (aha)

[Treyfish]

Re: Indonesia: Human Cases 8 Oct 2008 +

The Demak resident Suspect Bird Flu The


Sunday, November 23 2008 00:00

DEMAK?Lagi, a patient suspect bird flu was treated in RSUP Kariadi Semarang. The female patient had the initials Dj, 50, the resident RT 4 RW 5 Donorejo villages, Kecamatan Karangtengah, Demak, was reconciled to RSUP Kariadi on Tuesday (18/11), after could be treated for two hours in the Daerah Hospital (RSD) Sunan Kalijaga Demak. RSD Sunan Kalijaga Sukardjo SKM public relations said, Dj was carried to the hospital on Tuesday (18/11) with the sign of the hot body high was accompanied by acute coughs as well as was difficult to breathe.

Upon arrival at RSD, the patient suspect the bird flu was at once isolated in special space, that is in Soka space. And, after being carried out by observation for approximately two hours, finally Dj was reconciled to RSUP Kariadi Semarang by the Kesehatan Service (Dinkes) Demak. ?Ruang our isolation was more inadequate. Wanted did not want, the patient was reconciled by us to Semarang. Because, the patient needed tight isolation space. If not, we worried his condition increasingly memburuk,? said Sukardjo to the Semarang Radar yesterday.

One of the children Dj, Miftahul Ummah, 36, when being met this newspaper in his house the afternoon yesterday (22/11) said, his mother was carried to RSD Sunan Kalijaga last Tuesday (18/11) after experienced was sick difficult flu.
However, himself did not know whether his mother was affected by bird flu or not. According to him, two the previous day, to be precise on Sunday (16/11), his mother could throw his property chicken that suddenly died to the river close to his house away.
?Tapi, before that, the mother already coughs, and hot badan,? he said.
Beforehand, continued Miftahul, his mother could also sell as many as 20 nonpedigreed chickens that were maintained. The chicken that was sold in the healthy situation all. The chicken sales revenue was then used by casualties to buy fertiliser. ?Selang two days, the mother felt his body to be hot. He direct memeriksakan to the village doctor. But, not sembuh,? he said.

In the meantime, last Friday (21/11), the Kesehatan Service side of the Regency and the Central Javan Province has also carried out the checking to the location of the Dj residence in the Donorejo Village, Karangtengah. They took the sample of blood of hundreds of chickens belonging to the Dj neighbour for the need of the research in the laboratory.
Suwarno, Donorejo Village equipment that also the neighbour Dj said, the sample of blood that was taken by this Kesehatan Service was not yet known by results. Because, still in the process of the research. ?Kita was asked to be waiting hasilnya,?ujar him in the Dj house yesterday.

When being confirmed, Plt Section Head Kesehatan Demak Dr Singgih went through Kasi Pemberantasan of Sri Hartanto infectious diseases explained, the patient suspect this bird flu of two could the previous day hold his property chicken that suddenly died. Two days afterwards that was relevant experienced hot high, then was brought took medicine, and has been given medicine tamiflu.

However, because of not having the change, finally was brought to RSD Demak. After being observed two hours in the hospital, then were sent to RS Kariadi, Semarang. ?Setelah was checked by results of the negative. But, we not yet confirmation ulang,? he explained the afternoon yesterday. Contacted was separated, public relations of RS Kariadi Semarang M. Alfan confirmed if Dj was the reconciliation patient from RSD Kalijaga Demak. ?Dj entered RSUP Kariadi on Tuesday, November 18 lalu,? obviously him.
While being treated in RSUP Kariadi Semarang, continued he, Dj was placed in special isolation space the bird flu patient. This remembered Dj had the clinical sign that was suspected by Avian Influenza (AI). Among them, the high fever, breathless, as well as beforehand contact with the poultry. Nevertheless, according to Alfan, the Dj condition was not as serious as DS (15), the positive patient bird flu from Medoho, Kelurahan Siwalan, Kecamatan Gayamsari that died last Friday (7/11).

?Karena the patient diindikasi bird flu, then we then gave the handling was proper for the flu patient burung,? he explained. Until striking 20,00 last night, the Dj condition continued to improve. Unfortunately, through to last night did not yet have the explanation whether Dj positive bird flu or not. This newspaper also did not yet get medical information from the doctor RSUP Kariadi, because of the doctor who handled Dj was being outside negeri.