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Indonesia: The Latest Human Suspected & Confirmed Cases January 29 + April 6, 2009

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  • Re: Indonesia: The Latest Human Suspected & Confirmed Cases January 29 +

    hat tip Senior Moderator Fla Medic -
    Indonesian Official: Four More Bird Flu Fatalities



    # 2856


    Overnight the International press has reported that the head of the Indonesian Bird Flu Commission, Bayu Krisnamurthi, revealed that the death toll in Indonesia from bird flu had increased to 119 cases.

    This is an increase of 4 fatalities since the last numbers were provided to the WHO (World Health Organization) on January 22nd.

    There are reasons to believe, however, that this latest tally may be several weeks old.

    On February 11th and 12th, newshounds on both FluTrackers and the Flu Wiki picked up on local media reports of statements attributed to a couple of local officials that the new tally stood at 145 cases and 119 deaths.
    On Flutrackers, posts #96, #97, and #98 (Hat tip Dutchy & Fla1) on this thread have local media reports attributing these new numbers to the local head of UNICEF, Jinung D Kritanto, and to Emil Agustiono, Vice Chairman Executive Committee of Komnas FBPI.
    And that was three weeks ago.

    The issue was `discussed' on the flu forums, but no follow up ever came from the Health Ministry, and the WHO never updated their numbers.



    Today's announcement (Xinhua has it, for some reason, as 117 deaths) of 119 deaths has yet to be reflected in the WHO's numbers. Perhaps later today, assuming that Depkes - The Indonesian Health Ministry - plans to confirm these numbers.

    First this, from the Associated Press, then some discussion.

    Mar 3, 3:55 AM EST
    4 Indonesians die of bird flu; toll climbs to 119
    By IRWAN FIRDAUS
    Associated Press Writer

    JAKARTA, Indonesia (AP) -- Four Indonesians have died of bird flu, bringing the death toll in the country hardest hit by the disease to 119, an official said Tuesday.

    Bayu Krisnamurthi, chief of the National Bird Flu Commission, said all the victims were believed to have been infected after coming into contact with sick poultry. They were from Java island and died in January and February.

    Indonesia, which has been criticized in recent months for refusing to immediately make public news of human deaths and in some cases hushing them up all together, has been worst affected by bird flu since it started ravaging Asian poultry stocks in late 2003.

    <snip>

    Krisnamurthi had little details about the latest deaths, saying only that two were siblings from the city of Bogor and the others were women from Bekasi and Surabaya.
    (Continue . . .)


    The `siblings from Bogor' would appear to be Ruslani (30) and his sister Nurul, who both died in mid January. A third sibling, Ridwan (35), was reportedly suffering from a high fever and refused medical treatment.

    Details on this incident are here.
    We've never heard anything, one way or the other, about the fate of the 3rd sibling.
    The `woman from Surabaya' is most likely ST (18) who died at Dr Sutomo hospital in Surabaya in late January.

    After her death, we received word (see Indonesia: Health Care Workers Quarantined) that a doctor and 4 paramedics of Dr Sutomo hospital Surabaya were quarantined due to severe flu-like symptoms.

    Two tested negative for H5N1, but as of Feb 22nd, 3 were supposedly still in critical condition.

    Once again, we've heard no follow up to this report.
    Pinpointing the 4th victim, a woman from Bekasi, becomes more difficult. Over the past two months there have been multiple reports of suspected cases from that city.

    Hopefully we'll get more details when the WHO updates their information.

    Of course, the actual number of human H5N1 infection in Indonesia is unknown. (bolding and underlining here - Fla1)

    These are just the `officially recognized' cases.

    Comment


    • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

      From Niman commentary above (bolding and underlining Fla1)

      "....This high case fatality rate strongly suggests that milder cases are not report, either because they test negative because of titers lowered by treatment, or they are not tested at all because they are misdiagnosed or self medicated at home, which has been described for many suspect cases. Indeed, many of the fatal cases die within hours of being transferred to an infectious disease hospital after local treatment at home, clinics, or smaller local hospitals and fatally infected family members linked to lab confirmed cases have been misdiagnosed as having lung inflammation, dengue fever, or typhus. The recent Tangerang case was diagnosed as dengue fever, and the recent Bogor case was diagnosed as having dengue fever and typhus prior to lung x-rays and reports of contact with dead or dying poultry, which then led to the H5N1 diagnosis.

      The spike in H5N1 cases in the Jakarta area increases concerns that the number of H5N1 in Indonesia in general and the Jakarta area in particular, are markedly higher that the recently announced confirmed cases....."

      Comment


      • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

        Here's what the WHO lists as one of the 2 confirmed cases this year; although the other death occurred in Dec. 2008.

        "The second case, a 5-year-old female from Bekasi City, West Java Province developed symptoms on 23 December 2008, was hospitalized on 27 Dec 2008 and died on 2 January 2009. The investigation indicated that she visited a wet market to buy chicken meat and eggs two days prior to symptom onset. Contacts were placed under medical observation, where none developed illness."
        The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

        Comment


        • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

          Although hemorrhages are often reported during clinical course of avian influenza in humans (usually, there is blood discharge from trachea or in vomit material) one may also suspect that - as in the region dengue fever is widespread - other conditions may contribute to these clinical features.

          Further, it is also likely that high case fatality rate of human cases of avian influenza in Indonesia may be caused by concurrent health conditions of patients, such as dengue, chikungunya, tubercolosis.

          Unfortunately, no pathological results of necroscopic examinations are available in order to know microbiological findings on tissue culture and for a comprehensive understanding of avian influenza human clinical course in Indonesia.

          So, when clinicians diagnosticate dengue fever in people often lately stated as H5N1 infected, it may be well possible that diagnosis is not faulty, but that really the two conditions were present.

          I don't understand the lack of data about pathological and microbiological findings on human indonesian bird flu cases and international health agencies are not helping us to undestand better the situation.

          Perhaps, a clear picture of clinical course and possible worsening effect of other infectious diseases or malnourishment in Indonesian could help to save more lives.

          Are there people who are hearing out there?

          Comment


          • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

            Strict monitoring like now in Bekasi, normally is done when there is a positive human avian influenza case. This is a strong indication of A. being tested positive.

            Bird Flu Patient Case, Dozens Of Bekasi Residents Monitored

            On Tuesday, March 03 2009 |

            The Interaktif TIME, Bekasi: the Team of the Control of Bird Flu of Kabupaten Bekasi, West Java, named the total 33 residents of the Sukamantri Village, Desa Suka Raya, of Kecamatan Karang Bahagia, was supervised specially.

            They who were involved in close contact less than one metre with casualties died, said the member the Team of the Control of Bird Flu of Kabupaten Bekasi, Heru Hermawan, to the Time in the location of the bird flu incident, on Tuesday (3/3).

            Totalling 33 residents the majority family's A, 8 years, the patient was expected by bird flu that died, last Saturday. Apart from them, some also the medical official who treated the victim.

            From the family among them, I, 43 years; Ms, 36 years; I, 4 years; and N.

            Now from the medical officials among them, the owner of the clinic of Kartika Medika that was not far from casualties's house, IL and T.

            According to Heru, the supervision was carried out twice the incubation period or 17 days had been counted since A died.


            The aim is, continued Heru, prevented transmission of the virus avian kind influenza H5N1 from the poultry to humankind and from humankind to humankind.

            Do not there are those that complained was sick as being sick the chicken was affected by bird flu, the fever, the cough and crowded ," he said. But they not necessarily were positive bird flu.

            Results of the identification of the source of bird flu that was carried out by the Team of the Control of Bird Flu of Kabupaten Bekasi concluded the spreading of bird flu against the poultry in 2009 this happened in two territories: the Sukatani Subdistrict and the Setu Subdistrict.

            The cause is, said Heru, the management of the poultry was not good. The chicken was maintained illegally, and his pen adhered to walls of the house was left dirty. The attack figure to the poultry in the territory was high, said Heru.

            "Addressing chronic disease is an issue of human rights that must be our call to arms"
            Richard Horton, Editor-in-Chief The Lancet

            ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

            Comment


            • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

              Bekasi, West Java ::: Bird Flu Eradication Team watches 33 residents.

              <SMALL>March 4, 2009</SMALL>

              Bird Flu Eradication Team watches 33 residents.

              Bekasi – Total 33 residents of Kampung Sukamantri, Desa Suka Raya, Kecamatan Karang Bahagia, Bekasi West Java are observed by Bird Flu Eradication team of Kabupaten Bekasi. These people are known to have close (less than 1 meter distance) contact. From 33 observed residents, most of them are victim’s family and relatives and also health care workers. From victim’s family that under observation are Ilyas (43); Mimin Setiawati (36); Ismawati (4) and Nanang. Health care workers, as Kartika Medika clinic’s owner, Ipah Latifza and Tarmizi are also observed.

              “Monitoring will be done during 17 days or two times incubation period since Ardiansyah casualty. The purpose is to prevent transmission of avian influenza H5N1 virus from bird to human or human to human”, says Heru Hermawan, team member of Bird Flu Eradication Kabupaten Bekasi. During 2009 bird flu spreading in poultries reported on two areas in Bekasi, they are Kecamatan Sukatani and Kecamatan Setu.

              Source: Indonesia local newspaper, Pikiran Rakyat. http://www.pikiran-rakyat.com/index.php?mib=news.detail&id=62416

              ===AvianInfluenzaIndonesia===

              Comment


              • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                Hospital Doctor Annisa Doubtful They contracting Bird Flu

                Monday, March 02, 2009 | 17:35 WIB

                TT Version:

                The head of the Service of Medis Rumah Sakit Annisa Kabupaten Bekasi, Dr Rina, said two doctors and an official who were taken the sample of his blood was still going to work. They also did not suffer the sign was sick the high fever, the cough and breathless. The "taking" of the "sample" of "blood in accordance with the standard" of the "Health of the Service that obliged each medical official after handling the bird flu patient must carry out the blood test," said Dr Rina, when being contacted on Monday (2/3). Concerning the assumption of the occurrence of the spread, Rina was not convinced. The test of blood of the sample laboratory was still being carried out the Penanggulangan Nasional Body of Bird Flu. Results will be known two weeks more. He acknowledged the use of the medical implement like the mask, clothes were closed, and isolation space, not there is because they only carried out the beginning inspection. After that, the patient was reconciled to the Persahabatan Hospital, Jakarta Timur.

                Moreover, the medical inspection that was carried out against the patient was expected by bird flu, A, 8 years, also were carried out in normal inspection space. A died Ahad (1/3) then. "We did not provide isolation space because the patient must be at once reconciled," said Rina. The head of the Control of the Illness and Sanitation of Lingkungan Rudi Ruhdiat said his side monitored for two weeks to three medical officials. If emerging the complaint was sick, they were asked immediately to report. "We asked the Hospital side to report if the medical team had the complaint," he said.

                According to Rudi, the spread could through hingus [ingus = mucus] casualties who were inhaled through air. "Only indeed might not infected because we were still waiting for results" of the "laboratory test," he said to answer the matter of the indication of the spread of bird flu from the patient to the doctor.

                Comment


                • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                  4 Indonesians die of bird flu; toll climbs to 119

                  Krisnamurthi had little details about the latest deaths, saying only that two were siblings from the city of <st1:city w:st="on">Bogor</st1:city> and the others were women from Bekasi and <st1:city w:st="on"><st1:place w:st="on">Surabaya</st1:place></st1:city>.<o:p></o:p>
                  <o:p>
                  </o:p>
                  <o:p> </o:p>
                  The original news article announcing 119 dead from bird flu was published on February 11, so all four of these individuals would have to have been deceased prior to February 11.
                  <o:p> </o:p>
                  As noted by Niman and Fla Medic the two siblings from <st1:place w:st="on"><st1:city w:st="on">Bogor</st1:city></st1:place> would be Ruslani, who died about Jan 16, 2009 and his sister, Nural Hikmah, who also died on Jan 16, 2009. The woman from <st1:place w:st="on"><st1:city w:st="on">Surabaya</st1:city></st1:place> was Sutini who died Jan 24, 2009. The fourth individual, a woman from Bekasi, is difficult to identify. From Commonground?s posted on Feb 16, 2009 (see below), the only death in Bekasi prior to February 12 was the young child NAD who died on Jan 2, 2009. This individual however was included in the official WHO tabulation for <st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region> on Jan 22, 2009. There will have to be further clarification on the individual that died from bird flu in Bekasi between Jan 2, and Feb 11, 2009.
                  <o:p> </o:p>
                  Although this report is only now appearing on major wire services, it is only current through Feb 11, 2009. As noted in this thread, since mid February there have been several other individuals highly suspected with bird flu, mostly children, and several have died.
                  <o:p> </o:p>
                  <o:p> </o:p>
                  Bekasi

                  Nad (5) Adm: 1/2 From: Bekasi. Hospital: RSPI Sulianti Saroso. Recon: RS Hermina Bekasi on 12/27. Onset sym: 12/23. Bought chickens at the market for parents. Her cat died after eating the chicken she bought. Died: 1/2. Confirmed Positive.

                  Sukatani (in Bekasi)
                  2/14: <st1:place w:st="on"><st1:placename w:st="on">Sukamulya</st1:placename> <st1:placetype w:st="on">Village</st1:placetype></st1:place>. Rt 13/6. 30 Residents hot high & breathless. Given Tamiflu. Blood drawn from all 30.
                  2/15: 6 people infected.
                  2/16: Two Families (derived from 6 reported yesterday)
                  NY Ita: Mother
                  Syahroni (43): Father
                  Ipin (10) Child Being treated at Comm. Hlth. Ctr.
                  Family owned 19 Chickens

                  2nd Family:
                  Sri Rahaya
                  Jema
                  Arni

                  Mohamad Doas (possible suspect)
                  <o:p> </o:p>
                  http://www.flutrackers.com/forum/sho...7&postcount=75
                  http://novel-infectious-diseases.blogspot.com/

                  Comment


                  • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                    Commentary

                    Comment


                    • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                      Thank you everyone.

                      Comment


                      • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                        snip from long article, testing is going on of samples of the girl Nurul from Depok:

                        In the meantime, the side of Plt Head Health Section Hardiono said that the sample of Nurul blood was still continuing was researched by Health Service Depok and Health Service Provinsi West Java.

                        Hopefully the assumption suspect this bird flu did not develop became positive bird flu. We were still being waiting for results for four days in the future, he said.

                        He explained the sign of bird flu of the beginning indeed was difficult to be diagnosed because of resembling the sign of flu and the common fever.

                        The exception when the case of the death of the poultry in this environment happening, said Hardiono.

                        "Addressing chronic disease is an issue of human rights that must be our call to arms"
                        Richard Horton, Editor-in-Chief The Lancet

                        ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

                        Comment


                        • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                          Post #236...Dutchy I just happened to finish that long article. Took me a half hour...here it is:

                          Depok: One Child Died

                          03-Mar-2009

                          RANGKAPAN JAYA, MONDE: Nuruliza Mahmudah the daughter (5) the resident of the Village of Setu Asih Pulo RT 06/08 No 1 district of Rangkapan Jaya Pancoranmas died, on Saturday (on February 28). Nurul it was suspected suffered bird flu or suspect bird flu. On Monday (on February 23), Nurul suffered hot high and was reconciled to RS Bhakti Yudha. While five days underwent the maintenance of the child was diagnosed suffered dengue fever. The father Nurul, Mahmudin Sudin said results x-rayed showed that on his child's lungs was gotten by white circles small that increasingly the day increasingly grew. ?Dokter said had the indication that headed to flu burung,? he said.

                          Finally the side of RS Bhakti Yudha reconciled Nurul to RS Persahabatan that had facilities was more complete. The family complained about the slowness of the car ambulance that will be used to carry the patient. Finally Nurul was carried to RS Persahabatan on Friday anxious (on February 27) used ambulance belonging to RS Bhakti Yudha. Mahmudin that also Chairman Asosiasi of this Honorer Teacher said that the side of RS Bhakti Yudha made him disappointed with carried out the taking of the daughter's blood in ten points on his daughter's body. ?Saya did not have the heart to see my daughter's body was full of the former injection to take blood,? he said while terisak.

                          When undergoing the maintenance in RS Persahabatan, the doctor in this RS said that the Nurul condition still could be helped if this bird flu diagnosis more previously was proven. ?We regretted slow him RS Bhakti Yudha in diagnosing the illness that was suffered by the daughter us,? said Mahmudin. RS Persahabatan said that they have lifted the hands and said that the Nurul life expectancy remained at 50%. Mahmudin was still having difficulty trusted that his daughter was affected by bird flu. He said indeed a week beforehand had 50 chickens that died. However, the resident that burnt was not affected by the impact anything in fact had also the resident who ate chicken that died this.

                          The mother of casualties, Elisa, claimed still did not believe the daughter of his youngest child currently has not. ?Saya still believed not believed. This the dream or the reality? His process was too fast. ?Not yet had the assurance of our daughter died because of bird flu because of not yet having positive or negative results. However, from perlakuann him quite like that. The hospital side wrapped rapid an put our daughter's body in fact they not dared to every that bird flu.

                          Visited by Mayor

                          While Depok Mayor Nur Mahmudi Isma?il ended visited the residence of casualties's family sent up until yesterday the medical side did not yet determine that Nurul was affected by bird flu or just was limited suspect bird flu. ?Masih needed the research of the hospital side to determine whether this bird flu or not. Distan also has taken sample from the available poultry around.

                          However, the Mayor really regretted why the resident did not report the existence of the incident died suddenly around 50 poultries on February 11-18 2009. ?Seharus him after having the maximal incident 24 hours, the sample of blood was from the poultry that died suddenly taken to be researched. Now the matter of the refusal that was carried out by the RSUD side, according to Walikot, because the RSUD condition indeed was full of the patient DBD. Whereas the side of RS Bhakti Yudha also in fact carried out the maintenance.

                          When being questioned by the matter of the wrong existence of the diagnosis, the Mayor said that the indication of an illness occasionally had the characteristics of the resemblance so as to need the further research to ascertain him. Nur Mahmudi also delivered that although not yet having the provisions of the final, the patient suspect bird flu that died indeed must was treated like bird flu casualties to prevent the spread. ?Jika had the poultry that died suddenly and really, the resident was hoped for immediately reported to the related service to receive the handling immediately.

                          In the meantime, the side of Plt Section Head Kesehatan Hardiono said that the sample of Nurul blood was still continuing was researched by Dinkes Depok and Dinkes Provinsi West Java. ?hopefully the assumption suspect this bird flu did not develop became positive bird flu. We were still being waiting for results for four days to in the future,? he said. He explained the sign of bird flu of the beginning indeed was difficult to be diagnosed because of resembling the sign of flu and the common fever. ?Excluding when the case of the death of the poultry in the environment happening infected,? Hardiono words.

                          The head of the Penyehatan Lingkungan Ani Rubiani Field said that like that had the case of the death of the resident's poultry it was hoped to immediately reported. Officially Kesehatan will open the command post for two weeks to monitor. ?Kami opened the post in RW Siaga,? Ani words.

                          Comment


                          • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                            Indonesia reports 4 H5N1 deaths

                            Lisa Schnirring Staff Writer

                            Mar 3, 2009 (CIDRAP News) – An Indonesian health official said today that four more people have died of H5N1 avian influenza over the past month, as an Indonesian newspaper reported two more deaths possibly due to the disease.

                            Bayu Krisnamurthi, head of Indonesia's National Bird Flu Commission, gave few details about the four victims . Two were siblings from the city of Bogor in West Java province, and the two others were women from Bekasi, a suburb of Jakarta, and Surabaya in East Java province, the Associated Press (AP) reported today.

                            If the World Health Organization (WHO) confirms the cases, the country's count will rise to 145 cases and 119 deaths. For now, the total stands at 141 cases and 115 deaths.

                            Krisnamurthi said all four of the victims were believed to have had contact with sick poultry. He told Reuters that all four died in February.

                            Mike Coston, who authors the Avian Flu Diaryblog, provided a round-up today of additional details about the four cases, based on information that he and flu reporters at the FluWiki and FluTrackers blog sites have gleaned over the past several weeks from Indonesian media reports and other online sources.

                            He wrote that the siblings from Bogor appear to have been a 30-year-old man and his sister who died in mid January. A third sibling reportedly had a high fever, but refused medical treatment. The woman from Surabaya was most likely an 18-year-old who died at Sutomo Hospital in Surabaya in late January, Coston wrote. He added that five healthcare workers there were reportedly quarantined with severe flulike symptoms, but there was little follow-up news other than that two of them tested negative for the H5N1 virus.

                            Several reports of suspected H5N1 cases have come out of Bekasi over the past 2 months, making it difficult to infer the identity of the Bekasi woman mentioned in Krisnamurthi's total today, Coston wrote.

                            Indonesia's last H5N1 cases were reported on Jan 22. One was in a 29-year-old woman from Tangerang district in Banten province who died in mid December, and the other was in a 5-year-old girl from Bekasi who got sick in late December and died on Jan 2.

                            Last June, Indonesia announced that it would no longer provide immediate announcements of individual avian flu deaths, opting instead to give periodic updates.

                            In other developments, the Indonesian Republika newspaper today reported two more H5N1 deaths, both which occurred over the weekend near Jakarta, Reuters reported. The patients were a 5-year-old girl from Depok and an 8-year-old boy from Bekasi. The National Bird Flu Commission said the children's samples were sent to Jakarta to confirm the cause of death.

                            Indonesia has had more H5N1 cases and deaths than any other nation. The WHO's current global H5N1 count, which doesn't yet reflect the four Indonesian case-patients, stands at 409 cases, 256 of them fatal.

                            See also:
                            Mar 3 Avian Flu Diary blog post
                            Jan 21 CIDRAP News story "2 Indonesian cases push global H5N1 death toll over 250"
                            WHO global H5N1 case count

                            Comment


                            • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                              Originally posted by niman View Post
                              Indonesia reports 4 H5N1 deaths

                              Lisa Schnirring Staff Writer

                              Mar 3, 2009 (CIDRAP News) ? If the World Health Organization (WHO) confirms the cases, the country's count will rise to 145 cases and 119 deaths. For now, the total stands at 141 cases and 115 deaths.
                              The above is a rather curious wording for the process of WHO confirmation. WHO no longer independently confirms cases in Indonesia (in the past NAMRU-2 in Jakarta confirmed cases and then sent samples out to WHO regional affiliated labs in Atlanta (CDC) and Hong Kong (HKU).
                              It would appear that at this time updates and revised case counts just require Indonesian approval.

                              Comment


                              • Re: Indonesia: The Latest Human Suspected &amp; Confirmed Cases January 29 +

                                Congratulations to the news analysts!

                                "...Mike Coston, who authors the Avian Flu Diary blog, provided a round-up today of additional details about the four cases, based on information that he and flu reporters at the FluWiki and FluTrackers blog sites have gleaned over the past several weeks from Indonesian media reports and other online sources...."

                                Comment

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