Announcement

**Giuseppe** · August 31, 2012, 04:22 AM

Re: Indonesia - H5N1 mortality high, Aditama suggests a change in the virus

Unfortunately, the Indonesia authorities continue to not disclose the actual number of human cases on H5N1 avian influenza virus infections so any conclusion about an increased mortality among infected patients remains unfounded.

Indonesia is among a number of countries with H5N1 endemic outbreaks in poultry in Asia and elsewhere where the number of sporadic human cases is almost unknown for several reasons.

This is revealing very dangerous from a global public health perspective. (GM)

**sharon sanders** · September 1, 2012, 03:03 PM

Re: Indonesia - H5N1 mortality high, Aditama suggests a change in the virus

Originally posted by Laidback Al View Post

Death from Bird Flu Still High

Kamis, 30 Agustus 2012 | 06:45 WIB

Jakarta, Kompas - Cases of bird flu that lead to death are still high. In fact, deaths from bird flu in Indonesia is the highest in the world. . . .

Director General of Disease Control and Environmental Health Ministry Tjandra Yoga Aditama, Wednesday (29/8), said the high mortality factors associated virus (H5N1) and human. "So far the virus is different from the previous virus," said Tjandra. The Ministry of Health is to analyze possible differences in viral malignancies, but no confirmation yet.

Tjandra confirmed bird flu infection have occurred from human to human. Transmission is from patient contact with the animal source, though not always detected.

The cause of death due to delays in getting help. Drug oseltamivir bird antiflu effective if given within 48 hours of symptom onset. "Bird flu is difficult to distinguish from the common cold at first," he said. Health workers receive training on bird flu must be alert to the possibility of bird flu infection.

Experts biomolecular of Avian Influenza-zoonotic Research Center-University of Airlangga, CA Nidom, say, bird flu could become a time bomb in Indonesia. Source of transmission, ie, infected poultry, still exist and live together with the seasonal flu virus carriers. "Viruses can mutate or exchange genes. Also opens the possibility of transmission of H5N1 between humans, "he said. . . .

Kematian akibat Flu Burung Masih Tinggi

http://health.kompas.com/read/2012/08/30/06453717/Kematian.akibat.Flu.Burung.Masih.Tinggi

Kasus flu burung yang berujung pada kematian masih tinggi. Bahkan, kematian akibat flu burung di Indonesia tertinggi di dunia.

Is Dr. Tjandra suggesting that the 100% case fatality rate is real (or close to it) and not a statistical anomaly due to the few number of cases being reported?

Our chart with links to WHO:

#183 - Male, 23, onset date December 31, hospitalized January 3, 2012, died January 7 - Jakarta province Death

#184 - Female, 5, family member of case #183, onset date unknown, hospitalized January 7, died on January 16 - Jakarta province Death

#185 - Female, 19, onset date February 8, hospitalized February 12, died on February 13 - Tangerang, Banten province (near Jakarta) Death

#186 - Male, 12, onset date February 11, hospitalized February 16, died on February 21 - Badung, Bali Death

#187 - Female, 24, onset date February 23, hospitalized February 24, died March 1 - Bengkulu, Sumatra Death

#188 - Male, 17, onset date February 28, hospitalized March 7, died March 9 - West Lombok, West Nusa Tenggara Death

#189 - Male, 2, onset date April 17, hospitalized April 21, died April 27 - Riau Province Death

#190 - Female,8, onset date June 18, hospitalized June 24, died July 3 - West Java Death

#191 - Male 37, onset date July 24, hospitalized July 27, died July 30 - Yogyakarta Province Death

**Vibrant62** · September 1, 2012, 04:42 PM

Re: Indonesia - H5N1 mortality high, Aditama suggests a change in the virus

There are anomalies in the report.

The cause of death due to delays in getting help. Drug oseltamivir bird antiflu effective if given within 48 hours of symptom onset. "Bird flu is difficult to distinguish from the common cold at first," he said. Health workers receive training on bird flu must be alert to the possibility of bird flu infection.

This suggests that people who seek help early enough, survive. Survival cases are not reflected in the data of 100% mortality, so this implies that there are cases treated early enough, who are not reflected in the figures.

This comment is not intended to underestimate the risks of H5N1 in Indonesia, and I think any report of a change in the virus must be taken seriously. However, I wonder about how much of a PR exercise this report might be re: international funding. Culling, economic losses to the country etc as a result of H5N1 control measures are a serious issue for this region of the world - and it is not a rich country.

**Laidback Al** · September 2, 2012, 11:18 AM

Re: Indonesia - H5N1 mortality high, Aditama suggests a change in the virus

Obviously with the world’s largest number of confirmed human H5N1 cases, Indonesia has the expertise to diagnose human cases of H5N1. Health authorities ought to be able recognize some cases early enough to administer a life-saving antiviral. They have certainly done so in the past.

As note by Vibrant62 above, the comments suggest that there are 2012 H5N1 survivors in Indonesia, even though as pointed out by Sharon, every H5N1 case in Indonesia so far in 2012 has been reported as a death.

IHR require that all H5N1 cases be reported, not just the deaths. The political rational by Indonesia for not reporting H5N1 survivors is not clear.
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Announcement

Indonesia - H5N1 mortality high, Aditama suggests a change in the virus

Indonesia - H5N1 mortality high, Aditama suggests a change in the virus

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