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  • INDONESIA - Garut Cluster PART I

    Indonesian girl dies of suspected bird flu <!-- END HEADLINE --><!-- BEGIN STORY BODY -->26 minutes ago


    A suspected bird flu victim who is from the same area as Indonesia's latest confirmed case died in hospital, a health official said.
    The nine-year-old girl, Ai Siti Aminah, was from Cikelet in West Java's Garut district, said Wijayanti, a doctor from Garut's main hospital. It is the same area as a 17-year-old confirmed two days ago as infected with H5N1.
    Wijayanti told AFP that the girl, who was from a different village to the teenager, was admitted to hospital on Monday afternoon with pneumonia.
    "She was immediately taken to the isolation unit, had samples taken and then received treatment but her condition was already failing at the time. She remained unconscious until her death today," she said.
    Senior health ministry official Nyoman Kandun told AFP that laboratories in Jakarta had not released results of her tests yet.
    Positive tests must be returned at two separate laboratories in Jakarta before being listed by the World Health Organisation as a confirmed case.
    Seventeen-year-old Umar Aup was listed as Indonesia's 57th confirmed case of H5N1 on Sunday. Forty-four of those died, making the nation the world's worst-hit.
    Another health official said Tuesday that a cousin of Aup had died showing symptoms of the virus more than a week ago.
    Iman Firmanulah, the head of the contagious disease section of Garut's health office, told AFP that Aup's cousin Misbah died on August 6 exhibiting bird flu-like symptoms.
    But 20-year-old Misbah was buried before samples were taken, he said.
    "We cannot positively say that he died of avian influenza but he showed symptoms that were similar to those of bird flu patients," he said.
    The health ministry's Kandun said he was being a considered a "probable positive" case.
    Firmanulah also urged Indonesia's health ministry to provide his office and Garut hospital with suitable equipment to treat patients.
    "Health minister (Siti Fadilah Supari) has appointed Garut hospital as a designated center for bird flu treatment, but don't just give us difficult tasks -- please also give us proper equipment," he said.
    He said Garut hospital lacked ventilation and defibrillation equipment and also needed vehicles for surveillance in isolated areas. It takes four hours by motorcycle to reach Cikelet, he said.
    Indonesia reported its first bird flu deaths in July last year and has seen a steady rise in its toll.


    http://news.yahoo.com/s/afp/healthfl...esia&printer=1

  • #2
    Re: Garut Cluster

    Commentary at

    http://www.recombinomics.com/News/08...1_Garut_3.html

    Comment


    • #3
      Re: Garut Cluster

      H5N1 Bird Flu Cluster in Garut Indonesia Grows to Three?
      Recombinomics Commentary
      August 15, 2006

      The nine-year-old girl, Ai Siti Aminah, was from Cikelet in West Java's Garut district, said Wijayanti, a doctor from Garut's main hospital. It is the same area as a 17-year-old confirmed two days ago as infected with H5N1.

      Wijayanti told AFP that the girl, who was from a different village to the teenager, was admitted to hospital on Monday afternoon with pneumonia.

      "She was immediately taken to the isolation unit, had samples taken and then received treatment but her condition was already failing at the time. She remained unconscious until her death today," she said.

      Seventeen-year-old Umar Aup was listed as Indonesia's 57th confirmed case of H5N1 on Sunday. Forty-four of those died, making the nation the world's worst-hit.

      Another health official said Tuesday that a cousin of Aup had died showing symptoms of the virus more than a week ago.

      Iman Firmanulah, the head of the contagious disease section of Garut's health office, told AFP that Aup's cousin Misbah died on August 6 exhibiting bird flu-like symptoms.

      But 20-year-old Misbah was buried before samples were taken, he said.
      "We cannot positively say that he died of avian influenza but he showed symptoms that were similar to those of bird flu patients," he said.

      The above comments describe three suspect H5N1 bird flu cases in Garut in West Java. Although H5N1 has only been confirmed in the only surviving member, the index case was the cousin of the H5N1 confirmed case and test results from the third member has not been released. However, these three cases appear to be forming a geographical cluster in West Java. These cases are in addition to the two confirmed fatalities in suburbs of Jakarta who also died with the past week.

      Five new cases on Jakarta are cause for concern. Although WHO updates cite contact with dead or dying poultry, the sequences released from the patients on Java do not match the poultry H5N1 sequences. Recent bird samples are being tested in Australia, but the first set of samples released are from birds from Wates in northern Sumatra and are closer to the Karo cluster, although there are also significant differences in that group also. However, those differences may be related to collection dates. Currently, there are no public bird H5N1 sequences from 2006.

      However, the Java cases have been reported for over a year, and all but one of the human sequences reported to date have the novel cleavage site, RESRRRKKR. These isolates also have changes in all eight gene segments that do not match the poultry isolates. Thus far the only match with the human sequences is with H5N1 from a cat in the Jakarta area..

      Comment


      • #4
        Re: Garut Cluster

        JAKARTA, Indonesia Bird flu is suspected in the death of a nine-year-old girl in Indonesia.
        If confirmed, she would be the 45th person in Indonesia to die from the H-five-N-one virus in just over a year.
        The H-Five-N-One strain has killed at least 139 people worldwide since it began ravaging Asian poultry stocks in late 2003. Indonesia has been hit hardest.
        Most human cases have been traced to contact with infected birds and is hard to catch. But experts fear the virus will mutate into a form that spreads easily among people, potentially sparking a pandemic.

        http://kvoa.com/Global/story.asp?S=5281740&nav=HMO6

        Comment


        • #5
          Re: Garut Cluster

          <TABLE cellSpacing=0 cellPadding=0 width=400 border=0><TBODY><TR><TD vAlign=top bgColor=#ffffee>


          The patient Suspect Bird Flu died in Garut the writer: Sugeng SumaryadiBandung -- MIOL: Ai Siti the message, 9, the patient suspect bird flu died, on Tuesday (15/8), around struck 15.30 WIB, after 24 hours were treated in RSUD Slamet, Garut, on Tuesday (15/8).The citizen of the Jojok Village, RT 01/11, the Cikelet Subdistrict, this Garut Regency was brought to RSUD Garut, on Monday (14/8) around struck 15.30 WIB.At "that time, the condition for casualties has been very heavy."He suffered the disturbance of the respiratory tract and hot high, like the sign of the bird flu sufferer, explained Director RSUD Slamet, Garut, Yati Maryati, on Tuesday.Casualties could receive the maintenance intesif and was placed in the special isolation the bird flu sufferer.He was also given several Tamiflu tablets and got respiratory aids.However, because his condition has been very heavy, medical efforts did not produce results.But, Yati still could not ascertain the cause of the death of casualties.From his clinical sign was similar to bird flu.But to ascertain him, said he, his side has sent the sample of his blood to Labkes Jakarta.In the meantime, Umar, 14, the citizen of the Rancasalak Village, the Cikelet Subdistrict, that also had been treated in RSUD Slamet, as the patient suspect bird flu, his condition gradually improved.Umar could be treated for three days in RS, before being brought had come home by his family."In fact, we forbade him to be brought came home, because in accordance with the procedure, he must be treated for seven days."But, we continued to monitor his condition, because he was treated the road in the Pamengpeuk Community Health Centre, explained Yati.(SG/OL-02).
          </PRE>
          </TD></TR><TR><TD colSpan=2></TD></TR></TBODY></TABLE>http://www.mediaindo.co.id/berita.asp?id=108935</P>

          Comment


          • #6
            Re: Garut Cluster

            Metrotvnews.com, Garut: A patient suspect bird flu in Garut finally had died on Tuesday afternoon (15/8).The patient was named Ai Siti Aminah (9 years) just one night underwent the maintenance in the regional Public Hospital (RSUD) Garut, West Java.The Ai Siti Aminah body rencanaya will be brought to his house tonight also.The citizen of the Jojok Village, the Cikelet Village, of this Cikelet Subdistrict was treated in the Garut regional Public Hospital since last Monday.Because of his sign that was similar to bird flu like breathless and the temperature of the high body, Siti Aminah was treated in isolation space with the handling suspect bird flu.RSUD Garut Director the doctor Yati stated, the cause of the Siti Aminah death was still being waiting for results of the test of blood of the sample laboratory from Health Research And Development, Jakarta.The sample of blood was sent yesterday and it was estimated just will be known by results two days more.()

            http://www.metrotvnews.com/berita.asp?id=22302


            </PRE>

            Comment


            • #7
              Re: Garut Cluster

              Post #1 by Niman in Today's Headlines: Indonesia Bird Flu Patient Refuses Treatment thread:

              "Health officials have said they suspect that many Indonesians have died from bird flu unreported because they no tests were performed."

              Why do you believe this is a cluster? Because they are in the same area? There may be many clusters....for all we know.

              Comment


              • #8
                Re: Garut Cluster

                Originally posted by Commonground
                Post #1 by Niman in Today's Headlines: Indonesia Bird Flu Patient Refuses Treatment thread:

                "Health officials have said they suspect that many Indonesians have died from bird flu unreported because they no tests were performed."

                Why do you believe this is a cluster? Because they are in the same area? There may be many clusters....for all we know.
                A cluster is 2 or more patients with a link (could be familial or geographic). Three patients in the same area with symptoms within days of each other would be a cluster, and there may be many more, but this cluster is getting some media and WHO attention, which should generate more info (and the cousins have both a familial and geographic link - WHO's failure to mention the familial link is also a red flag)

                Comment


                • #9
                  Re: Garut Cluster

                  Thanks Dr. Niman, I want to go research and see if we've had clusters before in the middle of August. I've only been following this since March.

                  Comment


                  • #10
                    Re: Garut Cluster

                    Originally posted by Commonground
                    Thanks Dr. Niman, I want to go research and see if we've had clusters before in the middle of August. I've only been following this since March.
                    The first report case in Indonesia was a cluster in Tangerang (3 family members) in July of 2005 and the second was at the end of August (another cluster of 2 - aunt and nephew) in Jakarta (both of these clusters were close to the receent confirmed cases in Bekasi and Tangerang)..

                    Comment


                    • #11
                      Re: Garut Cluster

                      Liputan6.com, Garut: A positive patient bird flu in the regional Public Hospital Doctor Slamet, Garut, West Java, died, on Tuesday (15/8) struck 15.00 WIB. Siti Fatimah was the bird flu patient who was treated from the hospital in the critical condition since several days set.Siti was one of the bird flu patients who came from the Cikelet Village, the Pameungpeuk Subdistrict, Garut South.The female child was 9 years old was reconciled from the Cikelet Community Health Centre.He was treated with the other patient who was named Umar.The man was 17 years also old came from the Cikelet Village and only could be treated a day in RSUD Slamet.However he forced came home because of not having the medicating cost.The side of RSUD Slamet and the Garut Health Service could follow Umar in his house after being based on his laboratory inspection was stated positive bird flu.However Umar and his family insisted on refusing to be treated.Dinkes Garut at once determined the status of the extraordinary incident bird flu resulting from this case.Up to now bird flu casualties who died in Indonesia reach 47 people.As for since July 2005 set was gotten by 61 positive cases of bird flu.With this condition for Indonesia occupied the first level in the world for the death rate of the bird flu sufferer.The department of the RI Health stated Indonesia still in the stage was on the alert the spread of bird flu antarmanusia [read: Oki and Megi Positive Terjangkit Bird Flu].(ZIZ/Tim Coverage 6 SCTV)</PRE>
                      http://www.liputan6.com/view/7,12750...155650339.html</PRE>

                      Comment


                      • #12
                        Re: Garut Cluster

                        Originally posted by Commonground
                        Thanks Dr. Niman, I want to go research and see if we've had clusters before in the middle of August. I've only been following this since March.
                        Not in August. In July 2004 in Vietnam in Hai Giang (3 cases) and in 2005 in Tangerang in Indonesia (3 cases).

                        (http://www.cdc.gov/ncidod/EID/vol11no11/05-0646.htm)
                        http://novel-infectious-diseases.blogspot.com/

                        Comment


                        • #13
                          Re: Garut Cluster

                          Originally posted by Commonground
                          Thanks Dr. Niman, I want to go research and see if we've had clusters before in the middle of August. I've only been following this since March.
                          Here is more info on the first cluster (July, 2005 - father's H5N1 is A/Indonesia/5/05)

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

                          http://www.recombinomics.com/News/07...Tangerang.html

                          here's the second cluster (August 2005) and suspect cases (only the aunt and nephew were confirmed - aunt's H5N1 is A/Indonesia/6/05 and is only human Java isolate without the novel cleavage site)

                          http://www.recombinomics.com/News/09...l_Phase_5.html

                          Comment


                          • #14
                            Re: Garut Cluster

                            Cousin of Indonesian bird flu case dies with flu-like symptoms

                            Jakarta (ANTARA News) - A cousin of Indonesia's latest bird flu
                            patient died showing symptoms of the virus more than a week ago, a health official said Tuesday as he pleaded for more medical equipment.

                            Seventeen-year-old Umar Aup, from Cikelet in West Java's Garut district who has refused hospital treatment, is Indonesia's 57th confirmed case of H5N1.


                            Forty-four of those were fatalities, making the nation the world's worst-hit.

                            Iman Firmanulah, the head of the contagious disease section of Garut's
                            health office, told AFP that Aup's cousin Misbah died on August 6 exhibiting bird flu-like symptoms.

                            Both youths had come into contact with dead poultry.

                            But 20-year-old Misbah was buried before samples were taken, he said.

                            "We cannot positively say that he died of avian influenza but he showed
                            symptoms that were similar to those of bird flu patients," he said, adding that any decision to exhume the body was outside his jurisdiction.

                            Samples from Misbah's parents had since been taken for testing, he said.

                            Firmanulah also urged Indonesia's health ministry to provide his office and Garut hospital with suitable equipment to treat patients.

                            "Health minister (Siti Fadilah Supari) has appointed Garut hospital as a
                            designated center for bird flu treatment, but don't just give us difficult tasks -- please also give us proper equipment!" he said.

                            He said Garut hospital lacked ventilation and defibrillation equipment and also needed vehicles so they could carry out surveillance in isolated areas. It takes four hours by motorcycle to reach Cikelet, where the current patient is, he said.

                            Indonesia reported its first bird flu deaths in July last year and has seen a steady rise in its toll.

                            The world's first lab-confirmed human-to-human transmission of bird flu
                            occurred in Indonesia three months ago in a cluster of seven deaths, sparking serious concern among scientists. (*)<!-- google_ad_section_end -->

                            Copyright 2006 ANTARA
                            August 15, 2006 14:58
                            http://www.antara.co.id/en/print/index.php?id=18370
                            Last edited by Sally Furniss; August 16th, 2006, 04:44 PM. Reason: formatting
                            "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

                            Comment


                            • #15
                              Re: Garut Cluster

                              Thanks Laidback Al & Dr. Niman, now I've got some background. Very interesting....to say the least. For any new people just starting to learn about H5N1, here is a chart you may be interested in.

                              Table. Family clusters of influenza A (H5N1) in Southeast Asia, January 2004–July 2005*

                              http://www.cdc.gov/ncidod/EID/vol11n...0646.htm#table

                              Comment

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