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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
If I recall correctly from prior posts [more than] a year ago here, objective analyses of the 1918 epidemic deaths showed Dengue was either an accompanying, or unusually frequent cause of 1918 deaths. However, perhaps the 1918 Dengue definition and current are different.Originally posted by niman View Post
Logistically, there will be lot of PacRim contacts as the Olympics conclude and travelers return to their countries via air connections. It would be best for WHO to publish promptly what the Sumatran thing is all about."Recommendations on how to confront a pandemic in populations must be relentlessly practical; if they are anything less, they shouldn?t be taken seriously."Dr. David S. Fedson,M.D.Comment
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
Dengue was a frequent misdiagnosis for pandemic H1N1 in 1918.Originally posted by e_armigeri View PostComment
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
I urge ProMED-mail, which is a program operated by the International Society of Infectious Diseases (ISID), to continue surveillance of suspected H5N1 cases in Indonesia without the confirmation of such cases by any entity. Whether these individuals were infected by H5N1 is not material as far as investigation is concerned. They may be infected by any number of infectious diseases and their disease status is of importance to the world.
From the front page of the ISID website (underlining Fla1):
"The ISID is committed to the concept that what happens in a remote village oceans away is important to world health. Since many infectious agents are equal opportunity pathogens, citizens of developed countries are often as vulnerable as poor natives in distant communities. Furthermore, timely international communication is essential for control. All of these concepts were clearly illustrated with the emergence and global spread of the SARS pandemic. In fact, ProMED-mail was the first active surveillance system to notify the world of the outbreak that would later be known as SARS and did so weeks before international attention became riveted on this problem.
The international transmission of known and currently unknown pathogens is an ineluctable fact of nature. But members of ISID can make a difference with the clinical recognition, global reporting, laboratory discovery, worldwide education, policy development, prevention and control. Ours is a vibrant society committed to global health. You too can make a difference in your career by joining us..."
In response to the ISID decision FluTrackers.com is opening a new forum at the bottom of this site located here.
We have established a new email address to receive reports. Please make reports of suspected H5N1, or any other infectious or interesting disease phenomena to:
reportbirdflu@flutrackers.com
Our moderators will review for posting. Amongst our moderators are some of the most knowledgeable persons in the world on the subject of H5N1.
Thank you!
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
LABUHANBATU BERJIBAKU interrupted the CHAIN H5N1.
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The official Dinkes and the Service of Peternakan gave the explanation concerning the bird flu danger and his handling.
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On Monday, August 11 2008 10:03 WIB Metrotvnews.com, Labuhanbatu: the Labuhanbatu Regency, North Sumatra (North Sumatra), was stated alert one bird flu. This status was dismissed following the discovery of thousands of poultries that died suddenly in two last weeks. The data of Dinas Peternakan North Sumatra named the virus H5N1 infected thousands of poultries in six districts in Rantauprapat. Now the poultry that died more than 1,000 tails.
despite this was not yet found by the resident that terjangkit this deadly virus. To interrupt and prevent the spreading of bird flu, the Service of Peternakan North Sumatra followed various methods. One of them gave the mass vaccination, epopulasi, and carried out spraying in poultry centres.
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Also was made the bird flu command posts in the area that terindikasi terjangkit. Like in the Alhuda Environment, the Sirandorung District, the North Shoreline. In two last weeks in this territory as many as 250 poultries died suddenly. Apart from the socialisation, also was carried out by spraying with the guidance from the Peternakan Labuhan Batu Service. According to the Village Head Sirandorung Umar Dani Siregar, spraying was just carried out by Ahad yesterday.
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The plan is, spraying will be carried out continuously. To the resident was appealed to to destroy his livestock of the kind of the property poultry. The resident was also asked for to immediately report when in his environment was found by the indication of the spreading of bird flu. This was carried out to interrupt the chain of the spreading of bird flu. (the SHOT)
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Petugas Dinkes dan Dinas Peternakan memberi penjelasan mengenai bahaya flu burung dan penanganannya.
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Re: Suspected Bird Flu Outbreak in Indonesia Hospitalizes 13, 3 Suspected Deaths
CommentaryOriginally posted by niman View Post
WHO H5N1 Investigation In Sumatra Indonesia Raises Concerns
Recombinomics Commentary 22:42
August 10, 2008
The United States consulate general (the USA) in Medan also asked about the situation and the last condition for the Damuli Hut community, the IV Village, the Air Batu Village of 39,Kecamatan Air Batu, this Regency
Experts from the World Health Organisation (WHO) had arrived in the affected village in North Sumatra to help investigate the possible outbreak and the sudden death of three residents last week, a provincial health official said.
The above comments on the outbreak in Medan reflect the level of concern of non-Indonesian agencies with the situation in Medan. As noted, three patients died with bird flu symptoms, and additional patients were hospitalized. Although these patients are said to have tested negative, poultry in the region is H5N1 positive.
The presence of a WHO team, in the absence of confirmed H5N1 cases, is unusual, and raises concerns that there has been unreported lab evidence of H5N1 in patients in the region.
This region has had a history of confirmed or suspect clusters. The largest confirmed cluster was in Karo over two years ago, The cluster was linked to clear human to human to human transmission which led to increased surveillance of poultry in the region.
That cluster was followed by a cluster of similar size, but those patients tested negative. However, negative testing in Indonesia remains highly suspect. False negatives can be generated by widespread and aggressive Tamiflu use and the suspect sensitivity of the testing in Indonesia. In addition to the largest number of confirmed H5N1 cases and the largest number of confirmed H5N1 deaths, Indonesia also has the highest case fatality rate, over 80%, raising concerns that milder cases are either not tested or test negative.
Indonesia?s failure to test H5N1 infected patients in clusters is also cause for concern. Recent confirmed cases have been associated with relatives who die with bird flu symptoms, but these fatalities are said to be lung inflammation, typhus, or dengue fever.
These clusters, representing limited human to human transmissions have been followed by a new policy of delaying reports of cases. International Health Regulations require notification of WHO 24-48 hours after confirmed cases. Although WHO has stated that they have a good relationship with Indonesia, the WHO updates have been delayed and the two confirmed cases in Tangerang in July have not yet been reported in WHO updates, indicating Indonesia is not reporting these cases in violation of IHR requirements, or WHO is withholding reports of these confirmed cases in their situation updates, which report cases within a day or two of confirmation.
The WHO team on the ground, coupled with reporting failures by Indonesia and WHO, continue to raise concerns about the true situation in the Medan region of North Sumatra.
."The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller FoundationComment
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Re: Suspected Bird Flu Outbreak in Indonesia Hospitalizes 13, 3 Suspected Deaths
CommentaryOriginally posted by niman View Post
Indonesian Denials of H5N1 Cases In Sumatra Raise Concerns
Recombinomics Commentary 00:18
August 11, 2008
A senior health official says 13 villagers hospitalized with bird flu-like symptoms in western Indonesia have tested negative for the disease.
Nyoman Kandun said the test results came back negative on Saturday and the patients' conditions are improving.
He says dozens of chickens started dying last week from the H5N1 bird flu virus in Air Batu, a village on Sumatra Island, sending panicked residents rushing to a nearby hospital.
The above comments provide an update on the situation in northern Sumatra, but it is not convincing. H5N1 is endemic in poultry in Indonesia, and the fully extent is unclear because Indonesia has not filed an OIE report since 2006. Although their reporting requirement is every six months, since they declared H5N1 endemic, they have not met the six month requirement.
Similarly, they have not released any sequence data on human H5N1 isolates since early 2007, and have only sent samples from a handful of patients who have died in the past 18 months. Their recent announcement that they will limit reports on human cases, and the absence of WHO confirmation of the patients who were confirmed in July, continues to raise concerns due to lack of transparency.
These changes happened while clusters were obvious, even though Indonesia denied their existence. One of the clusters was specifically denied by Kandun, who stated that the brother of an H5N1 fatal case died of dengue fever.
This is of concern, because now media reports are stating that the patients who are being hospitalized with bird flu symptoms are being diagnosed with dengue fever. The association of H5N1 positive poultry, patients with bird flu symptoms, including fatal cases, and a diagnosis of dengue fever, are cause for concern.
Clarification of the situation by the WHO team on the ground in northern Sumatra would be useful.
."The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller FoundationComment
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
CommentaryOriginally posted by niman View Post
Dengue Fever Diagnosis In Sumatra Raises Concerns
Recombinomics Commentary 02:11
August 11, 2008
The concerned atmosphere was mixed with panic covered casualties's family from the Asahan Regency, they expected his two children terjangkit bird flu because by chance their area was found by casualties suspect bird flu. ?Melihat our child's fever did not descend-descended we concerned was mixed with panic, we suspected our child of being affected by bird flu because in our area was found by bird flu casualties but after being brought by us to this hospital and results were stated positive DBD not flu burung? clear Zuhaina the mother Fitra and Aiman to the reporter.
the Team of the doctor suspected the patient of being suspected of by bird flu having the initials F (7) was attacked by dengue fever dengue fever or DBD. the Content trombosit in the F body was below normal.
We were not sure the dengue fever attack happened from here (Medan), said public relations of RSUP Adam Malik Medan Sinar Ginting, on Sunday (10/8).
The volunteer furthermore was assigned to monitor 5 to 10 families that suffered the sign of bird flu.
The above translation describes the hospitalization of more patients with bird flu symptoms. These comments suggest multiple members from the same family are being hospitalized, and some reports have piu the number of patients seeking treatment above 70. The above translation indicates some patients being hospitalized in Medan are being diagnosed with dengue fever.
Fatal dengue fever cases are being reported in other cities in the area, which raises additional concerns. In the past, H5N1 patients have been misdiagnosed as dengue fever because symptoms are similar, especially for the more serious dengue hemorrhagic fever. However, the dengue fever diagnosis for a family member of a confirmed H5N1 case raised serious questions about an increased reliance of a dengue fever diagnosis to reduce the number of confirmed H5N1 cases. This diagnosis was of particular concern because it was repeated by the Director General at the Ministry of Health, Nyoman Kandun, who has also indicated the the dramatic increase in hospitalized patients is due to villager concern over the H5N1 poultry. However, H5N1 positive poultry is common in Indonesia, where it has been declared endemic.
Recently, WHO has dispatched a team to North Sumatra in the absence of any confirmed H5N1 cases, raising concerns that the public denials of cases is inconsistent with the situation on the ground. Similarly, Japan agreed to supply an additional 500,000 courses of Tamiflu to southeast Asian countries, raising additional concerns regarding the situation in Indonesia. The earlier shipment of 500,000 courses of Tamiflu was stored in Singapore, which is adjacent to North Sumatra.
More information on the patients with bird flu symptoms and those being diagnosed with dengue fever would be useful.
."The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller FoundationComment
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
CommentaryOriginally posted by niman View Post
ProMED Halts Reports Of Suspect H5N1 Cases in Indonesia
Recombinomics Commentary 02:54
August 11, 2008
Until further notice, ProMED-mail will not report suspected human cases of avian influenza in Indonesia until they have been confirmed by the Indonesian Ministry of Health.
The above statement by ProMED is unfortunate. It is in response to Indonesia's failure to confirm H5N1 in the 13 hospitalized patients in North Sumatra. Indonesia's track record on confirming H5N1 patients has been poor. In addition to having the largest number of confirmed H5N1 cases and confirmed H5N1 deaths, it also has the highest case fatality rate, raising questions about its ability to detect non-fatal cases of H5N1.
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Although Indonesia has failed to recently confirm H5N1 in patients in North Sumatra, H5N1 has been confirmed in poultry and three patients recently died with H5N1 symptoms. However, these patients were not tested for H5N1, which is still not uncommon in Indonesia.
The number of hospitalized patients continues to rise, and some are being diagnosed with dengue fever. However, Indonesia's record on diagnosing H5N1 patients as dengue fever cases has also raised concerns, especially when the dengue fever diagnosis is confirmed by the Minister of Health even when the sister of the dengue fever patient tested positive for H5N1.
The presence of a WHO team investigating the three fatal cases is unusual, especially since no H5N1 cases in humans has been reported.
ProMED's reliance on confirmation by the Indonesian Ministry of Health is unfortunate. The Ministry of Health has yet to issue a report the lab confirmed cases from July, and they have stated that they will report cases on a delayed basis.
ProMED's aiding and abetting of this diminished transparency in Indonesia, the country with the highest number of confirmed H5N1 cases in the world, should not stand.
."The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller FoundationComment
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
I am confused. The Indonesian MoH statement of 9th August (the only one formally posted) reads as follows, and nowhere is there any mention of a positive diagnosis of Dengue.
From Dep of Health
Twelve Residents of Dusun IV Air Batu Asahan are AI Negative
09 Aug 2008
Result of Real Time Polymerase Chain Reaction (RT-PCR) test by National Institute of Health Research and Development (Balitbangkes Depkes) is negative of avian influenza (AI) virus to 12 residents of Afdeling 5 Damuli Dusun IV Air Batu, Asahan District, North Sumatera .
Now they are hospitalized in Kisaran District Hospital and Adam Malik Hospital, Medan . Those who are in Adam Malik Hospital, Medan (AI referral hospital) are FH (f, 7 year) and MSM (m, 8 year), getting better, while the remains are in Kisaran District Hospital.
This latest information is received by Center for Public Communication from MoH AI Post on August 9, 2008.
The cases were found during active surveillance on August 5�7, 2008 by North Sumatera Provincial Health Office and Asahan District Health Office.
Therefore, some efforts are attempted, such as free hospital treatment, oseltamivir provision, taking and delivering specimen to MoH Balitbangkes, suspect observation, contact surveillance and health information.
By now, MoH team is still implementing active surveillance to detect new cases as well as Communication, Information and Education on Avian Influenza.
Rapid Test by Asahan District Farming Office and Veterinar laboratory research of North Sumatera Provincial health Office to 15 birds (chicken and duck) suddenly dead on July 28, 2008 in Afdeling 5 Damuli Dusun IV Air Batu, Asahan District, figured out AI positive infection.
Mostly people in Afdeling 5 Damuli Dusun IV Air Batu are bird (chicken, duck and wild duck) farmers, usually for consumed and sold out. The coops are usually right next to the house, and sometimes the birds are not cooped.
Children usually wear no sandal when playing around while birds are freely on the surrounding. The sanitation in that village has not met the health requirements. It could be the risk factor, especially in AI infected areas.
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
You aren't alone!
I am also confused.
Until now, avian influenza virus H5N1 infections in human have a severe clinical outcome with a variable case-fatality rate that ranges from 33 to more than 85 per cent (since its appearance in HK in 1997).
In some countries, cfr was lower than others (Vietnam, Egypt, Turkey vs Cambodia, Thailand, China and Indonesia), in relation to specific H5N1 sub-lineage and time onset.
Clinical features range from influenza-like illness (sudden onset with high fever and chills, rapid deterioration of breath funcions, multi-organ failures), to gastro-intestinal tract symptoms (diarrhoea, votiming), shock (with hemorrhages), primary viral pneumonia.
To date, no clear data is available to state that mild form of H5N1 influenza infections in human happened.
Clearly, it is possible that more human cases with mild or asymptomatic presentation were totally overlooked, in special mode in some countries with very poor health care services.
Sero-surveys demonstrated low or non-existence of prior H5N1 immunity in people even in areas with widespread epizootics. However, it is difficult to detect H5 antibody and requires advanced laboratory equipment, adeguate personnell training and proper collection and handle of samples.
Thus, there aren't enough proven data that mild or asymptomatic cases haven't occurred in the past.
Also, in poor health care settings might be the case that severe respiratory illnesses with fatal outcome were overlooked because the age of patients (elderly, disabled people) or their later-stage illness.
When a poor, elderly patient die at home, it may be that he is buried without medical counselling. And this is another chance for reduce cases detection sensitivity.
In Sumatra suspected cluster, at least for the two Medan children hospitalized one may argue that a CAP self-limiting pneumonia no linked with influenza A/H5N1 is the culprit. Rapid resolution of pneumonia and recovery of children is suggestive for an infecton less virulent than human H5N1 one.
Dengue fever and dengue hemorrhagic fever and two distinct conditions caused by dengue viruses.
Dengue fever is sometimes self-limiting disease and its initial stage mimic an influenza-like condition. It is uncommon the development of pneumonia.
Dengue hemorrhagic fever is sometimes fatal (less than 10 per cent of cases if promptly treated in hospital with trained hcws) and it is characterized by low platelets counts, coagulopathy and rapid development of shock.
I think that if the health care officials would send a clear picture of current epidemiological situation may be enough to declase with more openess the clinical description of cases, the outcome and laboratory findings even without aetiological isolation of causative agents.
There are a lot of conditions that may mimic H5N1 in humans (malaria, tb, measles, for example) but if no clear picture of the clinical, pathological and epidemiological features, we continue to remain in the mist and rumors could spread rapidly, damaging further a yet frail economy.Comment
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
Post #164:
I'm also a little confused.Monday, 11-08-2008
In the meantime, RSU Haji public relations Adam Malik Medan Sinar Ginting, on Sunday (10/8), said, the condition for two patients suspect bird flu has from shavings that were treated begun to improve, including one of the pre-school casualties berinsial MSM, where being pulled out by his infusion. [B]His side currently is waiting for results of the laboratory of Department of Health RI, Jakarta.[/B]Comment
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
Bird flu alert
Mon, 08/11/2008 10:33 AM | Headlines
Indonesia has been the worst hit by the bird flu epidemic, with more than 110 people dead. The virus has struck again, with at least 11 people hospitalized in North Sumatra. What's wrong with the government program handling the problem? Send your thoughts by SMS to +62 811 187 2772. Please include your name and city.
--Editor
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Re: Suspected Bird Flu Outbreak in North Sumatra (Air Batu, & Environs) Indonesia
My computer isn't working very well. Here's a story:
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