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  • Lampung - 99 students suspected with H1N1, 8 in treatment

    credits to dbg for translation and bolding . . .

    Dozens Of Students Suspected Of Swine Flu [Lampung]
    [January 19, 2011]

    Lampung - Dozens of students at a boarding school, in Metro Lampung suspected swine flu virus. Until Monday (17,01,11) afternoon they were still treated in isolation rooms in boarding school, while others treated at the clinic. The number of swine flu has reached 99 people. But most of his condition improves, only 15 students are admitted to intensive.

    The result of the examination while 78 students Muhsin boarding school in Purwosari Metro, Lampung allegedly attacked by the virus H1N1 or pig flu, not bird flu as originally expected. Until Monday afternoon, the number recorded is 99 students, but some have been improved.

    Local Health Department stated, this case has been categorized as KLB or exceptional cases. However, to ensure currently a team of doctors are still waiting for lab test results of blood samples of patients. Of 99 students who allegedly contracted the flu, 8 of them critical condition and still get intensive treatment at the isolation room in the boarding school and seven students admitted to the nearest health center.

    The ill patients generally suffer high fever, nausea and cough and prolonged cold symptoms resemble the beginning of a outbreak of bird flu virus. Initially they were allegedly attacked by bird flu since before the case came, dozens of birds around the school sudden death.

    http://www.indosiar.com/fokus/89059/...rduga-flu-babi
    http://novel-infectious-diseases.blogspot.com/

  • #2
    Re: Lampung - 99 students suspected with H1N1, 8 in intensive care

    Comment: Incidences of flu in closed environments such as boarding schools and prisons provide a unique insight into the transmission and severity characteristics of any viral illness that takes hold in that setting.

    There is no indication of the size of this boarding school i.e the total number of pupils and teachers, and this information would be useful to allow some objective assessment of this outbreak.

    However, on the face of it, the figures are concerning and unusual, especially bearing in mind the probable age distribution of the students: of 99 patients contracting this flu, 15 have required intensive treatment (15&#37 and 8 are in a critical condition (8%). However, as treatment appears to be ongoing in the boarding school itself, it is not completely clear how serious their condition is.

    More information about the virus involved and the size of this school and its demographics would be helpful if anyone should come across this data.

    Comment


    • #3
      Re: Lampung - 99 students suspected with H1N1, 8 in intensive care

      According to recent information the boarding school "Al-Muhsin Ponpes Purwosari Metro" has 864 students.

      609 of them live day and night at the school and sleep in the dormitory.


      Media online yang dibuat khusus untuk pegiat teknologi di Indonesia.
      ?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


      • #4
        Re: Lampung - 99 students suspected with H1N1, 8 in intensive care

        On this basis, to date and at this stage of the outbreak, 99 students ill represents

        -11.5% of all students at the school infected to date of the entire school population
        - 1.7% have serious illness (but 15% of the infected group)
        - just under 1% of the entire school population are critically ill (but 8% of the infected group).

        If this report and our translation is accurate and this is indeed an H1N1 virus, this represents a massive increase in severity of swine flu.

        Sequence analysis of the virus must be an urgent priority.

        Comment


        • #5
          Re: Lampung - 99 students suspected with H1N1, 8 in intensive care

          Originally posted by Laidback Al View Post
          credits to dbg for translation and bolding . . .
          Of 99 students who allegedly contracted the flu, 8 of them critical condition and still get intensive treatment at the isolation room in the boarding school and seven students admitted to the nearest health center.
          When I originally read this I assumed the 'critical condition' translation was suspect as if 'intensive treatment' is roughly the equivalent of 'intensive care' how, and why, was it being administered at the school?

          The other, more worrying, question is why - if they had been working on the assumption it was H5N1 - is this the first we are hearing of it? If it had been, or is, H5N1 we need to know about suspected zoonotic emergences a lot more quickly, unless WHO's containment plan has been abandoned.

          Comment


          • #6
            Re: Lampung - 99 students suspected with H1N1, 8 in intensive care

            It does state that 7 have been admitted to the nearest health centre (which I presume is equivalent to the local hospital).

            I would guess that isolation within the school itself could be part of a containment plan to limit spread, and would tend to indicate that no more than medication etc is needed in immediate care, but that where ventilation etc is required, the students are being moved to hospital. All quite confusing, but still concerning even if we assume that our translations are in error.

            7 out of 99 infected patients requiring hospitalisation is still high.

            Comment


            • #7
              Re: Lampung - 99 students suspected with H1N1, 8 in intensive care

              As you say on the face of it worrying because the numbers are suspiciously high for H1N1(2009), or any seasonal flu, but low - and far too transmissible - for H5N1. Hopefully they will announce the basis for the 'swine flu' diagnosis and then some sequence data.

              Comment


              • #8
                Re: Lampung - 99 students suspected with H1N1, 8 in intensive care

                From: FluTrackers <flutrackers@earthlink.net></flutrackers@earthlink.net>
                To: ProMed
                Subject: Indonesia - 99 students suspected with H1N1, 8 in intensive care in Lampung boarding school - initially suspected bird flu
                Date: Jan 19, 2011 6:16 AM

                Comment


                • #9
                  Re: Lampung - 99 students suspected with H1N1, 8 in intensive care

                  Local health clinics (Puskesmas) are not hospitals, they offer basic healthcare.

                  You have 15 to 20 beds, 3 or so GP's and some nurses. Some of the Puskesmas can do X-rays, others can't . No ventilators, no ICU.
                  A lab for basic tests.

                  People go there for:

                  - mother & child care, sometimes a delivery
                  - vaccination, tuberculosis treatment (DOT)
                  - first aid for wounds etc.
                  - elderly care

                  If the patient has a serious illness, he or she is sent to a hospital.

                  The Puskesmas have Tamiflu. Suspect bird flu patients can get Tamiflu, if they don't improve they go to a hospital.

                  As long as the boys from the boarding school are in a Puskesmas, the nurses can take care of them, give them water, monitor their health, may be give them Tamiflu.

                  If their condition worsens, I assume they will be transferred to a hospital.

                  ----------------------------------------------------------------------

                  Edit: an excerpt from a Unicef document (1999), describing the "Puskesmas" from a maternal health angle:


                  Puskesmas Services
                  The Puskesmas, or sub-district community health centre, serves a population of about 30,000.
                  There are two kinds of Puskesmas - Puskesmas with beds and those without.

                  The variety without beds generally
                  acts as a public outpatient treatment facility, is rarely open after mid-day, and is definitely not likely to be
                  either open or prepared to deal with an obstetric emergency outside of clinic hours. This centre is usually
                  staffed by a Bidan or nurse and a general practitioner who provide preventative and curative services
                  related to 18 different health programmes including ANC and family planning.

                  These Puskesmas have
                  been characterized as under-burdened and are generally bypassed by patients seeking emergency services.
                  Should a critically ill patient appear at this type of facility, the staff are more likely to simply send the
                  patient on to the next level of care than to attempt to administer first aid or try to prepare the patient for
                  transfer. When we presented a hypothetical case of a woman presenting with post-partum hemorrhage to
                  staff at two of these centres, none felt it was appropriate to give oxytocic drugs or attempt bimanual
                  massage of the uterus in an attempt to stop the bleeding. The treatment of choice was to start an IV and
                  send the patient on to the next facility, even if it was more than an hour away.

                  The Puskesmas with beds are usually located in more remote areas and ideally should be staffed and
                  equipped to provide basic essential obstetrical and neonatal care (BEOC/PONED) twenty-four hours per
                  day. A Bidan or nurse and a GP, who are not always trained to deliver BEOC/PONED, staff these
                  centres. Those who have been trained are reluctant to attempt procedures such as manual removal of
                  placenta when a case requiring this procedure presents to them very rarely. UNICEF has funded
                  BEOC/PONED/LSS training of some Puskesmas staff in all three provinces early in the life of the
                  project. They also funded education for Puskesmas Bidans on the administration of the MCH programme
                  and on how to supervise Bidan di Desa.



                  --------------------------------

                  Edit #2: an inside story from a Puskesmas (in English), 2002:

                  ?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


                  • #10
                    Re: Lampung - 99 students suspected with H1N1, 8 in treatment

                    Thankyou for that

                    What would your take be on the terminology of this report? Are there any reports of local hospital overloads I wonder? If standard procedure would be to treat with antivirals this could be done anywhere, including an isolation ward at the school. In which case, it might be reasonable to assume that the health centre referals were for individuals who did not appear to respond adequately; however, we are then left to wonder if they were referred onwards to fully fledged hospitals.

                    The point about the actions taken when this was thought to be an H5N1 outbreak are also very valid. It suggests a great deal that the local authorities felt comfortable enough to treat the students within the school when this was suspected as a possibility.

                    Let us hope further reports clarify the situation a little more.

                    Comment


                    • #11
                      Re: Lampung - 99 students suspected with H1N1, 8 in treatment

                      Although I posted this as a news article, we need to be cautious. There do not seem to be any other news stories about an outbreak of H1N1 in Lampung in the last 24 hours. The lack of additional articles confirming the first report is concerning. Did this outbreak really occur and there is now a media blackout or was the report incorrect?
                      http://novel-infectious-diseases.blogspot.com/

                      Comment


                      • #12
                        Re: Lampung - 99 students suspected with H1N1, 8 in treatment

                        We have no way to know which is true, except one, perhaps. The local health department classified this as a KLB or exceptional incident.

                        There should be some way to verify this aspect?

                        Comment


                        • #13
                          Re: Lampung - 99 students suspected with H1N1, 8 in treatment

                          Originally posted by Laidback Al View Post
                          Although I posted this as a news article, we need to be cautious. There do not seem to be any other news stories about an outbreak of H1N1 in Lampung in the last 24 hours. The lack of additional articles confirming the first report is concerning. Did this outbreak really occur and there is now a media blackout or was the report incorrect?
                          I can't see a reason to regard the news article to be incorrect. It reported a flu outbreak in a school. This is reported in many countries at the moment.

                          The local health department classified this as a KLB or exceptional incident.
                          There should be some way to verify this aspect?
                          Regarding "KLB": KLB refers to an exceptional outbreak in that region ; it means among other things you can get extra money and/or temporary extra manpower.

                          Another example:

                          dengue fever and chikungunya are endemic in many regions in Indonesia. Sometimes you have an upsurge in dengue patients is a certain region.
                          This upsurge could be way below the base level in other regions were dengue is endemic.

                          This "new" region can declare dengue outbreak to be "KLB" (you have guidelines for that), because it is new there or because they see a considerable higher level of infection than before.

                          So declaration of 'KLB" in some region does not automatically mean the situation is worse than elsewhere. It is worse in that region than before. It could very well be other dengue endemic regions would be glad if they had such a low level of infection.
                          ?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


                          • #14
                            Re: Lampung - 99 students suspected with H1N1, 8 in treatment

                            Another version of the same story, this is from last saturday; no mentioning of dead birds; machinetranslated;

                            "Santri" is what the orthodox students in these kind of Muslim boardingschools are called.



                            Dozens of Santri Suddenly Have Fever


                            Archipelago / Saturday, January 15, 2011

                            Metrotvnews.com, Lampung: As many as 70 students at boarding school Almuhsin, Purwowari, North Metro, Lampung, sudden fever, mass, Saturday (15 / 1). They suddenly complained of cough, shortness of breath, dizziness, and weakness.

                            Disease outbreak since three days. Strong suspicion that the disease was brought by one of his students who had just come from his hometown. For a while students who became ill were given a febrifuge and vitamins. They also were placed in isolation rooms.

                            Peni Puspita Sari, a member of the Metro Health Department medical team, said, saliva and blood samples all students had been taken and sent to Jakarta. Peni suspects, the students are attacked by influenza-like illness . Infectious disease attacks and quickly if the condition of the body is not fit.

                            Metrotvnews
                            ?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

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