Reconsidering Human H5N1 Cases in 2009 in Indonesia
The year 2009 probably represents a low point in the relationship between WHO and government of Indonesia regarding the timely report of human cases of H5N1. Under IHR, member countries such as Indonesia are requested to immediately report any confirmed cases of H5N1. However, throughout the year of 2009 Indonesia failed to report human cases to WHO in a timely manner. On December 28, 2009, DEPKES, the Indonesia Public Health authority, quietly report a total of 20 cases for the year. Ultimately WHO now reports a total of 21 human cases from Indonesia for 2009, with only 2 survivors that year. (link)
Public information on these 21 cases is limited. WHO has not published any demographic or epidemiological information about these cases. However, media reports since 2009 sometimes provide information about these cases years later. For example, a local media report in 2011 clearly indicates that there was a family cluster of three confirmed H5N1 cases in West Jakarta in 2009. (link)
And now in 2012 another media article on bird flu in Jakarta reports that there were 10 confirmed H5N1 cases in the greater urban area of Jakarta in 2009. Of these cases, only two survived.
Because WHO reports only two survivors among the 21 H5N1 cases in Indonesia in 2009, they must have been from Jakarta. It seems that at least 10 of the 21 confirmed cases of H5N1 in Indonesia in 2009 occurred in the urban Jakarta area including the family cluster.
Why discuss this now in 2012? Isn’t it almost ancient history?
First, it shows that H5N1 infections in Indonesia in 2009 were not just occurring in the countryside, but were common in urban settings in DKI Jakarta.
Second, had the H5N1 strain circulating in DKI Jarkarta in 2009 become easily transmissible, there would have been no stopping it in an urban environment. A “Tamiflu blanket” would have been ineffective. The failure of Indonesia to report these cases immediately would have hampered pandemic preparations elsewhere in the world. Thankfully the strain(s) didn’t mutate or change in 2009.
That is why we here at FluTrackers continually call for increased human and animal surveillance for H5N1 and other emerging infectious disease. While the world will not be able to stop the next pandemic, some advance warning might help us all better prepare for the outcome.