Commentary on Garut cluster

[Sharpe]

MHSC #27: I was so disappointed to read the article, because they was no mention at all of when we can expect some of these test results back.......

It's a good question, Commonground. When will the test results be back? But you have to consider that there are more important questions right now. H5N1 is clearly infecting. We're only hearing about the ones ending up in a hospital with double pneumonia and fever. What about the rest? My friends, as you realize, this is a serious situation, and this is not speculative. As usual, it is being dealt with in the most wishy-washy manner imaginable, with patients going home, patients staying at home, Tamiflu being given arbitrarily, la la la, and chickens randomly being culled.

 

[hawkeye]

Re: Commentary on Garut cluster

A very sad situation indeed...

 

[Commonground]

Re: Commentary on Garut cluster

I felt the article was sugar coating everything and was an insult to my integrity. There is only one question on everyone's mind so I don't know who they think they are kidding. I should know better than to read anything afiliated with (well, I'll let you fill in the blank)........

 

[Commonground]

Re: Commentary on Garut cluster

I haven't a clue as to where to post this? So here it is....

http://scienceblogs.com/effectmeasure/2006/08/cluster_in_indonesia_still_unr.php#more

Revere at Effect Measure

Cluster in Indonesia still unresolved
Category: Bird flu
Posted on: August 21, 2006 7:32 AM, by revere

We had hoped to have better information about the possible cluster of bird flu cases in remote West Java, but the situation remains murky and unresolved. Nothing especially reassuring has yet happened to ease the discomfort of health authorities regarding whatever is happening there, at any rate. Reporting by The Jakarta Post is typical:

A young boy with symptoms of bird flu was rushed to Garut hospital in West Java on Saturday, raising the official number of people suspected of having bird flu from Cikelet village to 10 and pushing health authorities to widen an investigation into a potential bird flu cluster.

The new patient, a five-year-old boy identified as R, is a resident of Rancamareme hamlet and the brother of a young girl also identified as R, who died two weeks ago after showing bird flu symptoms. No blood test was conducted on the girl to confirm that she had died of the disease.

Head of the West Java Health Office, Yudi Prayudha, said there were a total of 10 patients from five hamlets in Cikelet and Cigadog villages, located some 130 kilometers south of Garut city who had shown symptoms of bird flu. (The Jakarta Post)

Blood samples of about 40 contacts were said to have been obtained (for what purpose, it isn't clear, since evidence of H5N1 antibodies would not be epxected to appear so quickly). Several deceased cases were originally diagnosed as "typhoid" and no testing was done. There is now some question as to whether they were bird flu cases. Two other children were said to have negative PCR tests for H5N1 (we reported them in an Update to our previous post) but the tests are being repeated. This suggests there is reason to doubt the negative tests.

Not to worry, though. The ever unreliable Minister of Health, Siti Fadilah Supari assures us this does not represent a cluster. Her reasoning is given by a subordinate:

Meanwhile, Director General for Disease Control and Sanitation in the ministry I. Nyoman Kandun said that the Garut cases could not be categorized as a cluster case because it happened in separate places and was not simultaneous.
"It happened on different days and are far from each other," Kandun said on Saturday. (Xinhua)

This is either deliberately misleading or Nyoman Kandun doesn't understand the concept of clusters. Cases closer together in space or time (or both) are of interest only for what they can tell us about what is going on about disease transmission and occurrence. If many people are infected within a few days by a common source in a small geographic area (a time-space cluster) it could indicate a common source (e.g., poultry) infected with a virus that is passing more easily to humans. On the other hand, people falling ill a week or so apart might indicate person to person transmission if they have had direct or indirect contact with each other. Communicable disease travels on social networks.

Different days or different locations are not criteria that rule clusters in or out. Only good epidemiological investigative work can do that. Indonesia has been conspicuously bad at that kind of follow-up.

 

[MHSC]

Re: Commentary on Garut cluster

Vaffie, I felt the article was sugar coating everything and was an insult to my integrity. There is only one question on everyone's mind so I don't know who they think they are kidding. I should know better than to read anything afiliated with (well, I'll let you fill in the blank)........

I understand your frustration, I would like to know what is really happening, it's been obvious for some time now that we can't count on WHO to tell us the whole story.

 

[Niko]

Re: Commentary on Garut cluster

The citizen Cikelat was distributed Tamiflu Free
Senin, 21 Agustus 2006 | 18:23 WIB

Yudhi said, the case of bird flu in Garut that was found since last August 1 that not including the category cluster because of not coming from one family or having the genetic similarity. Yudhi hoped, the case of bird flu from Garut not was caused by the spread between humankind.

We all share Yudhi's hope. However, until a breakdown of disease onset dates(date 1st symtoms appear), viral sequences are known (poultry & human), and death/recovery dates are known, we can only assume that some H2H has occurred in this cluster. To say otherwise is ridiculous, IMHO.

P.S. Welcome aboard Richard McC and thanks for your contributions!

(moved from other thread by poster)

 

[Kimball Croft]

Re: INDONESIA - Garut Cluster Part III

Re: INDONESIA - Garut Cluster Part III

The antibiotics being given could just be as a precaution. Given the remote location and the lack of labs in the area, I suspect they are just trying to cover all the bases.

We talked about this at work today and come up with various scenarios. Most of us agreed that this is probably a test study of TamiFlu.

First... These are isolated villages that can be quarantined and studied to see how TamiFlu and BF react to each other in a semi-labratory real-world setting. It gives scientists an opportunity to see what TamiFlu can do and see how quickly BF modifies itself so TamiFlu becomes would not work as a treatment.

Second... We also talked about that scenario that BF is getting out-of-hand and WHO and the US are trying to head BF from escaping this area and heading into the wild (rest of the world).

Third... Do you notice that CNN or any other type of International News has not gotten to this area to do some informative hard reporting. No one is asking the hard questions and reporting facts.

 

[Goju]

Re: INDONESIA - Garut Cluster Part III

Re: INDONESIA - Garut Cluster Part III

We talked about this at work today and come up with various scenarios. Most of us agreed that this is probably a test study of TamiFlu.

First... These are isolated villages that can be quarantined and studied to see how TamiFlu and BF react to each other in a semi-labratory real-world setting. It gives scientists an opportunity to see what TamiFlu can do and see how quickly BF modifies itself so TamiFlu becomes would not work as a treatment.

Second... We also talked about that scenario that BF is getting out-of-hand and WHO and the US are trying to head BF from escaping this area and heading into the wild (rest of the world).

Third... Do you notice that CNN or any other type of International News has not gotten to this area to do some informative hard reporting. No one is asking the hard questions and reporting facts.

1 - How can you isolate a village with miles of countryside and a road or two? And isn't it nice that they would use Tami to "create" a resistant strain - IMHO - Insanity

2 - BF is out of hand, has probably escaped the area already, infecting in other areas as we already know. and soon coming to a theater near you.

3 - BF is yesterday's news until we see massive deaths or cases in the first world. The Mid east and Jon Bennett are all the rage in today's news

 

[Mellie]

Re: INDONESIA - Garut Cluster Part III

Re: INDONESIA - Garut Cluster Part III

Hi Kimball, welcome to the fray!

I'm just back temporarily from the complexes of lightning-caused wildfires in the NorCal mountains. No one there is focused on birdflu at the moment. They're focused on fire and smoke, keeping firefighters and citizens out of harm's way. Life is about dealing with immediate threats and survival of house and home.

I think a simpler explanation for what we observe in Indonesia is that people there are focused on their lives, and if and when they're focused on disease/death at all, it's diseases that many more people die from than birdflu. It's easy to attribute their behavior to something relating to birdflu since that's our focus. I doubt they give it an inordinate amount of thought, though.

I think tamiflu is being handed out. Whether people take it or not is another thing.

There aren't many people in the world that know what we know about birdflu. You're a member of a very select group. The lookouts... with an eye to one kind of changing "fire behavior", so to speak.

Welcome.

 

[Laidback Al]

Re: INDONESIA - Garut Cluster Part III

Re: INDONESIA - Garut Cluster Part III

We talked about this at work today and come up with various scenarios. Most of us agreed that this is probably a test study of TamiFlu.

First... These are isolated villages that can be quarantined and studied to see how TamiFlu and BF react to each other in a semi-labratory real-world setting. It gives scientists an opportunity to see what TamiFlu can do and see how quickly BF modifies itself so TamiFlu becomes would not work as a treatment....

Indonesia doctors and epidemiologists are well aware of the world-wide consequences of an easily transmissible strain of H5N1. They are also aware of how viruses can become resistant to anti-viral drugs. The use of Tamiflu in in these villages is not a test study of the drug, but an effort to restrict the infections and save lives.

 

[prepdeb]

Re: INDONESIA - Garut Cluster Part III

Re: INDONESIA - Garut Cluster Part III

I think tamiflu is being handed out. Whether people take it or not is another thing.

Good point Mellie. It seems that many in Indonesia are reluctant to be treated. We've read the articles about patients leaving hospitals or pulling their children from them to be cared for at home.

I've had trouble understanding the logic behind mass distribution of tamiflu to the area if they do not think it's being transmitted between people. The articles keep implying that the victims are getting it from infected poultry and there is no evidence of human to human transmission. So why not just eliminate the source of infection and cull all of the poultry in the area?

I have no medical training so if I understand the risks of carelessly distributing the antiviral, surely the folks making these decisions do too.
Perhaps I'm paranoid, but the blanket application of tamiflu in this area really concerns me.

 

[Richard McC]

Re: Commentary on Garut cluster

Thanks for the welcome.

I'm reassured by the Tamiflu blanket. Whatever it takes! With a hard-to-get-to place like Garut, Tamiflu and quarantine may work.

 

[Vibrant62]

Re: INDONESIA - Garut Cluster Part III

Re: INDONESIA - Garut Cluster Part III

Indonesia doctors and epidemiologists are well aware of the world-wide consequences of an easily transmissible strain of H5N1. They are also aware of how viruses can become resistant to anti-viral drugs. The use of Tamiflu in in these villages is not a test study of the drug, but an effort to restrict the infections and save lives.

There is another option for us all to consider here. There has been mention that this is a 'new' strain not seen before (as in Thailand) and a report somewhere that there have been changes in the receptor binding site.

Therefore, what if we have a virus subclade that has evolved that has a, say, 2,6 sialic acid receptor specificity/ affinity. It isn't the pandemic strain but is a significant step closer to one, and is more infectious to humans. If this were the case there would be very good reason to do everything possible to contain the virus (in birds and humans) and try very hard to eradicate it. You would want to limit human infections even more than normal, as the only final adaptation might be full aerosolisation of the virus in humans before we are in pandemic. ?Peiris? has been quoted recently as saying that H5N1 in China has moved significantly closer to acquiring this aerosol capability. I apologise for not having the time to locate the specific reports, but I have read them here somewhere.

Therefore, if this scenario were the case and I were in WHOs shoes, I would be using Tamiflu as they are now, even though it may well not be a pandemic strain yet, and even though there are significant risks of creating a tamiflu resistant strain. Pure speculation of course until we have the sequence and experimental data to verify or otherwise, but a possibility worth considering in this discussion.

 

[prepdeb]

Re: Commentary on Garut cluster

Thanks Vibrant for posing a possible scenario where it would make sense to blanket the area with tamiflu, even if it's not H2H.

 

[sharon sanders]

Re: Commentary on Garut cluster

Thank you for the analysis Vibrant62.

 

[Snowy Owl]

Re: Commentary on Garut cluster

Thnak you Vibrant62