Discussion: Indonesian Human Infection and Occupation

[Laidback Al]

With Indonesia having the unique distinction of the country with the most human H5N1 infections (reported) it is worthwhile discussing the general occupational/social setting in which these infections occur. Some statistics with percentages were posted earlier in a toggletexted translation from Indonesia that may have been missed in a cursory review of the Indonesian thread.

In detail, was based on the profession group, per June 1 bird flu infected several circles, among them for the livestock breeding worker of 2%, the industry of the production doll house how come badminton (11%), the farmer not the breeder (2%), the housewife (16%), the worker of the health field (1%), the student (16%), children (29%), was not known by his profession (2%), et cetera namely the banker, the accountant, as well as other (22%).

http://www.flutrackers.com/forum/showpost.php?p=84815&postcount=2

{Hat-tip to Commonground}


As usual, toggletext translations are confusing. Toggletext: the industry of the production doll house how come badminton. Original: industri rumahan pembuatan kok badminton. I interpret this to mean workers in the industry of the production doll houses [and] badminton shuttlecocks {kok badminton}.

Since the first infection in Indonesia in June, 2005, through June 1, 2007, 99 people have been infected in Indonesia. That means each percentage point equals about one individual.

Here is the percentages of human H5N1 infection of 99 individuals in Indonesia by occupation/social status in decreasing order.

Children (29%)

Other (22%)

Housewife (16%)

Student (16%)

?Factory Worker? (11%) workers the industry of the production doll house [and] badminton shuttlecocks

Professional (2%)

Poultry/livestock Breeder (2%)

Farmer (2%)

Health Care Worker (1%)


What is most striking is how few infections are reported from poultry breeders and farmers. Children, housewives, students, and factory workers (working with feathers?) are infected more often. Can we interpret these data that breeders and farmers have some form of seroimmunity to H5N1?

 

[Sally Furniss]

Re: Discussion: Indonesian Human Infection and Occupation

It would be interesting to have the stats also broken into sex and age groups.

 

[kent nickell]

Re: Discussion: Indonesian Human Infection and Occupation

At this point it might also be worthwhile to consider other modes of entry of the virus such as via the GI tract and then traveling to the lungs by the bloodstream. At the ASM conf in No. Calif a few months ago Dr. Boynton had mentioned that the movement of poultry inside to avoid it being confiscated may have led to an increase in cases in small children who of course like to put things in their mouth. Also the cat connection is always worth keeping in mind, reinvigorated recently by Susan Chu's comment on the HHS blog

"- Albert Osterhaus of Erasmus University in the Netherlands, who when I spoke to him a few days ago, is very concerned about the possibility of cats being an intermediate mammalian host in which H5N1 can acquire changes more suited to infect humans.

He tells me that there are places in Indonesia where there are no cats left, which means that the ability of H5N1 to infect cats (which btw was never known to suffer from flu virus infections before) is not a fluke but a consistent feature. "

and from Bird Flu, A Virus of our own hatching, is an excellent book written by Michael Greger, MD, 2006 http://www.birdflubook.org/

Leading flu expert Albert Osterhaus, director of the Netherlands National Influenza Centre, concludes, "Available evidence suggests that the gastrointestinal tract in humans is a portal of entry for H5N1"

On aquaculture: Pig-hen-fish aquaculture involves perching cages of chickens directly over feeding troughs in pig pens which in turn are positioned above fish ponds. The pigs eat the bird droppings and then defecate into the ponds. Depending on the species of fish, the pig excrement is then eaten directly by the fish or acts as fertilizer for aquatic plant fish food. The pond water can then be piped back up for pig and chicken drinking water. In parts of Asia human feces are also added to the ponds for additional enrichment. For pathogens spread via a fecal-oral route, this aquaculture system is a dream come true. Wild ducks are landing in increasing numbers on these farmed fish ponds. Integrating pigs and aquaculture affords this waterborne duck virus a rather unique opportunity to cycle through a mammalian species, accumulating mutations that may better enable it to adapt to mammalian physiology. 100 million pigs in China are involved in aquaculture production, plenty of fodder for viruses to potentially extract adaptive pearls from swine.

Here is a very interesting look at a Jakarta fish farm... http://www.drmartinwilliams.com/conservation/catfish-farm.html



A review of Dr. Gregers book by 2 Chinese virologists....

Chengfeng Qin and Ede Qin
State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Beijing 100071, China

http://www.virologyj.com/content/4/1/38

(some excerpts)


Due to my responsibility as member of advisory committee on pandemic influenza, I regard any new publication on bird flu with special enthusiasm.

"If changes in human behavior can cause new plagues, changes in human behavior may prevent them in the future".

Yes, we can change.

In my opinion, Greger's book is the best of its genre and deserves to be read by anyone who is concerned about human and animal health. This book is a must read for government and enterprise officials who are advocating and advancing poultry industry standards. Virologists and epidemiologists will also find it useful, since the basic science of bird flu is carefully set out. I highly recommend it.

(Although I would personally add that the book may benefit from a strong chapter on recombination theory) ie small changes aka 'not reassortment'

 

[sharon sanders]

Re: Discussion: Indonesian Human Infection and Occupation

Thanks Kent.

Here is also a video presentation by Dr. Greger:

http://www.flutrackers.com/forum/showthread.php?t=22913&highlight=greger

 

[Commonground]

Re: Discussion: Indonesian Human Infection and Occupation

Thanks Kent. I was also surprised by this article. I put it aside and I'll post it now. Just came upon it today. The reason it interested me is that on my personal map, that I keep track of cases, Lamongan is a hot spot so to speak. This market, would be a very good place to pass along virus'.

Ndosiar.com, Lamongan - Beginilah the activity in the Port of Perikanan Indonesian Archipelago Brondong, Lamongan, East Java, every day.
Since at daybreak, the atmosphere has been busy.
The fisherman's boat docked and unloaded cargo, the fish catch.
In a day, approximately 60 as far as the fisherman's 70 boats unloaded cargo here.
By the atmosphere morning got busy.
The congested street by people who brought the basket contained the fish.
The fish of the fisherman's catch in this place more than 100 ton a day.
According to Thamrin, Kepala of the Brondong Port, facilities that were available in this port were complete enough.
Director General Tangkap Departemen Kelautan and fisheries provided the station, as well as the workshop as well as several supporting facilities of the activity of the other fisherman of the fuel filling.
http://news.indosiar.com/news_read.htm?id=61894

 

[Gert van der Hoek]

Re: Discussion: Indonesian Human Infection and Occupation

Very good question about the poultryworkers/breeders/keepers (many many many in Indonesia...); BF in poultry almost anywhere...

Guess it leaves the next possibilities:

- it could be related to age: poultry workers are older , H5N1 seems to attack
children and young people, just like the Spanish Flu in 1918;

- it is hard to catch H5N1, you seem to need a certain level of viral load, may
be in combination with age, or diminished health, or less resistance to
virusses, caused by other reasons ( stress, genetic ?);

- other sources like cats, dogs, bats, lizards, flies, and .....

- indeed: poultry workers could build up antibodies, exposed to low viral load
many times, should be interesting to do a research.

- other possibilties: ..................?

 

[Niko]

Re: Discussion: Indonesian Human Infection and Occupation

Either there is a typo in your breakdown or I read the quote wrong. Doesn't this state that the unknown ("not known by his profession") is 2% and the professional ("namely the banker, the accountant, as well as other") is 22%? Please double check as I think the percentage of "professionals" has significance.

With Indonesia having the unique distinction of the country with the most human H5N1 infections (reported) it is worthwhile discussing the general occupational/social setting in which these infections occur. Some statistics with percentages were posted earlier in a toggletexted translation from Indonesia that may have been missed in a cursory review of the Indonesian thread.

Quote:
In detail, was based on the profession group, per June 1 bird flu infected several circles, among them for the livestock breeding worker of 2%, the industry of the production doll house how come badminton (11%), the farmer not the breeder (2%), the housewife (16%), the worker of the health field (1%), the student (16%), children (29%), was not known by his profession (2%), et cetera namely the banker, the accountant, as well as other (22%).

http://www.flutrackers.com/forum/showpost.php?p=84815&postcount=2

{Hat-tip to Commonground}


As usual, toggletext translations are confusing. Toggletext: the industry of the production doll house how come badminton. Original: industri rumahan pembuatan kok badminton. I interpret this to mean workers in the industry of the production doll houses [and] badminton shuttlecocks {kok badminton}.

Since the first infection in Indonesia in June, 2005, through June 1, 2007, 99 people have been infected in Indonesia. That means each percentage point equals about one individual.

Here is the percentages of human H5N1 infection of 99 individuals in Indonesia by occupation/social status in decreasing order.

Children (29%)

Other (22%)

Housewife (16%)

Student (16%)

“Factory Worker” (11%) workers the industry of the production doll house [and] badminton shuttlecocks

Professional (2%)

Poultry/livestock Breeder (2%)

Farmer (2%)

Health Care Worker (1%)


What is most striking is how few infections are reported from poultry breeders and farmers. Children, housewives, students, and factory workers (working with feathers?) are infected more often. Can we interpret these data that breeders and farmers have some form of seroimmunity to H5N1?

 

[Commonground]

Re: Discussion: Indonesian Human Infection and Occupation

AnneZ here's the age group (from the same article)

He added, from this figure, the group of children showed the highest figure so as to need the role of parents to keep away his child from the poultry.
In the meantime, was based on the age group per June 1 2007, the case of bird flu to humankind that was it was confirmed positive for the group of the age of pre-schoolers 1?5 the year totalling 11 people, 6?10 the year (13 people), 11?15 the year (15 people), 16?20 the year (16 people), 21?25 the year (14 people), 26?30 the year (14 people), 31?35 the year (5 people), 36?40 the year (6 people) ,41?45 the year (4 people), and the age on 45 years (1 person).
In the meantime, Chairman Urusan Publikasi and Pengendalian Communication of the Avian Influenza Illness, Departemen of Agriculture, Memet Zulkarnaen said, private enterprise's industry that was actively involved in the handling of bird flu, especially in the sector of the good poultry breeding large scale or micro.
(Abdul the owner)

 

[Laidback Al]

Re: Discussion: Indonesian Human Infection and Occupation

Either there is a typo in your breakdown or I read the quote wrong. Doesn't this state that the unknown ("not known by his profession") is 2% and the professional ("namely the banker, the accountant, as well as other") is 22%? Please double check as I think the percentage of "professionals" has significance.

Niko -

I struggled with this and I looked at the original Indonesian text carefully. Perhaps Commonground or someone with Indonesian language background can clarify. The fact that this 2% was broken out from the "other" 22% means that this category is significant to the the individual who tabulated these statistics. We are just not sure of the translation.

 

[Commonground]

Re: Discussion: Indonesian Human Infection and Occupation

Niko, all I can do is give you the original version. I'm just guessing here but the bolded words you can figure out as "banker" and "accountant".

Dengan estimasi 56,6%-nya laki-laki dan 43,4% perempuan. Secara rinci, berdasarkan kelompok profesi, per 1 Juni flu burung telah menginfeksi beberapa kalangan, di antaranya untuk pekerja peternakan sebesar 2%, industri rumahan pembuatan kok badminton (11%), petani bukan peternak (2%), ibu rumah tangga (16%), pekerja bidang kesehatan (1%), pelajar (16%), anak-anak (29%), tidak diketahui profesinya (2%), dan lain-lain yakni bankir, akuntan,serta lainnya (22%).

 

[JJackson]

Re: Discussion: Indonesian Human Infection and Occupation

Another's central tenet of Dr. Greger?s is the relationship between population density and virulence. The argument is basically simple and Darwinian. In the natural, as opposed to industrialised, environment the advent of a highly pathogenic mutation is not generally deemed to be a good thing, in evolutionary terms, as the unfortunate host organism is likely to die before it has the opportunity to pass it on to its peers. However, in the high population densities to be found in a modern poultry farm, pig farm or conurbation. This barrier to the spread of the high-path mutant is removed. In this environment, there is ample time to infect multiple new hosts prior to succumbing. While high virulence in one species does not necessarily translate to high virulence in a novel host, it does increase the likelihood. Overall the net effect is an increased probability of higher virulence in both animal diseases and zoonotics.