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Flu experts to help Indonesia's bird flu crisis
Updated Sun. Jun. 18 2006 11:31 PM ET
Canadian Press
Some of the world's leading influenza experts will gather in Jakarta this week to assess the worrisome avian flu situation in Indonesia, where human cases of H5N1 infection have mounted at a disturbing rate over the past year.
Observers say the expert consultation, taking place at the request of the Indonesian government, is a welcome sign of that country's concern about the threat H5N1 poses both for its citizens and the global community.
"I think calling this meeting is a step towards recognizing that they have got a problem and they do have a responsibility to the rest of the world in terms of trying to deal with it," says Lance Jennings, a virologist and epidemiologist at Christchurch Hospital in New Zealand.
"I think it's a positive move and will lead to improved understanding," adds Jennings, who last year participated in a similar World Health Organization-led assessment of the H5N1 problem in Vietnam.
Indonesia's National Committee for Avian Influenza Control and Pandemic Influenza Preparedness asked the WHO and its animal health counterpart, the Food and Agriculture Organization, to bring a variety of experts to Indonesia to study the scope of the problem and make recommendations on how best to attack it.
Leading experts such as Dr. Keiji Fukuda, co-ordinator of WHO's global flu program, Dr. Nancy Cox, head of the influenza branch at the U.S. Centers for Disease Control in Atlanta, and Dr. Malik Peiris of Hong Kong University will take part in the three-day review, which begins Wednesday.
Since Indonesia began reporting human cases of H5N1 last July, infections have been occurring at a rapid and unsettling clip - virtually one a week on average.
"There are special concerns about Indonesia," admits WHO spokesperson Dick Thompson.
"First, that these cases are turning up across this vast region - that's a huge country. And secondly, there's a number of clusters - more clusters than we've seen elsewhere."
Of the 49 confirmed cases, 37 have died. A number of other people are strongly suspected of having had the virus, but they died and were buried or cremated before samples could be taken to look for proof of infection.
Of the 10 countries that have recorded human cases of H5N1, Indonesia to date has had the second highest number of cases. Only Vietnam's tally exceeds that of Indonesia. But the former's efforts to combat the virus in poultry flocks appear to have paid off; Vietnam has not reported a human case of H5N1 since last November.
Many of the Indonesian cases have occurred in clusters of two or three, although last month the largest cluster of cases seen to date - eight members of a single family - had health authorities around the world on edge. The WHO said that cluster likely involved human-to-human-to-human spread, the first time such prolonged transmission is thought to have occurred.
Also concerning is the fact that many of the human cases in Indonesia have occurred in areas where no outbreaks of the virus have been reported in poultry. Experts say that points to gaping holes in the country's veterinary surveillance capacity.
Dr. Angus Nicoll, who heads influenza activities at the European Centre for Disease Control and Prevention in Stockholm, heard Indonesia's assessment of its avian flu problem at a recent meeting in Vienna of countries that are funding the fight against avian influenza.
Nicoll says control over veterinary services has been devolved to local authorities, hamstringing efforts to mount the type of co-ordinated attack needed to bring the virus under control.
"What the people from Indonesia were saying (in Vienna) was good in one way in that they were being open but worrying the other way because they've clearly got into a very substantial mess," Nicoll says.
"Their veterinary services in particular were very much weakened by decisions to distribute ... responsibility down to the local level."
Nicoll is heartened the country has asked for help. But he's also worried it may be outside Indonesia's capacity to act on the recommendations the experts will make - or wish to make.
"It's a positive sign. But the caveat there would be we have to wait and see whether the Indonesians are able to implement the recommendations.
"I think what's concerning is if the answer is 'You need to change your devolved veterinary services,' that's a big tanker to turn around," he says bluntly.
"That might not be a terribly easy or welcome piece of advice for them to get."
Updated Sun. Jun. 18 2006 11:31 PM ET
Canadian Press
Some of the world's leading influenza experts will gather in Jakarta this week to assess the worrisome avian flu situation in Indonesia, where human cases of H5N1 infection have mounted at a disturbing rate over the past year.
Observers say the expert consultation, taking place at the request of the Indonesian government, is a welcome sign of that country's concern about the threat H5N1 poses both for its citizens and the global community.
"I think calling this meeting is a step towards recognizing that they have got a problem and they do have a responsibility to the rest of the world in terms of trying to deal with it," says Lance Jennings, a virologist and epidemiologist at Christchurch Hospital in New Zealand.
"I think it's a positive move and will lead to improved understanding," adds Jennings, who last year participated in a similar World Health Organization-led assessment of the H5N1 problem in Vietnam.
Indonesia's National Committee for Avian Influenza Control and Pandemic Influenza Preparedness asked the WHO and its animal health counterpart, the Food and Agriculture Organization, to bring a variety of experts to Indonesia to study the scope of the problem and make recommendations on how best to attack it.
Leading experts such as Dr. Keiji Fukuda, co-ordinator of WHO's global flu program, Dr. Nancy Cox, head of the influenza branch at the U.S. Centers for Disease Control in Atlanta, and Dr. Malik Peiris of Hong Kong University will take part in the three-day review, which begins Wednesday.
Since Indonesia began reporting human cases of H5N1 last July, infections have been occurring at a rapid and unsettling clip - virtually one a week on average.
"There are special concerns about Indonesia," admits WHO spokesperson Dick Thompson.
"First, that these cases are turning up across this vast region - that's a huge country. And secondly, there's a number of clusters - more clusters than we've seen elsewhere."
Of the 49 confirmed cases, 37 have died. A number of other people are strongly suspected of having had the virus, but they died and were buried or cremated before samples could be taken to look for proof of infection.
Of the 10 countries that have recorded human cases of H5N1, Indonesia to date has had the second highest number of cases. Only Vietnam's tally exceeds that of Indonesia. But the former's efforts to combat the virus in poultry flocks appear to have paid off; Vietnam has not reported a human case of H5N1 since last November.
Many of the Indonesian cases have occurred in clusters of two or three, although last month the largest cluster of cases seen to date - eight members of a single family - had health authorities around the world on edge. The WHO said that cluster likely involved human-to-human-to-human spread, the first time such prolonged transmission is thought to have occurred.
Also concerning is the fact that many of the human cases in Indonesia have occurred in areas where no outbreaks of the virus have been reported in poultry. Experts say that points to gaping holes in the country's veterinary surveillance capacity.
Dr. Angus Nicoll, who heads influenza activities at the European Centre for Disease Control and Prevention in Stockholm, heard Indonesia's assessment of its avian flu problem at a recent meeting in Vienna of countries that are funding the fight against avian influenza.
Nicoll says control over veterinary services has been devolved to local authorities, hamstringing efforts to mount the type of co-ordinated attack needed to bring the virus under control.
"What the people from Indonesia were saying (in Vienna) was good in one way in that they were being open but worrying the other way because they've clearly got into a very substantial mess," Nicoll says.
"Their veterinary services in particular were very much weakened by decisions to distribute ... responsibility down to the local level."
Nicoll is heartened the country has asked for help. But he's also worried it may be outside Indonesia's capacity to act on the recommendations the experts will make - or wish to make.
"It's a positive sign. But the caveat there would be we have to wait and see whether the Indonesians are able to implement the recommendations.
"I think what's concerning is if the answer is 'You need to change your devolved veterinary services,' that's a big tanker to turn around," he says bluntly.
"That might not be a terribly easy or welcome piece of advice for them to get."