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Indonesia Discussion
- Thread starter Theresa42
- Start date
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20060523/flu_indonesia_tests_060523/20060523?hub=TopStories
Tests show no evidence of a significant mutation in the bird flu strain that killed at least six blood relatives in an Indonesian village, the World Health Organization said Tuesday.
The deaths in the village in the Karo district of North Sumatra sparked fears the virus is being transmitted from person to person.
"Sequencing ... found no evidence of genetic reassortment ... and no evidence of significant mutations," the agency said in a statement.
"The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak."
The World Health Organization confirmed details of the cluster last Thursday.
A 37-year-old woman from the village of Kubu Sembelang fell ill on April 27 and died on May 4.
But it's unlikely the cause of death will ever be confirmed as no samples were taken during her illness or before her burial.
Since her death, several of the woman's blood relatives have tested positive for the virus.
On Tuesday, Indonesia's Ministry of Health confirmed that another member of the woman's extended family, her 32-year-old brother, died on May 22.
"The man is the seventh member of an extended family to become infected with the H5N1 virus and the sixth to die," the agency said.
He is also the father of a 10-year-old boy who died on May 13.
"The father was closely involved in caring for his son, and this contact is considered a possible source of infection," the agency said in a statement.
Preliminary findings indicate that three of the confirmed cases stayed overnight in a small room with the initial case when she was symptomatic and coughing frequently.
Those confirmed cases include the woman's two sons and a second brother, who is the only surviving case among infected members of this family.
"All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness," the WHO said.
"Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing."
Some doctors have suggested the cluster could mean there is some sort of genetic feature in the family's make-up that rendered its members more vulnerable to the strain.
While the source of that outbreak hasn't been officially confirmed, investigators believe the victims were engaged in the practice of defeathering swans -- an illegal activity which surviving family members may have tried to hide from authorities.
The Indonesian family cluster is the largest seen until now, but a number of other clusters among family members have been observed, most recently in Turkey and Azerbaijan.
Since late 2003, the virus has sickened at least 217 people in 10 countries, killing 123 of them, according to the WHO's May 19 count.
Re: Indonesia BF - 5/22-5/23
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20060523/flu_indonesia_tests_060523/20060523?hub=TopStories
Tests show no evidence of a significant mutation in the bird flu strain that killed at least six blood relatives in an Indonesian village, the World Health Organization said Tuesday.
The deaths in the village in the Karo district of North Sumatra sparked fears the virus is being transmitted from person to person.
"Sequencing ... found no evidence of genetic reassortment ... and no evidence of significant mutations," the agency said in a statement.
"The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak."
The World Health Organization confirmed details of the cluster last Thursday.
A 37-year-old woman from the village of Kubu Sembelang fell ill on April 27 and died on May 4.
But it's unlikely the cause of death will ever be confirmed as no samples were taken during her illness or before her burial.
Since her death, several of the woman's blood relatives have tested positive for the virus.
On Tuesday, Indonesia's Ministry of Health confirmed that another member of the woman's extended family, her 32-year-old brother, died on May 22.
"The man is the seventh member of an extended family to become infected with the H5N1 virus and the sixth to die," the agency said.
He is also the father of a 10-year-old boy who died on May 13.
"The father was closely involved in caring for his son, and this contact is considered a possible source of infection," the agency said in a statement.
Preliminary findings indicate that three of the confirmed cases stayed overnight in a small room with the initial case when she was symptomatic and coughing frequently.
Those confirmed cases include the woman's two sons and a second brother, who is the only surviving case among infected members of this family.
"All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness," the WHO said.
"Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing."
Some doctors have suggested the cluster could mean there is some sort of genetic feature in the family's make-up that rendered its members more vulnerable to the strain.
While the source of that outbreak hasn't been officially confirmed, investigators believe the victims were engaged in the practice of defeathering swans -- an illegal activity which surviving family members may have tried to hide from authorities.
The Indonesian family cluster is the largest seen until now, but a number of other clusters among family members have been observed, most recently in Turkey and Azerbaijan.
Since late 2003, the virus has sickened at least 217 people in 10 countries, killing 123 of them, according to the WHO's May 19 count.
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
The writer: SugengBandung -- MIOL: A patient suspect bird flu died in RS Handsome Sadikin (RSHS) Bandung, on Tuesday (23/5).Casualties, Ai Tita, 10, the citizen liked the Well-being, Cileunyi, the Bandung Regency, it was suspected was casualties family cluster bird flu, because during simultaneously, his full sibling, Ade Firman, 18, also in the critical condition.The two casualties were beforehand treated in RS the Berung Tip for one day, before being reconciled to RSHS, on Monday night (22/5).However, after being treated less than 19 hours, Tita did not remain, and died 02.50 WIB.Like was said the team's member of the handling of bird flu RSHS Polite, had been based on the medical note, since coming the two casualties in the critical condition, with the breathless complaint difficult and has experienced shock.To confirm whether both of them were infected by bird flu, sample blood was at once sent to the Departemenresearch and development hallThe Jakarta health.The mother of casualties, Cacih, 50, said, before his two children suffered the hot complaint high, several tails of the chicken were belonging to his neighbour found died suddenly.Before being brought to the hospital, his two children have experienced the hot sign high for three days.The "clinical sign both of them were similar to bird flu, so as we at once treated him in special isolation space RSHS bird flu in Flamboyant space."If being proven the clinical test showed they were infected by bird flu, both of them to cluster third that was handled the hospital after the family from Sumedang and Indramayu, firm Polite.In the meantime, the condition for Ade Firman, also still was critical.The sign that was experienced by him was the same as his brother who has died that.(SG/OL-02).</PRE>
http://www.mediaindo.co.id</PRE>
Re: Indonesia BF - 5/22-5/23
The writer: SugengBandung -- MIOL: A patient suspect bird flu died in RS Handsome Sadikin (RSHS) Bandung, on Tuesday (23/5).Casualties, Ai Tita, 10, the citizen liked the Well-being, Cileunyi, the Bandung Regency, it was suspected was casualties family cluster bird flu, because during simultaneously, his full sibling, Ade Firman, 18, also in the critical condition.The two casualties were beforehand treated in RS the Berung Tip for one day, before being reconciled to RSHS, on Monday night (22/5).However, after being treated less than 19 hours, Tita did not remain, and died 02.50 WIB.Like was said the team's member of the handling of bird flu RSHS Polite, had been based on the medical note, since coming the two casualties in the critical condition, with the breathless complaint difficult and has experienced shock.To confirm whether both of them were infected by bird flu, sample blood was at once sent to the Departemenresearch and development hallThe Jakarta health.The mother of casualties, Cacih, 50, said, before his two children suffered the hot complaint high, several tails of the chicken were belonging to his neighbour found died suddenly.Before being brought to the hospital, his two children have experienced the hot sign high for three days.The "clinical sign both of them were similar to bird flu, so as we at once treated him in special isolation space RSHS bird flu in Flamboyant space."If being proven the clinical test showed they were infected by bird flu, both of them to cluster third that was handled the hospital after the family from Sumedang and Indramayu, firm Polite.In the meantime, the condition for Ade Firman, also still was critical.The sign that was experienced by him was the same as his brother who has died that.(SG/OL-02).</PRE>
http://www.mediaindo.co.id</PRE>
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
In essence they have found a mutation. It just doesn't classify as significant.
What is significant? Well, I can speculate that significant means Phase 6 full blown pandemic.
I don't think they found that.
But I do believe they found a mutation that would provide for, oh say Phase 4.
Limited human-to-human transmission of H5N1.
This is coming from WHO and pretty much seals the deal.
While I cannot confirm it is Phase 4, it looks like WHO is leaning toward a public announcement of such an event.
I could be wrong, but the words speak for themselves.
Re: Indonesia BF - 5/22-5/23
Tests show no evidence of a significant mutation in the bird flu strain that killed at least six blood relatives in an Indonesian village, the World Health Organization said Tuesday.
"Sequencing ... found no evidence of genetic reassortment ... and no evidence of significant mutations," the agency said in a statement.
The key word here boys and girls is 'significant'."Sequencing ... found no evidence of genetic reassortment ... and no evidence of significant mutations," the agency said in a statement.
In essence they have found a mutation. It just doesn't classify as significant.
What is significant? Well, I can speculate that significant means Phase 6 full blown pandemic.
I don't think they found that.
But I do believe they found a mutation that would provide for, oh say Phase 4.
"The father was closely involved in caring for his son, and this contact is considered a possible source of infection," the agency said in a statement.
Preliminary findings indicate that three of the confirmed cases stayed overnight in a small room with the initial case when she was symptomatic and coughing frequently.
"All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness," the WHO said.
There you have it.Preliminary findings indicate that three of the confirmed cases stayed overnight in a small room with the initial case when she was symptomatic and coughing frequently.
"All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness," the WHO said.
Limited human-to-human transmission of H5N1.
This is coming from WHO and pretty much seals the deal.
While I cannot confirm it is Phase 4, it looks like WHO is leaning toward a public announcement of such an event.
I could be wrong, but the words speak for themselves.
Theresa42
Well-known member
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
http://www.penyakitmenular.info//pm//images_data/img_2006_5_23_14_53_55.pdf
Re: Indonesia BF - 5/22-5/23
I believe it is cumulative:niman said:
http://www.penyakitmenular.info//pm//images_data/img_2006_5_23_14_53_55.pdf
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
Avian influenza ? situation in Indonesia ? update 14
http://www.who.int/csr/don/2006_05_23/en/print.html
23 May 2006
The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case occurred in a 32-year-old man. He developed symptoms on 15 May and died on 22 May.
The case is part of a family cluster in the Kubu Sembelang village, Karo District, of North Sumatra. The man is the seventh member of an extended family to become infected with the H5N1 virus and the sixth to die. An additional person, who was the first member of the family to fall ill, died of respiratory disease on 4 May. No specimens were taken prior to her burial and the cause of her death cannot be determined. However, as her clinical course was compatible with H5N1 infection, epidemiologists at the outbreak site include this woman as the initial case in the cluster.
The newly confirmed case is a brother of the initial case. Specimens were taken on 21 May and flown the same day to Jakarta. Tests run overnight confirmed his infection. His 10-year-old son died of H5N1 infection on 13 May. The father was closely involved in caring for his son, and this contact is considered a possible source of infection.
Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman?s two sons and a second brother, aged 25 years, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.
All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing.
Both the Ministry of Health and WHO are concerned about the situation in Kubu Sembelang and have intensified investigation and response activities. Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community. To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.
Analysis of viruses
Full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO H5 reference laboratories in Hong Kong and the USA. Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir (Tamiflu).
The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak.
<!-- include footer--><!-- include ftr-->
Re: Indonesia BF - 5/22-5/23
Avian influenza ? situation in Indonesia ? update 14
http://www.who.int/csr/don/2006_05_23/en/print.html
23 May 2006
The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus. The case occurred in a 32-year-old man. He developed symptoms on 15 May and died on 22 May.
The case is part of a family cluster in the Kubu Sembelang village, Karo District, of North Sumatra. The man is the seventh member of an extended family to become infected with the H5N1 virus and the sixth to die. An additional person, who was the first member of the family to fall ill, died of respiratory disease on 4 May. No specimens were taken prior to her burial and the cause of her death cannot be determined. However, as her clinical course was compatible with H5N1 infection, epidemiologists at the outbreak site include this woman as the initial case in the cluster.
The newly confirmed case is a brother of the initial case. Specimens were taken on 21 May and flown the same day to Jakarta. Tests run overnight confirmed his infection. His 10-year-old son died of H5N1 infection on 13 May. The father was closely involved in caring for his son, and this contact is considered a possible source of infection.
Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman?s two sons and a second brother, aged 25 years, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.
All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing.
Both the Ministry of Health and WHO are concerned about the situation in Kubu Sembelang and have intensified investigation and response activities. Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community. To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.
Analysis of viruses
Full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO H5 reference laboratories in Hong Kong and the USA. Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir (Tamiflu).
The human viruses from this cluster are genetically similar to viruses isolated from poultry in North Sumatra during a previous outbreak.
<!-- include footer--><!-- include ftr-->
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
Efficient is a word that is applied to Phase 6, not Phase 4.
Phase 4 is clusters. Phase 4 is limited human-to-human transmission.
Phase 4 is what we are witnessing in Indonesia.
Re: Indonesia BF - 5/22-5/23
To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.
This is a game of words.
Efficient is a word that is applied to Phase 6, not Phase 4.
Phase 4 is clusters. Phase 4 is limited human-to-human transmission.
Phase 4 is what we are witnessing in Indonesia.
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
Seven Indonesian Bird Flu Cases Linked to Patients, WHO Says
May 23 (Bloomberg) -- All seven people infected with bird flu in a cluster of Indonesian cases can be linked to other patients, according to disease trackers investigating possible human-to-human transmission of the H5N1 virus.
A team of international experts has been unable to find animals that might have infected the people, six of whom have died, the World Health Organization said in a statement today. In one case, a 10-year-old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said.
Almost all of the 218 cases of H5N1 infections confirmed by the WHO since late 2003 can be traced to direct contact with sick or dead birds. Strong evidence of human-to-human transmission may prompt the global health agency to convene a panel of experts and consider raising the pandemic alert level, said Maria Cheng, an agency spokeswoman.
``Considering the evidence and the size of the cluster, it's a possibility,'' Cheng said in a telephone interview. ``it depends on what we're dealing with in Indonesia. It's an evolving situation.''
The 32-year-old father in the cluster of cases on the island of Sumatra was ``closely involved in caring for his son, and this contact is considered a possible source of infection,'' The WHO said in its statement. Three others, including the sole survivor in the group, spent a night in a ``small'' room with the boy's aunt, who later died and was buried before health officials could conduct tests for the H5N1 virus.
``All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness,'' the WHO said.
Re: Indonesia BF - 5/22-5/23
Seven Indonesian Bird Flu Cases Linked to Patients, WHO Says
May 23 (Bloomberg) -- All seven people infected with bird flu in a cluster of Indonesian cases can be linked to other patients, according to disease trackers investigating possible human-to-human transmission of the H5N1 virus.
A team of international experts has been unable to find animals that might have infected the people, six of whom have died, the World Health Organization said in a statement today. In one case, a 10-year-old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said.
Almost all of the 218 cases of H5N1 infections confirmed by the WHO since late 2003 can be traced to direct contact with sick or dead birds. Strong evidence of human-to-human transmission may prompt the global health agency to convene a panel of experts and consider raising the pandemic alert level, said Maria Cheng, an agency spokeswoman.
``Considering the evidence and the size of the cluster, it's a possibility,'' Cheng said in a telephone interview. ``it depends on what we're dealing with in Indonesia. It's an evolving situation.''
The 32-year-old father in the cluster of cases on the island of Sumatra was ``closely involved in caring for his son, and this contact is considered a possible source of infection,'' The WHO said in its statement. Three others, including the sole survivor in the group, spent a night in a ``small'' room with the boy's aunt, who later died and was buried before health officials could conduct tests for the H5N1 virus.
``All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness,'' the WHO said.
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
If this continues to spread we may have a Phase 5 or Phase 6.
I hope everyone has completed their preps.
Re: Indonesia BF - 5/22-5/23
In one case, a 10-year-old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said.
So we have H2H2H.
Strong evidence of human-to-human transmission may prompt the global health agency to convene a panel of experts and consider raising the pandemic alert level, said Maria Cheng, an agency spokeswoman.
This is at least Phase 4. Hopefully it won't continue going 2H.
``Considering the evidence and the size of the cluster, it's a possibility,'' Cheng said in a telephone interview. ``it depends on what we're dealing with in Indonesia. It's an evolving situation.''
It is obvious that we are dealing with at least H2H2H Phase 4 virus.
If this continues to spread we may have a Phase 5 or Phase 6.
I hope everyone has completed their preps.
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
<TABLE cellSpacing=0 cellPadding=0 width=635 border=0><TBODY><TR><TD>http://www.bloomberg.com/apps/news?pid=10000081&sid=aWESsJvt6CFE
May 23 (Bloomberg) -- All seven people infected with bird flu in a cluster of Indonesian cases can be linked to other patients, according to disease trackers investigating possible human-to-human transmission of the H5N1 virus.
A team of international experts has been unable to find animals that might have infected the people, the World Health Organization said in a statement today. In one case, a 10-year- old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said. Six of the seven people have died.
Almost all of the 218 cases of H5N1 infections confirmed by the WHO since late 2003 can be traced to direct contact with sick or dead birds. Strong evidence of human-to-human transmission may prompt the global health agency to convene a panel of experts and consider raising the pandemic alert level, said Maria Cheng, an agency spokeswoman.
``Considering the evidence and the size of the cluster, it's a possibility,'' Cheng said in a telephone interview. ``It depends on what we're dealing with in Indonesia. It's an evolving situation.''
The 32-year-old father in the cluster of cases on the island of Sumatra was ``closely involved in caring for his son, and this contact is considered a possible source of infection,'' The WHO said in its statement. Three others, including the sole survivor in the group, spent a night in a ``small'' room with the boy's aunt, who later died and was buried before health officials could conduct tests for the H5N1 virus.
`Directly Linked'
``All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness,'' the WHO said.
While investigators have been unable to rule out human-to- human transmission in the Sumatran cluster, they continue to search for other explanations for how the infections arose, the WHO statement said.
Health experts are concerned that if H5N1 gains the ability to spread easily among people, it may set off a lethal global outbreak of flu. While some flu pandemics are relatively mild, the 1918 Spanish flu pandemic killed an estimated 50 million people worldwide.
So far, studies of the Sumatran outbreak and genetic analyses of the virus don't indicate the virus has undergone major changes, Cheng said. Scientists at WHO-affiliated labs in the U.S. and Hong Kong found no evidence that the Indonesian strain of H5N1 has gained genes from pigs or humans that might change its power or spreading ability, WHO said.
Mutations
``These viruses mutate all the time and it's difficult to know what the mutations mean,'' Cheng said.
Health officials earlier found strong evidence of direct human-to-human spread of H5N1 in Thailand in 2004. Scientists reported in the Jan. 27, 2005, issue of the New England Journal of Medicine that the H5N1 virus probably spread from an 11-year- old girl in Thailand to her aunt and mother, killing the mother and daughter. People who had more casual contact with the girl didn't become infected.
In the Sumatran cluster, close, direct contact with a severely ill person was also needed for spread, Cheng said. Preliminary findings from the investigation indicate that the woman who died, considered to be the initial case, was coughing frequently while the three others spent the night in the same room. One of the three, a second brother, is the sole survivor. The other two, her sons, died.
``It looks like the same behavior pattern'' of close contact and caretaking during illness with the bird flu virus, Cheng said. To raise the level of pandemic alert ``it would have to be transmissible from more casual contact.''
General Community
The Indonesian Ministry of Health and international scientists are continuing their investigation to trace the origins of the infections, the WHO said in its statement.
``Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community,'' the WHO said. ``To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.''
</TD></TR><TR><TD>
To contact the reporter on this story:John Lauerman in Boston at jlauerman@bloomberg.net.</PRE></TD></TR></TBODY></TABLE>
Re: Indonesia BF - 5/22-5/23
<TABLE cellSpacing=0 cellPadding=0 width=635 border=0><TBODY><TR><TD>http://www.bloomberg.com/apps/news?pid=10000081&sid=aWESsJvt6CFE
May 23 (Bloomberg) -- All seven people infected with bird flu in a cluster of Indonesian cases can be linked to other patients, according to disease trackers investigating possible human-to-human transmission of the H5N1 virus.
A team of international experts has been unable to find animals that might have infected the people, the World Health Organization said in a statement today. In one case, a 10-year- old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said. Six of the seven people have died.
Almost all of the 218 cases of H5N1 infections confirmed by the WHO since late 2003 can be traced to direct contact with sick or dead birds. Strong evidence of human-to-human transmission may prompt the global health agency to convene a panel of experts and consider raising the pandemic alert level, said Maria Cheng, an agency spokeswoman.
``Considering the evidence and the size of the cluster, it's a possibility,'' Cheng said in a telephone interview. ``It depends on what we're dealing with in Indonesia. It's an evolving situation.''
The 32-year-old father in the cluster of cases on the island of Sumatra was ``closely involved in caring for his son, and this contact is considered a possible source of infection,'' The WHO said in its statement. Three others, including the sole survivor in the group, spent a night in a ``small'' room with the boy's aunt, who later died and was buried before health officials could conduct tests for the H5N1 virus.
`Directly Linked'
``All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness,'' the WHO said.
While investigators have been unable to rule out human-to- human transmission in the Sumatran cluster, they continue to search for other explanations for how the infections arose, the WHO statement said.
Health experts are concerned that if H5N1 gains the ability to spread easily among people, it may set off a lethal global outbreak of flu. While some flu pandemics are relatively mild, the 1918 Spanish flu pandemic killed an estimated 50 million people worldwide.
So far, studies of the Sumatran outbreak and genetic analyses of the virus don't indicate the virus has undergone major changes, Cheng said. Scientists at WHO-affiliated labs in the U.S. and Hong Kong found no evidence that the Indonesian strain of H5N1 has gained genes from pigs or humans that might change its power or spreading ability, WHO said.
Mutations
``These viruses mutate all the time and it's difficult to know what the mutations mean,'' Cheng said.
Health officials earlier found strong evidence of direct human-to-human spread of H5N1 in Thailand in 2004. Scientists reported in the Jan. 27, 2005, issue of the New England Journal of Medicine that the H5N1 virus probably spread from an 11-year- old girl in Thailand to her aunt and mother, killing the mother and daughter. People who had more casual contact with the girl didn't become infected.
In the Sumatran cluster, close, direct contact with a severely ill person was also needed for spread, Cheng said. Preliminary findings from the investigation indicate that the woman who died, considered to be the initial case, was coughing frequently while the three others spent the night in the same room. One of the three, a second brother, is the sole survivor. The other two, her sons, died.
``It looks like the same behavior pattern'' of close contact and caretaking during illness with the bird flu virus, Cheng said. To raise the level of pandemic alert ``it would have to be transmissible from more casual contact.''
General Community
The Indonesian Ministry of Health and international scientists are continuing their investigation to trace the origins of the infections, the WHO said in its statement.
``Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community,'' the WHO said. ``To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.''
</TD></TR><TR><TD>
To contact the reporter on this story:John Lauerman in Boston at jlauerman@bloomberg.net.</PRE></TD></TR></TBODY></TABLE>
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
Are they once again they are trying to change requirements?
Here is a reminder for Maria.
http://www.cdc.gov/flu/pandemic/phases.htm
It's not.
Were all 8 members of the family taking care of this index case?
Not likely.
I have to wonder, has Maria ever heard of an airplane?
Re: Indonesia BF - 5/22-5/23
``It looks like the same behavior pattern'' of close contact and caretaking during illness with the bird flu virus, Cheng said. To raise the level of pandemic alert ``it would have to be transmissible from more casual contact.''
Maria knows better than this.
Are they once again they are trying to change requirements?
Here is a reminder for Maria.
http://www.cdc.gov/flu/pandemic/phases.htm
Phase 3: Human infection(s) with a new subtype but no human-to-human spread, or at most rare instances of spread to a close contact.
Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.
Where exactly is casual contact mentioned?Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.
It's not.
Were all 8 members of the family taking care of this index case?
Not likely.
I have to wonder, has Maria ever heard of an airplane?
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
Commentary at
http://www.recombinomics.com/News/05230603/H5N1_Sumatra_H2H2H2H.html
Re: Indonesia BF - 5/22-5/23
Commentary at
http://www.recombinomics.com/News/05230603/H5N1_Sumatra_H2H2H2H.html
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
http://www.recombinomics.com/News/05230603/H5N1_Sumatra_H2H2H2H.html
Commentary
Extended Human to Human H5N1 Trasmission in North Sumatra
Recombinomics Commentary
May 23, 2006
The case occurred in a 32-year-old man. He developed symptoms on 15 May and died on 22 May.
The case is part of a family cluster in the Kubu Sembelang village, Karo District, of North Sumatra.
His 10-year-old son died of H5N1 infection on 13 May. The father was closely involved in caring for his son, and this contact is considered a possible source of infection.
Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman's two sons and a second brother, aged 25 years, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.
The above WHO description of the North Sumatra familial cluster suggests that H5N1 bird flu was transmitted human-to-human (H2H) through three generations. Most H2H of H5N1 has a 2-4 day incubation period, which explains the 5-10 day gap between the index case and other family members in the vast majority of clusters since 2004. The incubation range would explain all of the transmissions in the above Indonesian cluster.
The index case developed symptoms on April 27 and was symptomatic and coughing on April 29 when she could have infected her two sons (19M and 18M) and one brother (25M) generating H2H.. Media reports indicated they developed symptoms at the beginning of May, consistent with a 2-4 day incubation period. Disease onset dates were not included in the earlier WHO update.
The index case died May 4 so additional family members could have been infected at that time by the members who developed symptoms at the beginning of May. The new infections would extend the chain to H2H2H. Included would have be the nephew of the index case (10M) who died May 13. The nephew could have then infected his father (32M) who developed symptoms on May 15. This last infection would extend the chain to H2H2H2H.
The above scenario requires no tortured logic or unusual incubation times. This is in marked contrast to WHO updates, which tried to explain clusters using common source and incubation times that fell outside of the 2-4 day period, which explains the extended chain above.
One earlier example was in late December of 2004. It also involved a family gathering and the cases were linked to duck blood pudding. However, the index case developed symptoms one day after the meal, which requires an unusually short incubation time. His brother developed symptoms 17 days after the meal, requiring an unusually long incubation. The brother-in-law who was the third person to eat the pudding developed no symptoms or detectable antibody. A third brother who did not eat the pudding did develop antibodies. The epidemiological data clearly pointed away from the duck blood pudding as a source, yet WHO subsequently used the 17 day incubation period as an outside value for incubation times.
The same logic was applied to another cluster that also involved duck blood pudding. The index case developed symptoms 5 days after the meal and his younger sister developed symptoms 10 days after the meal. The older sister who also had the pudding developed no symptoms or detectable antibody, but the grandfather who did not eat the pudding had antibodies and the nurse of the index case developed symptoms and was H5N1 positive. Another nurse also developed symptoms, but she tested negative.
These two clusters and almost all familial clusters from Vietnam, Thailand, Cambodia, Indonesia, China, Turkey, Iraq, and Azerbaijan have the same 5-10 day gap and are readily explained using a 2-4 day incubation period coupled with transmission 2-6 days after symptoms.
The H5N1 transmission chain of H2H2H2H is among the longest reported, and generates yet another signal indicating the H2H transmission within families is common and several recent clusters are uncommonly large and have uncommonly long H2H transmission chains.
The H2H transmission placed the pandemic phase at four or higher over a year ago and the "proof" of H2H has been in the disease onset dates in the WHO updates since early 2004.
Media Link
Map
Re: Indonesia BF - 5/22-5/23
http://www.recombinomics.com/News/05230603/H5N1_Sumatra_H2H2H2H.html
Commentary
Extended Human to Human H5N1 Trasmission in North Sumatra
Recombinomics Commentary
May 23, 2006
The case occurred in a 32-year-old man. He developed symptoms on 15 May and died on 22 May.
The case is part of a family cluster in the Kubu Sembelang village, Karo District, of North Sumatra.
His 10-year-old son died of H5N1 infection on 13 May. The father was closely involved in caring for his son, and this contact is considered a possible source of infection.
Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman's two sons and a second brother, aged 25 years, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.
The above WHO description of the North Sumatra familial cluster suggests that H5N1 bird flu was transmitted human-to-human (H2H) through three generations. Most H2H of H5N1 has a 2-4 day incubation period, which explains the 5-10 day gap between the index case and other family members in the vast majority of clusters since 2004. The incubation range would explain all of the transmissions in the above Indonesian cluster.
The index case developed symptoms on April 27 and was symptomatic and coughing on April 29 when she could have infected her two sons (19M and 18M) and one brother (25M) generating H2H.. Media reports indicated they developed symptoms at the beginning of May, consistent with a 2-4 day incubation period. Disease onset dates were not included in the earlier WHO update.
The index case died May 4 so additional family members could have been infected at that time by the members who developed symptoms at the beginning of May. The new infections would extend the chain to H2H2H. Included would have be the nephew of the index case (10M) who died May 13. The nephew could have then infected his father (32M) who developed symptoms on May 15. This last infection would extend the chain to H2H2H2H.
The above scenario requires no tortured logic or unusual incubation times. This is in marked contrast to WHO updates, which tried to explain clusters using common source and incubation times that fell outside of the 2-4 day period, which explains the extended chain above.
One earlier example was in late December of 2004. It also involved a family gathering and the cases were linked to duck blood pudding. However, the index case developed symptoms one day after the meal, which requires an unusually short incubation time. His brother developed symptoms 17 days after the meal, requiring an unusually long incubation. The brother-in-law who was the third person to eat the pudding developed no symptoms or detectable antibody. A third brother who did not eat the pudding did develop antibodies. The epidemiological data clearly pointed away from the duck blood pudding as a source, yet WHO subsequently used the 17 day incubation period as an outside value for incubation times.
The same logic was applied to another cluster that also involved duck blood pudding. The index case developed symptoms 5 days after the meal and his younger sister developed symptoms 10 days after the meal. The older sister who also had the pudding developed no symptoms or detectable antibody, but the grandfather who did not eat the pudding had antibodies and the nurse of the index case developed symptoms and was H5N1 positive. Another nurse also developed symptoms, but she tested negative.
These two clusters and almost all familial clusters from Vietnam, Thailand, Cambodia, Indonesia, China, Turkey, Iraq, and Azerbaijan have the same 5-10 day gap and are readily explained using a 2-4 day incubation period coupled with transmission 2-6 days after symptoms.
The H5N1 transmission chain of H2H2H2H is among the longest reported, and generates yet another signal indicating the H2H transmission within families is common and several recent clusters are uncommonly large and have uncommonly long H2H transmission chains.
The H2H transmission placed the pandemic phase at four or higher over a year ago and the "proof" of H2H has been in the disease onset dates in the WHO updates since early 2004.
Media Link
Map
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
<TABLE cellSpacing=7 cellPadding=2 width="75%" border=0 valign="top"><TBODY><TR><TD vAlign=top>I thought people might find it interesting to see the current headline about bird flu at this very moment.
What I find most interesting is how the headlines contradict themselves and how some of the headlines do not actually describe the story. For example the headline about 'No Mutation' should read 'No Significant Mutation'.
WHO probes possible human-to-human bird flu spread
[SIZE=-1]Washington Post, United States - <NOBR>10 minutes ago</NOBR>[/SIZE]
[SIZE=-1]GENEVA (Reuters) - The World Health Organization (WHO) said on Tuesday human-to-human transmission of bird flu could not be ruled out in the deaths of six ... [/SIZE]
</TD></TR></TBODY></TABLE><TABLE cellSpacing=7 cellPadding=2 width="75%" border=0 valign="top"><TBODY><TR><TD vAlign=top>WHO sees no mutation in Indonesia bird flu strain
[SIZE=-1]Dose.ca, Canada - <NOBR>16 minutes ago</NOBR>[/SIZE]
[SIZE=-1]GENEVA (Reuters) - The World Health Organization (WHO) said on Tuesday tests had shown no evidence of a significant mutation in the bird flu strain that has ... [/SIZE]
</TD></TR></TBODY></TABLE><TABLE cellSpacing=7 cellPadding=2 width="75%" border=0 valign="top"><TBODY><TR><TD vAlign=top align=middle width=80></TD><TD vAlign=top>
[SIZE=-1]Voice of America - <NOBR>17 minutes ago</NOBR>[/SIZE]
[SIZE=-1]... Latest World Health Organization figures put the known number of humans infected with the H5N1 bird flu virus at 217, with 123 deaths. ... [/SIZE]
</TD></TR></TBODY></TABLE><TABLE cellSpacing=7 cellPadding=2 width="75%" border=0 valign="top"><TBODY><TR><TD vAlign=top>'No mutation' in bird flu strain
[SIZE=-1]Sunday Times.au, Australia - <NOBR>18 minutes ago</NOBR>[/SIZE]
[SIZE=-1]THE World Health Organisation says tests have shown no evidence of a significant mutation in the bird flu strain that has killed at least six people in North ... [/SIZE]
</TD></TR></TBODY></TABLE>
Re: Indonesia BF - 5/22-5/23
<TABLE cellSpacing=7 cellPadding=2 width="75%" border=0 valign="top"><TBODY><TR><TD vAlign=top>I thought people might find it interesting to see the current headline about bird flu at this very moment.
What I find most interesting is how the headlines contradict themselves and how some of the headlines do not actually describe the story. For example the headline about 'No Mutation' should read 'No Significant Mutation'.
WHO probes possible human-to-human bird flu spread
[SIZE=-1]Washington Post, United States - <NOBR>10 minutes ago</NOBR>[/SIZE]
[SIZE=-1]GENEVA (Reuters) - The World Health Organization (WHO) said on Tuesday human-to-human transmission of bird flu could not be ruled out in the deaths of six ... [/SIZE]
</TD></TR></TBODY></TABLE><TABLE cellSpacing=7 cellPadding=2 width="75%" border=0 valign="top"><TBODY><TR><TD vAlign=top>WHO sees no mutation in Indonesia bird flu strain
[SIZE=-1]Dose.ca, Canada - <NOBR>16 minutes ago</NOBR>[/SIZE]
[SIZE=-1]GENEVA (Reuters) - The World Health Organization (WHO) said on Tuesday tests had shown no evidence of a significant mutation in the bird flu strain that has ... [/SIZE]
</TD></TR></TBODY></TABLE><TABLE cellSpacing=7 cellPadding=2 width="75%" border=0 valign="top"><TBODY><TR><TD vAlign=top align=middle width=80></TD><TD vAlign=top>
[SIZE=-1]Voice of America - <NOBR>17 minutes ago</NOBR>[/SIZE]
[SIZE=-1]... Latest World Health Organization figures put the known number of humans infected with the H5N1 bird flu virus at 217, with 123 deaths. ... [/SIZE]
</TD></TR></TBODY></TABLE><TABLE cellSpacing=7 cellPadding=2 width="75%" border=0 valign="top"><TBODY><TR><TD vAlign=top>'No mutation' in bird flu strain
[SIZE=-1]Sunday Times.au, Australia - <NOBR>18 minutes ago</NOBR>[/SIZE]
[SIZE=-1]THE World Health Organisation says tests have shown no evidence of a significant mutation in the bird flu strain that has killed at least six people in North ... [/SIZE]
</TD></TR></TBODY></TABLE>
Last edited:
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
WHO is waiting for a shift in the virus genetic code before they call it H2H for real. Maybe hoping the virulence will go down as a result.
They will probably still be waiting while H5N1 just recombines and adds the effecient/sustained pieces it needs to go pandemic while not losing any of its virulence.
The pot of water is bubbling a bit faster now.
Re: Indonesia BF - 5/22-5/23
WHO is waiting for a shift in the virus genetic code before they call it H2H for real. Maybe hoping the virulence will go down as a result.
They will probably still be waiting while H5N1 just recombines and adds the effecient/sustained pieces it needs to go pandemic while not losing any of its virulence.
The pot of water is bubbling a bit faster now.
Auburn Boy
Active member
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
A death by a thousand cuts.
It appears to me that the WHO is leading us in the direction of announcing H2H by incremental acknowledgements of the evidence.
The fact that they see "no significant mutation" is not sufficient to rule out the significance of such mutations.
Where's the open kimono? Where's the peer review?
Re: Indonesia BF - 5/22-5/23
A death by a thousand cuts.
It appears to me that the WHO is leading us in the direction of announcing H2H by incremental acknowledgements of the evidence.
The fact that they see "no significant mutation" is not sufficient to rule out the significance of such mutations.
Where's the open kimono? Where's the peer review?
Re: Indonesia BF - 5/22-5/23
Re: Indonesia BF - 5/22-5/23
Commentary at
http://www.recombinomics.com/News/05230604/H5N1_Sumatra_Sequences.html
Re: Indonesia BF - 5/22-5/23
Commentary at
http://www.recombinomics.com/News/05230604/H5N1_Sumatra_Sequences.html