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INDONESIA - Garut Cluster PART I

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HenryN

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Indonesian girl dies of suspected bird flu <!-- END HEADLINE --><!-- BEGIN STORY BODY -->26 minutes ago


A suspected bird flu victim who is from the same area as Indonesia's latest confirmed case died in hospital, a health official said.
The nine-year-old girl, Ai Siti Aminah, was from Cikelet in West Java's Garut district, said Wijayanti, a doctor from Garut's main hospital. It is the same area as a 17-year-old confirmed two days ago as infected with H5N1.
Wijayanti told AFP that the girl, who was from a different village to the teenager, was admitted to hospital on Monday afternoon with pneumonia.
"She was immediately taken to the isolation unit, had samples taken and then received treatment but her condition was already failing at the time. She remained unconscious until her death today," she said.
Senior health ministry official Nyoman Kandun told AFP that laboratories in Jakarta had not released results of her tests yet.
Positive tests must be returned at two separate laboratories in Jakarta before being listed by the World Health Organisation as a confirmed case.
Seventeen-year-old Umar Aup was listed as Indonesia's 57th confirmed case of H5N1 on Sunday. Forty-four of those died, making the nation the world's worst-hit.
Another health official said Tuesday that a cousin of Aup had died showing symptoms of the virus more than a week ago.
Iman Firmanulah, the head of the contagious disease section of Garut's health office, told AFP that Aup's cousin Misbah died on August 6 exhibiting bird flu-like symptoms.
But 20-year-old Misbah was buried before samples were taken, he said.
"We cannot positively say that he died of avian influenza but he showed symptoms that were similar to those of bird flu patients," he said.
The health ministry's Kandun said he was being a considered a "probable positive" case.
Firmanulah also urged Indonesia's health ministry to provide his office and Garut hospital with suitable equipment to treat patients.
"Health minister (Siti Fadilah Supari) has appointed Garut hospital as a designated center for bird flu treatment, but don't just give us difficult tasks -- please also give us proper equipment," he said.
He said Garut hospital lacked ventilation and defibrillation equipment and also needed vehicles for surveillance in isolated areas. It takes four hours by motorcycle to reach Cikelet, he said.
Indonesia reported its first bird flu deaths in July last year and has seen a steady rise in its toll.


http://news.yahoo.com/s/afp/healthfluindonesia&printer=1
 
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H5N1 Bird Flu Cluster in Garut Indonesia Grows to Three?
Recombinomics Commentary
August 15, 2006

The nine-year-old girl, Ai Siti Aminah, was from Cikelet in West Java's Garut district, said Wijayanti, a doctor from Garut's main hospital. It is the same area as a 17-year-old confirmed two days ago as infected with H5N1.

Wijayanti told AFP that the girl, who was from a different village to the teenager, was admitted to hospital on Monday afternoon with pneumonia.

"She was immediately taken to the isolation unit, had samples taken and then received treatment but her condition was already failing at the time. She remained unconscious until her death today," she said.

Seventeen-year-old Umar Aup was listed as Indonesia's 57th confirmed case of H5N1 on Sunday. Forty-four of those died, making the nation the world's worst-hit.

Another health official said Tuesday that a cousin of Aup had died showing symptoms of the virus more than a week ago.

Iman Firmanulah, the head of the contagious disease section of Garut's health office, told AFP that Aup's cousin Misbah died on August 6 exhibiting bird flu-like symptoms.

But 20-year-old Misbah was buried before samples were taken, he said.
"We cannot positively say that he died of avian influenza but he showed symptoms that were similar to those of bird flu patients," he said.

The above comments describe three suspect H5N1 bird flu cases in Garut in West Java. Although H5N1 has only been confirmed in the only surviving member, the index case was the cousin of the H5N1 confirmed case and test results from the third member has not been released. However, these three cases appear to be forming a geographical cluster in West Java. These cases are in addition to the two confirmed fatalities in suburbs of Jakarta who also died with the past week.

Five new cases on Jakarta are cause for concern. Although WHO updates cite contact with dead or dying poultry, the sequences released from the patients on Java do not match the poultry H5N1 sequences. Recent bird samples are being tested in Australia, but the first set of samples released are from birds from Wates in northern Sumatra and are closer to the Karo cluster, although there are also significant differences in that group also. However, those differences may be related to collection dates. Currently, there are no public bird H5N1 sequences from 2006.

However, the Java cases have been reported for over a year, and all but one of the human sequences reported to date have the novel cleavage site, RESRRRKKR. These isolates also have changes in all eight gene segments that do not match the poultry isolates. Thus far the only match with the human sequences is with H5N1 from a cat in the Jakarta area..
 
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JAKARTA, Indonesia Bird flu is suspected in the death of a nine-year-old girl in Indonesia.
If confirmed, she would be the 45th person in Indonesia to die from the H-five-N-one virus in just over a year.
The H-Five-N-One strain has killed at least 139 people worldwide since it began ravaging Asian poultry stocks in late 2003. Indonesia has been hit hardest.
Most human cases have been traced to contact with infected birds and is hard to catch. But experts fear the virus will mutate into a form that spreads easily among people, potentially sparking a pandemic.

http://kvoa.com/Global/story.asp?S=5281740&nav=HMO6
 
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The patient Suspect Bird Flu died in Garut the writer: Sugeng SumaryadiBandung -- MIOL: Ai Siti the message, 9, the patient suspect bird flu died, on Tuesday (15/8), around struck 15.30 WIB, after 24 hours were treated in RSUD Slamet, Garut, on Tuesday (15/8).The citizen of the Jojok Village, RT 01/11, the Cikelet Subdistrict, this Garut Regency was brought to RSUD Garut, on Monday (14/8) around struck 15.30 WIB.At "that time, the condition for casualties has been very heavy."He suffered the disturbance of the respiratory tract and hot high, like the sign of the bird flu sufferer, explained Director RSUD Slamet, Garut, Yati Maryati, on Tuesday.Casualties could receive the maintenance intesif and was placed in the special isolation the bird flu sufferer.He was also given several Tamiflu tablets and got respiratory aids.However, because his condition has been very heavy, medical efforts did not produce results.But, Yati still could not ascertain the cause of the death of casualties.From his clinical sign was similar to bird flu.But to ascertain him, said he, his side has sent the sample of his blood to Labkes Jakarta.In the meantime, Umar, 14, the citizen of the Rancasalak Village, the Cikelet Subdistrict, that also had been treated in RSUD Slamet, as the patient suspect bird flu, his condition gradually improved.Umar could be treated for three days in RS, before being brought had come home by his family."In fact, we forbade him to be brought came home, because in accordance with the procedure, he must be treated for seven days."But, we continued to monitor his condition, because he was treated the road in the Pamengpeuk Community Health Centre, explained Yati.(SG/OL-02).
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Metrotvnews.com, Garut: A patient suspect bird flu in Garut finally had died on Tuesday afternoon (15/8).The patient was named Ai Siti Aminah (9 years) just one night underwent the maintenance in the regional Public Hospital (RSUD) Garut, West Java.The Ai Siti Aminah body rencanaya will be brought to his house tonight also.The citizen of the Jojok Village, the Cikelet Village, of this Cikelet Subdistrict was treated in the Garut regional Public Hospital since last Monday.Because of his sign that was similar to bird flu like breathless and the temperature of the high body, Siti Aminah was treated in isolation space with the handling suspect bird flu.RSUD Garut Director the doctor Yati stated, the cause of the Siti Aminah death was still being waiting for results of the test of blood of the sample laboratory from Health Research And Development, Jakarta.The sample of blood was sent yesterday and it was estimated just will be known by results two days more.()

http://www.metrotvnews.com/berita.asp?id=22302


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Post #1 by Niman in Today's Headlines: Indonesia Bird Flu Patient Refuses Treatment thread:

"Health officials have said they suspect that many Indonesians have died from bird flu unreported because they no tests were performed."

Why do you believe this is a cluster? Because they are in the same area? There may be many clusters....for all we know.
 
Re: Garut Cluster

Re: Garut Cluster

Commonground said:
Post #1 by Niman in Today's Headlines: Indonesia Bird Flu Patient Refuses Treatment thread:

"Health officials have said they suspect that many Indonesians have died from bird flu unreported because they no tests were performed."

Why do you believe this is a cluster? Because they are in the same area? There may be many clusters....for all we know.

A cluster is 2 or more patients with a link (could be familial or geographic). Three patients in the same area with symptoms within days of each other would be a cluster, and there may be many more, but this cluster is getting some media and WHO attention, which should generate more info (and the cousins have both a familial and geographic link - WHO's failure to mention the familial link is also a red flag)
 
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Thanks Dr. Niman, I want to go research and see if we've had clusters before in the middle of August. I've only been following this since March.
 
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Commonground said:
Thanks Dr. Niman, I want to go research and see if we've had clusters before in the middle of August. I've only been following this since March.

The first report case in Indonesia was a cluster in Tangerang (3 family members) in July of 2005 and the second was at the end of August (another cluster of 2 - aunt and nephew) in Jakarta (both of these clusters were close to the receent confirmed cases in Bekasi and Tangerang)..
 
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Liputan6.com, Garut: A positive patient bird flu in the regional Public Hospital Doctor Slamet, Garut, West Java, died, on Tuesday (15/8) struck 15.00 WIB. Siti Fatimah was the bird flu patient who was treated from the hospital in the critical condition since several days set.Siti was one of the bird flu patients who came from the Cikelet Village, the Pameungpeuk Subdistrict, Garut South.The female child was 9 years old was reconciled from the Cikelet Community Health Centre.He was treated with the other patient who was named Umar.The man was 17 years also old came from the Cikelet Village and only could be treated a day in RSUD Slamet.However he forced came home because of not having the medicating cost.The side of RSUD Slamet and the Garut Health Service could follow Umar in his house after being based on his laboratory inspection was stated positive bird flu.However Umar and his family insisted on refusing to be treated.Dinkes Garut at once determined the status of the extraordinary incident bird flu resulting from this case.Up to now bird flu casualties who died in Indonesia reach 47 people.As for since July 2005 set was gotten by 61 positive cases of bird flu.With this condition for Indonesia occupied the first level in the world for the death rate of the bird flu sufferer.The department of the RI Health stated Indonesia still in the stage was on the alert the spread of bird flu antarmanusia [read: Oki and Megi Positive Terjangkit Bird Flu].(ZIZ/Tim Coverage 6 SCTV)</PRE>
http://www.liputan6.com/view/7,127500,1,0,1155650339.html</PRE>
 
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Commonground said:
Thanks Dr. Niman, I want to go research and see if we've had clusters before in the middle of August. I've only been following this since March.

Here is more info on the first cluster (July, 2005 - father's H5N1 is A/Indonesia/5/05)

http://www.recombinomics.com/News/06030601/H5N1_Tangerang_Cluster_Grows.html

http://www.recombinomics.com/News/07150505/H5N1_H2H_Tangerang.html

here's the second cluster (August 2005) and suspect cases (only the aunt and nephew were confirmed - aunt's H5N1 is A/Indonesia/6/05 and is only human Java isolate without the novel cleavage site)

http://www.recombinomics.com/News/09200504/H5N1_Casual_Phase_5.html
 
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Cousin of Indonesian bird flu case dies with flu-like symptoms

Jakarta (ANTARA News) - A cousin of Indonesia's latest bird flu
patient died showing symptoms of the virus more than a week ago, a health official said Tuesday as he pleaded for more medical equipment.

Seventeen-year-old Umar Aup, from Cikelet in West Java's Garut district who has refused hospital treatment, is Indonesia's 57th confirmed case of H5N1.


Forty-four of those were fatalities, making the nation the world's worst-hit.

Iman Firmanulah, the head of the contagious disease section of Garut's
health office, told AFP that Aup's cousin Misbah died on August 6 exhibiting bird flu-like symptoms.

Both youths had come into contact with dead poultry.

But 20-year-old Misbah was buried before samples were taken, he said.

"We cannot positively say that he died of avian influenza but he showed
symptoms that were similar to those of bird flu patients," he said, adding that any decision to exhume the body was outside his jurisdiction.

Samples from Misbah's parents had since been taken for testing, he said.

Firmanulah also urged Indonesia's health ministry to provide his office and Garut hospital with suitable equipment to treat patients.

"Health minister (Siti Fadilah Supari) has appointed Garut hospital as a
designated center for bird flu treatment, but don't just give us difficult tasks -- please also give us proper equipment!" he said.

He said Garut hospital lacked ventilation and defibrillation equipment and also needed vehicles so they could carry out surveillance in isolated areas. It takes four hours by motorcycle to reach Cikelet, where the current patient is, he said.

Indonesia reported its first bird flu deaths in July last year and has seen a steady rise in its toll.

The world's first lab-confirmed human-to-human transmission of bird flu
occurred in Indonesia three months ago in a cluster of seven deaths, sparking serious concern among scientists. (*)<!-- google_ad_section_end -->

Copyright ? 2006 ANTARA
August 15, 2006 14:58
http://www.antara.co.id/en/print/index.php?id=18370
 
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Suspect Bird Flu was from Garut reconciled to RSHSBandung -- MIOL: the Handsome Sadikin Hospital (RSHS) Bandung, on Wednesday (16/8) accepted the patient suspect bird flu, Is (5), the citizen of the Village Jojok the Village Cikelet the Village Tipar the Subdistrict Cikelet the Garut Regency.
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http://www.mediaindo.co.id/berita.asp?id=109035

http://www.mediaindo.co.id/cari.asp?E=A&query=flu+burung&Ctgl=
 
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Liputan6.com, Jakarta: Siti Fatimah, the bird flu patient that yesterday the afternoon died in the regional Public Hospital of the doctor Slamet, Garut, of West Java, was buried in the Jojok Village, the Cikelet Village, Pameungpeuk, Garut, on Wednesday (16/8).However the citizen around casualties's residence up to now still worried because of not yet knowing definitely the cause of the Siti death.They only knew beforehand chickens in their village died suddenly.Siti personally beforehand suffered hot high and breathless since early August set.The first child could be from the couple Ade Supriadi and Solehah that were nine years old examined by the community health centre doctor and was stated only suffered the sign of typhus.On Cikelet Community Health Centre reconciliation, casualties were afterwards treated in RSUD the doctor Slamet, but his spirit was not helped [read: the Bird Flu Patient in Garut died].In the meantime Health Minister Siti Fadilah Supari regretted the family's Umar attitude, the bird flu patient that forced came home from RSUD Slamet's doctor because of the lack of the cost.According to Siti, bird flu indeed did not yet spread from humankind to humankind.However the Umar existence was needed for observation of the strength of his body towards the bird flu virus [read: Menkes regretted the Patient Bird Flu Force came home].(ADO/Tim Coverage 6 SCTV)
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Metrotvnews.com, Bandung:

A villager Cikeulet, the Garut Regency, West Java, was again brought to the Handsome Sadikin Hospital, Bandung, West Java.

He was Isma.He was it was suspected infected by the bird flu virus.Isma was brought by making use of the ambulance belonging to the Garut regional Public Hospital to RS Handsome Sadikin.

Like the other bird flu sufferers, Isma was at once handled by the clothed medical team especially.According to Endi, parents of the patient, before being reconciled to RS Handsome Sadikin, his child could be treated in RSUD Garut for two hours.

Because the temperature of the patient's body continued to heat up was accompanied by coughs, the side of RSUD Garut reconciled the patient to RS Handsome Sadikin.Was based on information of several citizens, several last days, several poultries around the patient's house died suddenly.Moreover, the distance of the patient's house only one hundred metre from the Siti Aminah house that died on last Tuesday with the sign similar to the bird flu patient.

The case of bird flu to humankind in Indonesia has been found in eight provinces.According to the central data of the Department's Communication of the Health, since July 2005 till July 20 2006 was reported by 607 cases cumulatively.

After being done by the clinical inspection, epidemiological, and the laboratory, the case of most positive bird flu was found in West Java totalling 16 cases.Followed by Jakarta totalling 15 cases, Banten eight cases, and North Sumatra seven cases.

The case suspect most bird flu was found in Jakarta totalling 51 cases, was followed West Java 36 cases.The number of the total casualty died as a result of bird flu for the length of July 2005 till July 2006 was recorded by as many as 43 people.Whereas 37 other people died with the status suspect bird flu.(BEY)
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http://www.metrotvnews.com/berita.asp?id=22385
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Liputan6.com, Bandung: Ismayati, the patient that was expected terjangkit bird flu was from the Garut Regency reconciled to the Handsome Sadikin Hospital, Bandung, West Java, on Wednesday late afternoon (16/8).

Nana Permana, the uncle Ismayati, said the child five years suddenly were sick after could pay a condolence call for the death of his neighbour, Siti Aminah -- assumption casualties of bird flu that died yesterday.
"If in the location that died yesterday, almost 20-30-an (the person)," said Nana [read: the Bird Flu Patient in Garut died].

The citizen of the Jojoh Tipar Village, Garut, that was put into Space of the Poinciana Tree Isolation RS Handsome Sadikin to be treated further.
Clinically, Ismayati showed the sign was similar to bird flu as the high fever achieved 38.6 Celsius levels.

Likewise the cough was accompanied breathless with respiration reached 38.
To ascertain the virus kind, the official took the sample of blood the patient to be tested in the central Laboratory of Jakarta Health Research And Development.

Before being reconciled to RS Handsome Sadikin, Ismayati could be treated in Space Slamet, Garut, of the Isolation of the doctor's Public Hospital for half of the hour.

The transfer reason because of being pushed by the limitations of medical equipment that was available in this hospital.
(AIS/Patria and Guidance Divine Guidance)

http://www.liputan6.com/view/3,127568,1,0,1155757857.html
 
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