Indonesia Reporting Human Cases of H5N1 Controversy

[Shiloh]

Indonesia says it will no longer formally announce bird flu deaths

Indonesia says it will no longer formally announce bird flu deaths

Source: http://canadianpress.google.com/article/ALeqM5iLjLvzqks0dzVsIRggemVMdfp-QA

WHO says Indonesia has given assurances it will report bird flu cases

TORONTO ? A senior official of the World Health Organization says the global health agency has been assured Indonesia will continue to report human cases of, and deaths from, H5N1 avian flu as they occur.

The WHO had sought clarification from Indonesia after Health Minister Siti Fadilah Supari said last week that her country would in future only report H5N1 deaths sporadically, perhaps at six month intervals.

The suggestion was met with dismay and with warnings that Indonesia would be in violation of the International Health Regulations if Supari carries through on her threat.

That international treaty requires prompt reporting of cases of diseases such as H5N1 that have been designated as global health threats. Indonesia is a signatory to the treaty.

"We've received official notice at our WHO office in Jakarta that the minister will continue - as she has been - notifying WHO on confirmed infections under the International Health Regulations," Dr. David Heymann, assistant director general for health security and environment, said from Geneva.

"She's been clear ... that she has no intention of not conforming to the International Health Regulations. She knows what they are. She's been told what those regulations require."

Despite the assurances, it seems Indonesia may not have formally notified the WHO yet of an H5N1 death that occurred nearly a month ago.

In an interview with the Associated Press last week, Supari revealed that a teenage girl died on May 14, but the government decided not to announce her death right away.

"How does it help us to announce these deaths?" she asked in the interview.

The most recent death Indonesia reported to the WHO occurred on April 23. As of Thursday, the WHO's official case count for Indonesia was 108 deaths out of 133 confirmed cases - the highest toll of any country afflicted with the H5N1 virus.

Heymann said the WHO's country office in Jakarta may have been notified Thursday of the death and was putting the information through channels. But if that's not the case, the WHO will be asking questions.

"If that was a confirmed case, we will have to work to understand what went wrong" in the notification process, he said.

The International Health Regulations stipulate that countries must report new H5N1 cases within 24 hours of confirmation and must report important related information, such as deaths, in a timely manner.

The WHO needs the information to make an assessment of the risk the event poses. Changes in the H5N1 death rate, for instance, could signal that the virus has mutated and experts would want to study sample viruses to look for what triggered the shift.

Indonesia has been enmeshed in a dispute with the WHO for more than a year, refusing to allow outside scientists to study sample viruses until it receives assurance it will get a share of any vaccine produced from Indonesian viruses.

 

[Gert van der Hoek]

Re: Indonesia Reporting Human Cases of H5N1 Controversy

Indonesia's new bird flu policy on reporting deaths leads to confusion, anger


2008-06-13


BITUNG, Indonesia (AP) - Ali Usman's wife died of bird flu 10 days ago, but he still has not been officially notified by the government. Desperate for information, he scours the newspapers, which until last month aggressively wrote about deaths in the country hardest hit by the disease, but finds nothing.

That's because of a new government policy to no longer publicize individual bird flu cases immediately _ an attempt to shift media attention that politicians say focuses too heavily on deaths instead of successes.
From now on, fatalities will be announced in clusters, perhaps just a few times a year.

The news blackout worries health experts and has left government officials and people living in areas worst affected by the virus confused and frustrated.

It took The Associated Press a week to track down and confirm the June 3 death of Usman's wife, Susi Lisnawati, which raised the country's toll to 110.

Though she was suffering from classic symptoms of the disease _ breathing difficulties, coughing and high fever _ she was not kept in isolation during her two days of hospitalization or otherwise treated as a suspected bird flu patient, her husband said.

She also was given a traditional Muslim burial, her body washed and shrouded by barehanded family members, before being placed in the ground without a casket, he said.

?I'm terribly scared, I need to know what the test results were,? said Usman, a 44-year-old tailor with three sons. ?The government should be intensifying public awareness.

Indonesia, which has tallied more human deaths than any other country, is seen as a potential hot spot for a pandemic because of its high density of people and large number of backyard chickens. The virus remains hard for people to catch, but experts fear it could mutate into a form easily transmitted between humans, potentially killing millions across the globe.

The World Health Organization, which has been engaged in a bitter dispute with Indonesia since early 2007 over the sharing of virus samples, said Health Minister Siti Fadilah Supari promised to keep it informed about new deaths and did not appear to be violating international health regulations with her new policy.

?Indonesia has agreed to continue notifications to WHO .... they have never said they would not do that,? said David Heymann, the U.N. agency's top flu expert, adding that it does not matter if it takes several weeks to publicize the country's official toll ?as long as the virus is known about and handled properly.

Still, the lack of transparency has forced health workers, scientists and residents to rely on word of mouth and raised fears that deaths could be covered up _ especially since the government has been exclusively responsible for carrying out genetic sequencing of H5N1 viruses needed for diagnosis and risk assessment since its standoff with WHO.

Next-of-kin are still shown official test results almost immediately and Usman's case appeared to be an aberration.

But when asked for an explanation, Health Ministry spokeswoman Lily Sulistyowati said test results had come back negative and would be delivered to the family within days.

A senior ministry official, speaking on condition of anonymity because the issue has become so politically sensitive, later confirmed the tests were positive.

Four other health workers agreed, some after double-checking with the National Institute for Health Research and Development, the government laboratory that is responsible for confirmations but no longer speaks to the media.

Neighbors too were confused after seeing bird flu investigators visit Usman's house, taking blood samples from family members and handing out the antiflu drug Tamiflu, but only to his youngest son and a child living next door. Residents were asked if they had backyard fowl.

Gusti Ngurah Mahardika, a virologist at Udayana University on Bali island, said the new policy on announcements was a setback. ?People will become complacent about bird flu and its threat.

http://www.pr-inside.com/print641928.htm

 

[Readymom]

Re: Indonesia says it will no longer formally announce bird flu deaths

Re: Indonesia says it will no longer formally announce bird flu deaths

[snip].

All for one, one for all.

:applause: Yes, Florida1 ... the children. All the children. We must keep pressing ahead for them! -k

 

[sharon sanders]

Re: Indonesia Reporting Human Cases of H5N1 Controversy

Thank you to AP for investigating this case....



Indonesian government mum as AP reports H5N1 case

Robert Roos

News Editor

Jun 13, 2008 (CIDRAP News) ? An Indonesian woman died of H5N1 avian influenza 10 days ago, but her case has not yet been publicly confirmed by the government, which is continuing to withhold information about avian flu cases, the Associated Press (AP) reported today.
The news came on the heels of the word from a World Health Organization (WHO) official that Indonesia has promised to keep the agency informed of human cases and deaths, as it is obligated to do under the International Health Regulations (IHR). The WHO official's comments appeared to contradict statements last week from Indonesia's health minister.
On Jun 5, Health Minister Siti Fadilah Supari said the government would no longer report human H5N1 cases and deaths promptly to the WHO. Different news accounts said she planned to report cases after they were reported in the news media or only at 6-month intervals. Supari said she wanted to focus attention on the country's successes in fighting avian flu.
Today's AP story says that a 34-year-old woman named Susi Lisnawati died of avian flu Jun 3. Speaking anonymously, a senior health ministry official and four other health workers confirmed the case to the AP. But the government had not yet notified Lisnawati's husband, Ali Usman, that she had the virus, according to the story, which came from Bitung, a city near the northeastern tip of Sulawesi island.
The case has not been reported in the local news media, and it took the AP a week to track down and confirm it, the report said.
The case apparently raises Indonesia's H5N1 death toll to 110, out of a total of 135 cases. The WHO's tally for Indonesia stands at 133 cases with 108 deaths; the agency has not yet included Lisnawati and a 15-year-old girl whose case was announced by Supari just last week, though she had died May 14.
Dr. David Heymann, the WHO's assistant director general for health security and environment, said yesterday that Indonesia had assured the agency it would continue reporting avian flu cases, according to a Canadian Press (CP) report published yesterday.
"We've received official notice at our WHO office in Jakarta that the minister will continue?as she has been?notifying WHO on confirmed infections under the International Health Regulations," Heymann told CP.
"She's been clear . . . that she has no intention of not conforming to the International Health Regulations," he said. "She knows what they are. She's been told what those regulations require."
Today's AP story carried similar comments from Heymann. But according to the AP account, Heymann said it doesn't matter if it takes several weeks for the government to report cases, "as long as the virus is known about and handled properly." He also said it did not appear that Indonesia was flouting the IHR.
Under the IHR?agreed to by all WHO member countries?governments are required to quickly report cases of diseases labeled as global health threats. Novel influenza strains are among the diseases that countries are specifically obligated to report.
Indonesia has been at odds with the WHO since early 2007, when Supari announced the government would no longer send H5N1 virus samples to the agency. The country wants guarantees that it will receive a supply of any vaccine derived from the isolates it supplies. The WHO has relied for decades on free sharing of flu viruses in its effort to identify new strains, develop vaccines, and monitor drug resistance.
See also:
Jun 5 CIDRAP News story "Indonesia quits offering prompt notice of H5N1 cases"
WHO's H5N1 case count
Information on the International Health Regulations
http://www.who.int/csr/ihr/prepare/en/index.html
Jun 15, 2007, CIDRAP News story "New global disease-control rules take effect"



http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jun1308indo.html

 

[Gert van der Hoek]

Re: Indonesia Reporting Human Cases of H5N1 Controversy

The Jakarta Post now also has the AP story.

This is added by Jakarta Post:

This is not the first time Indonesia's handling of bird flu has raised eyebrows.

Supari, the health minister, got widespread attention - and some praise - when she bucked the WHO's 60-year-old virus sharing system in January 2007, saying it was unfair to developing nations. She's worried pharmaceutical companies will use her country's virus strain to make pandemic vaccines that are ultimately unaffordable to her own people.

But by refusing to share virus samples, Supari is making it almost impossible for international scientists to make sure the virus isn't morphing into a more dangerous form.

Supari defended her new policy on reporting deaths last week, saying the focus now should be on positive steps taken by the government to combat bird flu. She pointed to a "declining trend" in cases, with at least 18 people infected in the first six months of 2008, down from 27 during the same period in 2007 and 35 in 2006. (*)

http://www.thejakartapost.com/news/...y-reporting-deaths-leads-confusion-anger.html

 

[Sunshine123]

Re: Indonesia's new bird flu policy on reporting deaths leads to confusion, anger

Re: Indonesia's new bird flu policy on reporting deaths leads to confusion, anger

The Health Ministry said Friday it would start announcing deaths on a monthly basis — not several times a year as earlier implied — clearly spelling out its new strategy for the first time.


But for now, the lack of transparency has forced people to rely on word of mouth and rumors. It has also raised fears that deaths could be covered up, especially because the government has been exclusively responsible for carrying out genetic sequencing needed for diagnosis and risk assessment since its standoff with WHO.

IMHO this article reflects the trend Asian governments are starting to use in dealing with the press for Bird Flu.

 

[sharon sanders]

Re: Indonesia Reporting Human Cases of H5N1 Controversy

I do not think it is "Asian" governments. None of the governments in the world want to admit they have bird flu.