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Indonesian Clusters

L

Laidback Al

Well-known member
Cluster situation in Indonesia

There have been several posts noting "10 human clusters" in Indonesia quoting Nyoman Kandun from the Directorate General of Disease Control and Environmental Health.

http://www.flutrackers.com/forum/showpost.php?p=58569&postcount=22

http://www.flutrackers.com/forum/showpost.php?p=58623&postcount=25

Note that the reference to 10 human clusters is a cumulative number of clusters since Indonesia starting tracking and reporting human H5N1cases. This number, 10, is NOT the number of current human clusters being treated in Indonesia at the moment.

As noted in the post by Dutchy (http://www.flutrackers.com/forum/showpost.php?p=58630&postcount=27) on 2/18/2006 Minister Kesra Emil Agustiono is quoted as saying "In Indonesia from 28 cases was 5 cluster." That is, through 2/18/2006, five clusters of human H5N1 infection were recognized by the Indonesian government. (the original Indonesian source for this article is available at http://www.detiknews.com/index.php/detik.read/tahun/2006/bulan/02/tgl/19/time/004520/idnews/542537/idkanal/10).

Since February, 2006, there have been 4 other human H5N1 human clusters, in which at least two of the individuals were confirmed by WHO. That totals 9 human clusters in Indonesia to date.

The tenth cluster, as indicated by Nyoman Kandun, would include Riyah (37F) who died on January 11 and is confirmed by WHO and one, or possibly, two associated family members (a daughter who died on 1/12/2007 and a son who was infected).

In summary, we do not currently have ten separate human clusters in Indonesia at this time.

Here is a list of of the previous nine clusters is Indonesia.

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</TD></TR><TR style="HEIGHT: 12.75pt; mso-yfti-irow: 1"><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 39pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=52 x:num>
215<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 62pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=83><?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region><o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283>Tangerang, Baten, Java (Iwan Iswara family)<o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 48pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=64 x:num>
2005<o:p></o:p>​
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7<o:p></o:p>​
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3<o:p></o:p>​
</TD></TR><TR style="HEIGHT: 12.75pt; mso-yfti-irow: 2"><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 39pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=52 x:num>
240<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 62pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=83><st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region><o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283><st1:City w:st="on"><st1:place w:st="on">Jakarta</st1:place></st1:City>, Java (Rini Dina Family)<o:p></o:p>
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2005<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 44pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=59 x:num>
9<o:p></o:p>​
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2<o:p></o:p>​
</TD></TR><TR style="HEIGHT: 12.75pt; mso-yfti-irow: 3"><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 39pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=52 x:num>
216<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 62pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=83><st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region><o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283>Lampung, <st1:place w:st="on">Sumatra</st1:place> (Hendriansyah family)<o:p></o:p>
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2005<o:p></o:p>​
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9<o:p></o:p>​
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3<o:p></o:p>​
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219<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 62pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=83><st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region><o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283>Tangerang, Baten, Java (Ina Solati family)<o:p></o:p>
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2005<o:p></o:p>​
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10<o:p></o:p>​
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2<o:p></o:p>​
</TD></TR><TR style="HEIGHT: 12.75pt; mso-yfti-irow: 5"><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 39pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=52 x:num>
225<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 62pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=83><st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region><o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283><st1:place w:st="on">West Java</st1:place> (Nurochmah family)<o:p></o:p>
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2006<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 44pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=59 x:num>
1<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 53pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=71 x:num>
4<o:p></o:p>​
</TD></TR><TR style="HEIGHT: 12.75pt; mso-yfti-irow: 6"><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 39pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=52 x:num>
233<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 62pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=83><st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region><o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283>Karo, <st1:place w:st="on">Northern Sumatra</st1:place><o:p></o:p>
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2006<o:p></o:p>​
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4<o:p></o:p>​
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8<o:p></o:p>​
</TD></TR><TR style="HEIGHT: 12.75pt; mso-yfti-irow: 7"><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 39pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=52 x:num>
234<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 62pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=83><st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region><o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283><st1:City w:st="on">Bandung</st1:City>, <st1:place w:st="on">West Java</st1:place><o:p></o:p>
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2006<o:p></o:p>​
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5<o:p></o:p>​
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3<o:p></o:p>​
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245<o:p></o:p>​
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 62pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=83><st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region><o:p></o:p>
</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283>Makssar, <st1:place w:st="on">South Sulawesi</st1:place><o:p></o:p>
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2006<o:p></o:p>​
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6<o:p></o:p>​
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4<o:p></o:p>​
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249<o:p></o:p>​
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</TD><TD style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 5.4pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; BORDER-LEFT: #d4d0c8; WIDTH: 212pt; PADDING-TOP: 0in; BORDER-BOTTOM: #d4d0c8; HEIGHT: 12.75pt; BACKGROUND-COLOR: transparent" vAlign=bottom noWrap width=283><st1:PlaceName w:st="on">Kaligentong</st1:PlaceName> <st1:PlaceType w:st="on">Village</st1:PlaceType>, Tulungagung, <st1:place w:st="on">East Java</st1:place><o:p></o:p>
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2006<o:p></o:p>​
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9<o:p></o:p>​
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2<o:p></o:p>​
</TD></TR></TBODY></TABLE>
 
Re: Indonesian Clusters

Richard McC said:
Laidback Al

In a previous post, you referred to (at least) four 'possible clusters'.

Are these no longer 'possible clusters', or are you using a tight definition - associated WHO-confirmed cases only?

How many clusters do you count in the latest outbreak?

I asl from interest after reading the discussion at https://www.singtomeohmuse.com/viewtopic.php?t=234
Click to expand...

I believe that the four possible clusters I referred to are some of those listed in the post by MHSC (updated today) http://www.flutrackers.com/forum/showpost.php?p=58782&postcount=7

As noted by MHSC "Cluster A" only had one confirmed H5N1 case, Ramli. The other potential cases in the cluster all tested negative and are apparently well since they have discharged. I would no longer consider this to be a potential cluster.

One person from Cluster B, Riyah has been confirmed by WHO. Her husband and at least one of her children were sick and were being treated. The family relationship between members of this cluster is unclear. I believe this is the cluster that Nyoman Kandun indicated is the 10th human cluster in Indonesia.

More information and testing results are necessary for Cluster E, Cluster C, and Cluster F, to determine whether or not these are H5N1 clusters. (Note, there is no cluster D in the post).

Reviewing the cluster list that I presented above for Indonesia indicates that the Directorate General of Disease Control and Environmental Health is using a "tight" definition for human clusters. That is, there must be at least two WHO confirmed human cases to have a cluster.
 
Re: Indonesian Clusters

Thanks for that.

Of course, we all have suspicions about the reliability of the negative results - for instance in cluster B, Riyah and Afir (the son) both tested positive but the husband (U) is still negative (but receiving treatment - presumably for an unrelated disorder ...)

So ten 'confirmed' clusters is an absolute minimum and the real number is likely to be higher.
 
Re: Indonesian Clusters

Cluster D turned out not to be a cluster but unrelated cases.
 
Re: Indonesian Clusters

Bird Flu Cluster in Indonesia Raises Fears of Change in Virus
By Jason Gale
Jan. 15 (Bloomberg) -- A new cluster of bird flu infections is worrying disease trackers, who say suspected cases involving three members of a family in Indonesia may indicate a change in the virus's ability to sicken people.


The H5N1 avian influenza strain was confirmed yesterday to have infected an 18-year-old man whose mother died of the disease four days ago, said Mukhtar Ikhsan, a doctor treating the teenager and his father in Jakarta's Persahabatan hospital.


Tests on the 42-year-old father are pending. If confirmed, the family from a western part of Java may represent the first incidence of H5N1 in a husband and wife, and indicate the virus can infect those without genetic susceptibility to infection, a theory doctors have used to explain previous clusters among blood relatives. The virus could spark a pandemic if it spreads among humans as easily as seasonal flu.


The concern is that the virus may eventually overcome a ``genetic component'' that has appeared so far to limit its ability to infect humans, Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy in Minneapolis, said in a Jan. 12 interview. ``If that happens, then to me that is the really first worrisome piece of information that the pandemic may be pending.''


Avian flu has killed four people in Indonesia since Jan. 10 after a hiatus of almost two months. World health officials say H5N1 may touch off a pandemic capable of killing millions if it mutates to become easily transmissible between humans.


The H5N1 strain is known to have infected 265 people in 10 countries since 2003, killing 159 of them, the World Health Organization said on Jan. 12. Indonesia has recorded at least 59 fatalities, it said.


Sumatra Cluster


The southeast Asian nation attracted international attention in May when blood relatives from the island of Sumatra contracted the H5N1 virus, six of them fatally. The cases represented the largest reported cluster of infections and the first laboratory-proven instance of human-to-human transmission.


``We have had enough proof from these clusters that there is something about at least certain genetically related individuals in whom the virus does fairly well,'' Osterholm said. ``That, to me, is not necessarily a big barrier to cross.''


Infections in birds and people are increasing, particularly in Asia, where the virus was first identified a decade ago. Hong Kong, Japan, Vietnam, South Korea and Nigeria have reported diseased birds in the past month, while China and Egypt also found new human cases.


New Thai Outbreak?


In Thailand, which reported three H5N1 fatalities in July and August, Agriculture Ministry officials are testing dead poultry found on a duck farm in Phitsanulok province earlier this month, the Krungthep Thurakit newspaper reported today, without saying where it obtained the information. The results of laboratory tests may be released today, it said.
The Thai ministry intensified monitoring for avian flu after it reemerged in Vietnam where it spread to at least seven southern Vietnamese provinces.
Almost all human H5N1 cases have been linked to close contact with sick or dead birds, such as children playing with them or adults butchering them or plucking feathers.


Veterinary officials in Japan are culling fowl on a farm on the southern island of Kyushu, where H5N1 was confirmed Jan. 13, the country's first outbreak in almost three years.


The administrative vice minister of agriculture will brief reporters in Tokyo later today on the outbreak.


To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net
Last Updated: January 14, 2007 21:47 EST

http://www.bloomberg.com/apps/news?pid=20601080&sid=aJeu3qEeXQ6o&refer=asia
 
Re: Indonesian Clusters

Turns out the husband has "seasonal flu," dispelling husband-wife cluster combo...
 
Re: Indonesian Clusters

KBD said:
Turns out the husband has "seasonal flu," dispelling husband-wife cluster combo...
Click to expand...
Do you have any information on his onset of symptoms, clinical presentation, anti-virals administered, etc?

H5N1 and seasonal flu residing in the same household can't be a good thing.
 
Re: Indonesian Clusters

Hope to learn more from a press conference in an hour from now. rgrds. kenny d
 
Re: Indonesian Clusters

Thank you KBD. I don't know if I can stay awake that long. My keyboard doesn't make a good pillow:sleep:
 
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