Pro med Mail Update on Indonesia

WHO confirms 6 avian influenza cases
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The World Health Organization (WHO) today [17 May 2006] confirmed 6 more
human cases of bird flu infections in Indonesia, including 5 members of a
family whose case has triggered fears of human-to-human transmission.
"There are 6 confirmations. One from Surabaya and 5 from Medan. One from
Medan is still alive," said Sari Setiogi, WHO's Indonesia spokeswoman.

An outbreak of H5N1 bird flu involving up to 8 members of a family at Medan
in North Sumatra province has worried health agencies around the world, but
a Health Ministry official said today [17 May 2006] it was not a case of
human-to-human transmission. "The spread was through risk factors from
poultry or other animals. There is no proof of human to human," Nyoman
Kandun, director-general of disease control, said to Reuters. "The world is
watching us. We are not being hasty." Four of the 5 family members have
died, and samples from a further 3 people believed to be part of the family
cluster of infections are still being tested.

WHO has sent a team to the area near Medan. The agency said it was on alert
for signs the virus is mutating into one that can be easily transmitted
between people, a development that could signal the start of a pandemic in
which millions could die. Such a mutation could occur anywhere there is
bird flu, the WHO says. Mr. Kandun said authorities were still trying to
identify the source of the virus in the cluster case in Kubu Simbelang
village in Karo regency, about 50 km south of Medan.

But an Indonesian agriculture official who declined to be named told
Reuters tests had shed no light on the case. "There is a big question mark.
Blood samples from all kinds of animals, from chickens, ducks, geese,
birds, pigs, cats and dogs, turned out negative so far. Manure has also
been checked. The result is negative," the Jakarta-based official said.

Some reports have suggested chicken manure used as fertilizer might be the
link. Infected birds can excrete large amounts of the H5N1 virus, and this
can be one way it can spread to birds and people.

The 6th case of the 6 cases confirmed today [17 May 2006] was a 38 year old
catering businesswoman from Surabaya who had dealt with live pigs and pork
meat before she died last week.

The latest deaths bring the number of Indonesians who have died from bird
flu to 30, by far the highest death rate in the world this year [2006] from
the disease. Bird flu has killed 115 people worldwide, the majority in east
Asia, since reappearing in 2003. Virtually all the victims caught the
disease from poultry. The H5N1 virus is endemic in much of Indonesia.
Yesterday [16 May 2006], a senior Agriculture Ministry official said H5N1
had been detected for the 1st time in poultry in remote eastern Papua province.

--
Joseph P Dudley, PhD
Chief Scientist
Biosecurity and Bioinformatics
EAI Corporation
4301 North Fairfax Drive
Suite 200
Arlington, VA 22203


******
[2]
Date: Wed 17 May 2006
From: Joe Dudley
Source: Reuters Foundation AlertNet, Wed 17 May 2006 [edited]



H5N1 spread among people not ruled out in Indonesia
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Health experts are investigating how several members of a family in
Indonesia's North Sumatra province contracted the H5N1 bird flu virus and
are not ruling out the possibility of human-to-human transmission. Clusters
of human infections are worrying, as they indicate that the virus, which
has killed 115 people worldwide since late 2003, might be mutating into a
form that is easily transmissible among humans. That, experts say, could
spark a pandemic in which millions might die.

Samples taken from 6 members of the family were sent to a WHO-affiliated
laboratory in Hong Kong, and 5 tested positive for H5N1. Results of the 6th
were still pending. According to the World Health Organization and experts
familiar with the case, the family -- which raised a small number of pigs
and had chickens, ducks and geese in the neighborhood -- held a barbecue on
29 Apr 2006, when they ate pork and chicken.

The 1st person to fall ill was a 37 year old woman, and 2 of her sons, her
brother, sister, niece, and nephew later fell sick. Except for the woman's
brother, everyone has since died. Contrary to earlier reports from the
Indonesian government that 8 members of the family were infected, the WHO
says the 8th person, a woman, had fever for only a day and is now well.
Local tests showed she was not infected with H5N1.

Samples taken from 11 pigs, 4 geese, 4 ducks and an unspecified number of
chickens in Kubu Simbelang village in Karo regency, where the family lived,
have also turned up negative for H5N1, but experts are not ruling anything
out. "The possibility that they may have been infected by the same source
is still there," said Sari Setiogi, the WHO spokeswoman in Indonesia. More
animal samples will be collected for local tests.

"Any time we have a cluster, it raises the suspicion that human-to-human
transmission may have occurred. We don't rule out either way ... it is too
early to make any conclusion because investigations are still going on,"
Setiogi said. More than 15 people attended the barbecue, but there were no
signs of any spread beyond this cluster of 7, she said.

There have been a few other probable cases of human-to-human transmission
of the virus in Hong Kong and Thailand in the past, possibly due to
prolonged and very close contact, although these have never spread beyond
the initial clusters.

But Indonesia's Health Ministry said the cluster in Sumatra was not a case
of human-to-human transmission. "The spread was through risk factors from
poultry or other animals. There is no proof of human-to-human," Nyoman
Kandun, director-general of disease control, told Reuters. But an
Indonesian agriculture official who declined to be identified said animal
tests have not shed any light. "There is a big question mark. Blood samples
from all kinds of animals, from chickens, ducks, geese, birds, pigs, cats
and dogs, turned out negative so far. Manure has also been checked. The
result is negative," the Jakarta-based official said.

In Hong Kong, microbiologists tasked with decoding the genomic sequence of
the 6 virus samples cautioned against making any quick conclusion either
way. Guan Yi, who heads the laboratory decoding the samples, said the long
time lag of 9 days between the 1st and last victims showing symptoms of the
disease was unusual. The 37 year old woman fell ill on 27 Apr 2006, while
one of her sons and her sister -- the last ones to fall sick -- felt the
1st symptoms on 5 May 2006. WHO recommends that an incubation period of 7
days be used for field investigations. "If they were all infected by the
same source, their onset time (of illness) would have been closer, but that
is not the case ... The later cases may involve the possibility of
human-to-human transmission," Guan told Reuters. "They may have infected
one another ... but we have no evidence. This needs to be investigated by
the locals."

Some reports say chicken manure used as fertilizer might be the link.
Infected birds can excrete large amounts of the virus, and birds and people
can be infected this way. "This could be one likely infection source," Guan
added.

[byline: Tan Ee Lyn]

--
Joseph P Dudley, PhD
Chief Scientist
Biosecurity and Bioinformatics
EAI Corporation
4301 North Fairfax Drive
Suite 200
Arlington, VA 22203


[With contrasting interpretations of the same events, there is not yet
sufficient information available to resolve the important question of
human-to-human transmission or independent transmission from a common
source. Further details are awaited. ProMED-mail acknowledges receipt of
similar information from Mary Marshall. - Mod.CP]

[see also:
Avian influenza, human - worldwide (64): Djibouti, Indonesia 20060516.1378
Avian influenza, human - worldwide (63): Indonesia 20060513.1363
Avian influenza, human - worldwide (62): Indonesia, Djibouti 20060512.1351
Avian influenza, human - worldwide (61): GI trans. 20060509.1338
Avian influenza, human - worldwide (60): Indonesia 20060508.1331
Avian influenza, human - worldwide (50): Sudan case neg 20060420.1162
Avian influenza, human - worldwide (40): Egypt 20060403.0998
Avian influenza, human - worldwide (30): Cambodia, Egypt 20060322.0890
Avian influenza, human - worldwide (20): Asia 20060302.0668
Avian influenza, human - worldwide (10): Iraq, India 20060219.0547
Avian influenza, human - Worldwide (01) 20060209.0433]

.......................cp/msp/sh


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