Problems with Indonesia cluster reporting

Indonesia's bird flu fight riddled with problems
Tue May 23, 2006 1:57am ET163

By Tan Ee Lyn

JAKARTA (Reuters) - Indonesian laboratory chief Abdul Adjid sent one of his staff to a village in Sumatra to collect animal samples this month after several members of a family fell sick with the H5N1 bird flu virus and died.

The staffer came back with blood and nasal swab samples of a few ducks but failed with the pigs because he could not get anywhere near them.

"He was alone. He couldn't handle the pigs. People there were unhappy with the situation so they did not help," said Adjid of Indonesia's Veterinary Research Institute.

Those few, short sentences reflect a litany of simple, but tremendous, problems Indonesia, the world's fourth most populous country, faces in its fight against the H5N1 virus.

There's a lack of trained personnel and equipment and many Indonesians are ignorant about the disease and suspicious of government workers as well as efforts to control the virus.

Add to this a massive geographical landscape of 17,000 islands that stretch 5,000 kilometers (3,100 miles) from east to west and it makes control of any infectious disease a nightmare.

"There is substantial room for more work to be done. We are ramping up our team here to work with the Agriculture Ministry to increase personnel in the field to deal with the problem of surveillance and response to cases when they are found," said Larry Allen of the UN's Food and Agriculture Organization.

Since its first known attack on Indonesian poultry in late 2003, the H5N1 virus has wreaked havoc in terms of human lives and losses to the poultry industry. At least 32 Indonesians have died of bird flu, the second highest total in any country so far. Some experts blame the crisis partly on Jakarta's policy against killing large numbers of fowl in infected areas.

Sick chickens are the main source for human infections worldwide and experts say the best way to prevent the virus spreading is to stamp out the disease in poultry.

But the cash-strapped government says mass culling is just too expensive and too hard to carry out in many areas of the country. Widespread culling would also meet resistance in a nation where millions keep a few birds in their yards.

For millions more, fowl are essential to their livelihoods.

While Thailand and Vietnam seem to have controlled the virus, H5N1 is believed to be endemic in almost all Indonesia's 33 provinces.

ANGRY VILLAGERS

The medical community was alarmed last week when the World Health Organization confirmed the virus killed at least five members of a Sumatran family within a week -- the largest known cluster of H5N1 human infections.

Such "clusters" are looked on with far more suspicion than isolated infections because they raise the possibility the virus might have mutated to transmit efficiently among humans. Such a change could spark a pandemic that could kill millions.

The first victims in that cluster in Kubu Simbelang village died in early May, but three weeks on, authorities have not been able to trace the likely source. "We cannot conclusively confirm or rule out the possibility of human-to-human transmission," said I Nyoman Kandun of the Health Ministry's communicable disease control directorate.

Animal tests have been inconclusive. Although Adjid's laboratory detected H5 antibodies in pigs, chickens and ducks in a village a short distance from Kubu Simbelang, they have yet to test for the N1 component -- something they cannot do without reference materials from the WHO.

Nasal swab samples were free of live H5N1 virus, which means the animals were not infected at the time of sampling.

But samples that are perhaps most crucial in solving the mystery -- those of chickens and pigs in Kubu Simbelang -- are missing, because villagers refused to help Adjid's staff.

Pigs are susceptible to human and bird viruses and because in Asia they are often reared in close quarters with people, they are also seen as likely sources of infection.

The family cluster has wrecked the poultry industry in the wider Karo region in north Sumatra and villagers have turned on the government, accusing it of not providing enough help.

In a show of anger, about 100 Karo chicken traders tore apart live chickens with their bare hands on Monday and defiant villagers have pledged to hold a traditional feast that involves slaughtering pigs and poultry and cooking them in blood.

"They are disappointed that we have not been more responsive. They are not angry, just unfriendly. They are unfriendly to the people from the central government, the provincial government," said Sidharta Pinem, head of animal husbandry in Karo Regency.

(With additional reporting by Achmad Sukarsono and Diyan Jari)

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