Troublesome worries about Indonesia and avian flu spread

22 May, 2006
INDONESIA
Human-to-human bird flu transmission feared in Indonesia
Health Ministry cannot rule out this possibility. The country is unable to control the virus. In China the WHO fears that official figures might not indicate how widespread the virus actually is.

Jakarta (AsiaNews/Agencies) – Indonesia cannot rule human-to-human bird flu transmission, said I. Nyoman Kandun, director of the Health Ministry's Communicable Disease Control Centre after an epidemiological investigation was conducted into a family cluster of six fatal cases in Sumatra, the last one confirmed today. Meanwhile the World Health Organisation (WHO) has voiced deep concerns the viral outbreak might be more widespread in China than hitherto thought.

“We cannot confirm that (human-to-human transmission) has occurred but we cannot rule it out,” Kandun said today. “The good news is there is not yet any mutation”

The death toll due to the H5N1 virus has reached 32 in Indonesia, half reported this year. But unlike other countries, the disease has not been stopped in archipelago. For experts the bird flu might be even more widespread that officially reported since the there are no WHO lab in the country. Samples must instead be sent to Hong Kong or elsewhere for testing.

Emil Agustiono, a senior official at the National Commission on Bird Flu, said that the lack of coordination among and between government agencies and international partners such as the WHO and the Food Agricultural Organisation (FAO), partly contributed to the rapid spread of the H5N1 strain of virus across 27 of the country's 33 provinces.

“There was a tendency to work individually, but now we're starting to step up our internal communication,” he said.

Poor inter-agency communication has been a chronic problem. The Health and Agriculture Ministries have always announced the results of their investigations separately. For example, in Medan (Karo Regency), where the WHO confirmed a cluster of seven people, teams from the Health and Agriculture Ministries came and announced their own separate findings confusing the public.

“In the next several days, I will coordinate a visit to the Karo regency. This time we'll have a strong team, consisting of representatives of all the agencies, to find out the source of the virus and how it spread,” Mr Agustiono said, adding that he suspected organic fertilisers would likely turn out to be the source.

Still, there is much confusion. Last week, a test from the Agriculture Ministry's laboratory in Bogor contradicted Agriculture Minister Anton Apriyantono's statement that pigs in the Karo tested positive.

China. Beijing's ability to contain the spread of the virus in poultry remains low, according to the WHO. “We do not think that there has been enough emphasis on the animal surveillance side to do that in China,” said Dr. Henk Bekedam, the WHO’s top representative in that country.

“Somehow the [. . .] system in China is unable to detect the circulating H5N1 (virus).”

None of China's 18 confirmed human cases to date have occurred in areas where outbreaks in poultry were previously reported.

“The human cases are the proof that it [the virus]is still circulating, that there is still something, but again, we don't know the extent,” Bekedam said.

He suggested China could look to Thailand and Vietnam, nations which have not reported a human case so far this year.

Backyard farms are the most dangerous because of poor surveillance and greater human-to-animal contact.

Moreover, while farmers are compensated for birds that must be culled to stop the spread of the virus, the level paid, especially for more expensive birds like ducks and geese, is seen to be on the low side. Chinese farmers must also wait six months before restocking compared to three months in other countries.

“From a preventive perspective, that's fine,” Bekedam said of China's position. But “you're out of business,” he said of affected farmers. “And that's the part of compensation I think that needs to be looked into.”

“The [. . .] situation is not optimistic,” Vice Premier Hui Liangyu told a national meeting on the prevention and control of avian flu.

His warning came as the Agriculture Ministry reported Saturday that more than 300 wild migratory birds have died in the remote province of Qinghai.

The WHO opened its annual assembly today on a sad note. Its director-general, Lee Jong-wook, died in hospital today two days after emergency surgery for a blood clot on his brain. (PB)