Update on Indonesia cluster {?}

Indonesia: Avian Influenza Situation - WHO Update 28
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As of Mon 21 Aug 2006, the Ministry of Health in Indonesia has
confirmed the country's 59th case of human infection with H5N1 avian
influenza virus. The case occurred in a 35-year-old woman from the
remote sub-district of Cikelet, West Java Province. She was
hospitalized with severe respiratory disease on 17 Aug 2006 and died
shortly after admission. She is the 3rd confirmed case from this
sub-district to be reported in the past week.

Preliminary findings from the Cikelet investigation
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A team of experts is presently in the Cikelet sub-district
investigating the outbreak and monitoring for further cases. Three
hamlets are the focus of investigation.

The Cikelet sub-district consists of around 20 isolated hamlets, each
with a population of around 200 to 400 persons, many living in large
extended families. The hamlets sit in a basin surrounded by steep
mountains with rocky winding paths best accessed by foot or
horseback. In this area, mortality from endemic diseases, especially
malaria, is common, access to health care is poor, and medical
records of deaths are scanty or non-existent.

Prior to late June 2006, no mass die-offs of poultry are known to
have occurred in the area. At that time, live chickens were purchased
from an outside market in preparation for a religious feast and were
integrated into local flocks. Shortly thereafter, chickens began
dying in large numbers in an outbreak that continued throughout July
2006 and the 1st week of August 2006, gradually spreading from one
hamlet to another.

As the population had no experience with this disease, high-risk
behaviors commonly occurred during the disposal of carcasses or the
preparation of sick or dead birds for consumption. These exposures
are, at present, thought to be the source of infection for most
confirmed or suspected cases.

Deaths from respiratory illness are known to have occurred in late
July and early August 2006, but no samples were taken, and medical
records are generally poor. Though some of these undiagnosed deaths
occurred in family members of confirmed cases, the investigation has
found no evidence of human-to-human transmission and no evidence that
the virus is spreading more easily from birds to humans.

The cooperation of residents is good, house-to-house surveillance for
febrile illness is continuing, and specimens have been taken from
symptomatic persons and sent for testing. The team is well-supplied
with antiviral drugs, and these are being administered
prophylactically to close contacts of cases and therapeutically to
persons showing symptoms of influenza-like illness.

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