Human to Human H5N1 transmission

Human-to-human transmission possible in Indonesia's 65th avian flu case

Sep 14, 2006 (CIDRAP News) – The World Health Organization (WHO) today recognized two cases of H5N1 avian influenza in Indonesia, including one from March that was first reported yesterday by a WHO official and one from May involving a man who may have become infected after exposure to an ill family member.

In both instances, the WHO has retroactively confirmed the cases on the basis of its new criteria for laboratory confirmation. The boy's case put Indonesia's count at 64 cases with 49 deaths, and the man, who recovered, represents the country's 65th officially confirmed case.

The 5-year-old boy from East Bekasi in West Java province became ill on Mar 4, was hospitalized 2 days later, and died on Mar 19. The WHO said test results using two different assays revealed high antibody titer for H5N1 on serum samples taken on days 11 and 15 of his illness. Field investigators had determined that the boy had been exposed to sick poultry near his home, where some birds had tested positive for the H5 virus subtype.

Investigators identified the second case, in a 27-year-old man from Solok in West Sumatra province, when they traced contacts of the man's 15-year-old sister who had a confirmed H5N1 infection in May. Her brother spent 6 days caring for her during her hospitalization. On May 28 he experienced mild cough and abdominal discomfort but no fever. His symptoms improved and he recovered in a few days.

Despite his mild and atypical symptoms, the brother was tested as part of the health ministry's contract tracing and management program. He was given a 5-day course of oseltamivir beginning Jun 1 and was placed in voluntary isolation during his recovery.

Initial samples were negative for H5N1 infection; however, in August, follow-up testing of paired-serum samples found a fourfold rise in neutralization antibody titer for H5N1, a result that meets WHO's new criteria for laboratory confirmation.

The man reported no contact with diseased or dead poultry before he became ill. Investigators determined that human-to-human transmission resulting from exposure to his sister could not be ruled out.

The WHO issued a report confirming his sister's H5N1 infection on May 29. It said she remained hospitalized, but no details were available on the outcome of her illness.

In other developments in Indonesia, the director of the country's main treatment center for avian flu told participants attending a scientific conference in Jakarta yesterday that avian flu will continue to circulate among the country's poultry flocks because of shortfalls in vaccination and biosecurity measures, according to an article today in The Jakarta Post.

Santoso Soeroso, director of Sulianti Saroso Hospital, said improper vaccination of ducks and chickens may be contributing to the spread of the H5N1 virus. He said authorities are using substandard vaccines and are unable to evaluate the effectiveness of the programs because they lack an unvaccinated control group.

Soeroso said recent research in Bali province revealed a vaccine failure rate of 39% and that 60% of the area's ducks had avian flu.

Indonesian agriculture minister Bagoes Poermadjaja told the group that only 60% of the country's 300 million chickens and ducks had been vaccinated. He said the country lacked resources of early detection and is not adequately compensating citizens for slaughtered birds.

He said biosecurity measures are also deficient, and he noted that most cases of avian flu in humans had occurred in provinces where transport of poultry is constant. Poermadjaja also said weak coordination between central government and regional administration hinders the coordination of avian flu prevention and management.