Standards of care in bird flu

WHO, Indonesia disagree on bird flu diagnosis

Adisti Sukma Sawitri, The Jakarta Post, Jakarta

Although the Health Ministry has confirmed two new victims of bird flu under a new World Health Organization (WHO) case definition, it has yet to decide whether to adopt the new standard in the fight against the killer virus.

The head of the ministry's bird flu patient verification team, Santoso Soeroso, said the WHO definition is less restrictive, so that possible cases can be identified earlier.

Based on the new guidelines, patients can be considered possible bird flu victims when they are suffering from acute lower respiratory problems with fever and cough, shortness of breath or difficulty breathing.

The Health Ministry, by contrast, has been using acute upper respiratory illness as the main symptom for declaring people to be suspected victims of the disease.

"It's like catching fish with big-holed nets. We may be able to identify possible cases when patients reach the stage that the flu is incurable," said Santoso, who is also the head of Jakarta's Sulianti Saroso hospital for infectious diseases.

He added that a quick response is important to bird flu patients due to the short effective period of oseltamivir, the only medicine available so far to treat the illness.

Oseltamivir, or Tamiflu, is most effective when patients take it on the first two days after the initial symptoms are detected. The medicine's effectiveness falls by 80 percent after that.

The WHO recently issued its first international case definition for avian flu to create a single standard for all countries across the globe.

The standard is expected to help the WHO do a multinational analysis of the data and classify the H5N1 infections reported by national and international health authorities.

Based on the new case definition, the WHO retroactively added two bird flu victims to Indonesia's case list last week.

The first was a five-year-old child from East Bekasi, West Java. He developed bird flu symptoms on March 5 and died two weeks later.

The second was a 27-year-old man from Solok, West Sumatra, who took care of his sister when she fell ill with bird flu. She died in May. The man survived.

The two retrospectively confirmed cases bring the total in Indonesia to 65. Of these cases, 49 were fatal.

The WHO representative for Indonesia, George Petersen, said that although it was a little late for his agency to promote the international standard, it would help make the global fight against bird flu more effective

"It is important to have one proper definition that every country uses, so we can compare the statistics," he told The Jakarta Post.

However, he said, the new standard would depend on the needs of each nation, and would only prove its effectiveness over time