Announcement

**Theresa42** · May 18, 2006, 02:52 AM

The nurse from Medan the Burung Flu Negative

toggletext-ed from Indonesian:

The nurse from Medan the Burung Flu Negative

Yogyakarta -- the Nurse from Medan that treated the bird flu patient from the Karo Land, North Sumatra (North Sumatra), was stated by the negative. The status of the nurse's bird flu of the negative, according to the Head of the Centre of the Public's Department of Health Communication, Dr Lily S Sulistyowati MM, was known was based on results of the sample inspection of the nurse's blood that was brought to the laboratory in Hong Kong. While results of the sample inspection of blood of two nurses of Surabaya that was sent to Hong Kong were not yet available.

This means that per May 15 2006 the number of cases to positive humankind bird flu in Indonesia had 38 people and that died 29 orang,''kata Lily to Republika, in Yogyakarta, on Tuesday (16/5).

The Pulmonary Disease specialist from RS the Friendship, Dr Tjandra Yoga Aditama, SpP (K), said despite the poultry around the patient's residence that was infected by bird flu in the Karo Land, North Sumatra (North Sumatra) was stated by the negative, was not possible to not have the source of the spread.

As being reported in Republika (16/5), although having eight casualties that dterinfeksi bird flu in the Karo Land, but results of the inspection of the animal there evidently the negative. However according to Pengendalian Breakingprep Penyakit Director and Department of Health environmental Sanitation, I Nyoman Kandun, up to now did not yet have proof that showed the existence of the spread of the virus from humankind to humankind.

It was clear, bird flu was the illness that spread from the poultry/the animal to humankind. So if having eight people who were sick in Medan, then must have the source of his spread. Was not possible to not have the source of the spread. Possibly did not yet meet, or possibly was not found, but must him yes was available. If being not then from where the patient could kemasukan the virus? 'Tjandra words, yesterday.'

If having the spread from humankind to humankind, according to Dr Tjandra, there was some consideration:
- Possibly the eight people tertular in one same source, because they indeed was in one same place.
- Not the discovery of the source of the spread to the place of the eight patients settled could not be made the reason that there is no source of the spread. Must have the source of his spread, but was not yet found.
- If had the second generation then possibly indeed has had the spread from humankind to humankind. The second generation was them that was not in the location that together with eight people when they fell ill. For instance 'for example they entered RS, then had the doctor or the nurse that evidently afterwards also positive bird flu, then meaning that having the second generation, and that showed the spread from humankind to humankind happened', he explained. But, the assumption of the existence of the spread of bird flu from humankind to humankind, was not yet proven.

http://www.republika.co.id/koran_detail.asp?id=248518&kat_id=13

**Sally Furniss** · May 18, 2006, 04:01 AM

Re: Indonesia BF - 5/17/06

Sumatra pigs carry bird flu virus -minister

JAKARTA (Reuters) - Pigs have tested positive for bird flu in the same village on Indonesia's Sumatra island where five people have been confirmed infected with the H5N1 avian influenza virus, a minister said on Thursday.

The case involving up to seven family members, six of whom have died, has raised alarm around the world because authorities cannot rule out human-to-human transmission.

But the World Health Organisation and Indonesian health officials had been frustrated by the lack of evidence pointing to a source of the virus, usually infected poultry.

The WHO confirmed on Wednesday that five members of the family had contracted H5N1 and tests on a sixth were pending.

Officials had said earlier that on-the-spot testing of various animals living around Kubu Simbelang village in North Sumatra province had given negative results for avian influenza.

However, Agriculture Minister Anton Apriyantono told reporters on Thursday the pig samples from the village had been brought to a leading animal research centre on Java island, and scientists there found a positive result for bird flu.

"After we brought them to Bogor, the serology test found positive results. From 11 pig samples, 10 are positive. Reconfirmation testings are still underway," he said, but did not specify the H5N1 virus.

Bogor is a West Java city where a veterinarian institute is located.

Clusters of human infections are worrying because they indicate that the virus might be mutating into a form that is easily transmissible among humans. That, experts say, could spark a pandemic in which millions might die.

For the moment, the virus is mainly a disease in birds and is hard for humans to catch.

The minister's comments are also likely to concern health officials. Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, leading to a strain that can easily infect people and pass from person to person.

At least 30 people have died of bird flu in Indonesia, the second highest toll of any country. More than half that number have died this year.

Not including the latest WHO confirmed cases in Indonesia, the disease has killed 115 people worldwide, the majority in east Asia, since reappearing in 2003. Virtually all the victims caught the disease from poultry.

The H5N1 virus is endemic in much of Indonesia.

Just a moment...

http://news.scotsman.com/latest.cfm?id=739232006

**Bruce** · May 18, 2006, 05:57 AM

Re: Indonesia BF - 5/17/06

<table align="center" border="0" cellpadding="3" cellspacing="0" width="100%"><tbody><tr><td>Pigs tested positive for bird flu in Indonesia

</td> </tr> <tr> <td>Front page / World
</td> </tr> <tr> <td> <table align="center" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr valign="middle"> <td align="center" bgcolor="#e7e7e7" width="132">05/18/2006 14:28</td> <td bgcolor="#e7e7e7"> Source: </td> <td align="center" bgcolor="#e7e7e7" width="120"> <table border="0" cellpadding="0" cellspacing="0" width="100"> <tbody><tr> <td>
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 Poultry and pigs tested positive for bird flu in a district where the H5N1 virus killed four family members and infected another, Indonesia said Thursday, pleading for international help fighting the disease.
<table align="right" border="0" cellpadding="2" cellspacing="2" width="208"> <tbody><tr> <td width="16"></td> <td></td> </tr> <tr> <td width="16"></td> <td> <table border="0" cellpadding="0" cellspacing="0" width="208"> <tbody><tr> <td></td> </tr> <tr> <td id="11">Bird Flu</td> </tr></tbody></table> </td> </tr> <tr> <td width="16"></td> <td></td> </tr> <tr> <td width="16"></td> <td> <table border="0" cellpadding="2" cellspacing="1" width="100%"> <tbody><tr> <td>

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</td> </tr> </tbody></table> </td></tr><tr> <td width="16"></td> <td></td> </tr> </tbody></table> The multiple infections among people living in Tanah Karo,an area on Sumatra island previously believed to be free of the disease, raised concerns that the virus had mutated into a form easily passed between humans.
 But international and local officials said that, while further investigations were needed, it appeared unlikely that had happened.
 Agricultural Minister Anton Apriantono told reporters initial tests on dozens of chickens, ducks and pigs living in Tanah Karo came back positive for the H5N1 strain of bird flu.
 The findings still needed to be reconfirmed, he said.
 World Health Organization spokeswoman Sari Setiogi, meanwhile, said there was "no evidence that the virus has spread beyond this family, this cluster."
 "Other family members, neighbors and health workers tested negative," she said, adding that the probe was not yet complete.
 Right now "it is not a disease of human beings, it is a disease of animals," Jacques Diouf, the director general of the Food and Agriculture Organization, told reporters Thursday in the Indonesian capital, Jakarta.
 "If we are able to eliminate or at least limit the number of birds that are infected, then we would limit the risk of transmission to human beings and other consequences of mutation for direct transmission from human to human," he said, reports the AP.

http://english.pravda.ru/news/world/18-05-2006/80546-Indonesia-0

**Goju** · May 18, 2006, 07:56 AM

Re: Indonesia BF - 5/18/06

Confusion in news about Indonesia

A Niman release quotes WHO as saying there are 3 more family members with symptoms. Looking at the dates it sounds like at least one of the 2nd group infected may have spread it. If they are indeed infected, we are looking at worst case - a superspreader or more easily passed strain (pandemic if it is one person).

In other stories - pigs are infected... or pigs are not infected.

Which is it??????

DB · May 18, 2006, 09:14 AM

Re: Indonesia BF - 5/18/06

<TABLE cellSpacing=0 cellPadding=0 width=635 border=0><TBODY><TR><TD>http://www.bloomberg.com/apps/news?p...Z2w&refer=asia
Indonesian Bird Flu Cases Raise Transmission Fears (Update1)
May 18 (Bloomberg) -- The lack of a clear cause for bird flu in as many as seven members of an Indonesian family is unnerving authorities who are attempting to rule out the possibility that the virus was transmitted from person to person.

Without a definitive link between the infected people and any diseased animals, scientists are unable to rule out the possibility that the Indonesians transmitted the virus to each other -- a sign that would suggest the virus has undergone genetic changes making it more contagious. Avian flu could spark a pandemic if it spreads easily among people.

``If the virus has changed, then we need to know,'' epidemiologist Thomas Grein said in a telephone interview today after visiting Kubu Sembilang, the village where some of the family members lived. ``A cluster is always serious. This one by its sheer size and that it has occurred in an area where there have been no confirmed outbreaks is of course of interest.''

Grein, from the World Health Organization in Geneva, and Timothy Uyeki from the U.S. Centers for Disease Control and Prevention in Atlanta joined local authorities and other WHO officials in North Sumatra province today to try to pinpoint how the people became infected with the lethal H5N1 strain of avian influenza the past month.

At least 115 of the 208 people known to be infected with the bird flu have died since 2003, mainly in Asia, the WHO said on its Web site May 12. Fatalities from H5N1 this year have surpassed 2005 levels as the virus spread to animals in more than 30 countries on three continents.

Sick Birds

Almost all human H5N1 cases have been linked to close contact with sick or dead birds, such as children playing with them or adults butchering them or taking off feathers, according to the WHO. Cooking meat and eggs properly kills the virus.

The WHO's tally doesn't include six cases -- five of which were fatal -- in North Sumatra and an unrelated fatality in East Java confirmed by the WHO yesterday. A 75-year-old woman from southern Egypt, who was infected with H5N1 by infected birds, died today, Agence France-Presse reported, citing John Jabbour, a WHO officer.

The Sumatran woman suspected of being the first family member to die was buried before samples were taken. Another family member was reviewed for possible infection and later found to be negative, Maria Cheng, a WHO spokeswoman in Geneva, said today.

`Very Serious'

``We like to certainly rule out the possibility that this is the beginning of human-to-human transmission,'' Shigeru Omi, the WHO's regional director for the western Pacific region, said in a telephone interview from Hong Kong today. ``If that were the case, it would be very serious. There is no indication of that, but we have to rule it out.''

Waterfowl are the natural hosts of avian influenza. Pigs are susceptible to both human and avian strains and are considered a potential ``mixing bowl'' of flu viruses. Pigs, chickens and ducks are raised by about half the 400 households in Kubu Sembilang, about 180 kilometers (112 miles) south of the provincial capital, Medan.

No Evidence

``We have not yet found any evidence of the ongoing transmission among chickens in that area,'' Omi said. ``That's why we want to know what is happening there.''
Ten of 11 pigs in the district where the infected people lived were found to have avian flu antibodies in their blood, Indonesia's Agriculture Minister Anton Apriantono told reporters in Jakarta today.

The presence of antibodies is an indication of an existing or previous infection. Antibodies were also found in the blood of chickens and ducks by a national laboratory in Bogor, and confirmatory tests on the animal samples are under way, Apriantono said. He didn't give more details on the location of the animals.

``If the virus is in pigs, that would be a major concern,'' Ton Schat, a professor of virology and immunology at Cornell University, said in an interview today.

Previous testing on farm animals surrounding the patients' homes had shown no evidence of avian flu, raising concern that the virus may have been passed from one person to another.

``It is certainly alarming,'' said Dick Thompson, a WHO spokesman in Geneva. ``This is the largest H5N1 cluster we have seen. There are obviously important questions that we need answered. But right now it is too early in the investigation to say anything definitive.''
Instances of limited human-to-human transmission of H5N1 and other avian flu viruses have occurred in association with outbreaks in poultry and shouldn't be a cause for alarm, the WHO said on its Web site. In no instance has the virus spread beyond a first generation of close contacts or caused illness in the general community, it said.

It's often impossible to determine if human-to-human transmission has occurred in clustered cases involving family members because they are often exposed to the same animal and environmental sources as well as to one another, the WHO said.
</TD></TR><TR><TD>

To contact the reporter on this story:Jason Gale in Singapore at j.gale@bloomberg.net</PRE></TD></TR></TBODY></TABLE>

**Laidback Al** · May 18, 2006, 09:21 AM

Re: Indonesia BF - 5/18/06

Question for discussion--

The recent case in Egypt, and the preceding cases in Egypt, Turkey, and other areas outside of Southeast Asia seem fairly certain to have derived from B2H transmission from poultry or wild birds. These new cases in Indonesia seem to be transmited from another source besides birds.
And based on limited data, it appears that the the CFR is higher for the "new" Indonesian strain.

How many deadly strains do we think are circulating and how different are the CFRs?

DB · May 18, 2006, 09:28 AM

Re: Indonesia BF - 5/18/06

http://za.today.reuters.com/news/New...U-20060518.XML
By Achmad Sukarsono

JAKARTA (Reuters) - Indonesia will be transparent if human-to-human transmission of bird flu does occur, a senior health official said on Thursday, a day after five members of a family were confirmed infected with the H5N1 avian flu virus.

The case has baffled experts because the source of the virus has not been confirmed and human-to-human transmission cannot be ruled out. Six of the family have died and one has survived.

But, offering a possible answer, Indonesia's agriculture minister said pigs had tested positive for bird flu in the same village in North Sumatra.

The family slaughtered animals for a barbecue feast in late April before the outbreak in Kubu Simbelang village where pigs and chickens live near homes and cats and dogs roam freely.

I Nyoman Kandun, the health ministry's director-general of communicable disease control, said there had been no proof of H5N1 virus transmission between people in Indonesia.

"I guarantee Indonesia is not covering up. A cover-up has more harm than benefits. By opening up, we are actually welcoming contribution from everywhere."

He also called on leaders at all levels in the country to step up efforts to raise awareness among the public.

"There are so many people who do not know what has happened. Even the educated do not know the situation is like a time-bomb," Kandun said, adding that his nephew had laughed when told his pet birds could carry the disease.

At least 30 people have died of bird flu in Indonesia, the second-highest toll of any country. More than half that number have died this year.
Egypt confirmed a sixth death on Thursday, a 75-year-old woman from Minya in the south.

Not including this death and the latest Indonesian cases, H5N1 has killed 115 people worldwide since re-appearing in 2003. Virtually all the victims caught the disease from poultry.

PIGS IN THE MIDDLE?

Agriculture Minister Anton Apriyantono said a number of pigs from the village 50 km (30 miles) south of Medan city, had tested positive.

"After we brought them to Bogor, the serology test found positive results. From 11 pig samples, 10 are positive. Reconfirmation testings are still underway," he said, but did not refer specifically to the H5N1 virus.

The minister's comments are likely to concern health officials. Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, leading to a strain that can easily infect people and pass from person to person.

Clusters of human infections are worrying because they indicate that the virus might be mutating into a form that is easily transmissible among humans. That, experts say, could spark a pandemic in which millions might die.

For the moment, the virus is mainly a disease in birds and is hard for humans to catch.

The WHO and the U.N.'s Food and Agriculture Organisation say better surveillance is crucial for rapid detection of outbreaks in birds and family clusters like the Sumatra case.

"If we do not hear about it for a couple of weeks and there are already a hundred or so cases, then it may be too late," WHO spokeswoman Maria Cheng said in Geneva.

"We heard about it relatively quickly (Sumatra). Indonesia has much higher awareness than other countries because they have been dealing with human cases for almost year now," she said.

But the WHO also says health services are sorely lacking in rural areas of many countries and these must be beefed up in the event of a pandemic.

"Bird flu is now hitting rural areas ... that is the challenge. The challenge now rests at the grassroots level (rural areas), which have not benefitted from measures taken after SARS," Shigeru Omi, the WHO's regional director for the Western Pacific, told reporters in Hong Kong.

In the aftermath of the SARS outbreak, many governments improved public health services but these tended to be in urban areas.

Omi also called for calm over the Sumatra cluster.

"There's no indication of increased efficiency in human-to-human transmission," he said, adding that the disease had not spread beyond the seven affected members of the family.

DB · May 18, 2006, 09:41 AM

Re: Indonesia BF - 5/18/06

My Comments:

"But, offering a possible answer, Indonesia's agriculture minister said pigs had tested positive for bird flu in the same village in North Sumatra."

It is already well known and documented that pigs have been infected with H5N1 in Indonesia and other countries as well. This is not a new development.

"The family slaughtered animals for a barbecue feast in late April before the outbreak in Kubu Simbelang village where pigs and chickens live near homes and cats and dogs roam freely."

This statement does not describe the whole story. Here is what Guan Yi had to say about this cluster.

"...Hong Kong virologist Guan Yi said the long time lag of nine days between the first and last victims showing symptoms of the disease was unusual.

“If they were all infected by the same source, their onset time (of illness) would have been closer, but that is not the case ... The later cases may involve the possibility of human-to-human transmission,” Guan told Reuters..."

Clearly this family cluster could not have all become infected by eating the animals at the barbecue.

"I guarantee Indonesia is not covering up. A cover-up has more harm than benefits. By opening up, we are actually welcoming contribution from everywhere."

It should not be forgotten that it was Indonesia was that found guilty of covering up their Bird Flu outbreak in 2004. While they may have changed we should not just "take their word on it".

"There's no indication of increased efficiency in human-to-human transmission,"

The key phrase is "increased efficiency". This implies that there is already human-to-human transmission occuring in Indonesia it just has not increased it's efficiency to spread beyond small clusters.

It is obvious that the situation in Indonesia is at least Phase 4.

http://www.cdc.gov/flu/pandemic/phases.htm

Phase 3: Human infection(s) with a new subtype but no human-to-human spread, or at most rare instances of spread to a close contact.

Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 3 allows for "rare instances" of spreading "TO A" close contact. I repeat "TO A", as in 1, close contact. There is NO mention of clusters in Phase 3.

Everyone got that, Phase 3 does not mention anything about clusters.

Phase 4 however does. To be in Phase 4 you need only 1 cluster with limited human-to-human transmission which is highly localized.

**Mellie** · May 18, 2006, 10:25 AM

Pigs infected with H5N1 -- info from last May

ProMed Mail, Snowy Owl links and info from last year and reports/ comments from many others including Niman ~~ from last year (4/05 through 5/05). H5N1 in pigs, the mixing vessel, his may be why Osterholm said the pandemic was likely to come out of Indonesia...

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
ProMed in April, 05:

http://www.promedmail.org/pls/askus/f?p=2400:1001:8941011922486374714::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,28662

<table summary=""> <tbody><tr><td nowrap="nowrap" align="right">Archive Number</td> <td nowrap="nowrap" colspan="1" rowspan="1" align="left">20050412.1058</td></tr><tr><td nowrap="nowrap" align="right">Published Date</td> <td nowrap="nowrap" colspan="1" rowspan="1" align="left">12-APR-2005</td></tr><tr><td nowrap="nowrap" align="right">Subject</td> <td nowrap="nowrap" colspan="1" rowspan="1" align="left">PRO/AH/EDR> Avian influenza - Eastern Asia (44): Indonesia, pigs, RFI</td></tr> </tbody> </table>
AVIAN INFLUENZA - EASTERN ASIA (44): INDONESIA, PIGS: REQUEST FOR INFORMATION
************************************************** ***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Tue, 12 Apr 2005
From: Irene Lai <iwlai@attglobal.net>
Source: Kompas, 9 Apr 2005 [translated from Indonesian, edited]

Indonesia: Avian Influenza Virus Identified in Pigs
---------------------------------------------------
Ca Nidom, a molecular biology researcher from [the Centre for]
Tropical Disease Control, Airlangga University, Surabaya, East Java,
has reportedly identified avian influenza virus in throat swabs and
sera of pigs by RT-PCR. [District location not mentioned].

Inactivated RNA isolates have been sent to the Tokyo University,
where 8 fragments (HA, NA, PA, PB1, PB2, M, NP, NS) were sequenced.
Results showed that the virus was [structurally?] similar to the
avian influenza virus from poultry, and is characterised by high
pathogenicity (based on the study regarding the cleavage site).

--
Dr. Irene Lai
International SOS
<iwlai@attglobal.net>

******
[2]
Date: Tue, 12 Apr 2005
From: Irene Lai <iwlai@attglobal.net>
Source: Kompas, 5 Apr 2005 [5 first paragraphs translated from
Indonesian, edited]
<http://www.kompas.com/kompas%2Dcetak...mi/1676599.htm>

Indonesia: Agriculture Department to Investigate Avian Influenza Virus in Pigs
--------------------------------------------------
The Department of Agriculture will study the discovery of avian
influenza virus from infected pigs. The agriculture department will
carry out sampling from several pig farms. More research is needed,
especially regarding the background and route through which the
infection of pigs with avian flu virus took place.

The Minister of Agriculture, Anton Apriyantono, said to the
journalist on Mon, 11 Apr 2005 in Jakarta, that his staff has already
ordered the General Director of Farming Production to investigate
that finding. "We need confirmation because the news is not clear
yet. First, it is not clear where the pigs are originally from, what
is their current location and which type of pigs have been involved".
The General Director of Farming Production will assist the veterinary
investigators in studying samples from pigs. "We are already working
on it", said Anton

As broadcast on Saturday, the molecular biology researcher in
Airlangga University, CA Nidom, discovered the avian influenza virus
in pigs. The finding was based on identification of [DNA/RNA?] and
might be interpreted as indicative for the presence of new avian
influenza cases in Indonesia. "We are responding to that report by
taking samples from pigs in Indonesia. Is it correct that pigs have
been infected? For me this is still the question", he said.

--
Dr. Irene Lai
International SOS
<iwlai@attglobal.net>

[ProMED-mail is grateful to Dr Lai for sending us the above
translated reports. - Mod.AS]

[These reports are somewhat contradictory. On the one hand it is
suggested that the complete genome of an avian influenza virus
isolated from a pig in Indonesia has been sequenced from RT-PCR
fragments, whereas on the other hand the presence of avian influenza
virus infection in pigs in Indonesia has still to be confirmed by
isolation of infectious virus. The serotype of the virus does not
appear to have been established, so it cannot be assumed at this
stage that the virus is the H5N1 East Asian epidemic strain.

However, although the situation is somewhat confused, these reports
cannot be dismissed lightly, because the presence of H5N1 virus in
pigs might increase the risk of adaptation of the epidemic avian
influenza virus to growth and transmission in mammals -- although it
should be emphasized that the role of pigs as mixing vessels in the
generation of pandemic influenza viruses is no more than a
hypothesis. Further information is awaited with some apprehension. -
Mod.CP]

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Niman's Recombinomics Commentary:

H5N1 in Indonesian Pigs Confirmed
Recombinomics Commentary
May 25, 2005

The government responded to the media attention by carrying out its
own survey, and found H5N1 in three out of eight pigs it tested in Banten,
Naipospos told Nature. Like those tested by Nidom, the pigs showed no
outward signs of disease.

Despite this worrying result, communication has faltered between
Indonesia and the international organizations charged with monitoring
animal health, such as the United Nations' Food an Agriculture Organization
(FAO) and the World Organisation for Animal Health (OIE).
When interviewed by Nature last week, the OIE's regional representative
for the Asia-Pacific region still referred to the presence of H5N1 in </span>pigs
as "a rumour".

The above story of H5N1 in pigs in Indonesia has parallels to the human and birdflu
found in pigs in South Korea. WHO's initial response was that the human WSN/33
sequences were a lab error. Eventually they did send a high ranking
member who saw the data generated while he was in the lab. Although he
commented "something is going on here", WHO has yet to issue a
statement.

Previously, the WHO had written a press release indicating that they were
going to halt verification efforts, but that release may have never circulated.
In South Korea the pigs are infected with two human (H1N1 and H1N2) and one avian
(H9N2)flu virus.

The viruses are evolving, the pigs are dying, yet WHO just hears a noisy car.
</pre> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
CIDRAP piece (Osterholm's organization) FROM LAST YEAR

http://www.cidrap.umn.edu/cidrap/con...2705avflu.html

Indonesian pigs have avian flu virus; bird cases double in China

May 27, 2005 (CIDRAP News) ? Avian influenza could be infecting up to half of the pig population in some areas of Indonesia, but without causing symptoms, Nature magazine reported in this week's edition.

Meanwhile, Chinese officials said a flu outbreak among wild birds is twice as large as previously reported, but they denied reports of human cases.

In Indonesia, Chairul Nidom, a virologist at Airlangga University's tropical disease center in Surabaya, Java, was conducting independent research earlier this year. He tested the blood of 10 apparently healthy pigs housed near poultry farms in western Java where avian flu had broken out, Nature reported. Five of the pig samples contained the H5N1 virus.

The Indonesian government has since found similar results in the same region, Nature reported. Additional tests of 150 pigs outside the area were negative. However, the story said, lack of funding for surveillance and testing is a concern to Nidom, who said he has samples from 90 more pigs from Banten, but he can't afford to test them or to broaden his investigation.

"I think pigs pose a much greater threat of spreading the disease to humans than poultry," Nidom told Nature. Pigs are often described as a mixing vessel in which human and avian flu viruses can swap genetic information, which could lead to a hybrid virus with the ability to spread easily among people.

The Indonesian government sent a report to the World Organization for Animal Health (OIE) on May 23 that describes three surveys involving "purposive and pooled sampling" of pigs, with a total 187 samples.

The first survey, Nidom's Feb 23 study on one farm, yielded 5 positives out of 10 samples tested for H5N1. The second, on Apr 14 in another village, involved 10 nasal swabs from 31 pigs and produced positives in 6 of the 10.

The third survey included six pigs from the same village as Nidom's small survey and yielded 1 positive swab. The report says that no pig has shown visible signs of avian flu. It lists the source of the pig infections as "contamination with chicken manure" from adjacent backyard chicken farms.

Additional tests included 250 blood serum and swab samples from pigs in seven provinces, the report says. All the results were negative.

The Nature report said the H5N1 virus was found in pigs in China in 2001 and 2003, but two surveys last year, involving 8,457 pig samples, found no evidence of the virus.

In China, more than 1,000 migratory birds have died of H5N1 avian flu in Qinghai province, according to a report today by Xinhua, the Chinese news agency.

The size of the outbreak, initially reported as not being H5N1, grew this week from 178 birds to 519, and now to more than 1,000. Emergency measures are being taken in Qinghai, including increasing infectious disease control and surveillance for animals and humans, Xinhua reports. The agency said earlier that authorities planned to vaccinate 3 million poultry in the region.

The Chinese government has repeatedly said that no people have been infected with avian flu, despite unconfirmed claims on Internet sites that as many as 120 people have died of the illness.

The World Health Organization (WHO) is seeking details on the provincial outbreak, according to a Canadian Press (CP) report quoting Maria Cheng, WHO spokeswoman in Beijing.

"We've seen those reports about possible human H5N1 cases, and have requested more information from the Ministry of Health," Cheng said. The WHO is urging China to share virus samples from the dead birds as well as information on human exposure to dead birds.

"It would be premature to consider this event over," Cheng said.

In a separate report in Xinhua yesterday, Chinese researchers claimed to have developed two H5N1 vaccines that are "100%" effective for birds, animals, and people, CP reported. Officials at the WHO office in Beijing, however, described that research as involving only birds and said no animal or human clinical trials have been conducted.

~~~~~~~~~~~~~~~~~~~~~~~~~~~
Indonesian report to OIE
http://www.oie.int/eng/info/hebdo/aIS_69.htm#Sec2

<center>HIGHLY PATHOGENIC AVIAN INFLUENZA IN INDONESIA
Follow-up report No. 8 (infection detected in pigs)
</center> See also: 27 April 2006, 12 January 2006, 5 August 2005, 1 July 2005, 8 April 2005, 11 March 2005
Information received on 23 May 2005 from Prof. H.R. Wasito, Director General of Livestock Services, Department of Agriculture, Jakarta:
End of previous report period: 6 April 2005 (see Disease Information, 18 [14], 102, dated 8 April 2005).
End of this report period: 23 May 2005.
Precise identification of agent : highly pathogenic avian influenza virus subtype H5N1.
Three surveys were conducted in Tangerang district, Banten province, using purposive and pooled sampling. A total of 187 samples were taken during the surveys.
- The first survey was conducted on 23 February 2005 in a farm in Babat village, Legok subdistrict, where 5 out of 10 nasal swabs were positive and the subtype involved was identified as H5N1.
- As a follow-up, the second survey was conducted on 14 April 2005 in Rancaiyuh village, Panongan subdistrict, where 6 out of 10 nasal swabs taken from 31 pigs over 5 months old were positive for H5N1.
- The third survey was on 26 April 2005 in Babat village, Legok subdistrict, where 1 out of 6 nasal swabs taken from 6 pigs over 1 year old was positive for H5N1.
Not a single pig has shown clinical signs of avian infuenza.
Details of outbreaks:
<center><table border="2" cellpadding="3"><tbody><tr valign="top"><td rowspan="2" width="12%" align="center">First administrative division</td><td rowspan="2" width="10%" align="center">Lower administrative division</td><td rowspan="2" width="4%" align="center">Type of epide-miolo-gical unit</td><td rowspan="2" width="8%" align="center">Name of the location</td><td rowspan="2" width="8%" align="center">Date of start of the outbreak</td><td rowspan="2" width="3%" align="center">Spe-cies</td><td colspan="5" align="center">Number of animals in the outbreaks</td></tr><tr valign="top"><td width="7%" align="center">susceptible</td><td width="7%" align="center">cases</td><td width="7%" align="center">deaths</td><td width="7%" align="center">destroyed</td><td align="center">slaugh-tered</td></tr><tr valign="top"><td width="12%">Jawa Barat<sup>(1)</sup></td><td width="10%">Banten province</td><td width="4%" align="center">village</td><td width="8%">Legok subdistrict</td><td width="8%" align="center">24 Feb. 2005</td><td width="3%" align="center">sui</td><td width="7%" align="center">897</td><td width="7%" align="center">6*</td><td width="7%" align="center">0</td><td width="7%" align="center">0</td><td align="center">...</td></tr><tr valign="top"><td width="12%">Jawa Barat<sup>(1)</sup></td><td width="10%">Banten province</td><td width="4%" align="center">village</td><td width="8%">Panongan subdistrict</td><td width="8%" align="center">14 April 2005</td><td width="3%" align="center">sui</td><td width="7%" align="center">823</td><td width="7%" align="center">6*</td><td width="7%" align="center">0</td><td width="7%" align="center">0</td><td align="center">...</td></tr></tbody></table> </center> (1) West Java
* infected animals without clinical signs
Diagnosis:
<center><table border="2" cellpadding="3"><tbody><tr valign="top"><td align="center">Laboratories where diagnosis was made</td><td align="center">Species examined</td><td align="center">Diagnostic tests used</td><td align="center">Date</td><td align="center">Results</td></tr><tr valign="top"><td>Faculty of medicine, Airlangga University</td><td align="center">sui</td><td>RT-PCR<sup>(1)</sup></td><td align="center">7 March 2005</td><td align="center">H5N1</td></tr><tr valign="top"><td>Research Institute for Veterinary Science, Bogor</td><td align="center">sui</td><td>agar-gel precipitation test, RT-PCR<sup>(1) </sup>and sequencing analysis</td><td align="center">28 April 2005</td><td align="center">H5N1</td></tr><tr valign="top"><td>Disease Investigation Centre Region I-VII</td><td align="center">sui</td><td>haemagglutination inhibition test</td><td align="center">2 May 2005</td><td align="center">H5N1</td></tr></tbody></table> </center> Further investigations have been made in seven provinces (Central Java, West Java, West Kalimantan, South Sulawesi, Bali, Riau and North Sumatra). The results of the serological testing of 250 samples (sera and swabs) were all negative.
Source of outbreaks or origin of infection: these pig farms are adjacent to backyard chicken farms. The infection in pigs was due to contamination with chicken manure.
Control measures
A. Undertaken:
- quarantine;
- movement control inside the country;
- disinfection of infected premises/establishment(s).
B. To be undertaken: partial stamping out.
Treatment of affected animals: no.
Vaccination prohibited: no.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Nature report on H5N1 virus in pigs in Indonesia (Java)

303 See Other

http://www.nature.com/nature/journal/v435/n7041/full/435390a.html

Nature 435, 390-391 (26 May 2005) | <abbr title="Digital Object Identifier">doi</abbr>: 10.1038/435390a
Bird flu spreads among Java's pigs

David Cyranoski, Tokyo

Abstract

Indonesian government scrambles to track disease.

Concerns over the presence of a dangerous strain of avian flu virus in Indonesia's pigs are growing, as government tests confirm the existence of infection. In some areas, the H5N1 virus could be infecting up to half of the pig population, without causing any signs of disease.

The initial discovery was made earlier this year by an independent researcher working outside national and international surveillance systems. Chairul Nidom, a virologist at Airlangga University's tropical-disease centre in Surabaya, Java, found the H5N1 virus in five of ten pigs tested from Banten in western Java.

The presence of the virus in pigs is a particular worry because the animals can harbour both bird and human flu viruses, and act as a 'mixing vessel' for the emergence of a strain of avian flu that can easily infect humans. There are now signs that the virus could be spreading unchecked through the pig population.

Nidom says that the pigs he tested showed no signs of illness, and the only reason he tested them was that they were kept near a chicken farm that was struck by avian flu last year. Nature has discovered that a government survey has since found similar results in the same region.

The virus was not found in 150 pigs tested from outside the area. Although the government says it has stepped up the surveillance of pigs in its seven satellite laboratories, it may fail to spot any spread of the virus because resources are short. "It's a big country," says Tri Satya Putri Naipospos, director of animal health at Indonesia's agriculture ministry. "If you want to commit to eradicating a disease, you need more money."

Nidom is also frustrated by a lack of resources. He says he has samples from another 90 pigs in Banten, but cannot afford to test them or to expand his survey to other areas.

Some health officials in Asia fear the presence of avian flu in pigs even more than in chickens or ducks. "I think pigs pose a much greater threat of spreading the disease to humans than poultry," says Nidom.

The virus was found in pigs in China in 2001 and in 2003 (see Nature 430, 955; 2004). The country stepped up its surveillance, and two surveys in 2004 found that all 8,457 samples tested were free of H5N1.

Nidom's discovery of H5N1 in pigs is a wake-up call for the Indonesian government. He says that when he first alerted the government to his findings in February, there was no reaction. "I don't know why they are so passive," he says. Nidom took his findings to a local newspaper, the Jakarta-based Kompas, which ran the story on 9 April. The news spread to international media earlier this month.

The government responded to the media attention by carrying out its own survey, and found H5N1 in three out of eight pigs it tested in Banten, Naipospos told Nature. Like those tested by Nidom, the pigs showed no outward signs of disease.

Despite this worrying result, communication has faltered between Indonesia and the international organizations charged with monitoring animal health, such as the United Nations' Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE). When interviewed by Nature last week, the OIE's regional representative for the Asia-Pacific region still referred to the presence of H5N1 in pigs as "a rumour".

The FAO and OIE cannot act until they have received official government reports, says Carolyn Benigno, animal-health officer at the FAO's regional headquarters in Bangkok. She hadn't heard of Nidom's work until Nature contacted her last week. However, Naipospos complains that although she is preparing an official report for the FAO, she cannot fast-track it because the FAO and the OIE do not classify the case as an emergency. "This is not an outbreak, it's a finding," she says, because the pigs are not ill or dying. As Nature went to press, the Indonesian government was preparing to send a report on the matter to the OIE. (See Box).

Nidom says he would like to expand his project, and to sample pigs from eastern Java. But he is not counting on being given the resources to do so. This is his second run-in with the government ? in 2003 he caused a stir by releasing data showing that mass deaths of chickens at the time were caused by H5N1.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

DB · May 18, 2006, 11:02 AM

Re: Indonesia BF - 5/18/06

http://www.nytimes.com/2006/05/18/wo...335&ei=5087%0A
Bird Flu Deaths in Indonesia Raise Concerns
By DONALD G. McNEIL Jr.
</NYT_BYLINE>Published: May 18, 2006

<NYT_TEXT>A cluster of avian flu deaths in an extended Indonesian family has raised the possibility that the virus has passed between people there, the World Health Organization said yesterday.

There have been several avian flu clusters in Indonesia, but this is the largest known one, and the different beginning dates of symptoms in the family are worrisome, officials said.

The flu is spreading rapidly in Indonesian flocks, and before this week, the country had 25 known human deaths, the second-highest number in the world, after Vietnam.

"We haven't seen any evidence of spread beyond this cluster," said Maria Cheng, a W.H.O. spokeswoman. "The investigation is still at an early stage."

Reports of limited transmission of the virus between humans worry health officials but do not necessarily alarm them. Unlike seasonal flu viruses, which attach in the nose or throat, making them easy to spread, the A(H5N1) virus is known to attach to receptors found deep in the lungs.
Reports from the village of Kubu Sembilang, on the island of Sumatra, repeated by news agencies and Web sites, were somewhat confusing. Five family members have been confirmed by a W.H.O.-certified laboratory in Hong Kong as having the A(H5N1) virus. Seven or eight members of the family were said to have shown symptoms, and six were reported to have died.

According to experts familiar with the case who were cited on the Web site recombinomics.com, which tracks genetic changes in infectious diseases, the first to die was a 37-year-old woman who fell ill on April 27, two days before a family barbecue, and died May 4. Two sons, a brother, a sister, a niece and a nephew developed symptoms after the barbecue and five more died from May 9 to last Sunday.

No tissue from the 37-year-old woman was tested, so it is possible that she died of something else and that other members of the family were also infected by something else.

Indonesia's health minister speculated that the family was infected by chicken manure bought from a farm that had a flu outbreak. Tests on poultry and pigs in the village have not found the virus.

DB · May 18, 2006, 11:22 AM

Re: Indonesia BF - 5/18/06

http://www.alertnet.org/thenews/newsdesk/SP47506.htm

(Updates with WHO comment, Denmark, Russia outbreaks)

By Achmad Sukarsono

JAKARTA, May 18 (Reuters) - Indonesia pledged on Thursday there would be no cover-up if human-to-human transmission of bird flu does occur, after five members of a family were confirmed to have died from the H5N1 avian flu virus.

The case has baffled experts because the source of the virus has not been confirmed and human-to-human transmission cannot be ruled out.

But, offering a possible answer, Indonesia's agriculture minister said pigs had tested positive for bird flu in the same village in North Sumatra.

The family slaughtered animals for a barbecue feast in late April before the outbreak in Kubu Simbelang village where pigs and chickens live near homes and cats and dogs roam freely.

Six of the family have died and one has survived. The sixth family member was buried before tests could be carried out.

"This is the largest cluster of cases, closely related in time and place, reported to date in any country ...," the World Health Organisation said in a statement.

The U.N. agency said exposure to infected poultry or an environment contaminated by their faeces was the most plausible source.

"The possibility of limited human-to-human transmission cannot be ruled out at present," the WHO said, but added: "If human-to-human transmission has occurred, it has not been either efficient or sustained."

I Nyoman Kandun, the Indonesian health ministry's director-general of communicable disease control, said there was no proof of H5N1 virus transmission between people in Indonesia.

"I guarantee Indonesia is not covering up. A cover-up has more harm than benefits. By opening up, we are actually welcoming contribution from everywhere."

He also called on leaders at all levels in the country to step up efforts to raise awareness among the public.

TIME BOMB

"There are so many people who do not know what has happened. Even the educated do not know the situation is like a time bomb," Kandun said.

Thirty-one people have died of bird flu in Indonesia, the second-highest toll of any country. More than half that number have died this year.

Egypt confirmed a sixth death on Thursday, a 75-year-old woman from Minya in the south.

H5N1 has killed 122 people worldwide since re-appearing in 2003. Virtually all the victims caught the disease from poultry.

Denmark on Thursday halted exports of poultry from Funen after birds on a farm on the island tested positive for the H5 strain of avian flu. The outbreak may force Denmark to halt all poultry exports.

In Russia, the H5N1 bird flu virus was found in six dead chickens in Siberia, where more than 80 dead birds have been found since the end of April, a regional health official said.

Indonesian Agriculture Minister Anton Apriyantono said a number of pigs from the village 50 km (30 miles) south of Medan city, had tested positive.
"After we brought them to Bogor, the serology test found positive results.
From 11 pig samples, 10 are positive. Reconfirmation testings are still underway," he said, but did not refer specifically to the H5N1 virus.

The minister's comments are likely to concern health officials. Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, leading to a strain that can easily infect people and pass from person to person.

Clusters of human infections are worrying because they indicate that the virus might be mutating into a form that is easily transmissible among humans. That could spark a pandemic in which millions might die.

For the moment, the virus is mainly a disease in birds and is hard for humans to catch.

The WHO and the U.N.'s Food and Agriculture Organisation say better surveillance is crucial for rapid detection of outbreaks in birds and family clusters like the Sumatra case.

"If we do not hear about it for a couple of weeks and there are already a hundred or so cases, then it may be too late," WHO spokeswoman Maria Cheng said in Geneva.

"We heard about it relatively quickly (Sumatra). Indonesia has much higher awareness than other countries because they have been dealing with human cases for almost year now," she said. (Additional reporting by Yoga Rusmana in Jakarta, Tan Ee Lyn in Hong Kong and Richard Waddington and Stephanie Nebehay in Geneva)

**Mingus** · May 18, 2006, 11:31 AM

Re: Indonesia BF - 5/18/06

World Health Organization - Weekly Epidemiological Record e-mail
bulletin service

DISEASE OUTBREAK NEWS Item(s)published on the World Wide Web

404

http://www.who.int/csr/don

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-------------------------

Avian influenza - situation in Indonesia - update 12

18 May 2006

The Ministry of Health in Indonesia has confirmed an additional seven
cases of human infection with the H5N1 avian influenza virus. Six of the
cases were fatal.

One fatal case, in a 38-year-old woman, occurred in the city of
Surabaya, in East Java. She developed symptoms on 2 May, was
hospitalized on 7 May, and died on 12 May. The case is the first
reported from this area.

The remaining six cases are from the village of Kubu Sembelang in the
Karo district of North Sumatra. All six are members of an extended
family, and all but one lived in neighbouring houses.

Associated with the Kubu Sembelang outbreak is a seventh family member,
a 37-year-old woman. She developed symptoms on 27 April and died of
respiratory disease on 4 May. No specimens were obtained before her
burial, and the cause of her death cannot be confirmed. She is, however,
considered the initial case in this family cluster.

The six confirmed cases in Sumatra include the woman's two sons, aged 15
and 17 years, who died respectively on 9 May and 12 May. The 28-year-old
sister of the initial case died on 10 May. This sister had an
18-month-old girl, who died on 14 May. The fifth confirmed case, who is
still alive, is the 25-year-old brother of the initial case. The sixth
confirmed case is the 10-year-old nephew of the initial case. He died on
13 May.

One additional family member, who had been hospitalized, has
subsequently been ruled out based on both negative laboratory results
and the absence of clinical symptoms compatible with H5N1 infection.

This is the largest cluster of cases, closely related in time and place,
reported to date in any country and is being carefully investigated by
Indonesia's ministries of health and agriculture and by WHO
epidemiologists. The source of exposure for the initial case is still
under investigation, with exposure to infected poultry or an environment
contaminated by their faeces considered the most plausible source.

The likely source of infection for the additional cases has not yet been
determined. Multiple hypotheses are being investigated. Apart from
living in close proximity to each other, the cases in this cluster are
known to have participated in a family gathering around 29 April. The
cases may have acquired their infection from a shared environmental
exposure yet to be identified. The possibility of limited human-to-human
transmission cannot be ruled out at present.

Investigators at the outbreak site have found no evidence that infection
has spread beyond members of this single extended family. No
influenza-like illness has been identified in health care workers or
other persons in close contact with the patients. If human-to-human
transmission has occurred, it has not been either efficient or
sustained.

The newly confirmed cases bring the total in Indonesia to 40. Of these
cases, 31 have been fatal.

DB · May 18, 2006, 11:34 AM

Re: Indonesia BF - 5/18/06

WOW.

There is so many messages going on in this press release it is ridiculous.

We have Indonesia protesting that it has not been involved in a cover-up.

"Indonesia pledged on Thursday there would be no cover-up if human-to-human transmission of bird flu does occur, after five members of a family were confirmed to have died from the H5N1 avian flu virus"

"I guarantee Indonesia is not covering up. A cover-up has more harm than benefits. By opening up, we are actually welcoming contribution from everywhere."

This next part would be pretty amusing if it wasn't so serious.

"But, offering a possible answer, Indonesia's agriculture minister said pigs had tested positive for bird flu in the same village in North Sumatra."

Indonesia Agriculture Minister says it might be pigs.

"The family slaughtered animals for a barbecue feast in late April before the outbreak in Kubu Simbelang village where pigs and chickens live near homes and cats and dogs roam freely."

Then it is mentioned that it could be a barbecue and by the way there are pigs, chickens, cats and dogs roaming around add that to the list.

"The U.N. agency said exposure to infected poultry or an environment contaminated by their faeces was the most plausible source. "

Then WHO says it is most likely infected poultry or some faeces.

Basically they have no clue what is going on.

Now comes the cue-de-gras:

"The case has baffled experts because the source of the virus has not been confirmed and human-to-human transmission cannot be ruled out."

They cannot rule out human-to-human transmission and then they try to calm everyone down by saying:

"The possibility of limited human-to-human transmission cannot be ruled out at present," the WHO said, but added: "If human-to-human transmission has occurred, it has not been either efficient or sustained."

So there you have it. Even if human-to-human transmission has occurred it has not been either efficient or sustained.

Feel better?

Me neither.

**Theresa42** · May 18, 2006, 03:26 PM

Re: Indonesia BF - 5/18/06

Originally posted by Goju

Confusion in news about Indonesia

A Niman release quotes WHO as saying there are 3 more family members with symptoms. Looking at the dates it sounds like at least one of the 2nd group infected may have spread it. If they are indeed infected, we are looking at worst case - a superspreader or more easily passed strain (pandemic if it is one person).

In other stories - pigs are infected... or pigs are not infected.

Which is it??????

H5N1 antibodies have been found in pigs -- so those pigs definitely were infected at some point. I think it's safe to say that, in Indonesia, pigs are infected -- some of them anyway -- who knows how many....

Question. I didn't understand your point that "looking at the dates it sounds like at least one of the 2nd group infected may have spread it." Can you clarify, please? Thanks.

Announcement

Indonesia Human Cases - May 18 to May 19, 2006

Indonesia Human Cases - May 18 to May 19, 2006

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