4 Indonesian Health Care Workers with Flu-like Symptoms

[natielkin]

http://www.who.int/csr/don/2006_06_06/en/index.html
6 June 2006

For the past four days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in four nurses who were involved in the care of confirmed H5N1 patients.

Test results have now convincingly ruled out H5N1 infection in all four nurses.

Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.

The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.

The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present.

[HenryN]

Re: Avian influenza: Indonesia

Commentray at

http://www.recombinomics.com/News/06...donesia_4.html

[DB]

Re: Avian influenza: Indonesia

http://www.recombinomics.com/News/06...donesia_4.html
Commentary

4 Indonesian Health Care Workers with Flu-like Symptoms

Recombinomics Commentary
June 6, 2006

Test results have now convincingly ruled out H5N1 infection in all four nurses.

Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.

The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.

The above comments in today's WHO update are cause for concern. Although WHO comments indicate the health care workers are "convincingly" negative, convincing tests would require collection of serum 3-4 weeks after disease onset dates. Since at least two of the health care workers developed symptoms in the past week, appropriate samples would not be ready for antibody testing for another two - three weeks.

Moreover, the identification of seasonal H1N1 is an additional cause for concern. All human H1 isolates to date, including the 1918 pandemic strain have PB2 E627K. Dual infections with H5N1 and H1N1 could lead to acquisition of E627K via recombination. Therefore, determining the H5 antibody level in convalescing serum is important, even though the health care workers had mild cases.

The optimistic report by the WHO is clearly premature, and is cause for concern.

The tendency to focus on optimistic results is a concern and endangering lives. One of the most telling examples is the status of anti-viral resistance markers in the Medan H5N1 isolates, which are amantadine resistant. Instead of disclosing the resistance, the WHO update indicated the isolates were oseltamivir sensitive, and withheld the amantadine resistances. Moreover, when asked about the changes, WHO consulting sequencer Malik Peiris declined comment.

The withholding of important sequences changes, couple with withholding of human H5N1bird flu sequences in Indonesia is cause for concern.

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[Dark Horse]

Re: Avian influenza: Indonesia

BTW, Dr. Niman, congratulations to you. You have made the big time: NY Times and WSJ. You very much deserve this recognition and I sincerely hope that you will be the voice that keeps WHO and CDC on their toes.

If I believed in fairy tales, I would be thrilled to hear that all four nurses involved in nursing the Karo cluster were H5N1 negative. If I had half a brain, I might worry about them treating H5N1 patients when they are infected with the "regular" flu. I might even worry about why we are hearing about them now. There is even a possiblity that my little head would be troubled that four seemed to be a pretty large number of nurses involved with that cluster having any flu symptoms at all. But, thankfully, I trust the WHO and the CDC and the officials of Indonesia to faithfully tell me the truth.

I just love stories, especially at bed time, and am looking forward to hearing a bedtime story about those 54 persons in perfect quarantine sucking Tamiflu daily through a straw. I believe that they will live happily ever after, don't you?

[Dark Horse]

Re: Avian influenza: Indonesia

http://www.who.int/csr/don/2006_06_06/en/index.html
6 June 2006

For the past four days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in four nurses who were involved in the care of confirmed H5N1 patients.

Please correct me if I am wrong, but I seem to remember many, many articles quoting WHO and Indonesia officials saying that no one who was exposed to the Karo cluster show ANY symptoms of influenza. Could these venerable politicians have been misquoted? Perhaps the answer is this: they forgot to include the HCW in that list of 54 people who were exposed.

[Laidback Al]

Re: Avian influenza: Indonesia

The way I read the WHO announcement is that three of the four HCW have only recently developed symptoms (within the last 4 days). The fourth HCW was first noted in the news media with symptoms about June 1. These 4 HCW were probably not counted in the previous 54 individuals, although they were probably being monitored because of their contact with H5N1 patients.

You have to ask yourself why WHO is impelled to have an Outbreak News article for negative cases. We don't see that very often. Niman's observation's are pertinent. Let's hope this announcement is not premature and these HCWs are not infected with H5N1.

[HenryN]

Re: Avian influenza: Indonesia

WHO rules out bird flu in four Indonesian nurses
Tue Jun 6, 2006 6:14 PM IST


GENEVA (Reuters) - The World Health Organisation said on Tuesday that bird flu had been ruled out in the cases of four Indonesian nurses who fell sick after caring for people infected with H5N1 virus.
"Test results have now convincingly ruled out H5N1 infection in all four nurses," the United Nations' health agency said in a statement posted on its website (www.who.int)
For four days, Indonesian health authorities and the WHO had monitored the influenza-like illnesses of the four, two of whom worked in Bandung, West Java and two in Medan, North Sumatra.
The two from Sumatra had been involved in caring for members of an extended family, seven of whom died last month in a case that raised fears that the virus was mutating and becoming better at infecting people.
But subsequent laboratory tests showed no significant change in the virus, a result that was further confirmed by the nurses' diagnosis, the WHO said.
"The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present," it said.
Bird flu has killed over 125 people worldwide since reappearing in 2003. It remains difficult to catch, but scientists fear it could evolve to pass more easily from person to person, triggering a pandemic in which millions may die.

http://in.today.reuters.com/news/new...archived=False

[Theresa42]

Re: Avian influenza: Indonesia

If I believed in fairy tales, I would be thrilled to hear that all four nurses involved in nursing the Karo cluster were H5N1 negative.

Just a note -- two of the nurses in the report treated patients in the Karo cluster -- the other two treated a cluster of patients (brother and sister who died) in Bandung (it was one of these nurses that we had heard about previously).

[Dark Horse]

Re: Avian influenza: Indonesia

Just a note -- two of the nurses in the report treated patients in the Karo cluster -- the other two treated a cluster of patients (brother and sister who died) in Bandung (it was one of these nurses that we had heard about previously).

Thanks for the clarification, Theresa. I don't think it changes my take on the news as long as it's four nurses who had been treating H5N1 patients. Even if it is just two nurses from the Karo cluster, it flies in the face of what WHO has been telling us for more than a week: that NOBODY exposed to the Karo cluster was showing any symptoms. At a minimum it is deceit and misinformation -- meaner folks might say it was lies.

[Theresa42]

Human-to-human bird flu infection ruled out in latest Indonesian cases

From the UN News Centre...

Human-to-human bird flu infection ruled out in latest Indonesian cases

6 June 2006 ? The United Nations health agency today ruled out human-to-human transmission of bird flu in four Indonesian nurses tending patients with the disease, confirming that none of the nurses has the H5N1 virus and easing fears that it might already be acquiring the ability to spread more readily among humans.

?The negative test results [what sort of tests?] for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present,? the World Health Organization (WHO) said, referring to the stage that could make a potentially deadly human pandemic more likely.

Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. One nurse has now been shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia.

The second nurse experienced only mild, transient symptoms, but was tested urgently as a precaution. Her test results were also negative for H5N1 infection.

Two additional nurses at a hospital in Medan, North Sumatra, cared for confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses experienced only mild symptoms while the second developed an influenza-like illness, but test results received today are also negative for H5N1.

Although more than 200 million birds have died worldwide from either the virus or preventive culling, there have so far been only 225 human cases, 128 of them fatal, since the current outbreak started in South East Asia in December 2003, and these have been ascribed to contact with infected birds.

But experts fear the virus could mutate, gaining the ability to pass from person to person and, in a worst case scenario, unleashing a deadly human pandemic similar to the so-called Spanish flu outbreak of 1918 that is estimated to have killed from 20 million to 40 million people worldwide by the time it had run its course two years later.

Indonesia is currently a main locus of the disease with 49 cases, 37 of them fatal, second only to Vietnam with 93 cases, 42 of them fatal, but no reported infections at all this year.

http://www.un.org/apps/news/story.asp?NewsID=18760&Cr=bird&Cr1=flu

[Theresa42]

WHO lab in Hong Kong says 4 nurses tested neg for H5N1

toggletext-ed from Indonesian:

The NURSE in Medan AND Bandung the BIRD FLU NEGATIVE
June 07, 2006

Metrotvnews.com, Jakarta: The laboratory of the World of the Health Body (WHO) in Hong Kong stated four nurses in Bandung, West Java and Medan, North Sumatra, the negative was infected by the bird flu virus. Results of the blood test of the four nurses by WHO that was received by the Department of the Health, on Wednesday (7/6), this proved that the bird flu virus not yet bermutasi between-humankind.

Totalling four nurses in Indonesia that beforehand could be indicated as their respective bird flu patient of two people in Bandung and two other in Medan. The two nurses in Bandung, currently, are treated in the Handsome Hospital of Sadikin Bandung. The two patients worked in RS Ujungberung, Bandung, that could treat two patients suspect bird flu, namely the older brother was siblings from Cinunuk, the Bandung Regency. Both of them died several days set.

While two nurses in Medan, beforehand could treat seven patients berstatus positive was infected by bird flu. The seven patients from one cluster or the family also died. Casualties came from the Simbelang Fortification Village, the Subdistrict of three bows, the Karo Land Regency, North Sumatra.

http://www.metrotvnews.com/berita.asp?id=18123