Indonesia Bird Flu - 2006 - June/11 - June/22

[Theresa42]

Suspected bf outbreak in chickens in Sulawesi

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Sulawesi
Hundreds of the Citizen's chickens Konawe died Suddenly, It Was Suspected Bird Flu
June 11, 2006

Penulis: Halim Agil

KENDARI--MIOL: Hundreds of tails of villagers's chicken Rawua, the Sampara Subdistrict, of the Konawe Regency, the South-East Sulawesi Province since the last two weeks this June, died suddenly. Expected resulting from the bird flu virus.

This kept chicken almost daily died suddenly. The chicken a citizen, on Saturday (10/11) was found died mendadak in the pen. The chicken that died was gathered and burnt by the citizen personally, but was also that only was exiled in the closest time.

According to villagers, they did not learn the cause of their chickens there are those that every day died suddenly. There was the chicken belonging to the citizen who died until forty tails in a day. Till this Sunday already hundreds of tails of the citizen's chicken died suddenly.

The citizen was still alarming the death of the chicken suddenly, but was not yet having the citizen who was sick resulting from the death of the chicken.

Juma Jabalnur, a citizen, who was met on Saturday, said the death of his chicken already forty tails. According to him, there was not again his kept chicken that still teringgal, all of them died suddenly.

Juma acknowledged after his chicken died, the South-East Sulawesi Livestock Breeding Service visited the Rawua Village to take the sample of the chicken that died, but up until currently did not yet have the assurance whether the poultry was killed resulting from bird flu.

The South-East Sulawesi side of the Health Service suspected the death of the citizen's chicken of being infected by the bird flu virus. This assumption of being not yet certain because of not yet having villagers Rawua that it was reported was sick by having the characteristics was infected by the deadly virus.

http://www.mediaindo.co.id/berita.asp?id=102556

[Theresa42]

Fire at Adam Malik Hospital, Medan [where bf pts are treated in N Sumatra]

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Fire RSUP H Adam the Owner, police were Still checking two security units
Ditulis oleh Redaksi
Sunday, 11 June 2006
Medan (SIB)

Till last Sunday (11/6), police were still questioning two officials of the security (the Security Unit) the central Public Hospital (RSUP) H Adam the Medan Owner that was burnt on Friday (9/6) dawns around struck 01.00 WIB. Nevertheless, as far as this is concerned police still could not ascertain the motive and the background of the fire, disengaja or resulting from the accident.

Kapolsekta Delitua AKP Hardian Pratama went through Kanit Resktim Iptu M. Nasution to the reporter, on Sunday late afternoon said, his side just checked two officials of the security unit who at the time of the incident was assigned to be on duty at the hospital with type main in North Sumatra.

Asked by results of the temporary inspection of the two security units, Nasution said, his side still could not give the specific explanation because the inspection was not yet complete.

"Possibly tomorrow could have been explained by us more far," said Kanit. As being reported, fire happened in RSUP H Adam the Medan Owner, on Friday the dawn yesterday.

The flame of the fire scorched several rooms and resulted in the loss hundreds of millions rupiah.

http://hariansib.com/index.php?option=com_content&task=view&id=6558&Itemid=9

[Theresa42]

"Paddy-field birds not Spread H5N1"

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Paddy-field birds not Spread H5N1
June 12, 2006

BANDUNG, (PR). -

The increase in the population of paddy-field birds in the period was married simultaneously the farmers processed his paddy-field in Kab. Bandung, will not bring the bird flu virus (H5N1). Because, the habitat and the way of life as well as food made paddy-field birds be different to the kept animal. The poultry animal that the wild life, more immune was compared the poultry that experienced domestifikasi.

Was like this it was said drh. Hendrawan, the observer of wild birds from the Lover's Community and the Observer of Indonesian birds (KPPBI) to PR in Kp. Bojongjati, Ds. Bojongemas, Kec. Solokanjeruk, Kab. Bandung, on Sunday (11/6). "My foreknowledge, until this was not yet found by the person or the farmer that tertular paddy-field birds and paddy-field birds that penyebarkan the virus H5N1," he said.

According to Hendrawan, uptil now information about the spread of bird flu still was very limited. As a result, the community fully did not yet understand how the virus H5N1 spread to humankind.

"That was known at this time, the virus was contagious because of having the poultry (was attacked by the virus) was eaten by humankind. In fact, the actual virus still relatives were close to the A influenza virus spread through air (airborne)," he said.

Whereas his virus personally, according to Hendrawan, could come from the waste, saliva, the place of food and the drinking water, the pen, and all the surfaces of the land that was polluted by him. That was the reason, that first tertular was them who often were adjacent to the pen or the poultry market, he said.

Four spesies

Was based on results of the research himself with the University of Diponegoro Semarang, at least had four species of paddy-field birds, namely the species of the heron, the water buffalo heron (Bubulcus ibis), the big heron (Egretta alba), the small heron (Egretta garzetta), and the silver heron (Egretta intermedia). The four birds kinds, had the way of life that almost same.

These kind birds, also including the "wanderer". At the end the 19th age, the water buffalo heron developed the colony in north South American coastal parts. They came from Africa by crossing the Atlantic Ocean. The amount increased very fast in his place of residence that just. In Indonesia, the water buffalo heron was gotten in the Sumatran Island, Java, Bali, Kalimantan, Sulawesi, and Papua.

The migration of the heron could it was estimated spread the bird flu virus. However the spreading data of the deadly virus through wild birds, up until now still was minimal and almost was not available.

Now against the population of paddy-field birds in Kp. Bojongjati, that developed each processing season of the paddy-field, in order to be not restricted by means of being pursued. "The birds including the animal that was protected," said Hendrawan.

http://www.pikiran-rakyat.com/cetak/2006/062006/12/0209.htm

Photo caption: A farmer hijacked the paddy-field between several heron birds and blekok in the area Bojongjati the Village BojongemasKec. Solokanjeruk Kab. Bandung, on Monday (5/6). The population of the two birds kinds continued to experience the increase simultaneously the season processed the paddy-field.

[Theresa42]

More outbreaks of bf in poultry in South Sulawesi

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Thousands of chickens died was affected by Bird Flu
June 13, 2006

Thousands of chickens belonging to the citizen in the Samata District, Gowa, South Sulawesi, died suddenly. After being done rapid test, the chicken that died positive bird flu. Doctor Muhammad Kafil, the chairman of the team of the control of the deadly virus said will check repeated in the laboratory veteriner the east Indonesian territory.

http://www.liputan6.com/view/12,124382,1,0,1150168214.html

[Theresa42]

Clustering of Human H5N1 Cases in Indonesia, 2005

Abstract #67, pg. 70...

Clustering of Human H5N1 Cases in Indonesia, 2005

E. Sedyaningsih1, P. Blair2, H. Wibisono3, S. Harun1, B. Heriyanto1, E. Tresnaningsih1, H. Kosasih2, M. Peiris4, J. Katz5, S. Lindstrom5, A. Klimov5, S. Putnam2, T. Uyeki5, N. Kandun3;

1National Institute of Health Research and Development, Jakarta, INDONESIA,
2U.S. Naval Medical Research Unit #2, Jakarta, INDONESIA,
3Center for Disease Control, Ministry of Health, Jakarta, INDONESIA,
4St. Mary Hospital, University of Hong Kong, Hong Kong, HONG KONG SPECIAL ADMINISTRATIVE REGION OF CHINA,
5Centers for Disease Control and Prevention, Atlanta, GA.

Background: The widespread epizootic of avian influenza A (H5N1) among poultry caused fatal H5N1 human cases across five Asian countries. In Indonesia, the first H5N1 human case occurred in July 2005, and cases continue to be identified.

Methods: Based on hospital reports starting in June 2005, clinical, epidemiological and laboratory data from suspected H5N1 human cases were collected and analyzed. A cluster was defined as two or more cases among household members, relatives or other contacts with one or more having laboratory evidence of acute H5N1 virus infection. Acute H5N1 virus infection was identified by a RT-PCR and serological assays and confirmatory testing was conducted at WHO H5N1 reference laboratories.

Results: During June through November 2005, 11 patients admitted for influenza-like illness were identified as having acute H5N1 infection. Eight of the eleven H5N1 patients were subsequently classified into four unrelated family clusters. Among these four clusters, severe respiratory disease occurred, including four deaths among three of the clusters. However, mild respiratory disease was occurred, especially among children. Each cluster was comprised of one adult (median age = 29 years, range 19 - 38) and one child (median age = 8 years, range 4 - 9). The case fatality rates were 75% and 25% among adults and children, respectively. Only one of the clusters’ index cases had direct poultry contact. However, in the other 3 clusters, poultry mortality occurred close by, including among chickens, pet birds and ducks. In each of three clusters, the second case did not have any poultry or animal contact. Among three of the clusters, H5N1 virus was recovered and nucleic acid sequencing classified each of these isolates as Clade 2, reflecting genetically distinct, indigenous viruses of avian origin.

Conclusions: Among the first 11 confirmed H5N1 cases in Indonesia, 73% were found in four distinct clusters. The clinical manifestations among these cases varied from severe/fatal lower respiratory disease, especially among adults, to mild respiratory symptoms, predominantly in children. Limited person-to-person transmission of H5N1 could not be excluded in 3 clusters.

http://www.iceid.org/documents/AbstractsFinal.pdf

[Theresa42]

Additional bf tests done on poultry in Gowa, South Sulawesi

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The example of Blood of Thousands Of chickens was in South Sulawesi tested Repeated
13/06/2006

Liputan6.com, Gowa: The team of the control of South Sulawesi bird flu, recently, dripped repeated the example of blood of thousands of chickens in the Samata District, Gowa that died suddenly in two weeks later. The repeated test to ascertain the cause of the death of the chicken after the test beforehand showed if the chickens died as a result of the bird flu virus.

The chairman Tim the Control of South Sulawesi Bird Flu, Muhammad Kafil said, results of the fast test available was felt was not yet enough. While the repeated inspection will be carried out in the Veteriner Laboratory the East Indonesian territory.

The chicken breeder in the Samata District, Basri Daeng Tompo said, before dying kept him always issued mucus from the mouth and continued with cramps. Generally the breeder did not know whether their chicken was attacked by reason bird flu for the insignificance sosisalisasi from the local Livestock Breeding Service.

The socialisation that not all that about the bird flu danger also caused the citizen in the Samata District still mengonsumsi chicken as usual. The believing citizen of their livestock chicken that died with the similar sign had happened several years ago.

http://www.liputan6.com/view/7,124397,1,0,1150222962.html

[Theresa42]

Karo community protests poultry culling / demands WHO investigators leave in 3 days

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The citizen gave Time 3 days WHO left Karo
14 Jun 06 00:43 WIB

Medan, WASPADA Online

Dozens of citizens were combined by the Coalition of the Karo Community, on Tuesday (13/6), did the demonstration in the Gubsu Office and meng ultimatum 3x24 the hour [3 days] will expel the World Health Organization official (WHO) that was carrying out the research in the area.

They also carried out the action cut off four chickens sembari drank blood and fried him as well as asked PNS the Gubsu Office took part in tasting him. The citizen said better died than their chicken was destroyed. Moreover results of agriculture and livestock breeding were traded in not the behaviour because of rumours of bird flu.

Before being fried, they also swallowed chicken bile disembelih in fact mengusapkan blood to their face opposite the public. They also showed the chicken was maintained by them did not contract bird flu. The urgent mass was accepted by Gubsu Drs Rudolf M. Pardede, but was found by Kabiro Binsos Drs Hasbi Nasution and Wakadis the Health Provsu Dr Syaiful M. Sitompul.

"Don't blame us, if the Karo Regional Government, Pemprovsu or the government of the centre still could not resolve the case of bird flu in Karo," said the citizen. Responded to the demand and the aspirations of the Coalition of this Karo Community, Dr Syaiful Sitompul said, the case of the spread of bird flu until this still in the research. "I could confirm, the citizen of the Simbelang Fortification died some time before positive bird flu. However I, could not confirm, all the livestock in Kab. Karo positive was affected by bird flu," he said.

They explained, a bird flu casualty was treated in RSU H Adam the Owner was named Jones Ginting already negative bird flu. "Now his maintenance in the other case," said Syaiful. The explanation of the problem of the livestock will in Karo be destroyed or whether all the livestock in Karo already tertular the bird flu virus, that the authority Kadis Livestock Breeding, he said.

The mass called himself the Coalition of the Community of Karo Anti rumours of Bird Flu explained, as a result of the behaviour of the government of the centre went through Menkes RI resulted in the community in Karo being discredited (was isolated psychologically). This resulted in the morale loss and materil. The RI government, they said, responded to the case of bird flu in Karo this recklessly and hurried before having results of the official research the world body. While doing their oration also spread out several banners that is stopping rumours of Bird Flu, were forbidden to sell rumours of Bird Flu and nande-nande made use of the coloured umbrella black.

Tuntut

The Karo community has been restless, restless and worried and incurred a loss by morale and materil will put forward the demand perdata to the government of the Centre cq Menkes RI, the Government of the Province and the Karo Regional Government cq the Regent Karo, that the community receives the feeling of justice.

The reason was raised Menkes RI stated the source of the AI spread came from manure/the waste of the poultry, was denied because of being unproven in accordance with results of the authority inspection of the health, agriculture and WHO. The Next One of Menkes again stated the AI spread was from pork consumed by the casualties.

This was also very strange, because evidently pork was meant Menkes RI was consumed by the Karo community other. If then was said the AI source came from pork, why in the Karo Regency in no way was found by the pig terindikasi AI. ended did the action, they left the Gubsu Office in an orderly manner.

http://www.waspada.co.id/berita/sumut/artikel.php?article_id=77969

[Theresa42]

Second hospital designated as a bf hospital in North Sumatra

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RSU Pematang Siantar the PATIENT's RECONCILIATION North Sumatran BIRD FLU
14/06/2006

Metrotvnews.com, Pematang Siantar: As a result of spreading him the case of bird flu in North Sumatra (North Sumatra), the Department of the Health, on Wednesday (14/6), again reconciled the Public Hospital (RSU) Pematang Siantar as the reconciliation hospital for the bird flu patient. RSU Pematang Siantar became the second reconciliation hospital after RS Adam Malik, Medan, that was indicated by the Department of the Health.

According to the side of RSU Pematang Siantar, his side was ready with penunjukkan this. Nevertheless, his side acknowledged the limitations of means and the shortage standarisasi as the hospital that handled the case of bird flu. So, RSU Pematang Siantar prepared the special room for the bird flu patient as well as the procurement of the medical staff, like the lung specialist and the internal disease specialist.

http://www.metrotvnews.com/berita.asp?id=18579

[HenryN]

Re: Indonesia BF - 06/11

Kabanjahe (SIB) was estimated seribuan the Karo community gathered with the students dariseveral state tertiary institutions and private enterprise in Medan, today (on Thursday 15/6) demonstrated to the regent's office and DPRD Karo in Kabanjahe.This demonstration plan to aim at sending the aspirations of the Karo Regency wider community responded to the appearance of Coordinating Minister for People's Welfare's instruction (the Co-ordinating Minister Kesra), that stressed will destroy the chicken poultry in Karo because terindikasi was affected by the bird flu virus.This it was stressed B got up, S Ginting and C Peranginangin to the reporter, on Wednesday (14/6) in Kabanjahe was in accordance with the demonstrating permit from Subregional Police Karo No. Pol STTP/07/VI/2006/IKA on June 12 2006 that was signed Kasat AKP S Tarigan Intelligence.He said, although in SK this Kesra Co-ordinating Minister was explained that the extermination of the poultry of the chicken kind was not carried out all over the Karo Land, but legally has confirmed had the bird flu virus was in the Karo Land.If the extermination was carried out, in a manner the fact justified the assumption of the cause of the death 7 villagers the Simbelang Fortification recently resulting from the bird flu virus from the kept poultry of the chicken kind the Karo Land community.Until this, in the Karo Land not there are those that was sick.Everything spread from the chicken to the other chicken.What the plan reason destroyed that.Only for the achievement project pemerintahkan?Said S Ginting.In the meantime, Kasat Intelligence Subregional Police Karo AKP S Tarigan when it was confirmed SIB, on Tuesday (13/6) around this demonstration plan, confirmed.His permission has we the process, said Tarigan.(AG/D5/g)</PRE>
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http://www.hariansib.com/index.php?o...=6809&Itemid=9</PRE>

[HenryN]

Re: Indonesia BF - 06/11

http://www.hariansib.com/index.php?o...=6802&Itemid=9


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The National Commission side the Control of Bird Flu and Preparedness Pandemiinfluenza (Komnas PFB-KPI) from Minister's Office Kordinator Welfare of the People (the Co-ordinating Minister Kesra) RI, warned the misunderstanding happened that very serious in the element circle of the conference headed by the area (Muspida) the province and Muspida the Karo Regency in handling the case of the occurrence of the plague of bird flu that took several fatalities to last May.Kordinator Komnas PFB-KPI the Co-ordinating Minister's Office Kesra RI Dr Emil Agustono said, the Co-ordinating Minister's side Kesra in fact had not been and published the instruction (SK) for the extermination of the poultry in the Karo Land in connection with the occurrence of the plague of bird flu in the area, but only normal letters that was shaped like a suggestion the co-ordination to look for steps in the solution, necessary with the act of the extermination of the poultry or had effective other efforts.There was the impression of the officials in the area (the Governor as far as the Regent) the misunderstanding with the Co-ordinating Minister's Letter Kesra the matter of the control of the plague of bird flu in Karo.In fact that not SK to destroy the poultry, but only normal letters that his characteristics the co-ordination between the element of the official in the area to deal with the plague, explained Emil Agustono to the press in Medan, on last Tuesday (13/6).He explained that in agenda gaps training the reporter several print medias and electronics in the Medan city, that was held Internews Indonesia (Ii) Jakarta, co-operated with Unicef-UN and several related agencies the matter of bird flu in North Sumatra like RSUD Adam the Owner, the North Sumatran Service of province Livestock Breeding.Training for choice medias in North Sumatra with special material about the bird flu put forward the choice instructors who controlled the case of bird flu like Prof Dr Luhur Soeroso from RSUD Adam the Owner that also the Chairman Tim Doctor Especially Bird Flu, Drh Sangkot Sayuti Nasution from the Big Hall Investigation and the Testing Veteriner Regional I Medan, Kordinator Komnas PFB-KPI the Co-ordinating Minister's Office Kesra Dr Emil Agustono, the Unicef Consultant for Indonesia in Jakarta seized Supomo, the instructor Sonny Inbaraj from Internews Indonesia, et cetera.


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Most discussion material about the case of the bird flu, especially was related to rumours and the policy of the government towards the case of bird flu in the Karo Land that later was stated specific that, was stated very limited for the media's circle, so as not completely could be broadcasted.For example the matter of summaries of the medic about proof whether the casualties as a family in the Karo Land (villagers the Simbelang Fortification, the Subdistrict three bows), true or not as a result of the plague of bird flu, in no way could be received by the reporter although in the form of photograph-kopian from the side Dr Luhur Suroso on the basis of very sensitive and only could circulate in the doctor's circle then.To the summary that only was presented sekilas through the presentations slide-projector in Space of Hotel Mahogany Emerald the curtain, in part was shown the session of the medical process began the casualty entered the hospital, the development stage of the infection (Ispa), the condition for the final of the patient and to date-hour-minute-second the death the patient personally.The same thing was not very much received by the reporter in the opportunity to be the chronology of the spreading of the virus from the main source (from the poultry animal or humankind, or the pig around casualties's house), and whether the data to the summary of the medic really the virus H5N1 or not.Unlike the case of bird flu in other areas that have been affected by bird flu, the case of bird flu in Karo this even made many silent doctors, moreover with the existence of rumours of politics (political issued) that developed in the official's circle of the matter of the source and the virus medium, said several participants training that, to SIB. Emil Agustono from Komnas PFB-KPI the Co-ordinating Minister's Kesra Office acknowledged, now this only matters of clarification SK the Co-ordinating Minister Kesra actual not SK that necessary disosialisasikan to the wider community in North Sumatra, especially in the Karo Land.So, the regional government's side could give the understanding to what community of poultries that was considered to be still safe was maintained and consumed, the poultry that how that necessary in safe would or diisolir or what poultry that indeed must be destroyed when absolute must be destroyed.The matter of the reaction of the Karocommunity
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According to him, available was the normal letter or the appeal letter from Menkokesra with No. B-91/Menko/Kesra/VI/2006 dated June 2 2006 concerning the handling of bird flu in the Karo Land Regency.This matter he said to the reporter in the building of DPRD North Sumatra, on Wednesday (14/6), responded to the existence of the extermination plan of the poultry in the Karo Land Regency by the government.Said, the Karo community might not be frightened, because of SK the extermination of the poultry was not available, available only normal letters or the appeal about the handling of bird flu, where the government asked the Karo Regional Government immediately to carry out the handling that more intensive in the control of bird flu, including doing the extermination of the chicken in the Karo Land, will be in accordance with the technique and the true method on the basis of the current rules.The handling of bird flu could by increasing sanitation and the cleanliness of the market in the Karo Land Regency that had the sale part of the poultry and carried out the supervision tighter towards the poultry traffic that passed by in the Karo Land as well as continued and increased steps in the control of bird flu that was carried out uptil now, he said.He also explained, if being found the sample of the positive poultry terjangkit the virus H5N1, then the extermination could be carried out, that too with the limited radius that is 1 Km.But, if being not was found by the virus H5N1 to the sample of the poultry, then the extermination of the poultry could not be carried out.Up until today, results of the inspection of the laboratory proved to not have one livestock then in the area of the Karo Land that that positive terjangkit the virus H5N1, mentioned he.(A14/DEH/d)</PRE>

[Theresa42]

Another Death in Indonesia Deepens Fears of Bird Flu's Spread

June 16, 2006
Another Death in Indonesia Deepens Fears of Bird Flu's Spread
By DONALD G. McNEIL Jr.

The death of a 38th person from avian flu in Indonesia was confirmed yesterday by the World Health Organization and the situation in that country continued to worsen.

Indonesia is now in second place, after Vietnam, which has had 42 deaths, but none this year, while Indonesia's caseload is climbing rapidly and striking many family clusters.

The World Bank said Monday that Indonesia's response to the flu was disorganized and underfinanced. On Tuesday, the World Animal Health Organization said Indonesia was no longer even counting most poultry outbreaks. In the last year, it has officially reported the deaths of only 800 chickens, while there have been news reports of the deaths of thousands of birds from 29 of the country's 33 provinces.

Indonesia, the world's fourth-most-populous nation, has 242 million inhabitants and an estimated 1.3 billion chickens spread across 18,000 islands.

On Monday The Jakarta Post quoted several local health experts as saying that the government was not disclosing how widespread the disease was or how many times human-to-human transmission might have occurred. And last week Indonesia's health minister, Siti Fadilah Supari, said she was "running out of ideas for how to make the public aware" of the threat and get them to kill sick chickens instead of eating them.

Yesterday the Indonesian Health Ministry said the death of a 7-year-old girl in Banten Province on June 1 was the country's 38th from avian flu. The girl's 10-year-old brother died May 29, but he was buried before specimens were taken, so he was not included in the count. Chickens in the family's household had died earlier.

According to news agency reports quoting health officials, the 7-year-old had tested negative for avian flu in nose and throat swabs taken when she was alive, but then tested positive when lung tissue was taken after her death. [Duh! ]

Nose and throat swabs ? the routine way of diagnosing regular flu ? may give false negatives because the bird flu virus attaches to cells deep in the lungs, not to the upper respiratory tract. In January, according to the World Health Organization, the same error caused the first human cases in Turkey's outbreak to be misdiagnosed.

Dr. Henry L. Niman, a biochemist who has questioned many of the health organization's official counts, argued that flu cases were underestimated because of that error and because blood tests could also produce false negatives if the blood was drawn before detectable antibodies had built up. Victims can die before that happens, and the outbreak in Indonesia has a very high death rate: of the 50 known cases, 38 have died.

An Indonesian newspaper, The Tempo, reported yesterday that one of its reporters who covered the extermination of infected poultry and the funeral of a flu victim near Jakarta had been hospitalized with flu symptoms; the newspaper did not report any test results.

Dick Thompson, a World Health Organization spokesman, said he knew nothing about the reporter who fell ill, but he said the agency was drafting safety guidelines for journalists. "Some of them are getting pretty close to cases," he said.

There have been several reports of Indonesian nurses' falling sick after tending avian flu victims, which could indicate that the virus was spreading more easily between humans. On June 6, the World Health Organization reported that tests on four such nurses had convincingly ruled out A(H5N1), the avian flu, and indicated that one had a seasonal flu, A(H1N1), instead.

Dr. Niman said convincing evidence could be obtained only from blood tests.

Mr. Thompson, who recently returned from Indonesia, said that he did not know how the nurses had been tested, but that he thought that Indonesian health authorities "are really on top of the human cases, investigating them aggressively," even though animal cases were spiraling out of control.

http://www.nytimes.com/2006/06/16/world/asia/16flu.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1150426490-NJuZnXrBZEw+cl+wDVC/tw

[Theresa42]

Source of Yohana and Toni's infection unknown

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YOHANA casualties 38TH BIRD FLU
June 16, 2006

Casualties died as a result of the bird flu illness in Indonesia improved to 38 people. Last casualties were Yohana, the citizen of the Kedaung District, Pamulang, Tangerang, Banten. The female child was seven years old died on June 1 set when being treated in the Fatmawati Hospital, Southern Jakarta.

Was based on results of the test of the World of the Laboratory of the Health Body in Hong Kong, on Thursday (15/6), Yohana positive died because of the bird flu illness. Yohana died four days after his older brother, Toni, the age nine years, died it was suspected because of the same illness. Till at this time, was not yet it was known certain the source of the spread of the bird flu virus that infected Yohana and Toni. His article, both in the house and around casualties's house was not found the poultry that died suddenly as a result of bird flu.

http://www.metrotvnews.com/berita.asp?id=18646

[Theresa42]

Joi Andre Simatupang (JAS - the 'preschooler') reportedly tests neg for bf

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The section head the North Sumatran Health: Joi Andre Simatupang the Bird Flu Negative
June 16, 2006

Medan, (Analisa)

The section head the North Sumatran Health Dr Hjjah Fatni Sulani DTMH Msi stressed, results of the laboratory inspection in Jakarta berkesimpulan the patient Joi Andre Simatupang (2), the bird flu negative.

Joi Andre the citizen Street Sisingamangaraja Medan evidently only experienced normal flu (influenza pneumonia). The same statement was reinforced from results rongen [X-ray] the lungs Prof Dr H Luhur Soeroso SpP (K) in the central Public Hospital of H Adam the Medan Owner, on Thursday (15/6) was sent to the Section Head the North Sumatran Health.

Said by Fatni, although Joi Andre the negative experienced bird flu but until this his side still could not know definitely the spread of bird flu from the animal to humankind, but his side has done as maximally as possible. Moreover his side also did not yet accept the report when Joi will be returned from the hospital. We were still being waiting for this report, he stressed.

Respond to will be done by the extermination of the poultry in the Village of Sembelang Kabanjahe the Karo Land, Fatni stressed, this extermination not the authority of the North Sumatran Health of the Service but the authority of Livestock Breeding of the Service.

Said by Fatni, since autonomy of the area it was hoped did not have again the hospital of the City Regency that did not know the case of bird flu in his area. Moreover the North Sumatran side of the Health Service in this case gave counselling about the handling of bird flu at the same time memperaktekan taking methods specimen someone who was suspected by bird flu.

In the reporting beforehand was mentioned, Joi Andre was originally reconciled from the Hospital of Elisabet Medan to the central Public Hospital of H Adam the Owner, on Tuesday (6/6) struck 23.30 WIB after experienced 5 fever days. He [she] was suspected (suspect) bird flu.

Whereas his maintenance was different to the patient Jones Ginting (23), villagers Sembelang Kabanjahe the Karo Land till Thursday (15/6) still underwent the maintenance in the special room of the A Longing isolation was not yet known when being returned to his native village because still in the maintenance of the team of the special doctor who handled the case of bird flu.

http://analisadaily.com/0-5.htm

[HenryN]

Re: Indonesia BF - 06/11+

Commentray at

http://www.recombinomics.com/News/06160601/H5N1_Indonesia_Surveillance_Concerns.html

[Sally Furniss]

Re: Indonesia BF - 06/11+

False Negatives Raise H5N1 Surveillance Concerns In Indonesia

Recombinomics Commentary
June 16, 2006

According to news agency reports quoting health officials, the 7-year-old had tested negative for avian flu in nose and throat swabs taken when she was alive, but then tested positive when lung tissue was taken after her death.

Nose and throat swabs - the routine way of diagnosing regular flu - may give false negatives because the bird flu virus attaches to cells deep in the lungs, not to the upper respiratory tract. In January, according to the World Health Organization, the same error caused the first human cases in Turkey's outbreak to be misdiagnosed.

There have been several reports of Indonesian nurses' falling sick after tending avian flu victims, which could indicate that the virus was spreading more easily between humans. On June 6, the World Health Organization reported that tests on four such nurses had convincingly ruled out A(H5N1), the avian flu, and indicated that one had a seasonal flu, A(H1N1), instead.

Dr. Niman said convincing evidence could be obtained only from blood tests.

Mr. Thompson, who recently returned from Indonesia, said that he did not know how the nurses had been tested, but that he thought that Indonesian health authorities "are really on top of the human cases, investigating them aggressively," even though animal cases were spiraling out of control.

The above comments in today's Donald McNeil article in the New York Times has more curious comments by WHO and health officials. Testing in Jakarta is generally quite reliable, so it was surprising that WHO failed to confirm an 18 year old brother who had tested positive in Jakarta and his sister had tested positive in both Jakarta and Hong Kong. It was highly unlikely that a sibling of an H5N1 bird flu confirmed patient would falsely test positive in Jakarta. The Hong Kong lab ran additional tests and confirmed the Bandung cluster.

The repeated false negatives by Hong Kong in the latest cluster from Bandung raises serious questions about the "definitive" negative results on the nurses in Bandung. As noted on the media reports, the false negatives were generated by nose and throat swabs. This type of testing has previously been called Goldilocks testing because it is too late to detect H5N1 in the nose and throat, but too early to detect H5N1 antibodies in the blood, but just right to generate false negatives.

The testing of the nurses was clearly in the Goldilocks category because the antibody levels peak 3-4 weeks after symptoms, and at least two of the four nurses were tested about a week after symptoms. Since the time for collecting samples is fast approaching, it is surprising that the WHO spokesperson did not know of plans to due further testing to truly rule up H5N1 infections in the nurses.

Moreover, the H5N1 isolated from patients in Western Java, including Tangerang, Jakarta, and Bandung, have a novel cleavage site that does not match reported bird isolates but do match and isolate from a cat. Therefore, the source of the H5N1 in these cases remains unclear.

As the number of human cases and poultry outbreaks continue to increase, the surveillance failures become more clear. New sequences at Genbank from birds in Indonesia identify one isolate with a cleavage site that matches the Qinghai strain. This isolate is cause for concern because all Qinghai isolates reported to date have PB2 E627K, which is associated with a poor outcome and was detected in the second reported Indonesian case. Thee has also been speculation that the higher levels of H5N1 in the nose and throat of members of the Sumatra cluster was due to E627K.

Thus, release of the human sequences, as well as more data on H5N1 in animals in Indonesia is urgently needed.