INDONESIA - Garut Cluster Part II

[HenryN]

Re: INDONESIA - Garut Cluster Part II

Dr. Niman, Thanks. Were these the 4 who died along the time of the index case? Who is "K"? Sorry for all the questions. Maybe I'm just tired, but the article is very confusing.

"K could be checked in the Cikelet Community Health Centre."

K is pictured in the article, which is mostly about her. I think she is 32F

[Theresa42]

Re: INDONESIA - Garut Cluster Part II

Dr. Niman, Thanks. Were these the 4 who died along the time of the index case? Who is "K"? Sorry for all the questions. Maybe I'm just tired, but the article is very confusing.

"K could be checked in the Cikelet Community Health Centre."

K sounds like a new case.

Whereas K since Friday (18/8) was treated in RSU Dr. Slamet Garut.

Edit: She's also from another village: Kampung Sawah Bera, Desa Cikelet, Kab. Garut [ << from the photo caption]

Village Sawah Bera, Sub-district Cikelet, Regency Garut

[Theresa42]

Re: INDONESIA - Garut Cluster Part II

Some highlights from the article Dr. Niman posted in post #5:

Lima died, Three "Suspect" was treated by
Bird Flu Increasingly Ganas
August 19, 2006

Garut, (PR).-

The Attack of the bird flu illness increasingly raged. The virus H5N1 that attacked the inhabitants in the Village and the Subdistrict Cikelet the Garut Regency, it was suspected killed five people. That died and was known positive bird flu quite new Ai Siti the message. He died on Tuesday (15/8). However apart from Ai, there were four other citizens that died in a beruntun manner in the village with the sign was similar was infected H5N1.

Four other people who died and were it was suspected attacked by bird flu were Euis Lina, Rubiah, Misbah, and Sardi. The four citizens, remained was not far from the house of Ai Siti the message in the Village and the Cikelet Subdistrict, around 120 km the south direction the Garut Regency. From four casualties died that, only one casualty that succeeded in being taken the sample of his blood to be researched in the laboratory namely Euis Lina.

Therefore, suspect and positive bird flu in Garut numbering 9 people. Umar and Ai Siti Amanah, has been stated positive bird flu. Umar has recovered. Whereas Ai Siti, died, on Tuesday (15/8). Three suspect other currently in the maintenance. Is (5) and S (8) was treated in Poinciana Tree Space of RSHS Bandung. Whereas K since Friday (18/8) was treated in RSU Dr. Slamet Garut. However last night has been moved to RSHS.

K (32) arrived in RSHS struck 19.30 WIB. the Citizen Kp. Sawah Bera Desa Cikelet could experience the fever and breathless since Friday at daybreak struck 4.00. He [She] could be treated in RSU Garut for two hours. However because his condition was serious enough, he was at once brought to RSHS. he arrived in UGD RSHS was accompanied by his older brother, Sohib (39) and the official RSU Garut. He suffered the fever achieved 38.6 Celsius levels, with blood pressure 80/60 and respiration 34 times per the minute.

K could be checked in the Cikelet Community Health Centre. "Casualties when coming to the Community Health Centre, suffered hot high. The fever he [she] the suffering since the last three days. Around the patient's house was known had dozens of poultries that died, including three tails of his property poultry," the Cikelet Community Health Centre headword Dr. Heri. Because of worrying, K was brought to RSU Garut and entered isolation space approximately struck 15.50 WIB. Only two hours were treated, K was afterwards brought to RSHS.

Heri suspected K of suffering bird flu, because of the Sawah Bera Village with Jojok, was not so far. The "patient's K house with the house the positive family bird flu Ai Siti the message and suspect Ismawati bird flu, was not far. His distance around 100 metre. Even with Santi's house only terhalang several houses," said Dr. Heri.

According to Osin, the husband K, his wife began to complain was sick gazed at the subuh prayer (on Friday 18/8). At that time, said Osin, his wife complained was sick the throat, breathless and feverish high. At that time, Osin asked the doctor the Cikelet Community Health Centre to come to his house. After being checked, the doctor suggested his wife was reconciled to RSU Dr. Slamet Garut.

Asked whether in his village had had the chicken died suddenly, Osin confirmed. A "previous month indeed had the chicken died suddenly," he said. He also claimed that the distance of his house with the Ai Siti house only terhalang twelve houses or approximately 100 metre.

Tidak parah

The head of the Field RSU of the Medic's Service Dr. Slamet Garut Dr. Widjajanti Utojo said, according to results of the last inspection, K unlike patients suspect other bird flu that came from Cikelet. The condition for the patient, he said, was not too serious. The temperature of his body of only 38.6 Celsius levels. His cough really quite difficult and was somewhat breathless.

The person responsible for Isolation Space of RSU Garut Wawan Sumiarsa said, his side has taken the sample of blood and did x-rayed against K. the "patient also suffered the cough and was sick the throat. His [Her] breathing, also was disrupted. The intensity of his breath was still high, that is 40 times per the minute," said Wawan.

The discovery 4 suspect other that has died, after the Section Head the West Javanese Health Dr. Yudhi Prewar inspected directly the Village and the Cikelet Subdistrict, Garut, on Friday (18/8). However according to Kadinkes West Java, his spreading still in the Cikelet Village and did not yet be the indication of the case of the spread in a cluster manner. On Friday (18/8), Kadinkes also led directly mass medical treatment with Tamiflu giving for the prophylaxis (the prevention) to them that contact with suspect.

Dinkes West Java with Tim [team] the Department of the RI Health, also carried out the taking of the sample of the citizen's blood with the sign of the fever and breathless. Two including being the sibling the Rubiah who has died. "Medical treatment, direct observation and counselling on Friday earlier were carried out in 4 villages namely the Rancasalak Village, Rancamareme, Jojok, and Sawah Bera," he said.

The director general of the Eradication of infectious diseases and environmental Sanitation (P3L) the Department of Health, I Nyoman Kandun overnight in Jakarta said, indeed already many that worried, bird flu could have been spread antarmanusia. However, uptil now did not yet have proof. ?Memang has been found positive the virus H5N1, but the spreading antarmanusia did not yet have proof. I would immediately to Garut and remained up until Sunday, said Kandun.

The Garut regent H. Agus Supriadi, on Friday (18/8) deliberate viewed several villages in the Cikelet Village. By making use of the truck and passing the steep street, the regent was welcomed by the citizen's local happiness. The "deliberate father came, to see directly the condition for the village in Cikelet, as well as give urging to the family that was known suspect bird flu," said Kabag public relations Setda Garut Drs. Dikdik Hendrajaya, M. Si.

In the meantime, the condition two patients from Cikelet that was reconciled to RSHS, Is (5) and S (8), on Friday night has been relatively stable. Both of them no longer experience the high or breathless fever. Is was reconciled to RSHS since Wednesday early afternoon (15/8), whereas S (8) on Thursday night (17/8). Both of them were handled as suspect bird flu with the taking of the sample apus blood, the throat and the photograph thorax in a manner the series.

http://www.pikiran-rakyat.com/cetak/2006/082006/19/0101.htm

[HenryN]

Re: INDONESIA - Garut Cluster Part II

The above aricle seems to name 9 patients who are hospitalized or dead. This doesn't seem to include the two siblings with symptoms or Dea (9F) or Eli (32F). Thus it seems that there are at least 9 plus two relatives with symptoms, but possible two more (one who died and one hospiyalized in Bandung).

The fact that there are two siblings of a fatal case, who have symptoms but are not hospitalized, are cause for concern.

[Harriet]

Re: INDONESIA - Garut Cluster Part II

Fox News reporting on their ticker about potential cluster in Indo.

[Harriet]

Suspected Indonesian bird flu victim dies, 3 others hospitalized

An Indonesian woman suspected of being infected with bird flu has died, while another three from the same West Java district were hospitalized on suspicion of contracting the deadly virus.

The woman, 35, who died Thursday night after displaying symptoms of the H5N1 virus came from Cikelet, the same district as Indonesia's latest bird flu fatality, health officials said.

"Euis Lina died Thursday night," Nurdin, a scientist from the Bird Flu Information Centre told AFP on Friday.

Three other people ? five-year-old Isma, six-year-old girl called Santi, and a 35-year-old woman called Esih ? also from Cikelet, were hospitalized Thursday evening as the health ministry launched an investigation into whether human-to-human transmission of the virus may have occurred.

"They are suspected of being infected with bird flu," said Nurdin, adding that they were being treated in isolation units in the Hasan Sadikin Hospital, in Bandung, provincial capital of West Java.

The health ministry and the World Health Organization (WHO) were dispatched Thursday to investigate the remote area for the possibility of a cluster case, after a nine-year-old girl from the district was confirmed as the country's 45th bird flu fatality.

Cluster cases heighten the chance of the virus mutating to become easily transmissible between humans. Scientists fear this could spark a global pandemic with the potential to kill millions.

However it was not clear whether any one of other four suspected bird flu cases had any contact with the nine-year-old girl, who died earlier this week, or with 17-year-old Umar Aup, also from Cikelet, who tested positive for the virus and is still alive, said Nurdin.

All six came from the subdistrict, but lived in different villages, said Nurdin.

Aup's 20-year-old cousin Misbah, another suspected bird flu case who died earlier this month, was buried before tests could be carried out.

Indonesia has the world's highest rate of human avian influenza fatalities. The human death toll from bird flu in Indonesia has been steadily rising since its first reported case in July last year. The H5N1 virus has been found in 28 of Indonesia's 33 provinces amid criticism that it has not done enough to curb the virus' spread.

Source: Reuters

[Theresa42]

Re: INDONESIA - Garut Cluster Part II

I count 11 -- 13 if you include 2 siblings of Rubiah who are presenting with symptoms & are being tested:

Misbah (20M) - Rancasalak, Cikelet village - Umar's cousin - not confirmed - dead

Umar Aup (16/17M) - Rancasalak, Cikelet village - Misbah's cousin - confirmed H5N1


Ai Siti Amanah (9) - Jojok, Cikelet village - Ismawati's paternal cousin - confirmed H5N1 - dead

Ismawati 5(M?) - Jojok, Cikelet village - paternal cousin/neighbor of Ai - father Pendi, mother Omay - not confirmed


Santi (6/8F) - Jojok, Cikelet village - daughter of Iwan & Surilah - neighbor of Ai - not confirmed

Eti (35F) - Jojok, Cikelet village - not confirmed


Euis Lina (32/35?F) - Jojok(?) - (Ai's mother?) - not confirmed - dead

Dea (9F?) - Jojok village - Euis' daughter - not confirmed - dead


K (32F) - Sawah Bera village - (Osin - husband) has had fever for last 3 days - house 100 m from Ai Siti's and Ismawati's houses - only several houses away from Santi's - not confirmed - in hospital

Rubiah (?) - dead - not confirmed - 2 of Rubiah's siblings tested - they have signs of fever & breathlessness

Sardi (?) - dead - not confirmed


According to the PR article:

9 suspected cases (missing Eti & Dea):
Umar, Ai Siti Amanah (dead) - both who have tested pos
Ismawati, Santi and K - all in hospital
Euis Lina, Rubiah, Misbah, Sardi (all dead)

5 people suspected dead: Ai Siti Amanah, Euis Lina, Rubiah, Misbah and Sardi (all 5 lived near each other -- samples taken only from Euis Lina)

[MHSC]

Re: INDONESIA - Garut Cluster Part II

Google satellite maps shows Cikelet in a little different spot than Encarta does, according to Google Cikelet is on the river. Encarta has it a little NW of the river. It would be interesting to see if the outbreaks follow the river like they so often do. I'll try to map it out this weekend on google earth.

Here is the link for the google map. You need to page down and wait for it to load.

http://www.maplandia.com/indonesia/jawa-barat/garut/cikelet/

[MHSC]

Re: INDONESIA - Garut Cluster Part II

I count 11 -- 13

Last night it was 5 or 6? Double in 24 hours?!

[Theresa42]

Re: INDONESIA - Garut Cluster Part II

Encarta has it a little NW of the river.

I think that's Cimari that's a little NW of the river:

http://tinyurl.com/qmtk2

But still, the position is different between Google and Encarta -- Encarta places Cikelet on the river, but closer to the coast than Google. From the descriptions of how the authorities have had to drive into the mountainous area on jeeps, I'd guess Google Earth is more correct.

[Theresa42]

Re: INDONESIA - Garut Cluster Part II

Here's Cikelet on the coast again -- and not next to the river either -- taken from West Java Urban Development Sector Project - Asian Development Bank:

http://www.adb.org/Documents/PCRs/INO/pcr-ino-29206.pdf

[Johnny Yuma]

Re: INDONESIA - Garut Cluster Part II

Here is a link to a nice clickable Java map:

http://www.travelpost.com/AS/Indonesia/West_Java/Bekasi/map/6660894

[Theresa42]

Re: INDONESIA - Garut Cluster Part II

Here we go. It's still not a map of the hamlets involved -- but it is a map with the village area limits (within which the hamlets must be).

Solid colors = batas kecamatan / subdistrict limits (Ciketel is a light pink)

Dotted blue lines = batas desa / village limits

There are apparently 7 village areas in the Ciketel subdistrict. Unfortunately, we don't know their names from this map -- but, I'm going to guess that Ciketel village is the area surrounding the red dot labelled Ciketel. So, I think all the "hamlets" we've been hearing about are within these Ciketel village limits (I've outlined in red).

http://www.bplhdjabar.go.id/soe/garut/index.cfm

[Note: I copied this map from the .pdf file found under "Deskripsi Wilayah" -- the desktop icon with the little, green lamp.]

Again, we're talking about a very small area. The coastline of Ciketel subdistrict (not just Ciketel village) is only ca. 15-20 miles in length.

[Theresa42]

Re: INDONESIA - Garut Cluster Part II

Cikelet subdistrict (as of 1 Aug 2005) -

Total area 17,232 hectares / 66.5 sq miles / 172 sq km

7 Desa / villages: Cikelet, Linggamanik, Kertamukti, Cigadog, Pamalayan, Karangsari and Cijambe [now we just have to match names to places! ]

Total population - 35,954 / 209 people per sq km
Average people per desa/village - 5,136

2 doctors, no pharmacy (apotek)

http://www.garut.go.id/static/kecamatan/Cikelet.php

[Theresa42]

Kuraesin

"K" -- Kuraesin -- is pregnant. Santi is from Sawah Bera hamlet -- the same hamlet as Kuraesin.

toggletext-ed from Indonesian:

The BIRD FLU SUFFERER in Garut improved
August 19, 2006

The assumption [suspected] patient of bird flu from Cikelet, Garut, continued to improve. A mother was pregnant, on Friday night (18/8), was reconciled to the Handsome Hospital of Sadikin Bandung. Kuraesin, the citizen of the Sawah Bera Village, Cikelet, that arrived in the Handsome Sadikin Hospital around struck 19.45 WIB. Apart From experiencing the high fever that was accompanied by the cough, the mother that was containing three months also experienced the breathing difficulty, so as to need help of oxygen.

According to the family, before Kuraesin was sick, several of his [her] neighbouring chickens died suddenly. Kuraesin was the third patient who was treated in Poinciana Tree Space, the Handsome Sadikin Hospital. Two other patients were Ismawati, the citizen of the Jojok Tipar Village, Cikelet, and Santi, the citizen of the Sawah Bera Village, Cikelet [now Santi's from Sawah Bera?].

http://www.metrotvnews.com/berita.asp?id=22514