Indonesia - Mother of 2 children who died last week of bird flu, died too

[Vibrant62]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

This report suggests that the mother tested H5N1 negative, which given the symptoms and outcome seems unlikely.

Two Boys? Mother Killed Because of Bird Flu Deaths

http://index.okezone.com/read/2011/10/17/340/516410/ibu-2-bocah-tewas-karena-flu-burung-ikut-meninggal

October 17, 2011

Bangli - overwrite melancholy story of a family in Bangli regency, Bali. After two children died as infected with bird flu virus, now the mother followed. Ni Wayan Purnami died (30) this morning.

Purnami departure is surprising, especially family recently lost KRA (5) and WA (10) Sanglah Hospital in Denpasar on Sunday, October 9, 2011. Grief enveloped families living in Banjar Antugan, Jehem Village, District Tembuku.

Had circulated the news, the victim dies because of bird flu virus. But it was denied Kadis Ranch Bangli, Anak Agung Ngurah Samba, which confirms the results of laboratory tests to mention victims of bird flu negative. "We have confirmed the results of laboratory tests in Sanglah Hospital, Lab Biomol Udayana University, and Kes RI R & D Lab. The result of bird flu negative patients, "said Samba when contacted Legal, Monday (10/17/2011).

Sam Until now, it did not yet know the cause of death of the victim. "The cause of death needs to be pursued with survailance action," continued Samba.

He explains, post-death of her two children, Purnami shock and health continued to decline. In fact, he had rushed to the local health centers and hospitals Bangli.

From the medical record is known, the victim had complained of cough and shortness of breath, so it should be two days in the hospital. Only, when asked to be referred to the appropriate procedure Sanglah Hospital stay for further treatment, they may reject the victim.

Further tests carried out as previously alleged victim was in contact with bird flu positive patients should be referred to the Sanglah Hospital.

"He even refused to even run away from the hospital until she died," said Samba.

As is known KRA (5) and WA (10) was treated in Sanglah Hospital, Denpasar, on Friday, October 7th. But they did not survive and died on the same day Sunday, October 9 at night.

KRA still unknown in the Kindergarten school while her brother sat on the bench WA 5 th grade at Jehem Banjar, District Tembuku. In the hospital records, the last bird flu case resulted in two deaths occurred in Bali in 2007.

[alert]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

I would think that the same motivation for fleeing the hospital could easily cause non-compliance with Tamiflu andministration.

That said, I have to wonder also whether the mother could have had a significantly earlier onset than we are assuming. If her children were already quite ill in late September, she could have contracted it from them then, resulting in an onset around October 5 or 6. That would be more consistent with the suspected incubation period of a week or so for H5N1. Then when she gets put on Tamiflu around the 12th or so, she is already at day 7 or 8 of illness, and it is too late. If her onset really was as late as I had earlier assumed, the time from onset to death would only be a couple days. An earlier onset might also explain the false negative result; tests taken around day 8 of illness might be too late to find the virus.

[Vibrant62]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

The only argument against this is that if the mother had been in any way symptomatic during her childrens illness, it would have been detected during screening and whilst they were treating the children. A later onset is more likely IMHO. We know Tamiflu treatment can cause false negatives (she would have been given this before hospitalisation at the time of her childrens admission), but again for her to be symptomatic at the time she sought treatment suggests a high viral load. The other possiblity is that her virus had mutated away from the testing reagent, producing a false negative - or? Perhaps only the Jakarta lab will be able to answer this and conduct sequencing. We will have to wait for answers.

[Giuseppe]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

Post no. 14:

Kadiskes Bangli dr. Dewa Made Siangan said the results of her lab tests when accompanying their children at Sanglah Hospital showed a negative result of bird flu.

The woman was tested when her children were hospitalized in Sanglah hospital; no further samples seem to have been collected since then.

If the virus was from children, the same test kit should have detected the mother's one as well, if the blood or throat swab were collected and properly processed.

Inter-human transmission cannot be ruled out at this stage, however there is a chance that all three (children and mother) would have caught the virus at the same moment and from the same source (animals, fomites).

The health status of husband and other relatives as well as health worker at Bangli medical centre must be traced for symptoms for the next two weeks.

[Gert van der Hoek]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

From another source some details; at this stage we can only speculate.

It seems plausible the woman was treated with Tamiflu. Her condition
worsened, that is probably why she was sent to Sanglah Hospital,
a bird flu dedicated hospital.

In that hospital her condition deteriorated even more,
however she refused further treatment and went home, were she died.

We know after using Tamiflu testresults tend to be negative.

This time the victim Ni Wayan Purnami, 30, mother of the brothers, Wayan Aldiawan,
10, and Nengah Rica Ani, 5, bird flu victim who died earlier. Purnami
died at his home in the village of Jehem, District Tembuku, Bangli District, yesterday
the morning.

Previously the victim was treated at local health centers and hospitals
Bangli. Purnami's health continued to decline after the death of her two children.

Purnami then fell ill with symptoms of fever, cough, and shortness of breath. head Office
Livestock Bangli Anak Agung Ngurah Samba denied if Purnai died from bird flu.
This was confirmed by laboratory test results negative victim says bird flu.

"We have confirmed the results of laboratory tests at Sanglah Hospital, Lab Biomolecular
Udayana University and the Department of Health R & D Lab. The result, patients negative bird flu, "
Samba stated.

However, Samba admitted Purnami was treated in local health centers and
Hospital Bangli. Only, when going on to refer to RS Sanglah further treatment,
victim actually declined.

Harian Seputar Indonesia oct 17

[sharon sanders]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

According to him, these patients were treated in health centers before they could close their homes because of the heat for three days. "Based on his family, both patients previously had a history of contact with poultry that died suddenly around her house in early October," he said

http://www.flutrackers.com/forum/showpost.php?p=424405&postcount=2

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

"We were immediately led the team to perform pelusuran around the patient's residence, on Saturday (8 / 10)," said Head of the Provincial Livestock I Putu Sumantra Bali in Denpasar, on Sunday.

He explained, the search results is known that the incident never happened poultry residents died suddenly about three weeks ago, but was not reported to authorities.

Therefore, the added Sumantra, against the surviving chickens in the area of Banjar Galiran, Jehem Village, District Tembuku that he said he did a quick test to find out whether or not infected with bird flu.

"The results of tests on birds found there was not positive of bird flu," said Sumantra

http://www.flutrackers.com/forum/showpost.php?p=424537&postcount=9

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

The mother died 2 days after the children. Her onset date is uncertain. But apparently the authorities cleared the area of chickens immediately. It is highly possible this is a human to human transmission but the mother did not have a sufficient viral load of H5N1 in her system to test positive initially. After that she was given tamiflu. I presume she took it. Especially after seeing how sick her children were.

Her clinical symptoms are that of an H5N1 infection as noted in the post above.

She was grieving. Losing 2 children is an extremely horrific event. Who knows what effect this had on her physically, probably worsening her prognosis.

I think what we want to know is if oseltamivir is becoming resistant to H5N1.

The children were administered oseltamivir too late. And probably the mother too.

However, it took only 1 year for the seasonal H1N1 oseltamivir resistant strain to become the dominant strain in the world. There are some documented cases of oseltamivir resistance in A/H1N1 too.

I am frankly surprised that oseltamivir has worked for so long against H5N1. Is it still working?

We will shortly know by the exponential numbers of human cases, or not, that will become apparent in some of the areas that we are following today.

[Vibrant62]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

History Lover@FW

The following report confirms that the negative test relates to the time that tests were done when the children were hospitalised and not a new subsequent test when she presented for treatment at the local health centre. Possibly more concerning is that it does not appear that protocols for body handling were followed, and samples were not taken to confirm H5N1 one way or the other from the body. I concur with Sharon and hope full contact tracing is put in place for the next weeks and that an assumption of bird flu is made so that prophylactic treatment is extended to those at greatest risk.

Bangli Officials Attend Funeral
http://www.balipost.co.id/medi...
October 17, 2011
Bangli: Wayan Rudana, a resident of Antugan, Bangli is suffering. After his two children, Aldiawan and Rini Ariani, died of bird flu, now his wife also died. Ni Wayan Purnami died Monday (17/10) at dawn yesterday at 03.00 pm. The disease is not yet known for the mother of two children, because while being treated in Hospital Bangli, she escaped. In fact, she had to take home the infusion that had been installed in her hand. Various efforts had been made between officials and local villagers to bring Purnami back to the hospital. However, due to trauma and grief after losing her two children, Purnami chose to lay limp at home. After two days of escape from the hospital, she finally breathed her last.

The victim's husband, Wayan Rudana, seemed very upset about what happened to his wife and children. So also were the in-laws of the victim who chose to confine themselves in the room when the victim's body was bathed in the funeral home and transported to the Setra Antugan around 11:00 pm by ambulance. Present on the occasion were Chairman of the Bangli Parliament Mudarma IB, Vice Chairman of the Bangli Parliament Made Sudiasa, wife of the Bangli Regent Ny., Made Gianyar, Head Tembuku AA Star Wives and other officials.

Kadiskes Bangli dr. Dewa Made Siangan said the results of lab tests when accompanying her children to Sanglah Hospital showed a negative result of bird flu. Thus, the possibility is that the victim died from complications of the disease. She was depressed because her two children were left behind. The victim's body was in a weak condition after days of not eating. This was exacerbated by an unstable mental state, so that in such conditions a variety of diseases can attack it.

As reported by Bali Post yesterday, Purnami escaped from the ER-care of the hospital when she went to be referred to Bangli Sanglah Hospital, Saturday (15/10) night. She fled to the house of Prajapati Antugan Stakeholders. The officers immediately sought the home of Purnami Jero Mangku, but an attempt to persuade her to be invited back to the hospital was to no avail. In fact, Purnami chose to go home. After twelve hours of living at home, finally Purnami died.
Many people suspected the victim's death was due to having been infected with bird flu. But officials did not conduct swab tests at Diskes Bangli or get the victim's blood, so the swab test (fluid) from the victim's mouth and nose are still referring to old data when the victim stayed with her son in Sanglah Hospital with a negative result of bird flu.

[cpg]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

Photo from the funeral. Some masks and protective suits. Many without.

http://www.balipost.co.id/mediadetail.php?module=detailberita&kid=2&id=57760

[Giuseppe]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

Oseltamivir-resistant A(H5N1) viruses appeared sporadically in the past and the likelihood for new detections is almost certain.

Since A(H5N1) avian influenza viruses are evolving into several and distinct lineages, the likelihood that a single cluster of resistant strains would become dominant is lower than the human seasonal influenza strains.

To date, no data suggests a sustained human-to-human transmission of the A(H5N1) virus into general population in Bali, Indonesia.

First responders such as medical and nurse professionals do not fall ill to date.

Limited non sustained human-to-human transmission may have occurred between children and mother in Bangli but - in absence of virological evidences - it remains possible that the infection could have arisen from a common animal source or through contaminated environment.

Oseltamivir is one of the tool used in treatment of avian influenza infections in human but cannot be the only since supportive care is essential as well as proper respiratory assistance, fluids replacement, antibiotics and hematological disorders control during the acute phase of illness.

[Gert van der Hoek]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

machinetranslation

Villagers Jehem Mandatory Wear Masks

Tuesday, October 18 2011 15:13 AM | Bali Update |

Bangli (Between Bali) - Neighbors of bird flu victims in Banjar Antugan, Jehem Village, District Tembuku, Bangli regency, Bali, must wear a mask, after Ni Wayan Purnami (30) passed away on Monday (17/10) ago.

"I was told to wear masks for fear of contracting bird flu, "said Ni Wayan Sudi, a resident of Banjar Antugan Tuesday.

Purnami is the biological mother of I Wayan Aldiawan (10) and I Nengah Rica Ani (5), bird flu positive patients who died in care in Sanglah Hospital, Denpasar, Sunday (9 / 10) ago. Until now there is no certainty, whether Purnami died of bird flu or the result of depression after left her two children.

Purnami previously also been investigated by the Sanglah Hospital. However, he refused to undergo forced treatment and chose to go home before she died, Monday (17/10) morning. Purnami day after his death, his family home in Banjar Antugan was deserted. Security and surveillance that is lined up at the hamlet looks tight.

Antaranews

[tetano]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

Denpasar-Bali Animal Husbandry Department reported outbreaks of bird flu has spread to eight regions after the deaths of two cases that the boy from Bangli
positively infected by H5N1.
Bali Animal Husbandry Agency head Putu Sumantra said this year the number of dead birds is relatively small, but the level of the case is very surprising, after causing the death of two sisters from Bangli. "It was quite surprising, let alone the relatively fast diffusion rate," he said yesterday. This condition, Sumantra said, almost like a case of bird flu which are astonishing in 2007, where for the first time found in human cases of bird flu that claimed two victims died. At that time, the case of poultry deaths occurred in all districts / cities in Bali by the number of 4,000 dead birds tail. "Compare with the case of 2011. Poultry deaths is relatively small, but the case of the death of two boys is quite surprising, "he said. Bali Animal Husbandry Department noted, until October 2011 had found 50 cases of AI (avian influenza), which infects poultry in Bali. Most cases it is found in the area of tourism, namely with 13 kasus.Disusul Tabanan Badung 10 cases, Klungkung 9 cases, 7 cases Jembrana, Karangasem 4 cases, 3 cases Bangli, Denpasar 2

While cases of AI found in 2779 birds, with a tail 1366 and 1206 had died suddenly destroyed. "Most are found in poultry in small quantities, while commercial farms are used to perform vaccinations on a regular basis," said Sumantra. In Bali, cases of bird flu was first detected in poultry in Bali in 2003. At that time, about 100,000 birds in Jembrana District, Badung, Levin, and Klungkung died suddenly. Vice Chairman of Commission IV DPRD Bali's Ketut Kariyasa Adnyana worrying if cases of bird flu continues to spread will impact tourism. "This is important given some time to come, will be held at the Bali international celebration of the East Asia Summit which was attended by U.S. President Barack Obama," he said. Kariyasa asked the government to immediately release funds for tactical combat this plague. Provincial Government of Bali including the regency / city government as Bali had to be responsive in tackling. "Do not wait for the situation is getting worse," he said. Meanwhile, cases of bird flu in Bali again take its toll.

http://www.seputar-indonesia.com/edisicetak/content/view/436679/

[Giuseppe]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

Source: BaliTV, http://www.balitv.tv/btv2/index.php/...eninggal-dunia

YouTube: http://www.youtube.com/watch?v=Qg7AR...layer_embedded

[Gert van der Hoek]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

The newssource only can be copied and pasted with a workaround. For now a short summary. The newssource is talking about "3 bird flu deaths", 2 children and their mother; I follow that.


Children from primary school in Jehem scared after 3 bird flu deaths

In Bali Post an article on the children of a primary school in Jehem who are scared because of the 3 bird flu deaths in their village. They asked the headmaster to let them go home.

People from the School Health Service were invited to explain more about bird flu to the children and how to take precautions.

Not only the children are scared, many adults too. Questions are raised about how bird flu is handled in Bali.

[alert]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

http://promedmail.org/pls/apex/f?p=2400:1001:3223279197957209::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,90735

Archive Number 20111018.3116
Published Date 18-OCT-2011
Subject PRO/AH/EDR> Avian influenza, human (62): Indonesia (BA) fatal, susp

AVIAN INFLUENZA, HUMAN (62): INDONESIA (BALI) FATAL, SUSPECTED
************************************************** ************
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: Mon 18 Oct 2011
Source: Bird Flu Information Corner, Indonesian newspaper MNCTV News
report [edited]
<http://birdflucorner.wordpress.com/>


Bangli, Bali: the mother of 2 H5N1 victims dies
-----------------------------------------------
A woman died in her house, in Jehem village, Tembuku sub-district,
Bangli, Bali. Officials suspected bird flu (H5N1) infection and
collected a sample from the woman. The victim is the mother whose 2
children died of H5N1 in Sanglah hospital several days ago (see "Avian
influenza, human (60): Indonesia (BA) fatal, susp. 20111010.3036").

After that the mother developed fever and was then treated in Bangli
hospital. When she was in hospital, her blood examination tested
negative for H5N1. She left the hospital and died 2 days after. The
victim is being treated as if she was infected by bird flu H5N1, with
officials wearing bio-security clothes. Mourners are obliged to wear
masks.

The Health Service and Livestock Service of Bali province sprayed
disinfection around victim's house, and culled surviving chickens.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Mon 17 Oct 2011
Source: CIDRAP (Center for Infectious Disease Research & Policy) News
[edited]
<http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/oct1711newsscan.html>


H5N1 suspected in death of Indonesian mother
--------------------------------------------
The mother of the 2 Indonesian children from Bali who died recently
from H5N1 avian flu has died at her home after having a fever and
being treated in the hospital, according to a report today [17 Oct
2011] from Bird Flu Information Corner [see item [1] above], a Web
message board operated by Kobe University in Japan and Airlangga
University in Indonesia.

The woman died 2 days after leaving the hospital, where her blood
tests were negative for H5N1 infection. Public health officials
suspect that the woman may have had an H5N1 infection and are taking
precautions, such as having officials wear protective clothing and
requiring mourners to wear masks, according to the report.

It's not clear if the woman had received oseltamivir (Tamiflu)
prophylaxis after H5N1 was confirmed in her children, who died in the
hospital on 9 Oct 2011. Translated reports from the Indonesian media
on the mother's death said she had fled the hospital before she died,
according to FluTrackers, an infectious disease message board that
monitors foreign-language news reports. [The full text, which gives a
more dramatic account of the events leading up to this fatality can be
read at http://www.flutrackers.com/forum/sho...d.php?t=174971. -
Mod.CP]

Family illness clusters raise concerns about possible human-to-human
H5N1 spread, though in this instance cause of the mother's death
hasn't been confirmed, and previous media reports suggested a possible
common exposure to the virus. The children had reportedly handled dead
poultry in their home.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[It remains true that none of these fatalities, the 2 siblings and
their mother, have been confirmed by a WHO-authenticated laboratory to
be a consequence of avian influenza A/H5N1 virus infection. Nor is it
certain that the they were exposed to avian influenza virus infected
poultry. Clarification is awaited. The last confirmed human case of
avian H5N1 influenza virus infection died in Western Java on 25 Aug
2011. - Mod.CP]

[sharon sanders]

Re: Indonesia - Mother of 2 children who died last week of bird flu, died too

[The full text, which gives a
more dramatic account of the events leading up to this fatality can be
read at http://www.flutrackers.com/forum/sho...d.php?t=174971. -
Mod.CP]

Family illness clusters raise concerns about possible human-to-human
H5N1 spread, though in this instance cause of the mother's death
hasn't been confirmed, and previous media reports suggested a possible
common exposure to the virus. The children had reportedly handled dead
poultry in their home.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[It remains true that none of these fatalities, the 2 siblings and
their mother, have been confirmed by a WHO-authenticated laboratory to
be a consequence of avian influenza A/H5N1 virus infection. Nor is it
certain that the they were exposed to avian influenza virus infected
poultry. Clarification is awaited. The last confirmed human case of
avian H5N1 influenza virus infection died in Western Java on 25 Aug
2011. - Mod.CP]

Thanks to ProMED for mentioning this thread.

I find it odd that the Indonesian Ministry of Health has not issued a report on this event. Without that I do not think WHO can confirm these cases.

Also, this is the first time, in years, I think, that a regional public health service, or hospital, or doctors, can openly report on human H5N1 cases. In the past 2 years H5N1 human case data has been generated by the Ministry (after the fact).