Announcement

**KBD** · June 6, 2007, 05:21 AM

Re: Indonesian researchers: BF could be more easily transmitted

Indonesia's Fatality Rate From Bird Flu Rises to 87% (Update1)

(Adds comment from scientist in sixth paragraph.)

By Karima Anjani
June 6 (Bloomberg) -- Bird flu has killed more than four of
every five people infected with the disease in Indonesia this
year, heightening concern over the nation's progress in
controlling the virus two years after its first human case.
The H5N1 strain of avian influenza is confirmed to have
infected 98 people in Indonesia since June 2005. Twenty of this
year's 23 cases were fatal. Scientists have even found traces of
H5N1 in the soil of potted plants, probably introduced in manure
from infected poultry, said Bayu Krisnamurthi, chief executive
officer of Indonesia's committee on avian and pandemic flu.
While the H5N1 virus has killed millions of poultry in
about 60 countries, human infection is rare, with fewer than 200
fatalities recorded globally. Higher levels of the virus in the
environment could put more people at risk of infection and
provide more opportunity for it to mutate into a pandemic strain.
``There's an indication that the virus may infect humans
more easily than it used to,'' Krisnamurthi told reporters in
Jakarta today. ``We need to study this suspicion further.
Hopefully it won't be scientifically proven.''
Disease trackers are trying to gauge whether exposure to
fewer diseased poultry results in the same level of infection
risk, said Amin Subandrio, who heads an expert panel for the
Indonesian government's avian flu committee.
``Previously, confirmed H5N1 cases had been exposed to as
many as 20 chickens. Recently, victims were infected from one
chicken, for example,'' Subandrio said in a telephone interview
today. ``Hypothetically, the virus might be more easily
transmitted to humans from birds.''

No Significant Changes

Studies show no sign that the virus in Indonesia has
undergone any significant change that makes it more dangerous to
humans, Krisnamurthi said today. The higher fatality rate among
avian-flu patients this year could be attributed to a delay in
the commencement of antiviral treatment, he said.
In 2006, 45 of Indonesia's 55 recorded H5N1 patients died.
The previous year, 13 of 20 cases were fatal.
The H5N1 virus has infected 309 people in a dozen countries,
killing 188 of them, since late 2003, according to the World
Health Organization. Almost all human H5N1 cases have been
linked with close contact with sick or dead birds, such as
children playing with them or adults butchering them or plucking
feathers, according to the WHO.

Pandemic Threat

Scientists have said the virus might kill millions if it
were to spread as easily among people as seasonal flu, which
causes as many as 500,000 deaths each year.
A survey conducted between January and April of 2,500
Indonesians living in rural and urban areas of the islands of
Java and Sulawesi found that about 15 percent of people said
avian flu has the potential to infect them or their families,
prompting them to implement protective measures.
``The findings led to the conclusion that communication is
key and needs to intensify,'' Krisnamurthi said today. A
nationwide campaign began about six months ago, he said.

**Commonground** · June 6, 2007, 05:30 AM

Re: Indonesian researchers: BF could be more easily transmitted

KBD: Link please

**Gert van der Hoek** · June 6, 2007, 05:37 AM

Re: Indonesian researchers: BF could be more easily transmitted

Originally posted by Commonground View Post

KBD: Link please

Bloomberg - Are you a robot?

http://www.bloomberg.com/apps/news?pid=20601080&sid=aom5sP_jtqrU&refer=asia

**KBD** · June 6, 2007, 05:41 AM

Re: Indonesian researchers: BF could be more easily transmitted

Thanks Dutchy

**Gert van der Hoek** · June 6, 2007, 06:56 AM

Re: Indonesian researchers: BF could be more easily transmitted

Indonesia worries over latest bird flu virus samples

06 Jun 2007 11:49:14 GMT

Source: Reuters

More By Adhityani Arga

JAKARTA, June 6 (Reuters) - The H5N1 bird flu virus in Indonesia may have undergone a mutation that allows it to jump more easily from poultry to humans, the head of the country's commission on bird flu control said on Wednesday.

Indonesia has recorded 79 human deaths from bird flu, the highest in the world, and the country has been struggling to contain the disease because millions of backyard chickens live in close proximity to humans across the archipelago.

"In the past it took exposure of high intensity and density to the virus to get infected. There are now suspicions, early indications that this has become easier," Bayu Krisnamurthi told reporters.

He said, however, that the suspicion had yet to be confirmed.

A microbiologist at the bird flu commission said the suspicions were based on preliminary findings of molecular genetic tests conducted at laboratories in Indonesia.

"Virus samples from poultry cases have increasingly shown a similarity in their amino acid structure to virus samples extracted from humans," Wayan Teguh Wibawan told Reuters.

"This makes it easier for the virus to attach to human receptors," he said, referring to receptor cells lining the human throat and lungs.

For the H5N1 virus to pass easily from bird to human, it would have to be able to readily attach itself to these special cells.

For the moment, because H5N1 is a bird virus, it has evolved to easily attach to these receptors in poultry. Humans have a different type of receptor site, making it harder for people to become infected.

Wayan said he had spotted "gradual changes" in the virus sample he receives every month. He did not give details on these gradual changes.

Lo Wing-lok, an infectious disease expert in Hong Kong, said changes such as these demonstrated how important it was for Jakarta to share virus samples.

"Are they going to share these samples with overseas labs? These must be confirmed and the world must be forewarned if there has been such an important change," Lo told Reuters in Hong Kong.

"If there is such a change, it would not only mean that the virus can jump more easily from bird to man, but from human to human, too."

Bird flu is endemic in poultry in many parts of Indonesia.

Scientists are worried about the virus's persistence and ability to adapt to new environments and hosts, fearing this increases the chances of the virus mutating into a form that can jump easily between people, triggering a pandemic.

Contact with sick fowl is the most common way humans become infected with bird flu.

Krisnamurthi said lack of medical facilities and late intervention were to blame for a recent surge in deaths in Indonesia because new cases have mostly occurred in remote areas.

Bird flu is often mistaken for seasonal influenza, which in most cases has led to delayed hospitalisation.

There have been 188 deaths globally from H5N1 and 310 known infections in total, according to World Health Organisation data.

Sharing samples is deemed vital to see if viruses have mutated, become drug resistant or grown more transmissible. The samples are also used to develop commercial vaccines.

Indonesia said last month it had resumed sharing samples with the WHO after a five-month hiatus. Along with other developing nations, Indonesia has been demanding guarantees that they will have access to affordable vaccines in the event of a pandemic.

(Additional reporting by Tan Ee Lyn in Hong Kong)

Thomson Reuters: Clarifying the complex

http://www.alertnet.org/thenews/newsdesk/JAK214520.htm

Thomson Reuters empowers professionals with cutting-edge technology solutions informed by industry-leading content and expertise.

**gsgs** · June 6, 2007, 07:39 AM

Re: Indonesian researchers: BF could be more easily transmitted

Bayu Krisnamurthi, chief executive officer of Indonesia's committee on avian and pandemic flu, said:
> Scientists have even found traces of H5N1 in the soil of potted plants,
> probably introduced in manure from infected poultry
> There's an indication that the virus may infect humans more easily than it used to

Amin Subandrio, head of an expert panel for the Indonesian government's avian flu committee , said:
> Disease trackers are trying to gauge whether exposure to fewer diseased poultry results
> in the same level of infection risk. Previously, confirmed H5N1 cases had been exposed to
> as many as 20 chickens. Recently, victims were infected from one chicken, for example
> Hypothetically, the virus might be more easily transmitted to humans from birds.''

Krisnamurthi:
>Studies show no sign that the virus in Indonesia has
> undergone any significant change that makes it more dangerous to humans
> The H5N1 bird flu virus in Indonesia may have undergone a mutation that allows it to jump
> more easily from poultry to humans,
> In the past it took exposure of high intensity and density to the virus to get infected. There are
> suspicions, early indications that this has become easier. The suspicion had yet to be confirmed.
> lack of medical facilities and late intervention are to blame for a recent surge in deaths
> in Indonesia because new cases have mostly occurred in remote areas.

Wayan Teguh Wibawan , a microbiologist at the bird flu commission said :
> the suspicions were based on preliminary findings of molecular genetic tests conducted
> at laboratories in Indonesia.
> Virus samples from poultry cases have increasingly shown a similarity in their amino acid
> structure to virus samples extracted from humans,
> This makes it easier for the virus to attach to human receptors,
> For the moment, because H5N1 is a bird virus, it has evolved to easily attach to these
> receptors in poultry. Humans have a different type of receptor site, making it harder for
> people to become infected.
> I have spotted "gradual changes" in the virus sample I receive every month.

Lo Wing-lok, an infectious disease expert in Hong Kong, said :
> changes such as these demonstrated how important it was for Jakarta to share virus samples.
> Are they going to share these samples with overseas labs? These must be confirmed
> and the world must be forewarned if there has been such an important change
> If there is such a change, it would not only mean that the virus can jump more easily from
> bird to man, but from human to human, too.

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

Krisnamurthi speaks of a change in the virus.
Wibawan seems to confirm this and mentions changes in the RBD,
but seems to be not very confident in the results of the Indonesian laboratories.
K. says that studies found no such sign. What studies ? The viruses are secret.

Did the reassorted virus from Jan. appear again ?
What changes in the RBD ? Is it secret ? For how long ?

Is this statement issued in preparation of the new samples which Indonesia
is going to share ? They knew it all along the whole time ?

This vaccine-thing, is it the real reason or are there others ?

Who else knew it and since when ? US-military ? Chan ? Supari ?

**Diane Morin** · June 6, 2007, 08:08 AM

Re: Indonesian researchers: BF could be more easily transmitted

Indonesians ignorant of flu risk
By Chris Xia
BBC News

The Indonesian authorities say the battle against bird flu is being hampered by widespread ignorance of the danger the disease poses to humans.

Indonesia has had 79 human deaths from bird flu, the most in the world.

Efforts to bring the epidemic under control will depend on better public education, according to bird flu expert Bayu Krisnamurthi.

He was addressing a news conference on the second anniversary of the first human infection in Indonesia.

Mr Krisnamurthi, the head of the committee in charge of bird flu control, admitted that while the majority of Indonesians knew of the disease, only one in seven realised it could kill them. Given that the disease is endemic in poultry across most of Indonesia, this suggests that the authorities have a long way to go if they are ever going to arrest the spread of the virus.

Until Indonesians are aware of the possibility of catching the disease, and of the likelihood of dying once infected, they will not take proper precautions and will not seek immediate medical help if they come into contact with diseased birds.

High rate of infection

Of the 180 confirmed cases of humans infected with bird flu worldwide over the past few years, Indonesia has had nearly half.

Mr Krishnamurthi also suggested at the news conference that there were preliminary indications that the disease was becoming more deadly in Indonesia.

But health experts have cautioned that many factors could be behind this, such as the length of time patients wait before going to hospital.

Story from BBC NEWS:

BBC NEWS | World | Asia-Pacific | Indonesians ignorant of flu risk

http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/asia-pacific/6726489.stm

BBC, News, BBC News, news online, world, uk, international, foreign, british, online, service

**Gert van der Hoek** · June 7, 2007, 02:37 AM

Re: Indonesian researchers: BF could be more easily transmitted

Posting from Dryheat on CE, I think it is important enough to share this here. This thread seems appropriate for it.

SusanC (=Anon_22) just posted a followup comment (#63) over at the DHHS blog under Sec. Leavitt's 3rd post that said in part the following:

Quote:

- Albert Osterhaus of Erasmus University in the Netherlands, who when I spoke to him a few days ago, is very concerned about the possibility of cats being an intermediate mammalian host in which H5N1 can acquire changes more suited to infect humans.

He tells me that there are places in Indonesia where there are no cats left, which means that the ability of H5N1 to infect cats (which btw was never known to suffer from flu virus infections before) is not a fluke but a consistent feature.

What we have been seeing in poultry in many countries may sooner or later start happening in cats, which in all societies live intimately with humans. (This last sentence is not from Osterhaus)

**Gert van der Hoek** · June 7, 2007, 02:49 AM

Re: Indonesian researchers: BF could be more easily transmitted

Indonesia says bird flu changing to infect people more easily; WHO sees no signs

By HELEN BRANSWELL

Wednesday, June 6, 2007

(CP) - Indonesian authorities suggested Wednesday that the H5N1 avian flu virus appears to be changing in ways that may allow it to transmit from poultry to people more easily.

Officials of the World Health Organization said they have seen no evidence to support the claim. They suggested Indonesia should share the data so other scientists can help investigate whether the virus is undergoing changes that might increase the pandemic risk it poses.

"I think it would be important to know the entire (genetic) sequence of these Indonesian viruses before we can make any assessments about virulence changes or transmissibility (to) host changes," Dr. Michael Perdue of the WHO?s global influenza program said from Geneva.

"We would certainly look forward to having the full sequence and antigenic analysis of these viruses reported as soon as possible."

Indonesia has not shared the findings with the WHO. And the country has only sporadically shared viruses with the global health agency since the beginning of 2007 in a dispute over access to pandemic vaccines.

In Jakarta, Bayu Krisnamurthi, the head of Indonesia?s avian flu control commission, told reporters that it appears recent human cases have become infected from less intensive exposure to the virus than previously had been the case.

That raises the suspicion, he suggested, that the virus has adapted to more easily infect humans.

It was not clear which cases Krisnamurthi was referring to or how exposure was measured.

It?s not even clear how exposure could be measured in many of Indonesia?s cases. A substantial portion of the 99 human infections there have occurred in people for whom no link to infected poultry was ever discovered.

In a presentation last fall, officials of the Ministry of Health told the WHO that in at least one-third of their cases, they could find no firm proof of how the people had come in contact with the virus.

"Even the updates I?ve seen from the Ministry of Health, still there?s a large percentage of the cases they can?t find any connection" to infected birds, Perdue said.

In a related issue a microbiologist from Krisnamurthi?s commission told Reuters news agency that molecular study of the viruses has revealed changes.

"Virus samples from poultry cases have increasingly shown a similarity in their amino acid structure to virus samples extracted from humans," Wayan Teguh Wibawan said.

Perdue said it would be important to know if the Indonesian scientists are drawing the conclusions by studying the entire genetic blueprints of viruses isolated from human cases, or if they are looking only at a portion of the hemagglutinin gene.

Hemagglutinin plays a key role in the ability of influenza viruses to infect various hosts, whether they are birds, people or other mammals.

And early efforts to figure out why the H5N1 virus can infect some people but very rarely does so focused on the notion that the H5N1 virus was better suited to attaching to receptors more commonly found in the cells of birds than in the respiratory tracts of humans. It was thought mutations at the receptor binding site might be all that was needed to turn this bird virus into a human virus.

But recently scientists have begun to question that theory. In a talk at a recent microbiology conference in Toronto, influenza expert Dr. Malik Peiris said work from a number of laboratories suggests the whole idea should be revisited.

"It still remains an open question what it will take to allow this virus to go human-to-human," said Peiris, who is from the University of Hong Kong.

Perdue concurred. "Nearly all influenza specialists now agree that single changes in a particular region alone will not likely set off a major change."

Indonesia has only shared H5N1 viruses in a limited fashion over the last half year, using the viruses as leverage in a bid to give H5N1-affected countries more control over the science conducted on viruses collected within their borders.

Health Minister Siti Fadilah Supari announced in early February that her country would not share viruses unless it received guarantees those viruses would not be used to make vaccine without Indonesia?s permission.

Since that time, she has gone back and forth on the issue, promising at times to resume sharing viruses with WHO reference laboratories. But so far, specimens from only two of the 18 cases that have occurred in the interval have been sent out of the country.

http://www.chroniclejournal.com/CP_stories.php?id=47794

**Commonground** · June 7, 2007, 06:01 AM

Re: Indonesian researchers: BF could be more easily transmitted

Everyone keeps talking about connections to "infected" birds. What about connections to birds that show no sign of infection?

The phenomenon Shading Burung Flu

WHAT that crossed when hearing words shading?
For the women, these words did not can be heard foreign, moreover for them who liked to put on makeup.
Then whether his connection with bird flu?
The phenomenon shading in the spreading of the deadly virus avian influenza (AI) was connected with the poultry.
For example, the chicken was seen healthy, there was no sign was sick, but brought the virus.
This phenomenon caused difficulties for the government to carry out the vaccination to this chicken.
According to Chairman Urusan Inserted Breaker Komunikasi Publik Unit Pengendali of the Influenza Departemen Illness of Agriculture M. Zoelkarnain Hasan, ideally must be carried out by 4 vaccination times so that the possibility shading increasingly small.
"If being carried out by the vaccination 2 through to 3 times, then the possibility shading only remained at 10 percent."
But if only was carried out by 1 time, then the possibility shading became 40 as far as 50 percent, said Zoelkarnain.

Nevertheless he appealed to the community too much might not worry the phenomenon shading.
Almost two years of the bird flu virus became the plague in Indonesia.
The number of his spreads was counted descended.
However the death rate resulting from this deadly virus jumped as far as more than 79 percent.
Since June 2005, was recorded by the bird flu virus infected 99 people in Indonesia.
Totalling 79 people including dying.
This was the highest figure in the world.
Newest cases to humankind more often came from the area of rural areas to be compared urban areas.

http://www.indomedia.com/bpost/062007/7/nusantara/nusa3.htm

**Commonground** · June 7, 2007, 06:04 AM

Re: Indonesian researchers: BF could be more easily transmitted

This article goes hand in hand with the article directly above.

Indonesia prepares bird flu vaccine for 290 million chickens

Indonesia, which has more human deaths of bird flu than any other countries in the world, has secured 70 million dosages of vaccine that can be used to inject up to 290 million chickens, an official said on Wednesday.

"The stocks will be used to launch at least three vaccination drives," said Zoelkarnain Hasan, spokesman for the avian influenza affairs with the Agriculture Ministry.

He said one or two vaccinations in bird flu-hit areas were not enough to get rid of the disease among chickens and prevent the spread to humans.

"It even takes four vaccinations within four months to fully eliminate the virus," he said.

403 Forbidden

http://english.people.com.cn/200706/06/eng20070606_381576.html

**HenryN** · June 7, 2007, 10:06 AM

Re: Indonesian researchers: BF could be more easily transmitted

Commentary at

http://www.recombinomics.com/News/06070701/H5N1_Indonesia_Evolution.html

**HenryN** · June 7, 2007, 11:06 AM

Re: Indonesian researchers: BF could be more easily transmitted

Commentary at

http://www.recombinomics.com/News/06070702/H5N1_Indonesia_Alternative.html

**MHSC** · June 7, 2007, 07:07 PM

Re: Indonesian researchers: BF could be more easily transmitted

<big><big>Commentary</big></big>

H5N1 Evolution in Indonesia
Recombinomics Commentary
June 7, 2007

"Virus samples from poultry cases have increasingly shown a similarity in their amino acid structure to virus samples extracted from humans," Wayan Teguh Wibawan told Reuters.

"This makes it easier for the virus to attach to human receptors," he said, referring to receptor cells lining the human throat and lungs.

For the H5N1 virus to pass easily from bird to human, it would have to be able to readily attach itself to these special cells.

For the moment, because H5N1 is a bird virus, it has evolved to easily attach to these receptors in poultry. Humans have a different type of receptor site, making it harder for people to become infected.

Wayan said he had spotted "gradual changes" in the virus sample he receives every month. He did not give details on these gradual changes.

The above comments may be related to changes seen in poultry H5N1 isolates from Indonesia. The first reports on H5N1 sequences in humans in Indonesia (Clade 2.1), showed that the sequences were significantly different than the sequences found in Indonesian poultry. These match failures were discussed at a WHO sponsored meeting in Jakarta last summer.

Presentations at that meeting noted that human isolates largely had a novel HA cleavage site, RESRRKKR, as indicated in HA phylogenetic trees. However, these differences were seen in all eight gene segments, strongly suggesting that human H5N1 infections in Indonesia were linked to an evolving reservoir that was not well represented by the public poultry isolates, although the chnages were in a cat from Indramayu.

Consequently, a batch of 91 poultry samples was sent to the WHO affiliated H5 reference lab in Australia. Over 50 sequences from those samples were made public, but these samples largely lacked the novel cleavage site. It was in one isolate from Indramayu, and two from central Sumatra. These samples were from isolates collected in late 2005 and early 2006.

However, new sequences were released in February, 2007 from isolates collected in the middle of 2006. In contrast to the earlier poultry sequences, these isolates were much more similar to the human H5N1 isolates. Twelve had the novel cleavage site as well as additional HA changes that were largely limited to the human isolates.

Thus, the WHO data from February, had evidence that the poultry isolates in mid-2006 were more closely matching the human sequences. As the sequences become more closely related, the chance of new acquisitions via recombination also increases, because of increased regions of identity.

The comments above suggest that these changes may be continuing, raising concerns that the poultry isolates were now efficient at infecting humans.

Since H5N1 is constantly evolving, the release of human and poultry Indonesian H5N1 sequences from 2007 would be useful.