Indonesia Human Cases - May 19 to May 21, 2006

[Sally Furniss]

WHO: Human bird flu cases rises to 216, with 122 fatal

GENEVA (AP): The U.N. health agency has raised the confirmed human death toll from the H5N1 bird flu strain to 122, adding six Indonesians who died of the virus earlier this month and an Egyptian who died Thursday.

The World Health Organization said the total number of confirmed human infections since the current outbreak began in 2003 has reached 216. Virtually all were exposed to the disease by contact with poultry.

Egypt's Health Ministry said earlier Thursday that a sixth person had died of bird flu in the country.

WHO said her infection, consistent with all other human cases in Egypt, has been linked to exposure to diseased birds. The health body has confirmed 14 cases in Egypt, six of which were fatal.

Five of the confirmed Indonesian deaths were members of an extended family living in a village in the country's North Sumatra province.

A 37-year-old woman, who died earlier this month, is believed to have initiated the deaths in the family, the health agency said, but added that no specimens were obtained before her burial and the cause of her death cannot therefore be confirmed.

The five who died were the woman's two sons, a sister, a nephew and a niece. A 25-year-old man, the woman's brother, also contacted the disease, but is still alive, WHO said.

Indonesia's sixth confirmed fatality was a woman who died in the East Java city of Surabaya, where no previous cases had been found, WHO said.

WHO said its epidemiologists and Indonesian health officials were closely investigating what sparked the rash of cases in the family group, calling it the "largest cluster of cases, closely related in time and place, reported to date in any country."

Multiple infections, or clusters, are closely monitored by officials who fear the disease could become more infectious.

Experts study "cluster" cases looking for signs that H5N1 may have mutated into a form easily passed between humans - a scenario that many fear could trigger a human pandemic capable of killing millions.

"Multiple hypotheses are being investigated," the agency said."The possibility of limited human-to-human transmission cannot be ruled out at present."

But, it added, "if human-to-human transmission has occurred, it has not been either efficient or sustained," noting that investigators have found no evidence that infection has spread beyond members of the family.

Since 2003, a total of 40 people have been infected with the H5N1 virus in Indonesia and 31 have died, according to WHO figures. (**)
http://www.thejakartapost.com/detail...9100614&irec=2

[Theresa42]

Village unnerved by bird flu scare
May 19, 2006

Apriadi Gunawan, The Jakarta Post, Medan

Ignorance and paranoia may prove the biggest hurdle in the daunting battle against bird flu, with fearful North Sumatra villagers vowing to turn away health inspectors Thursday after the death of at least four locals due to the virus.

"This village is not a source of bird flu. Our livestock have been examined and the results were negative," Kubu Simbelang village chief Baik Purba said, referring to testing of animals living in the surrounding area in Kubu regency.

His fervent argument belies the World Health Organization's confirmation Wednesday that four members of one family in the village -- ranging in age from an infant to a 29-year-old -- had died of the H5N1 virus. A fifth relative, also confirmed positive for the virus, is in intensive care at Adam Malik General Hospital in Medan.

Two other members of the family also died -- with one buried before samples could be taken for testing -- in one of the largest recorded clusters of cases.

Residents feel threatened amid the sudden notoriety of their village, located about 80 kilometers south of Medan, and worry about the negative impact of the attention.

Yet it may be their rustic livelihood of tending orange groves which is the source of the outbreak.

Provincial spokesman Eddy Sofian said the governor was informed by Coordinating Minister for the People's Welfare Aburizal Bakrie that animal waste bought from Riau and used as fertilizer in the regency was suspected of being the source of the outbreak.

His comments have added to swirl of speculation about the source of the outbreak, especially amid fears of human-to-human transmission.

The provincial health office initially said that members of the family dined on poultry before falling sick, with Reuters reporting the family hosted a feast in late April.

Agriculture Minister Anton Apriyantono in Jakarta said in Jakarta that tests conducted in Bogor, West Java, on pigs from the area confirmed they were positive for the virus. Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, perhaps leading to a strain that can easily infect people and be transmitted person to person.

Despite village chief Purba's exasperated plea for the villagers to be left in peace, it seems likely he will have to accept the arrival of a WHO team soon.

The team, led by Thomas Grein, is already in Karo and met Thursday with the local regent and health officials.

Grein said he understood the villagers' apprehension, but the team needed to determine the source of the outbreak.

The anxiety gripping the village mirrors the often reactive, fragmentary approach to tackling the disease at the national level. Although officials have made forceful declarations about dealing with the problem, critics say they have failed to carry through with necessary tough measures, such as mass culls of fowl and pet birds.

Although Indonesia still trails Vietnam's 42 deaths from the disease, the mortality incidence has almost tripled in the first five months of this year.

Food and Agriculture Organization (FAO) director-general Jacques Diouf said there may be a need to review the strategy in fighting bird flu from one of preventing a pandemic to limiting bird flu infection among poultry.

"If we are able to at least limit the number of birds that are infected, then we would limit the risk of transmission to human beings and other consequences," he told journalists after the opening of an FAO meeting in Jakarta on Thursday.

The FAO has committed some US$4 million in supporting the fight here, and is also mobilizing foreign donors.

"We need to strengthen veterinary services in Indonesia...and develop a compensation program for those whose poultry are affected," Diouf said.

http://www.thejakartapost.com/detail...519.@01&irec=1

[Theresa42]

toggletext-ed from Indonesian:

Eleven people was checked
May 19, 2006

Surabaya-Sun the Death L, suspect bird flu in Surabaya, had consequences the blood inspection of eleven people of the proximity. Nine among them the family's member and two the rest of them were the nurse RS Vincentius A Paulo the place L was treated.


Surabaya-Surya

The death L, suspect bird flu in Surabaya, had consequences the blood inspection of eleven people of the proximity.

Nine among them the family's member and two the rest of them were the nurse RS Vincentius A Paulo the place L was treated.

A "day before the patient died, I just got the report," said Dr Esty Martiana, the Section Head the Health (Kadinkes) the Surabaya City, on Thursday (18/5). He also explained, the inspection was carried out apart from in accordance with the procedure that must be passed also because of two nurses and an older brother L complained had a headache and breathless.

"His older brother complained about headache, he also at once was treated." I did not yet know how his development now, he stressed.

When being asked when results of the sample inspection of blood of the laboratory could be known, Esty refused answered while explained like that L died, all of the family's members were forbidden to carry out contact with the body. Because all that the related matter of the funeral including cremation was handled by the official.

Kadinkes said, his side also at once checked the environment around the residence L in Pucang Young. However there was not found the poultry that the possibility could spread the virus avian influenza (AI) H5N1. Moreover also did counselling to the citizen so that not concerned and expelled the family L.

"I already sosialisasikan to the citizen around, and was not yet proven this virus spread from humankind."

Because of beforehand the citizen around could be restless, he stressed. Added, a week before entering the hospital, L just came from Bali. When going that, he said, the possibility L could terjangkit, although not yet having authentication.

In the meantime, the Chairman Tim the Control of the Bird Flu Illness (Avian influenza) from RSU Dr Soetomo Surabaya, Dr Dr JF Palilingan SpP (K), admitted to not yet receiving the official certificate of results of the sample test of blood.

Answered the question about the side's RKZ reason for not reconciling the patient to RSU Dr Soetomo as one of the hospitals of reconciliation of the bird flu patient in East Java, Palilingan explained had the certain condition that did not enable the patient to be moved. The "condition for the patient did not enable was moved because we worried died in the road." The hospital side could continue the maintenance as long as being in accordance with the procedure. We have coordinated mutually, and that still not the problem because of the RKZ service personally really adequate, explained Palilingan that also took part in supervising the maintenance of this patient.

Palilingan information was justified by Director RKZ, Dr SI Sugiharto Tanto the MARCH, through public relations of Dafrosa Maria. That L entered to RKZ on Sunday (7/5), because of being expected strong at contracting bird flu and in the serious condition, on Wednesday (10/5) samples of his blood were taken and sent to Jakarta to be checked. The patient died on Friday (12/5).

"We did not mean hid information." Only we must discuss him with the management's side in order to be not wrong information. Until this we also still were waiting for results of the sample test of blood. However, for the further medical action, the side of the Health Service (the Surabaya City) that handled, said Dafrosa was found in his office.

In the meantime, Deputy Director RSU Dr Soetomo Surabaya, Dr Teguh Sylvaranto SpAnKIC, said at this time was gotten by a patient suspect bird flu. His identity AP, 18, that was reconciled from RS Muhammadiyah Kediri and just entered on Wednesday afternoon (18/5).

"When entering his condition has been critical and the medical team at once carried out the standard procedure of the patient suspect bird flu." Now he is treated in isolation space and in accordance with the procedure, the sample of his blood has been sent to the laboratory but results did not yet go out, Firm words.

AP experienced the characteristics like breathless, the hot body, and the content of blue blood (leucocytes) low. The young man from the Doko Village, the Gampengrejo Subdistrict, this Kediri Regency was treated in the room of the isolation, long anaesthesia space.

This case it was known started from the fever that was suffered by casualties. After his two fever weeks rose, his family was brought to RSI Muhammadiyah, Mojoroto, the Kediri City. Two days were treated, his condition continued to worsen.

"After dirongsen he was at once reconciled to RSU Dr Soetomo, Surabaya, he said he was attacked by the bird flu virus," said Purwanto, parents of casualties to the Sun in his house, on Thursday (18/5).

Purwanto tell about, every time came home from school the student SMK this Kediri City always cleaned the duck hair. He menekuni these efforts since dozens of years set. Duck hairs that has been clean and was organised that immediately was deposited to home the industry shuttle cock in Sukomoro Nganjuk.

Usually, the duck hair was obtained from Medan and South Sumatra. AP always cleaned and drained before before being taken by his producer.

Unfortunately, in the last sending last April 20 2006, AP accepted the consignment of the hair the shabby duck, ugly and dirty. Expected, the consignment of the last hair this that spread the bird flu virus.

According to the father of two children, AP began to feel the fever znumanyz weeks ago. At that time, his family did not suspect if AP was attacked by the bird flu virus. When his condition continued to worsen the AP family brought him to RSI Muhamadiyah. After getting the maintenance, just was determined casualties were it was suspected attacked by the bird flu virus.

The section head the Health of the Kediri Regency, Dr Suliyani Suwadji it was confirmed in casualties's house claimed immediately did anticipation after having casualties's information suspect bird flu.

His rank co-operated Officially Animal the Kediri Regency at once carried out the taking of the sample of blood and spraying of disinfectant.

In the taking of the sample of blood, the official was still taking available poultry blood around it. While for the sample of blood of casualties's family, immediately will be done by the team of the doctor from RSU Dr Soetomo, Surabaya.

"We still could not ascertain his illness, but information from Surabaya he was stated suspect bird flu." So as we at once carried out the taking of the sample of the family's blood and the available poultry around it. Apart from doing spraying all through the citizen of the radius 1 kilometre, he said.

http://www.surya.co.id/naskah.php?id=8553&rid=9

[Theresa42]

toggletext-ed from Indonesian:

Casualties's FAMILY SUSPECT BIRD FLU expelled the REPORTER
May 18, 2006

Lily's family (38 years), casualties died that was expected because suspect bird flu objected diliut the media. Saa the reporter visited Lily's house that was in Pucang Young Ii the number 27 Surabaya, the husband Lily, Ruskan Welly refused to give the response. Moreover, Welly expelled the reporter. To get death information of his wife, last May 11, he asked the reporter to visit the hospital that treated Lily, the Hospital of RKZ Surabaya. Welly personally claimed still sorrowful.

This Thursday (18/5), the Health Service of the Surabaya City had finally permitted Lily's death to be expected because of bird flu. The section head the Health of the Surabaya City Doctor Esty Maryana said, to ascertain the cause of Lily's death, ihak him still was waiting for the blood test that was sent to laboratoriu WHO in Hong Kong. Esty straightened Lily died last Friday after being treated three days in Rumat was sick RKZ Surabaya. Today, the RKZ Hospital that originally bungkan finally acknowledged and permitted the existence of the death of the patient to be named Lily.

In the meantime, on last Wednesday (17/5), Doctor's Public Hospital of Soetomo Surabaya received a patient of bird flu of case reconciliation was named Anang Prasetyo (18 years). This patient was reconciled by the regional Public Hospital of the Kediri City. According to Doctor Teguh, the doctor that handled Anang, the condition for the patient at this time was critical. Anang was treated in Anaesthesia Space and got help of breathing.

http://www.metrotvnews.com/berita.asp?id=16935

[Theresa42]

toggletext-ed from Indonesian:

Tim WHO failed to visit the VILLAGE of the BIRD FLU PATIENT
May 18, 2006

Metrotvnews.com, Tanah Karo: Three people of the team of the Health Body of the World (WHO) today failed to visit the village of six positive patients bird flu in the Karo Land Regency, North Sumatra, on Thursday (18/5). The team's three doctors of the handling of this WHO bird flu visited the Land Regency Karo on Thursday morning by being accompanied by the official of the North Sumatran Health of the Service.

However, their visit was cancelled because of being refused by the local community. Because of being refused, the WHO team changed his plan by visiting the Kabanjahe Public Hospital. This the hospital that the first time treated the eight patients suspect bird flu.

Tim WHO co-operated with the Department of the Health to find the cause of the emergence of the bird flu virus in the Karo Land Regency. WHO admitted that results of the laboratory test against blood, the waste and the poultry saliva as well as the land in the Simbelang Fortification Village were not found by the existence of the virus avian influenza. [??]

http://www.metrotvnews.com/berita.asp?id=16929

[KC]

This little nugget needs to hit the mainstream media... thanks Theresa....

However, their visit was cancelled because of being refused by the local community

It could be headlined.... "Village foils international investigation into bird flu spread in Indonesia." No copyright protection from me.... any media here, feel free to use.

[Sally Furniss]

For those of you who play badminton never fear plastic is here.
http://www.flutrackers.com/forum/showthread.php?t=2408

[Theresa42]

toggletext-ed from Indonesian:

Bird flu was Still threatening Indonesia
19/05/2006 06:15

The department of the decisive Health for the length of May had seven cases of bird flu that happened in the Karo Land, North Sumatra, and Surabaya, East Java, as well as Bekasi, West Java. Seven people were killed it was suspected terjangkit bird flu.

Liputan6.com, Jakarta: The department of the Health up to now has confirmed had seven cases of bird flu for the length of May in the Motherland. The seven cases were spread in the Karo Land, North Sumatra, Surabaya, East Java, and Bekasi, West Java. While the number of casualties died with the assumption was attacked by bird flu reached seven people. Was like this this information was dismissed by the Department of Health in Jakarta, on Thursday (18/5).

The case of biggest bird flu currently happens in the Simbelang Fortification Village, the Karo Land, North Sumatra. Six citizens died in two last weeks. Four including being ascertained suffered bird flu [read: casualties the Assumption of Bird Flu in Medan improved]. Apart from casualties died, a positive patient other bird flu was still being treated in the House Adam's Centre of the Public's Supernatural Power the Owner, Medan. Jonnes Ginting was supervised tightly after twice bolted. As far as this is concerned, the Government of the Karo Land Regency established the free inspection command post to know the sign of bird flu as early as possible.

In Surabaya, one casualty died with the assumption of bird flu. The Lily, the Surabaya citizen, died on Friday last week. The family rejected the Lily died resulting from bird flu. His article the body was buried without the special procedure was proper for the bird flu patient. But, the child the Lily is currently treated in the hospital with the sign similar to bird flu.

On Wednesday set, the regional Public Hospital of the doctor Soetomo, Surabaya, also received a reconciliation patient from RS Muhamadiyah Kediri with the sign similar to bird flu. The condition for the patient was named Anang Prasetyo, 18 years, was reported critical and made use of respiratory aids.

http://www.liputan6.com/view/3,12309...148017632.html

[sharon sanders]

Previous threads (except yesterday) have been moved to Flu Tracking - Asia - Indonesia forum.

http://www.flutrackers.com/forum/forumdisplay.php?f=95

[DB]

"Jonnes Ginting was supervised tightly after twice bolted."

It looks like Jonnes Ginting escaped twice from quarantine and now is being supervised.

"His article the body was buried without the special procedure was proper for the bird flu patient"

It appears that one of the victims has been buried without any special procedures that should be used for Bird Flu victims.

"But, the child the Lily is currently treated in the hospital with the sign similar to bird flu."

It appears Lily died on May 12th and now the child the Lily is currently showing symptoms similar to bird flu.

Is this a new case?

Wouldn't this also give further support to the fact that it is spreading human-to-human?

"On Wednesday set, the regional Public Hospital of the doctor Soetomo, Surabaya, also received a reconciliation patient from RS Muhamadiyah Kediri with the sign similar to bird flu. The condition for the patient was named Anang Prasetyo, 18 years, was reported critical and made use of respiratory aids."

And it appears we have another case, this time an 18 year old in critical condition.

[DB]

http://www.medicalnewstoday.com/heal...p?newsid=43704
How Did Seven Family Members Get Infected With Bird Flu?
Main Category: Bird Flu / Avian Flu News
Article Date: 19 May 2006 - 10:00am (PDT)

We still don't know how seven members of the same family in Indonesia became infected with the H5N1 bird flu virus strain. Six of them have died. It is vital to know whether some of them infected each other. If they did, this would mean that the virus might be changing.

The World Health Organization says that it is highly unlikely that H5N1 has mutated in this case. If it had, WHO believes more people from outside the family would have become infected.

The problem is that many days have passed and no one has managed to find any other source. If they had become infected by sick chickens or ducks, surely they would have been traced by now.

Henry Niman, Ph.D., President of Recombinomics, is calling for the release of the human H5N1 bird flu sequences from the dead family members which are held in the WHO database. He said the bimodal distribution of infection, starting with the index case who became ill on April 27, to family members in early May, indicates the possibility of human-to-human transmission. It is vital to know whether/how the H5N1 genome has changed.

Scientists fear that when the H5N1 bird flu virus strain mutates, it will gain the ability to transmit from human to human. At the moment it cannot do that easily. If it does manage to mutate in this way, we could be facing a serious flu pandemic. Nobody knows what the mutated virus will be like - it could be extremely lethal or relatively harmless.

Nowhere in the world so far, except in this case in Indonesia, have so many people of the same family become infected within a few days of each other.

Indonesia's neighbours are increasingly nervous at its inability to stop the bird flu spread. New cases of sick chickens have been reported in the eastern Papua province - which has alarmed Australia.

Over 200 million chickens live in people's backyards in Indonesia. This makes it especially hard to contain the bird flu spread and to really know how many sick chickens there are.

Indonesian authorities seem unable to cope with the task of implementing measures to control avian flu at the district level. Different regions of the country are doing what they can with very little supervision from central authorities.

WHO has urged Indonesian authorities to do more to raise public awareness.

Thailand and Vietnam have been praised for their effective efforts in containing the spread of avian influenza.

[Bruce]

Date of report	Country	Case No:	Relation	Age / Sex	Initials	Symptos started	Condition	Dead	Cluster	Follow up
19.4.2006	Indonesia	122		24 / M		29.3.2006		8.4.2006
8.5.2006	Indonesia	124		33 / M		17.4.2006		26.4.2006		Nobody
19.5.2006	Indonesia	126		37 / FM		27.4.2006		4.5.2006	No: 14
19.5.2006	Indonesia	127	Son of 126	15 / M				9.5.2006	No: 14
19.5.2006	Indonesia	128	Son of 126	17 / M				12.5.2006	No: 14
19.5.2006	Indonesia	129	Sister of 126	28 / FM				10.5.2006	No: 14
19.5.2006	Indonesia	130	Daughter of 129	1 / FM				14.5.2006	No: 14
19.5.2006	Indonesia	131	Nephew of 126	10 / M				13.5.2006	No: 14
19.5.2006	Indonesia	132	Brother of 126	25 / M			Alive		No: 14

[Theresa42]

toggletext-ed from Indonesian:

Refused in Medan, the OFFICIAL WHO visited Surabaya
05/19/06

Metrotvnews.com, Surabaya: After being refused in Medan, North Sumatra, Jum'at (19/5) this, two officials from Orgasnisasi the Health of the World (WHO) shifted the visit target. Both of them descended to East Java. This was done after being found by the sufferer suspect bird flu that died in Surabaya and one patient that currently still are treated in Doctor's regional Public Hospital (RSUD) Soetomo, Surabaya.

As being reported beforehand, the case of the bird flu patient in Surabaya struck Lily (38 years), the citizen Pucang Young Ii the number 27 Surabaya. Lily died last May 11 after he [she] was treated for three days in the Hospital of RKZ Surabaya. In the meantime, last Wednesday (17/5), Doctor's Public Hospital of Soetomo Surabaya received a patient of bird flu of case reconciliation was named Anang Prasetyo (18 years). This patient was reconciled by the regional Public Hospital of the Kediri City. According to Doctor Teguh, the doctor that handled Anang, the condition for the patient at this time was critical. Anang was treated in Anaesthesia Space and got help of breathing.

http://www.metrotvnews.com/berita.asp?id=16986

[Shannon]

Who put out this report? And what dos the number 14 mean in the cluster column?

Originally Posted by Bruce

[Theresa42]

toggletext-ed from Indonesian:

The CONDITION for the BIRD FLU PATIENT in Bandung worsened
May 19, 2006

Metrotvnews.com, Bandung: Aan (13 years), the patient suspect bird flu that underwent the maintenance in the Handsome Hospital of Sadikin Bandung, Jum'at (19/5) this, his condition increasingly worsened. Aan currently undergoes the maintenance in Space of the Poinciana Tree Isolation. The citizen Cisarua, the Bandung Regency, this still terbaring weak and still menngunakan the ventilator or aids penapasa.

Dookter the team of the handling of the case of Handsome Sadikin Jatnika Hospital bird flu said, the Aan condition increasingly worsened. Apart from the fever and hot that still was high, mucus on the Aan lungs also still could not be cleaned by all of them. However, the doctor was still being waiting for results of the inspection in the Kesehatana Research And Development Laboratory (Litbangkes) Jakarta to confirm whether Aan suffered bird flu or not.

http://www.metrotvnews.com/berita.asp?id=16992

[Bruce]

Shannon


The data is collected by me from official sites.

Case numbers and Cluster numbers are by me, as their is no numbering scheme for them yet (official anyway) so I took the liberty of doing it.

This is a preview of a official chart.

[Shannon]

Thank you for the clarification. I appreciate all the work you put into this.

[Theresa42]

toggletexted-ed from Indonesian:

The CONDITION for the BIRD FLU PATIENT in Medan improved
May 19, 2006

Metrotvnews.com, Jakarta: Jones Ginting, the bird flu patient that was treated in Adam's Hospital the Owner, Medan, North Sumatra, began to improve. Jones that has been treated while two weeks, currently, are moved to isolation space. Jones was one by one him the bird flu patient in RS Adam the Owner, that still was remaining. Beforehand he could be treated in RS Kabanjahe in Kabupatan the Karo Land and could be reconciled to RS Elisabeth, Medan.

According to the Section Head the Health North Sumatran Falni Sulani, Jones was the positive patient was infected by bird flu with the family's six other members. Beforehand the sample of their blood was sent to the Laboratory of the World of the Health Body in Hong Kong to know the truth of the illness that was suffered by this patient. Six relatives Jones that the week set died also was stated positive was infected by bird flu.

On the other hand, the agricultural Service and Karo Regency Livestock Breeding carried out spraying disinfektan all through the livestock belonging to the citizen. Moreover they also menyuntikan the vaccine to prevent the spreading of bird flu. The official also carried out spraying against the pen and the pig of the goat livestock belonging to the citizen.

According to the Section Head Agriculture and Karo Sidharta Finem Regency Livestock Breeding, spraying and the injecting will be done all through the available village in the Karo Land Regency. To speed up the process of the prevention with spraying and the injecting, Sidharta asked the citizen to visit the Office and Livestock Breeding of the agricultural Service. According to him, the vaccine anti-bird flu and disinfektan will be distributed no use. In North Sumatra, up to now, was gotten by five citizens who it was suspected died as a result of being affected by the bird flu virus.

http://www.metrotvnews.com/berita.asp?id=16981

[Theresa42]

More on patient Aan [ above >> http://www.flutrackers.com/forum/sho...8&postcount=15 ]...

toggletext-ed from Indonesian:

The PATIENT BIRD FLU RS HANDSOME SADIKIN did not yet improve
May 19, 2006

Metrotvnews.com, Bandung: The Aan Suwarsa condition, the patient suspect bird flu did still not improve. Till Friday (19/5), Aan was still being treated intensively in the Hospital of Hassan Sadikin, Bandung, West Java.

According to the doctor Djatmiko that handled the bird flu patient in this hospital, clinically and laboratoris, the Aan condition really headed to bird flu. He mentioned the patient showed the breathless sign, the story of the cough, and pneumonia spread with very fast. Moreover, in two finally, pneumonia has spread to his [her] two lungs.

Djatmiko added at this time the team of the handling of bird flu was looking for the story of the patient's contact to know the virus origin contagious bird flu to the patient. The plan is, results of the laboratory could have been known, today. However, till Friday early afternoon, the team of the doctor admitted to not yet getting him [the results].

http://www.metrotvnews.com/berita.asp?id=16967

[DB]

It looks like Aan Suwarsa (13 years) is in critical condition (Most likely not going to make it).

It looks like Jones Ginting (? years) is getting better.

It looks like Anang Prasetyo (18 years) is in critical condition (Most likely not going to make it).

And a Child of 'Lily' (? years), 'Lily' died on May 11th or 12th, is suspected of having bird flu.

[Sally Furniss]

Indonesia reports more bird flu deaths
Last Updated Fri, 19 May 2006 18:38:03 EDT
CBC News

The World Health Organization has confirmed two more deaths in Indonesia from bird flu, bringing the nation's overall toll from the virus to 32.
Two more deaths attributed to avian flu are reported in Indonesia. (Associated Press)

Health Ministry officials in Jakarta say one of the latest victims is a 10-year-old boy from Sumatra.

The boy is the fifth confirmed death in a cluster of deaths among relatives in the area. The cluster — Indonesia's largest to date — has raised fears of the possibility of human-to-human transmission in the world's fourth most populous nation.

The WHO says "if human-to-human transmission has occurred, it has not been either efficient or sustained."

The second of the latest two victims — a 12-year-old boy — died after being infected with the H5N1 strain of the virus on the outskirts of Jakarta.

"The Ministry of Health in Indonesia has confirmed an additional case of human infection with the H5N1 avian influenza virus," said the WHO in a statement on its website.

"The case occurred in a 12-year-old boy from Bekasi in East Jakarta. He was hospitalized on 7 May and died on 13 May. An investigation is under way to determine the source of his infection."

http://www.cbc.ca/story/world/nation...u05192006.html

[Theresa42]

Bird Flu Threat Ignored in Indonesia
Threat of Bird Flu Goes Unnoticed Across Much of Indonesia's Countryside
By NINIEK KARMINI
The Associated Press

MUNTILAN, Indonesia - When chickens began dying at his local market, Darmanto gratefully collected them from vendors, chopping them up and tossing the raw meat to his pet catfish.

He never wore gloves, and remembers smoking a cigarette with a bloody hand as he watched hundreds of fish greedily gobble up the scrawny black carcasses.

The thought of bird flu never crossed Darmanto's mind. It couldn't have. He never heard of it until he himself became ill, hospitalized with a burning 105-degree fever, a racing heart and a tightness in his chest that left him struggling to breathe.

Indonesia with 32 human deaths from the H5N1 virus, the world's second-highest number after Vietnam has come under fire for failing to slow the spread of the virus, which some fear could mutate into a strain that passes from human to human, potentially causing a global pandemic.

Others, like Vietnam, have succeeded thanks largely to strong political will and vaccination campaigns. But Indonesia has so far refused to carry out mass culls of poultry in all infected areas, one of the U.N. Food and Agriculture Organization's most basic containment guidelines, saying it cannot afford to compensate farmers.

Bio-security measures are virtually nonexistent and, as Darmanto's case illustrates, there is a lack of awareness about bird flu in the densely populated countryside, home to hundreds of millions of backyard chickens.

"If I had known about bird flu, I would have done a lot of things differently. I would have taken precautions to protect myself and my family," said the 46-year-old father of two, who does not understand even today how he could get sick from dead chickens or how he survived.

Darmanto, who like many Indonesians uses only one name, attributes his good fortune to "traditional herbal medicine, a strong spirit, and the will to live."

Indonesia's cash-strapped government says it is doing all it can to fight bird flu, which has been found in poultry in two-thirds of its 33 provinces. It is confident the sprawling archipelago will be free of the disease within two years.

"We are on a declining curve," Agriculture Minister Anton Apriyantono said recently, vowing to boost chicken vaccination drives and carry out limited culls in areas where humans have died.

But the problems run deep, in part because of radical decentralization introduced after the dictator Suharto was ousted amid massive street protests in 1998.

The government handed control of public services to regional and local authorities in 2001, but their roles were unclear, experts say, funding inadequate and priorities left to the whims of inexperienced officials, mayors and village heads.

That has affected almost every sector in the government, from health, to public information, to agriculture.

"There's no line of command and they're disorientated," said Peter Roeder, an FAO animal health expert working in Indonesia, adding that district veterinary officials seem more concerned with delivering clinical services to farmers, for instance, than controlling trans-boundary animal diseases.

And in the villages, where most people live on less than $1 a day, there are other things to worry about, from getting food on the table to more common illnesses like dengue fever, malaria and cholera.

Though health officers have gone door-to-door in some places, carrying educational brochures about the importance of personal hygiene and a clean living environment, the message often falls on deaf ears.

"We have been raising chickens and ducks from generation to generation without having any problems," said Mohammad Sodat, a rice farmer who owns more than 80 birds.

Adding to the worries of international and local health officials was confirmation this week of one of the world's largest clusters of H5N1 human deaths ever least five in one family living on Sumatra island, according to the World Health Organization.

The multiple infections initially raised fears the virus mutated to a form that passes more easily from human to human. But health officials now say it appears the infected family members had contact with sick poultry.

Darmanto, the man who survived bird flu, knows how lucky he is.

Doctors did many things right, suspecting immediately that he had the H5N1 virus that has killed more than 120 people worldwide and sending his swab and blood samples to laboratories in Jakarta and Hong Kong.

He was transferred Dr. Moewardi Hospital in nearby Solo, one of dozens nationwide equipped to deal with avian influenza.

Though he continued to lose weight 30 pounds in two weeks and X-rays of his lungs showed the rapid spread of the virus, he eventually recovered, thanks in part to the anti-viral drug Tamiflu.

But his problems did not end.

When Darmanto returned to Muntilan, his village 260 miles southeast of the capital Jakarta, in December he was hurting financially and eager to resume his job as a tailor.

"My neighbors avoided me," he said. "They didn't want anything to do with me."

http://abcnews.go.com/Health/wireStory?id=1984848

[Theresa42]

toggletext-ed from Indonesian:

It was other that the Patient Suspect Bird Flu in Surabaya died
May 20, 1006

SURABAYA--MIL: A male patient was approximately 20 years that were expected old (suspect) was infected by bird flu, on Saturday around struck 08.30 WIB, died, after being treated in Budi's Hospital Noble Surabaya since May 9.

"We still could not conclude whether the patient died because suspect bird flu." But was based on the possibility diagnosis headed there (contracted bird flu), said Budi's Hospital public relations Noble Surabaya, Octdy Hendrawan, in Surabaya, on Saturday.

Was based on the diagnosis and signs that apparently, the patient it was suspected contracted bird flu, because of the patient while being treated experienced breathless (pneumonia) and the high fever.

Nevertheless, to confirm whether this diagnosis was positive or negative, the management of Budi's Hospital Noble has sent the example of casualties's blood to Jakarta for the further inspection, he said.

Moreover, in order to anticipates the possibility of the existence of the patient suspect bird flu, the management of Budi's Hospital Noble currently has done the co-ordination Officially the Surabaya Health as well as the regional Public Hospital (RSUD) Dr Soetomo.

With the existence of the casualties then already three patients that it was suspected contracted bird flu that was treated in the hospital in Surabaya. Two patients beforehand were a woman was the citizen's approximately 30 years old Pucang Young Ii Surabaya and AP one of the citizen's Kediri students. [In other words, 2 bf suspects -- Pucang Young Ii Surabaya and her(?) student, A.P.]

The patient of the citizen's woman Pucang Young Ii Surabaya had finally died, after could be treated by RKZ because his condition has been serious enough. While the patient [A.P., I think] from Kediri that is reconciled to RSUD Dr Soetomo, currently still in the intensive maintenance in this hospital.

Resulting from the incident, 11 people were taken the sample of his blood to be checked in the laboratory in Yogyakarta. Two among them the nurse RKZ and close relative of the patient suspect bird flu.

From 11 people had three people that could dikarantina Dinkes Surabaya, because of contracting the sign like bird flu, namely two nurses RKZ and the older brother pengidap suspect bird flu.

However, the latest development only of the sufferer's older brothers suspect bird flu that still was undergoing quarantine.

http://www.mediaindo.co.id/berita.asp?id=100362

[HenryN]

Commentary at

http://www.recombinomics.com/News/05..._Clusters.html

[HenryN]

Commentary at

http://www.recombinomics.com/News/05..._Pandemic.html

[Mellie]

Commentary

Suspect H5N1 Clusters in Surabaya Indonesia Cluster

Recombinomics Commentary
May 20, 2006

A suspected 20-year male bird flu sufferer who has been treated in Budi Mulia hospital since May 9, died here at 8.3. am on Saturday.

Two patients beforehand were a woman was the citizen's approximately 30 years old Pucang Young Ii Surabaya and AP one of the citizen's Kediri students

The patient of the citizen's woman Pucang Young Ii Surabaya had finally died, after could be treated by RKZ because his condition has been serious enough. While the patient from Kediri that is reconciled to RSUD Dr Soetomo, currently still in the intensive maintenance in this hospital.

one casualty died with the assumption of bird flu. The Lily, the Surabaya citizen, died on Friday last week.

the child the Lily is currently treated in the hospital with the sign similar to bird flu.

The above translations define a new cluster of confirmed or suspect H5N1 bird flu cases in Surabaya. The confirmed case (38F) was describe in the WHO update. She developed symptoms on May 2, was hospitalized on May 7, and died May 11. The above report indicates her child is now hospitalized with bird flu symptoms, consistent with human-to-human transmission within a family.

Another suspect case (20M) died today, but the same hospital has admitted two additional suspect cases, a teacher (30F) who died earlier, and her student (18M) who is in critical condition and on a respirator.

Correction:

The teacher decribed above appears to be another media description of the confirmed fatality (38M) and therefore there is no infected teacher and no relationship between a fatally infected teacher and the H5N1 confirmed student.

The geographical cluster in Surabaya thus has one confirmed and four suspect cases. Two of the suspect cases have died, and the student of one has been hospitalized. Similarly, the child of the confirmed case has also been hospitalized.

Familial clusters in Indonesia have been common. Almost all have a 5-10 day gap between the index case and family member. Recently a seven member cluster in North Sumatra was described. H5N1 has been confirmed in all but the index case, and six of the seven have died, This cluster, the largest to date, has fueled concern about increased efficiency of human-to-human transmission. This cluster may be extended because one of the family members (10M) developed symptoms later than the other family member, and now the father of that fatal case has been hospitalized.

The growth in the number and size of the clusters has focused attention on the sequences of the H5N1 isolated from the patients. However, sequences from only one of the human H5N1 isolates has been released. It has a novel cleavage site, RESRRKKR, that has not been reported in any of the publicly available bird sequences from Indonesia or elsewhere.

These data suggest that the majority of the reported humans cases in Indonesia have not been linked to an avian sequence. Most of the sequences human isolates have been from West Java, including various locations in Jakarta and suburbs. Some of the avian sequence also are from West Java (see below)

The lack of a connection with bird H5N1 sequences and the increasing size and number of human clusters has raised pandemic concerns.

DQ320932 A/chicken/Bantul/BBVet-I/2005 2005 H5N1
DQ497667 A/chicken/Dairi/BPPVI/2005 2005 H5N1
DQ497668 A/chicken/Deli Serdang/BPPVI/2005 2005 H5N1
DQ497651 A/chicken/Gunung Kidal/BBVW/2005 2005 H5N1
DQ497652 A/chicken/Kulon Progo/BBVW/2005 2005 H5N1
DQ497643 A/chicken/Magetan/BBVW/2005 2005 H5N1
DQ497648 A/chicken/Purworejo/BBVW/2005 2005 H5N1
DQ320928 A/chicken/Salatiga/BBVet-I/2005 2005 H5N1
DQ497669 A/chicken/Tarutung/BPPVI/2005 2005 H5N1
DQ497666 A/chicken/Tebing Tinggi/BPPVI/2005 2005 H5N1
DQ320933 A/chicken/Wajo/BBVM/2005 2005 H5N1
DQ497659 A/duck/Parepare/BBVM/2005 2005 H5N1
DQ497655 A/chicken/Bangli Bali/BBPV6-1/2004 2004 H5N1
DQ497656 A/chicken/Bangli Bali/BPPV6-2/2004 2004 H5N1
DQ497657 A/chicken/Jembrana/BPPV6/2004 2004 H5N1
DQ320931 A/chicken/Kulon Progo/BBVet-XII-1/2004 2004 H5N1
DQ497650 A/chicken/Kulon Progo/BBVet-XII-2/2004 2004 H5N1
DQ497662 A/chicken/Kupang-1-NTT/BPPV6/2004 2004 H5N1
DQ497660 A/chicken/Kupang-2-NTT/BPPV6/2004 2004 H5N1
DQ497661 A/chicken/Kupang-3-NTT/BPPV6/2004 2004 H5N1
DQ497642 A/chicken/Malang/BBVet-IV/2004 2004 H5N1
DQ497658 A/chicken/Mangarai-NTT/BPPV6/2004 2004 H5N1
DQ497644 A/chicken/Ngawi/BPPV4/2004 2004 H5N1
DQ497663 A/chicken/Pangkalpinang/BPPV3/2004 2004 H5N1
DQ497653 A/chicken/Purwakarta/BBVet-IV/2004 2004 H5N1
DQ320930 A/chicken/Yogjakarta/BBVet-IX/2004 2004 H5N1
DQ497647 A/quail/Boyolali/BPPV4/2004 2004 H5N1
DQ497654 A/quail/Tasikmalaya/BPPV4/2004 2004 H5N1
DQ497645 A/chicken/Pekalongan/BPPV4/2003 2003 H5N1
DQ497646 A/chicken/Sragen/BPPV4/2003 2003 H5N1
AY651324 A/Ck/Indonesia/4/2004 2004 H5N1
AY651325 A/Ck/Indonesia/5/2004 2004 H5N1
AY651322 A/Dk/Indonesia/MS/2004 2004 H5N1
AY651323 A/Ck/Indonesia/2A/2003 2003 H5N1
AY651321 A/Ck/Indonesia/BL/2003 2003 H5N1
AY651320 A/Ck/Indonesia/PA/2003 2003 H5N1

[Mellie]

Commentary

Suspect H5N1 Clusters in Surabaya Raise Pandemic Concerns

Recombinomics Commentary
May 20, 2006

The recent reports of suspected H5N1 bird flu cases in Surabaya is cause for concern. The index case has been confirmed and died May 12. Her child is currently hospitalized with bird flu symptoms and an unrelated patient has also just died.

Although only one case has been confirmed, two additional suspect cases have raised additional concerns. One fatal infection is of a teacher, and one of her students has been hospitalized and is on a respirator. Transmission of H5N1 outside of a family has been rare. In Vietnam one confirmed transmission chain involved an index case, his sister, and a nurse, all of whom were H5N1 confirmed. A second nurse had symptoms, but was not confirmed in lab tests. However, the vast majority of clusters have been limited to family members. There was a large cluster in Turkey at the beginning of 2006, and more recently the largest Indonesian cluster, in North Sumatra. However, all members of these cluster were related to the index case.

Correction:

The teacher decribed above appears to be another media description of the confirmed fatality (38M) and therefore there is no infected teacher and no relationship between a fatally infected teacher and the H5N1 confirmed student.

The cluster involving teacher and student has not been reported previously. Such transmission would signal an increased efficiency and diminish the likelihood that the familial clusters were genetically linked. An earlier cluster of five in Haiphong involved a husband and wife and three daughter. All five family members were H5N1 confirmed and the infection of both husband and wife diminishes the genetic link. The results of tests on neighbors with symnptoms has been withheld.

Concerns that transmission is from a source other than avian has been raised since almost all sequenced human cases in West Java have a novel cleavage site not found in poultry isolates. This novel sequence has also been found in a cat, raising the possibility that the sequence is closely linked to mammalian infections.

Since most suspect cases in Indonesia are not tested in the absence of a poultry link, many infections from a mammalian source many not be diagnosed. The frequent detection of the novel cleavage site highlights the need for more aggressive testing of avian and swine H5N1 infections.

Similarly, the H5N1 human and animal sequences sequestered at the WHO private data base should be released immediately.

[Snowy Owl]

Hi all, Harfang des Neiges is the French name of Snowy Owl

All thanks to Flu Wiki Team at
http://www.fluwikie2.com/pmwiki.php?...wsReportsMay21

From Flu Wiki by rivky – at 09:56

Here is a translated article from Media Indonesia May 20th:

Surabaya — MILE: A male patient was approximately 20 years that were expected old (suspect) was infected by bird flu, on Saturday around struck 08. 30 WIB, died, after being treated in Budi’s Hospital Noble Surabaya since May 9. “We still could not conclude whether the patient died because suspect bird flu.” But was based on the possibility diagnosis headed there (contracted bird flu), said Budi’s Hospital public relations Noble Surabaya, Octdy Hendrawan, in Surabaya, on Saturday. Was based on the diagnosis and signs that apparently, the patient it was suspected contracted bird flu, because of the patient while being treated experienced breathless (pneumonia) and the high fever. Nevertheless, to confirm whether this diagnosis was positive or negative, the management of Budi’s Hospital Noble has sent the example of casualties’s blood to Jakarta for the further inspection, he said. Moreover, in order to anticipates the possibility of the existence of the patient suspect bird flu, the management of Budi’s Hospital Noble currently has done the co-ordination Officially the Surabaya Health as well as the regional Public Hospital (RSUD) Dr Soetomo. With the existence of the casualties then already three patients that it was suspected contracted bird flu that was treated in the hospital in Surabaya. Two patients beforehand were a woman was the citizen’s approximately 30 years old Pucang Young Ii Surabaya and AP one of the citizen’s Kediri students. The patient of the citizen’s woman Pucang Young Ii Surabaya had finally died, after could be treated by RKZ because his condition has been serious enough. While the patient from Kediri that is reconciled to RSUD Dr Soetomo, currently still in the intensive maintenance in this hospital. Resulting from the incident, 11 people were taken the sample of his blood to be checked in the laboratory in Yogyakarta. Two among them the nurse RKZ and close relative of the patient suspect bird flu. From 11 people had three people that could dikarantina Dinkes Surabaya, because of contracting the sign like bird flu, namely two nurses RKZ and the older brother pengidap suspect bird flu. However, the latest development only of the sufferer’s older brothers suspect bird flu that still was undergoing quarantine. http://tinyurl.com/akr4j

[Bruce]

WHO bans local journalists from coverning WHA meet


http://www.cna.com.tw/eng/info/twhead.php

[Treyfish]

oh.we'll find out soon enuff,i'm afraid.