INDONESIA - Garut Cluster Part III

[MHSC]

Re: INDONESIA - Garut Cluster Part III

Yes, you're right -- she is confirmed. Thanks! That's who this latest WHO update is referring to, right?

Gotta go fix the list...!

I think it is Euis, but it could also be....

EK? (32) - maybe Kuraesin, from Tipar/Hasan Sadikin, Garut

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

Esih 35/F Cickelet, NYK , Died 18/08

E (Maybe Esih or Euis?) wife of Daden, died in space of the isolation of Hospital bird flu Doctor Selamet, Garut, last August(2005 or translation problem?).

Unless they are all the same person.

[Commonground]

Re: INDONESIA - Garut Cluster Part III

MHSC #27: I was so disappointed to read the article, because there was no mention at all of when we can expect some of these test results back.......

[Theresa42]

Re: INDONESIA - Garut Cluster Part III

toggletext-ed from Indonesian:

Cluster Bird Flu in Garut Still was observed
August 21, 2006

Liputan6.com, Jakarta: The department of the Health still observed whether happening cluster or the case of the bird flu sufferer of one family in Garut, West Java. At this time the Department of Health team carried out the supervision was active in the region, including monitoring the health of the citizen. For the time being, the poultry traffic from Cikelet also might not go out from there. Was like this was stated by Health Minister Siti Fadilah Supari in Jakarta, on Monday (21/8).

In the meantime, the health post in the Rancasalak Village, Garut, several last days were filled up by the citizen. Several citizens received the capsule Tamiflu free to prevent the fall of casualties resulting from the virus H5N1. Giving Tamiflu will be given while seven days were endless. His plan the citizen of the Jojok Village, Rancamere, and Sawa Cikelet will also be given Tamiflu.

Up to now was recorded by seven cases cluster avian influenza that was begun in July 2005 namely three people in Tangerang, Banten. Then two their respective people in Southern Jakarta, Lampung, Tangerang, and Indramayu, West Java. Moreover, eight in the Karo Land, North Sumatra, and in May 2006 two people in Cileunyi, Bandung, West Java.

Up to now the case of the assumption of bird flu in Garut continues to improve. A citizen [Gilang] of Gunung Sula hamlet, the Cigadog Village, Cikelet, was treated in the Pameungpeuk Community Health Centre because of showing the sign was similar avian influenza. He was brought to puskemas late last week after complaining the fever, had a headache, and breathless.

http://www.liputan6.com/view/3,127807,1,0,1156176574.html

[Theresa42]

BIG Tamiflu blanket -- 2000 people in 4 hamlets to get Tamiflu

toggletext-ed from Indonesian:

The citizen Cikelat was distributed Tamiflu Free
Senin, 21 Agustus 2006 | 18:23 WIB

TEMPO Interaktif, Bandung: The section head the Health of the West Javanese Province, Yudhi Prewar, said the citizen of four villages in the Cikelat Village, the Garut Regency, got Tamiflu free. The medicine of the bird flu preventive was distributed following the discovery 13 cases of the virus avian influenza that infected the citizen there. [Possible cases, right?]

"This as part of the mass prophylaxis or prevention medical treatment for all the inhabitant," said Yudhi to Tempo, on Monday afternoon. According to him, Tamiflu this was given in the dose of the prevention not in the dose of therapy.

He explained, as the prevention of medicine for bird flu was given one tablet every day for 10 days. Whereas for medical treatment was given two tablets for one week.

Tamiflu that was distributed, he said, was help from the government of the centre. The medicines were given in every day to the citizen of four hamlets in the Cikelat Village namely the Ranca Salak Village, Ranca Mareme, Jojoh, and the Sawah Bera. He estimated, the inhabitants of four hamlets totalled 2.000 people.

Yudhi acknowledged, giving Tamiflu mass as the prevention just the first time in did in Indonesia. According to him, the decision carried out giving Tamiflu mass as the prevention was caused four hamlets relatively far from the closest community health centre. Moreover, he explained, the citizen of four hamlets was counted had the mobility that very low.

He also said, giving Tamiflu free that was not given at the same time. The citizen was asked to take the medicine every day in the command post of the health service that was established in the Cikelat Village. "Therefore we could carry out mass medical treatment at the same time the monitoring," he said.

From the Cikelat Village, the Cikelat Subdistrict, the Garut Regency was found by 13 cases of bird flu. Three people entered the positive category was affected by the virus H5N1, two including dying and one person was safe. Nine people still in the category suspect. One status insider of observation in the Cikelat Community Health Centre and it was suspected not was affected by bird flu.

Yudhi said, the case of bird flu in Garut that was found since last August 1 that not including the category cluster because of not coming from one family or having the genetic similarity. Yudhi hoped, the case of bird flu from Garut not was caused by the spread between humankind.

From results of investigation that was carried out by the team from WHO and the Department of the Health of concluding the case of bird flu in Garut came from the animal that tertular the virus. "Late June many poultries has happened died there, the possibility was affected of bird flu," he said.

http://www.tempointeraktif.com/hg/nusa/jawamadura/2006/08/21/brk,20060821-82258,id.html

[Commonground]

Re: INDONESIA - Garut Cluster Part III

Here's the breakdown of the 13:

From the Cikelat Village, the Cikelat Subdistrict, the Garut Regency was found by 13 cases of bird flu. Three people entered the positive category was affected by the virus H5N1, two including dying and one person was safe. Nine people still in the category suspect. One status insider of observation in the Cikelat Community Health Centre and it was suspected not was affected by bird flu.

[sara.smiles]

Re: BIG Tamiflu blanket -- 2000 people in 4 hamlets to get Tamiflu

"This as part of the mass prophylaxis or prevention medical treatment for all the inhabitant," said Yudhi to Tempo, on Monday afternoon. According to him, Tamiflu this was given in the dose of the prevention not in the dose of therapy.

Okay..let me check this out...Tamiflu was given as a mass prophylaxis, correct?? But the virus is, at this point, endemic, so these same folks are going to be exposed again and again at some point down the road. Will they get more Tamiflu?? How many courses of prophylaxis do they anticipate giving these people?

This virus will mutate to resist Tamiflu and the medication will then be wasted ...whereas in other areas where the virus has not yet acquired resistance, those drugs might prove useful. But ultimately all this is, is a time-buying measure, and soon, it will buy no time at all for anyone.

Tamiflu may lessen the symptoms and increase survival, but as there are 3 to 4 distinct recombinations spreading out there, and more to come, I am sure...in the virus' next recombination it's just going to strike again. Unless I am missing something drastic here..NOTHING is going to lessen the mortality of this disease.

Have I gotten too fatalistic or has reality just sunk in??

[Shannon Bennett]

Re: INDONESIA - Garut Cluster Part III

Sara, welcome to the brave new world. I admire the Indonesians in many ways, but they have a long way to go to satisfy the rest of the world that they are on top of the bf situation.

[Laidback Al]

Euis Lina Family Cluster

Euis Lina (32/35?F)[/b] - Cigadog village - (Dea's mother) - confirmed H5N1 - dead

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

Dadan - Euis Lina's husband

2 children of Euis & Dadan


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

Osin (36) - Kuraesin's husband

(EK? (32) - may be Kuraesin - from Tipar hamlet)

This is what I have....

Kuraesin/K (32F) - not confirmed, pregnant, stable, Sawah Bera/Jojok village - (Osin - husband) neighbor of Ai Siti, Ismawati, and Santi's
Osin 36/M, husband of Kuraesin, the citizen of the Sawah Beura Village

Santi (6/8F) - not confirmed- initial test neg, Stable, Jojok/Sawa Bera, Cikelet village - daughter of Iwan & Surilah - neighbor of Ai & Kuraesin



Esih 35/F Cickelet, NYK , Died 18/08

Daden, husband of E (Family has 5 members, 2 dead, 3 ill), Cigadog Pasir Gambir Village
E (Maybe Esih or Euis?) wife of Daden, died in space of the isolation of Hospital bird flu Doctor Selamet, Garut, last August(2005 or translation problem?).
DI, (M) child of E and Daden, died in space of the isolation of Hospital bird flu Doctor Selamet, Garut, last August (2005 or translation problem?).
?, second child of E and Daden
?, third child of E and Daden

Euis Lina Family Cluster (six individuals)

Euis Lina F (Dead)
Dadan M spouse
Dea Amalia F daughter (dead)
"DI" M son (dead?)
Child A
Child B

[MHSC]

Re: INDONESIA - Garut Cluster Part III

Laidback Al

Do you have the ability to sort your chart on this cluster?

I would be interested in seeing sorts based on village name, and dates infected.

Edit: I've been putting up pears over the past week, 62 quarts so far now I'm working on pear butter. I haven't had time to give this my full attention.

[Laidback Al]

Re: INDONESIA - Garut Cluster Part III

MHSC, Sorry, data is scarce.

I only have limited information for Euis and Dea. None for the rest of the family (except what is presented in the above posts).

Euis Lina
"Pasir Gambir Village, Cikelet Subdistrict, Garut Regency (Cigadog?)" Died 8/17/2006 same day she entered the hospital. No symptom onset date in the WHO announcement.

Dea Amalia
"Cikelet Subdistrict, Garut Regency" Dead, but we don't have a date of death, hospitalization, or sympton onset.

Dadan
"Cigadog Pasir Gambir Village" from the above post.

I assume the children are from the same hamlet/village as parents.

Maybe someone else has information I have missed.

[MHSC]

Re: INDONESIA - Garut Cluster Part III

For the time being, the Citizen might not go out Masuk
If needing Cikelet Diisolasi

Garut, (HOMEWORK).
- the Garut Regent H. Agus Supriadi, appeared so serious in pressing the spreading of the bird flu illness in his area.

After many suspect was found in Cikelet, the regent in fact said, if indeed was enabled and necessary, the Village community Cikelet the Cikelet Subdistrict could be isolated.

?Untuk now, the citizen was not permitted to go out entered the Cikelet Village for the certain period so that the spreading of bird flu does not spread in the Regency Garut,? he revealed.

But he afterwards stressed, all these will be investigated first.
?Apakah quite necessary or not that was done, he said to "HOMEWORK", on Monday (21/8) in the Langensari Kec Village.
Tarogong Kaler.

That was sent by the regent replied the question about the possibility of the spreading of bird flu in Cikelet has happened resulting from contact between humankind to humankind, not because of humankind with the poultry then.

The expert Pulmonologi the Medical Faculty of UI Dr. Tjandra Yoga Aditama believed, needed mass prevention efforts in the Cikelet Village to prevent the spreading of the virus H5N1.

"Must be done by the concept mass geographycal prophylaxis namely the mass prevention to all this villager," he said when being contacted in Jakarta, yesterday.

According to him, the method that could be carried out that is by giving medicine medicine oseltamivir to all the villager.

According to the lungs-new illness specialist in RS this Jakarta Friendship, the step that must be carried out namely medical treatment included 90% the inhabitants.

Moreover, according to him, villagers might not leave this area.
The "prevention with this model was effective enough," said Yoga.
However he mewanti-wanti this method so that fast was done so as the not fast plague developed.

Also needed the supervision from the official to prevent the mobilisation of the inhabitants and the poultry.

"This necessary to melokalisasi the illness."

Uptil now indeed the government has carried out various methods memerangi this virus, but still was not more intensive so as to have to be increased again, said Yoga.

He also explained health counselling, the handling of the poultry must be given to the community.

The "community must be reported how treated the good poultry but also washed the hands after doing the activity," he said.

The healthy life, said he, must be carried out by the inhabitants because at this time bird flu did not yet have his medicine.

Now tamiflu was used because of only medicine that effective prevented bird flu.

</pre>

That not yet terjadi

However, the Garut Regent stressed, the spreading of the bird flu virus in Cikelet still from the poultry to humankind, not yet from humankind to humankind.

Cluster just the spreading of the bird flu virus, also was not available.
That was sent by the regent, on Monday night (21/8) after getting the explanation from Pengendalian Breakingprep Penyakit Director General and environmental Sanitation (P2PL) I Nyoman Kandun.

On Monday, Nyoman Kandun carried out the research to the patient's family suspect bird flu in the Cikelet Kec Village.

Cikelet.

With his staff, Kandun inspected the Tactical Command Post in the Cikelet Village.

He was accompanied by the official of the Health of the Service, Komnas Bird Flu, and from the Department of Livestock Breeding.

He came especially to see how the bird flu virus spread in the Garut region South.

The "report that I received from Mr Dirjen, after researching the sample of the family's blood suspect, was not found by the indication of the spreading of the bird flu virus from humankind to humankind," said the regent.
Therefore, the community was asked for calm.

According to the regent, although being not yet found cluster just, the prevention continued to be carried out.

In part with Tamiflu giving that must be drunk by the citizen while 10 days were endless.

Moreover, was done also by medical treatment to the citizen who was sick, was freed whether the citizen suspect or not.

The "government also continued to carry out depopulation against the poultry."
Up until this Monday (21/8) the poultry that already didepopulasi 800 tails more.
Tomorrow will be done also in the Cigadog Village, the residence of Euis Lina, casualties died that was stated positive bird flu, said the regent.
</pre>

"For the time being had 3 new medicines that were researched, that indeed was made to treat bird flu among them namely Tramivir and Zanamivir," he said.
A circulating information on last Monday -- quoted the source from the Department of the Jakarta Health, mentioned the spreading of bird flu was in Garut resulted in by the existence of human contact with humankind.

The regent not yet tahu

The regent said, till last Monday himself did not yet receive information about the spreading of bird flu in Garut has happened between humankind to humankind.

Information from the related service, he said, continued to say that bird flu that attacked the humankind because of spreading him the bird flu virus from the certain poultry to humankind.

"However, was free from all that, the prevention spread him bird flu to the region that still more areas again will be done tightly."

One of them, by means of the severing of the traffic went out entered the poultry from and to the Cikelet Village to the radius 3 km, said Agus Supriadi.

The other method, said Agus, was with depopulation of hundreds of poultries in several villages in the Cikelet Village and the close village with the Cikelet Village.

He stated, depopulation continued to be carried out by the Health Service of the West Javanese Province, the Garut Health Service, the Garut Livestock Breeding Service, the organisation of the health a world (WHO), and was monitored by the official of the Department of the RI Health.
According to Kabag public relations Setda Garut Drs. Dik Dik Hendrajaya, M.

The depopulation of the poultry in Cikelet finally was done on Monday (21/8) in the Cimareme Village and the Dark Red Paddy-field.
The plan is, said Dik Dik, on Tuesday (22/8) was done again by depopulation in the Pasirgambir Village as well as Cigadog.

Depopulation will be carried out through to approximately 3.000 poultries belonging to the citizen who was suspected tertular the bird flu virus.

Was difficult memastikan

The regent admitted to not understanding why the bird flu virus could spread in the Cikelet Village that notabene the territory was isolated.
"I had difficulty decisive, why the poultry that terjangkit the bird flu virus could enter the Cikelet Village."

The Cikelet village would his location was isolated, he said.

The poultry population there then, said the regent, not too many.
Originally, the regent worried the bird flu virus spread in the Garut region North like Limbangan, Malangbong, Cibatu and other areas.
Because, the territory was the region was open and busy with the human traffic and the poultry from various areas.

The poultry from outside then often went out entered these regions.
The fact is, the bird flu virus even spread in Cikelet, Garut south.
(A-112/dtc)

http://www.pikiran-rakyat.com/cetak/2006/082006/22/0101.htm

</pre>

[Shannon Bennett]

Re: INDONESIA - Garut Cluster Part III

[snip]
According to him, the method that could be carried out that is by giving medicine medicine oseltamivir to all the villager.

According to the lungs-new illness specialist in RS this Jakarta Friendship, the step that must be carried out namely medical treatment included 90% the inhabitants.

....

Moreover, according to him, villagers might not leave this area.
The "prevention with this model was effective enough," said Yoga.
However he mewanti-wanti this method so that fast was done so as the not fast plague developed.

Also needed the supervision from the official to prevent the mobilisation of the inhabitants and the poultry
[snip]

It looks like the specialist is asking for prophylactic use of Tamiflu for 90% of the areas inhabitants, and put a strict quarantine around the area. I am unsure as to whether he thinks the one in place is effective or is calling for greater control. In any case I salute the Indonesians for recognizing the threat and hope their plans reach a quick fruition.

[Commonground]

Re: INDONESIA - Garut Cluster Part III

And we will also watch these areas in the future:

"Originally, the regent worried the bird flu virus spread in the Garut region North like Limbangan, Malangbong, Cibatu and other areas.
Because, the territory was the region was open and busy with the human traffic and the poultry from various areas.

The poultry from outside then often went out entered these regions.
The fact is, the bird flu virus even spread in Cikelet, Garut south."

(watch what they DO, not what they say). So it's unclear to me if they are going to restrict the residents from leaving. Does he need the supervision of the officials to keep everyone from leaving? Guess that might be why they are hesitating?

"Also needed the supervision from the official to prevent the mobilisation of the inhabitants and the poultry"
[snip]

[Harriet]

Third avian flu case verified in area of possible Indonesian cluster

Aug 21, 2006 (CIDRAP News) ? A third human case of H5N1 avian influenza has been confirmed in a remote part of Indonesia where a number of suspected cases are being investigated, but most of the cases probably resulted from exposure to sick poultry, the World Health Organization (WHO) said today.

The confirmed case was in a 35-year-old woman from the subdistrict of Cikelet in West Java province who died shortly after she was hospitalized Aug 17, the WHO said. She is the 46th Indonesian to die of the illness, out of 59 confirmed cases, by the WHO's count. An Aug 20 Agence France-Presse (AFP) report identified the woman as Euis Lina.

Multiple cases in close proximity raise the possibility of human-to-human transmission. The disease was confirmed in two other people from Cikelet in the past week: a 9-year-old girl who died Aug 15 and a 17-year-old boy who is still alive.

Three other people in the area died previously of suspected avian flu but were buried without being tested, according to Agence France-Presse (AFP). One of them was the daughter of Euis Lina, said Indonesian Health Minister Siti Fadilah Supari, as quoted by AFP.

Sixteen other people in the area have been tested for the virus, AFP reported today. Their initial results were negative, but the tests are being repeated, an Indonesian official told AFP.

WHO and Indonesian experts have been investigating in the Cikelet area since Aug 17, according to AFP. The WHO said investigators think the human cases are related to poultry outbreaks that began in late June.

Cikelet encompasses about 20 isolated hamlets of around 200 to 400 people each, situated in a basin surrounded by steep mountains and accessed only by rocky, winding paths, the WHO said. People in the area have little access to healthcare and often die of endemic diseases such as malaria.

No mass poultry deaths are known to have occurred in the area before late June, when some chickens were bought from an outside market and added to local flocks, the WHO said. Large numbers of chickens began dying shortly afterward in an outbreak that continued through July and the first week of August.

'High-risk behaviors' cited
"As the population had no experience with this disease, high-risk behaviors commonly occurred during the disposal of carcasses or the preparation of sick or dead birds for consumption," the agency said. "These exposures are, at present, thought to be the source of infection for most confirmed or suspected cases."

Some people in the area died of respiratory illnesses in late July and early August, but no samples were taken and medical records are generally poor, the WHO said, adding, "Though some of these undiagnosed deaths occurred in family members of confirmed cases, the investigation has found no evidence of human-to-human transmission and no evidence that the virus is spreading more easily from birds to humans."


The Cikelet situation comes about 3 months after seven confirmed avian flu cases and one probable case occurred in an extended family in the Indonesian province of North Sumatra. That cluster brought the first laboratory-confirmed instance of human-to-human transmission and the first three-person chain of cases. However, the WHO concluded that the disease did not spread outside the family.

Indonesian officials today played down the likelihood of a case cluster with person-to-person transmission in Cikelet, according to the AFP report.

I Nyoman Kandun told AFP that the cases couldn't be classified as a cluster at this point because the patients lived too far apart to have come into contact.

The 17-year-old boy who survived the illness had contact with a cousin who was one of the three people who died of possible avian flu without being tested. The WHO said previously that person-to-person transmission was highly unlikely in that instance because both patients were exposed to sick chickens and both got sick the same day, whereas there would have been a delay if one had been infected by the other.

Another suspected case-patient from the Cikelet area, a 4-year-old girl, was removed from a hospital today by family members against the advice of doctors, the Jakarta Post reported. After she showed some improvement, the family decided to treat her at home, though her test results were still awaited, said a spokesman for Dr. Slamet General Hospital in Garut regency.

The story described the girl as one of 11 people from Cikelet with suspected or confirmed avian flu.

The latest confirmed case raises the WHO's global avian flu toll to 240 cases with 141 deaths. That includes 95 cases so far this year, equal to the total for all of 2005. Sixty-four people have died of the illness so far this year, compared with 41 for all of last year.

FAO lists Balkans as high-risk area

In other developments, the United Nations Food and Agriculture Organization (FAO) said today that the spread of avian flu among poultry has slowed in most countries, but warned that the southern Balkan countries and the Caucasus are a "high-risk region" for more outbreaks.

"The region is not only a prime resting ground for migratory bird species, but poultry production is mostly characterized by rural and household husbandry with little in terms of biosecurity and strong regulatory inspection. In Romania it is still too early to say if the situation has stabilized," said Juan Lubroth, head of the FAO's Emergency Prevention System for Transboundary Animal Diseases, in a news release.


The agency said H5N1 has been confirmed in 55 countries, up from 45 in April. But the virus's spread among poultry has been slowed by efforts to improve surveillance, strengthen veterinary services, and, in some cases, vaccinate poultry, officials said.

"More than 220 million birds have died from the virus or been killed in culling activities aimed at stopping the spread of the disease," the FAO said.

To fight avian flu, the agency said it has received US $67.5 million so far and has signed agreements with donors for another $29 million. An additional $25 million has been promised. The FAO has disbursed $32.5 million since donor countries at a conference in Beijing last January pledged $1.9 billion for the campaign to stop the virus.

See also:

Aug 21 WHO statement

http://www.who.int/csr/don/2006_08_21/en/index.html

WHO avian flu case count

Aug 21 FAO news release

http://www.fao.org/newsroom/en/news/2006/1000378/index.html

[wetDirt]

Re: INDONESIA - Garut Cluster Part III

"Also needed the supervision from the official to prevent the mobilisation of the inhabitants and the poultry"
[snip]

How about ,"keep the inhabitants from moving poultry around." That would make sense, since they assume that people get it from poultry.