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**HenryN** · October 18, 2006, 12:30 PM

Re: Suspect Fatal Cluster in South Sulawesi

The student Rappang was expected Terjangkit BurungFlu (19 Oct 2006, 5 x, printed, Comment) PAREPARE --
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the Student from Rappang, the USA, 13, was expected has terjangkit the bird flu virus.The citizen from Street Poros Rappang-Enrekang, this, in fact since last October 17 has been treated in RSU Andi Makkasau, Parepare.The USA that was recorded as the class student of Ii SMP was delivered by his father, Sudirman, entered the Intensive Care Unit's space (UGD) RSU Andi Makkasau, around pukul13.05 Wita, on Sunday, on Tuesday, October 17.The same day, Asrullah was moved to Interna Space (the Water Lily) the III Class.Syamsuddin, the US uncle that guarded him in kamarsaid, they brought the USA to the hospital, because hot his body was very high.The condition had begun since dozens of his chickens died suddenly.The USA, said he, could be treated in the Rappang hospital before being reconciled to Parepare.Information that was assembled by the Dawn in the hospital mentioned, apart from the temperature of the high body, since the last two days, the USA also experienced breathless, the cough had phlegm, myalgia, was sick during swallowed, and sometimes had a headache.The hospital side denied it if the USA suspek bird flu.According to Dr RenyAngreani, one of the doctors that handled the USA, this patient was only attacked by asthma."That suspicious if he was attacked by the bird flu that dithere (RS Sidrap, red)."If we here were not available.That was based on the picture of the laboratory.So if wanting to ask the matter of bird flu that attacked the USA, please asked to Sidrap, said Reny.Was based on results of the photograph, according to Reny, clean also results."If bird flu must have the picture penemoni."But Asrul not.Results of his photograph were clean.His white blood cells were also not high.Nevertheless we every day controlled him, explained the doctor mudathis while continued that the temperature of the US body 38 levels celcius.According to him, the matter of results that showed the level of SGOT (the function of the heart) high, reached 43 U/I, not the characteristics of bird flu.Nevertheless, Reny acknowledged that the patient that suffered breathless that also one of the indications of bird flu."My conclusion with the team radiobiologi,
</PRE>

http://www.fajar.co.id/news.php?newsid=28896
</PRE>

</PRE>as well as the laboratory was concluded that is not found signs suspek bird flu."
His blood also will not be sent by us to Makassar, stated Reny.
In the meantime, from the monitoring of the Dawn, the afternoon yesterday, the USA was still being rolled over weak di
the room of his place doctor was treated.
He claimed to be the temperature of his body rose after his chickens died.
Nevertheless, he claimed already rather baikan.

**GaudiaRay** · October 18, 2006, 12:42 PM

Re: Suspect Fatal Cluster in South Sulawesi

It's worth noting the Indonesian "story" here is either the poultry at their home died (recently, whatever that is), or poultry in the "area" died recently.

Should someone have the ability to translate this, it would be clarifying, >That definitely, continued Said, in this location indeed has many kept poultries the citizen who died suddenly with the sign was attacked by bird flu.<

We know from reports that in the recent past it was projected that in Indonesia, certainly in its countryside, fully 1/4 of all poultry is infected with H5N1. Further, I've posted what is known to me, that South Sulawesi is the "Arkansas" / Holland of Indonesia, the home of large-scale chicken raising.

ED: From the second/later post above, we read, as to yet a different young person, age 13, from a different family as he is in not mentioned in the first posting > He claimed to be the temperature of his body rose after his chickens died.<

This person is apparently NOT from the same family. Therefore this strain / clade of HPAI, H5N1 appears to have no affinity to the genetic "bias"/precondition of a specific genetic lineage. But maybe this 13 year old is related in some close way, such as being a cousin/uncle/nephew/brother-in-law?

Based on the infection in the second person, the 13 year old, and the fact that two more of the deceased infant's family are now "suspect"-infected, we can reasonably expect more people who've had contact to become sick, if H5N1 is now efficient, H2H. We will be watching closely for 3rd Generation infection and the ease of its transmission, should it arise.

And, further, the infection raises probable confirmation that a significant minority of the poultry in South Sulawesi is infected with H5N1, and it being backyard raised, and even at the larger producers, very probably raised in un-isolated conditions (based on my observation of Indonesian farming and business practices when I was there in the cities, industrial districts and farms). The consequences of these conditions raise speculation as to further developments, do they not?

**HenryN** · October 18, 2006, 12:47 PM

Re: Suspect Fatal Cluster in South Sulawesi

Originally posted by niman

The student Rappang was expected Terjangkit BurungFlu (19 Oct 2006, 5 x, printed, Comment) PAREPARE --

</PRE>

the Student from Rappang, the USA, 13, was expected has terjangkit the bird flu virus.The citizen from Street Poros Rappang-Enrekang, this, in fact since last October 17 has been treated in RSU Andi Makkasau, Parepare.The USA that was recorded as the class student of Ii SMP was delivered by his father, Sudirman, entered the Intensive Care Unit's space (UGD) RSU Andi Makkasau, around pukul13.05 Wita, on Sunday, on Tuesday, October 17.The same day, Asrullah was moved to Interna Space (the Water Lily) the III Class.Syamsuddin, the US uncle that guarded him in kamarsaid, they brought the USA to the hospital, because hot his body was very high.The condition had begun since dozens of his chickens died suddenly.The USA, said he, could be treated in the Rappang hospital before being reconciled to Parepare.Information that was assembled by the Dawn in the hospital mentioned, apart from the temperature of the high body, since the last two days, the USA also experienced breathless, the cough had phlegm, myalgia, was sick during swallowed, and sometimes had a headache.The hospital side denied it if the USA suspek bird flu.According to Dr RenyAngreani, one of the doctors that handled the USA, this patient was only attacked by asthma."That suspicious if he was attacked by the bird flu that dithere (RS Sidrap, red)."If we here were not available.That was based on the picture of the laboratory.So if wanting to ask the matter of bird flu that attacked the USA, please asked to Sidrap, said Reny.Was based on results of the photograph, according to Reny, clean also results."If bird flu must have the picture penemoni."But Asrul not.Results of his photograph were clean.His white blood cells were also not high.Nevertheless we every day controlled him, explained the doctor mudathis while continued that the temperature of the US body 38 levels celcius.According to him, the matter of results that showed the level of SGOT (the function of the heart) high, reached 43 U/I, not the characteristics of bird flu.Nevertheless, Reny acknowledged that the patient that suffered breathless that also one of the indications of bird flu."My conclusion with the team radiobiologi,

</PRE>

http://www.fajar.co.id/news.php?newsid=28896

</PRE>

</PRE>as well as the laboratory was concluded that is not found signs suspek bird flu."
His blood also will not be sent by us to Makassar, stated Reny.
In the meantime, from the monitoring of the Dawn, the afternoon yesterday, the USA was still being rolled over weak di
the room of his place doctor was treated.
He claimed to be the temperature of his body rose after his chickens died.
Nevertheless, he claimed already rather baikan.

The student the JUNIOR HIGH SCHOOL Rappang was expected by Doctor's Bird Flu: Only contracted AsmaParepare, the Stand -- A class student two junior high school 2 Rappang, the Sidrap Regency, Asr (13), must be reconciled to the Hospital (RS) A Makkasau, the Parepare City, on Tuesday (17/10), because of being expected suspect bird flu.Asr could be handled a day in RS Arifin Nu'mang Rappang, the Sidrap Regency, before being moved to RS A Makkasau Parepare.From the report on RS Arifin Nu'mang reconciliation, this patient was it was suspected attacked by bird flu.Villagers Mario, the Kulo Rappang Subdistrict (the border Rappang-Enrekang), that was treated in the Aggrek ward, was separated with the child's other patient.Beforehand, he was in installation space treated the emergency.The Asr family brought him to the local hospital after experienced breathless, the cough had phlegm, and the high fever for two days.He could it was known be directly touching with the poultry died before being sick."Possibly because that so as information in reconciliation, he was reported suspect bird flu."However, after being checked by us, he evidently only contracted asthma.His patient has also been given by us the injection anbiotik, said Dr Amir, from the installation part treated the RS A Makkasau emergency, yesterday.In encountered in the maintenance ward, on Wednesday (18/10), Asr was seen still was limp with the infusion on the right hands.He was guarded by his two uncles, because his parents did not yet come.Apart from going to school, Asr also worked in a processing factory of unhulled rice.Now his father, Sudirman, a driver.Before being sick, Asr admitted to be able to be directly touching with his 10 kept chickens that died suddenly.(rip)</PRE>
http://www.tribun-timur.com/view.php?id=35496</PRE>

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**HenryN** · October 20, 2006, 08:56 AM

Re: Suspect Fatal Cluster in South Sulawesi

Commentary at

http://www.recombinomics.com/News/10..._Sulawesi.html

**Mellie** · October 21, 2006, 09:30 PM

Re: Suspect Fatal Cluster in South Sulawesi

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

Fatal Suspect H5N1 Cluster in South Sulawesi
Recombinomics Commentary
October 20, 2006

the Official of the Maros Health of the Service took the sample of blood against five citizens in the Bontopaddingin Village, the Bontotallasa Village, the Subdistrict Toss Up, on Wednesday October 18 yesterday.The taking of the sample of this blood, related the death a baby, Fajrin, 2 months that was expected suspect avian influenza (AI) or bird flu.

They who were taken the sample of his blood respectively the two parents Fajrin, the Dervish, 22 years with his wife, dahlias, 29 years.Three other citizens were still being the grandfather and the close Fajrin family respectively Kurdin, 60 years, Hj Indeed, 55 years, and Harbiah, 35 years.A Service staff the Maros Health, Muhammad Said, SKM M. Cash that led the taking of the sample of this blood in the location, mentioned, from the five citizens, two including being expected suspect bird flu.

The above translation describes a suspect fatal H5N1 bird flu case in South Sulawesi. In addition, at least two family members are hospitalized and several contacts are being tested. The H5N1 situation in South Sulawesi remains unclear.

Last month a fatal confirmed case from Mekassar was announced. However, the patient had died in June. The WHO update indicated the delay in reporting the confirmation was because it was collected during routine testing. However, the WHO update failed to mention the deaths of two family members who also had bird flu symptoms. Thus, the failure to report, couple with the misleading characterization by WHO is cause for concern.

Between the earlier fatal cluster and the current suspected fatal cluster, a large number of suspect cases have been hospitalized in South Sulawesi. Although these cases have tested negative, patients have been treated with Tamiflu which may lower the level of circulating H5N1 to a level that is below detection. False negatives are common in H5N1 cases and frequently multiple tests are required to detect H5N1. A recent confirmed H5N1 fatality in Thailand was tested nine times over several weeks, yet H5N1 was only detected at autopsy.

The frequency of H5N1 infections in Indonesian remains unclear. The H5N1 in patients does not match the H5N1 in poultry. Since a link to dead or dying poultry is usually required fro H5N1 testing, the level of H5N1 infections in patients with bird flu symptoms, but without a bird link is largely unknown.

If these patients have been infected with H5N1, they will have antibodies that can be detected 3-4 weeks after disease onset. It remains unclear how many of any surviving patients with bird flu symptoms are tested for convalescent H5N1 antibodies.

Similarly, sequence data from H5N1 positive cats has not been released. The only cat H5N1 sequence released to date does match the human H5N1 sequences, which provides additional evidence for a mammalian reservoir. Similarly, analysis of recently released H5N1 sequences in China show that recombination is frequent, and regions of identity are found in Indonesian patients, providing evidence for the introduction of new polymorphisms in Indonesia via migratory birds. H5N1 sequences from wild birds in Indonesia are also lacking.

The latest suspect cluster in Indonesia again highlights the need for expanded surveillance and more timely reporting.

Recent media reports indicate that there will be testing of waterfowl in the Trisik area, Yogyakarta, and the Eretan Coast, Indramayu. Thus far the only reported bird H5N1 from Java with the novel cleave site was from Indramayu. Although it did not match the majority of human cases, it was close to a small subset of patients infected at the end of 2005. The only other bird isolates with the novel cleavage site were from central Sumatra.

Although the novel cleavage site has not been detected outside of Indonesia, many polymorphism from patients in Indonesia have been detected in H5N1 in China, strongly implicating these isolates in the evolution of H5N1 worldwide, including several polymorphism that were widely detected in Indonesian patients. Moreover, the origins of these H5N1 sequences in China could be found in low path isolates in Hong Kong in the late 1970?s indicating low path flu sequences are also closely involved in the evolution of H5N1, which is largely driven by recombination, which was readily detected in the H5N1 from poultry, waterfowl, and swine in China.