Indonesia - West Java - Bird Flu Patient treated in Bandung Hospital - Confirmed H5N1, patient recovered

[Gert van der Hoek]

machinetranslated

on Saturday, 27/11/2010

The first patient in West Java presumed to have bird flu this year, is treated in RS Hasan Sadikin (RSHS) since November 22.

K, a woman is 21 years old she lived in the region Bandung Kulon.

http://us.bandung.detik.com/


Unexpected First Bird Flu Patient Treated in RSHS

Oris Riswan Budiana - detikBandung

Bandung - The first patient suspected H5N1 virus or bird flu in West Java this year, being treated at Hasan Sadikin (RSHS) since 22 November. K, 21-year-old woman was living in Bandung Kulon area.

This was confirmed by CEO RSHS Bayu Wahyudi when found in RSHS, Pasteur Road, on Friday (11/26/2010).

"Yes, there is a patient being treated, the situation is serious. She came 22 November with the state of pneumonia (inflammation of the lung - editor), shortness of breath, decreased consciousness, and other symptoms," said Bayu.

He explained that K Flamboyan treated at the Isolation Room. K is placed in that space because the symptoms of respiratory disease severe enough.

As is known, space is a special place for the treatment of patients with severe respiratory disease. For example, patients with H1N1 or swine flu (now called influenza A H1N1) and H5N1 or bird flu.

"We still do the examination and the results hopefully in the near future can be known," he said.

Based on the information collected, the woman suspected of contracting bird flu. That's because the clinical condition of the patient's body become heavy overnight. In fact, patients fitted with a ventilator or a ventilator since the first day of treatment.

http://us.bandung.detik.com/read/201...at-di-rshs?nhl

[Treyfish]

Saturday, 11/27/2010 14:07 pm
Patient K at RSHS Allegedly Strong Bird Flu
Oris Riswan Budiana - detikBandung

Bandung - treating K (21) in the Isolation Room Flamboyan RS Hasan Sadikin (RSHS), strongly suspected H5N1 virus or better known as bird flu. Therefore, the patient's condition deteriorated in a short time with symptoms that lead to bird flu.

It was said Primal Sudjana, physicians who are members of a special investigation team infectious disease. The team is a team of women from Bandung Kulon handle it.

"We are more suspicious of patients leading to H5N1 or bird flu. Due to the rapid clinical development become heavy," says Primal when contacted by phone on Saturday (27/11/2010).

He explained that the patient's condition when it comes to RSHS fairly bad condition. He suffered from abdominal pain, fever, and pneumonia (pneumonia-ed) weight. In fact, shortness of breath experienced by patients are already being felt a week before being taken to RSHS.

"He is shortness of breath a week before being taken to RSHS," he said.

Based on experience, he continued, patients with such conditions more suspected bird flu. Moreover, the patient was fitted with ventilators (ventilator-red) when first treated to date.

http://us.bandung.detik.com/read/201...rung?881104485

[Pathfinder]

Indonesian to English translation (Google)


Bird Flu Patients Unforeseen Already Improved

Saturday, November 27, 2010 | 22:33 WIBA

BANDUNG, Reuters - A woman suspected of contracting K berinisal H5N1 virus or bird flu. Now K is still being treated in hospital intensive Hasan Sadikin (RSHS) Bandung since six days ago. K suspected of having contracted bird flu in the Region of Cilacap. Condition K is now getting better than ever.

The Special Investigation Team of Communicable Diseases, Dr Primal Sudjana, Saturday (27/11) to the Tribune said the K come from six days ago. It was a very bad condition. He's since a week sebelm to RSHS already suffering shortness of breath, abdominal pain, fever, and pneumonia.

Obtaining and seeing the condition of the patient, then the RSHS, Primal said, immediately take action. That's three times the blood samples sent to K & D Department of Health to do kros checks on his illness, and recently contracted the flu virus known brung.

"Even now we are sending back a fourth time his blood sample to the research and development. To be sure," says Primal.

Primal Explained, now the patient's condition began to improve. His temperature is not too hot. Even the blood pressure drug, was not dikosumsikan back.

"Not bad there is progress, although still being treated in isolation rooms using a number of medical auxiliaries to his body," says Primal.

Primal is said, from the recognition of victims' families, K possible bird flu virus in the Region of Cilacap. Because some birds near his house a lot of sudden death. Meanwhile, at his residence in Bandung, no fowl. Even the team from Bandung Pertenakan Department have conducted investigations into the environment in the Region Bandung Kulon victims, and expressed negative bird flu.

"He was just living in Bandung since two months ago. Previously lived in Cilacap, and according to his family recognition there are many birds that died suddenly," says Primal. (Sob)



http://www.tribunjabar.co.id/read/ar...-sudah-membaik

[Shiloh]

Source: http://us.bandung.detik.com/read/201...gas?g991102485

Sabtu, 27/11/2010 20:25 WIB
Pasien Terduga Flu Burung Tidak Ada Kontak Dengan Unggas
Oris Riswan Budiana - detikBandung

Google translation:

Saturday, 11/27/2010 20:25 pm
Bird Flu Patients Unforeseen No Contact With Poultry
Oris Riswan Budiana - detikBandung

Bandung - K (21), patients suspected of bird flu or H5N1 virus from Bandung Kulon, has no history of contact with poultry. In fact, in the neighborhood of C And no one who suffered the same symptoms as women.

"Mrs K had no history of contact with poultry and there is no contact with diseased people alike," says Primal Sudjana, physicians who are members of specific communicable disease investigation team Hasan Sadikin (RSHS), when contacted via phone detikbandung, Saturday (27 / 11 / 2010).

In treating patients, he continued, carried out according to the standard handling of the World Health Organization (WHO). Until today, patients continue to show positive condition.

"Now the ventilator (a ventilator - ed) is still installed, but body temperature is not hot," he said.

In addition to installing ventilators, since treated, the doctors also provide a variety of drugs. Such drugs, including oseltamivir and drugs to raise blood pressure. However, drugs to raise blood pressure has been suspended since yesterday.

K treated at the Isolation Room Flamboyan RS Hasan Sadikin (RSHS) since 22 November. Strongly suspected H5N1 virus or bird flu known. Therefore, the patient's condition deteriorated in a short time with symptoms that lead to bird flu.

(ORS / ORS)

[Gert van der Hoek]

It seems this press release mentions:

1 confirmed H5N1 case , who entered the hospital as a suspect case. May be she still is a suspect, the press release is not clear to me.
On the other hand: reporting a suspect H5N1 case is not what you would expect the Ministry of Health in Indonesia would do.
I can't remember reporting a suspect bird flu case ever happened before. Well, you never know.

More details on the young woman with H5N1 in this thread: http://www.flutrackers.com/forum/sho...d.php?t=155610

1 confirmed H1N1 case

More details on the boy with H1N1 in this thread: http://www.flutrackers.com/forum/sho...d.php?t=155559


Both patients are treated in Hasan Sadikin Hospital in Bandung, West Java.



machinetranslated

BIRD FLU CASE REPORT UNTIL NOVEMBER 2010

At the end of November 2010 came / emerged the case of bird flu (H5N1) on behalf of Mrs. K (21 yo)

and the case H1N1 Child A (7 years) who were treated at Dr. Hasan Sadikin (RSHS).

Ny. K (21 yo), located at Jalan Holis Kodya signed on 22 November RSHS
2010, enter the status of "suspect H5N1" and is now being treated at room Flamboyan RSHS.

Whereas Child A (7 yo), located in Cibodas Regency Bandung, enter RSHS November 17, 2010,
current status () positive on the basis of notification from the Ministry of Health Research and Development

Number: LB.05.02/I/7574/2010 dated 19 November 2010 and currently also being treated at room
RSHS flamboyant.

RSHS already reported the case to the National Post Avian Influenza Ministry, Directorate of
Medical Services Association, the West Java Provincial Health Office, City Health Office Bandung, and
Bandung District Health Office.

This information is published by the Center for Public Communication, Secretariat General of the Ministry of Health.
For more information please contact via telephone: 021-52907416-9, fax: 021 -
52921669, Call Center: 021-500567, 30413700, or e-mail address puskom.publik @ yahoo.co.id,
info@depkes.go.id, kontak@puskom.depkes.go.id.

http://www.depkes.go.id/index.php/co...mber-2010.html

[Gert van der Hoek]

Today a press release Min of Health; she still seems to be a "suspect".


BIRD FLU CASE REPORT UNTIL NOVEMBER 2010

At the end of November 2010 came the case of bird flu (H5N1) on behalf of Mrs. K (21 yo)

.................

Ny. K (21 yo), located at Jalan Holis Kodya signed on 22 November RSHS
2010, enter the status of "suspect H5N1" and is now being treated at room Flamboyan RSHS.

http://www.depkes.go.id/index.php/co...mber-2010.html

[Shiloh]

Source: http://www.klik-galamedia.com/indexn...m=tatarbandung


Sabtu, 04 Desember 2010
RSHS Rawat Suspect H5N1

Google translation:

Saturday, December 4, 2010
Suspect H5N1 Patient RSHS

Pasteur, (GM) -
Despite already being treated for 12 days at room Flamboyan Hasan Sadikin Hospital (RSHS), but the status of the patient Mrs. K (21), residents of Bandung, has not been determined by the Ministry of Health of Indonesia cq Agency for Health Research and Development (Balitbangkes).

"The letter does not officially exist. But the symptoms shown by patients, it seems positive of H5N1 virus (bird flu, red)," team spokesman said the handling of bird flu and infectious disease infectious RSHS, dr. Primal Sudjana, Friday (3 / 12).

According to the Primal, allegedly leading to stronger positive for bird flu because the sample examination request more than five times. Balitbangkes usually just ask for sample tests of the suspect no more than five times.

Ny. K came in and received intensive care since 22 November. "If the result is negative, usually span of the sample examination is also much faster. Never mind many times. But, of course, to this day we still hope it's negative," he said.

Regarding the condition of the patient Mrs. K, according to Primal, already better than before. When arrived, the condition of Mrs. K was in critical condition with pneumonia (pneumonia) weight. The patient complained of abdominal pain and shortness of breath accompanied by high fever.

"To hell is past the critical period, although still assisted ventilator for breathing. Later in the lungs also still have spots," he explained.

Therefore, it is still waiting for other possibilities. This means patients could be suffering from a disease that is not suspect. "Especially the other possibility is there a history of other diseases before didiganosis bird flu," he said.

Regarding the possibility of C patients infected by members of his family, Primal can not ensure. Even to this day only contact between the patient with poultry has not been clear.

"Information about the transmission yet I got from family members. But surely we must do a diagnose the interview with the patient in order to ensure the disease," he explained.

Diagnose the process to be one part of treatment for suspected bird flu. Moreover, family members are not aware of any allegations of contact between patients with poultry. (B.107) **

[Gert van der Hoek]

Via e-mail, from Depkes (Min of Health) :


Thank you for your email concerning the avian flu case.

We have just received new report that Ny. K (21 th) is confirmed case now. She is alive and being treated in RS Hasan Sadikin, Bandung.

Best regards

Pusat Komunikasi Publik
Kementerian Kesehatan Indonesia

[sharon sanders]

Thanks Dutchy.

[Laidback Al]

Note that this confirmed individual is being treated in Bandung and apparently is a resident of Bandung Kulon, but she may have been exposed/infected in Daerah Cilacap in Central Java (post #3).

[Treyfish]

Wednesday, December 8, 2010

Health Office of Residence Monitor Bird Flu Suspect

BLK. FACTORY, (GM) -
Health Office (DHO) to monitor the full territory of Bandung residence suspect bird flu, Ny. K (21), which until now treated intensively in the Room of Hasan Sadikin Hospital Flamboyan (RSHS). Monitoring conducted across sectors with other agencies.

"Whatever the symptoms, health office epidimologi still investigating the incident directly to the location (place of residence, red). So it is with doing a diagnose or interviews with patients and other family," said Head of Monitoring Disease Bandung Health Office, dr. Yorisa Sativa, Tuesday (7 / 12).

Explained Yorisa, until now there has been no description of any poultry that died suddenly. In addition, there are no poultry farms whether legal or illegal in some suspect lived.

"For a while I have found no poultry that died suddenly. Even on a diagnose with his family, no contact with poultry," he explained.

Still, said Yorisa, intensive inspection and monitoring continue. Moreover, until now not known with certainty, the origin of the disease.

"If the suspect bird flu certainly caused by birds. Although home contact with poultry has not been found, we still ask the local health clinic to monitor the health conditions of its citizens," he said.

Cooperation is also carried out directly with the cantonal authorities. Health office officials expect the response and report directly if there are citizens who have symptoms of bird flu.

"Sometimes there are people who are afraid to report when symptoms are similar to the suspect. Therefore, the neighborhood must immediately report to the clinic for any preventive action," he said.

Cross-sectoral cooperation, he said, is for residents in the vicinity of suspected patients do not experience excessive anxiety or even caused a furore due to the suspect.

Meanwhile, a spokesman for the team handling the bird flu and infectious disease infectious RSHS, dr. Primal Sudjana said, to this Agency for Health Research and Development (Balitbangkes) have not submitted the results and status of the patient Mrs. K, who were treated since 22 November.

"We expect on Wednesday (8 / 12) This result will be we get," says Primal.

As reported earlier, when it comes to RSHS, Ny condition. K in critical condition with pneumonia (pneumonia) weight. Patients are also known to complain of abdominal pain and shortness of breath accompanied by high feverhttp://www.klik-galamedia.com/indexn...m=tatarbandung

[Gert van der Hoek]

The previous report from Gala Media describes the standard procedure in case of a positive H5N1 patient : health service looking for the source of infection; the direct contacts / family are checked/monitored.

In fact this is another confirmation of the patient in hospital being positive for H5N1.

[Gert van der Hoek]

machinetranslated

A citizen of Bandung Positive Bird Flu

WEDNESDAY, DECEMBER 8, 2010 |

TEMPO Interactive , Bandung - The bird flu virus re-emerged. Specific Diseases and Isolation Team Hasan Sadikin Hospital, Bandung, ensure there is an infection of influenza A subtype H5N1 virus in a resident Street Holis, Bandung. The source of the virus so far unknown.

The spokesman said team doctors Primal Sudjana, Hasan Sadikin Hospital has received confirmation from the Agency for Health Development Research Ministry of Health Jakarta, which examine a sample Ny. K, 21 years old. "Today has received a positive result (bird flu)," he told Tempo on Wednesday (8 / 12).

Ny. K is still undergoing treatment at room Flamboyan. He fills that particular disease isolation room since Monday (22/11) last. When arrived, his condition in a state of severe pain. "From the results of the examination, its features are similar to bird flu patients," said the doctor was a specialist in internal medicine.

The characteristics of people with bird flu after the virus incubation period of 1-7 days of them suffered from upper respiratory tract infection, high fever up to temperatures over 38 degrees Celsius, sore throat, headache, sudden weakness, and the most serious to arise pneumonia (pneumonia). The first symptoms resemble the common cold.

According to the Primal, the patient's condition has gradually improved. Tools respirator had been removed, the patient also had no fever, and can communicate. "Just a cough that is still there. If breathing is restored only able to go home," he said.

The team of doctors has not been able to confirm the source of the virus. But according to the Primal, the patient had been fond of eating chicken. "He said (chicken), cooked, baked or what we do not know," he said.

Bandung City Health Department officials and the local Community Health Centre who monitor and check around the house was nil patients get the source of transmission of bird flu virus.

To this day, according to the Section Head of Monitoring Disease Yorisa Sativa, husband and child patients are also neighbors who live in the same house no one contracted the virus.

"They did not keep poultry at home also no sudden deaths of poultry in the vicinity of their homes," he said, Wednesday (8 / 12).

Tempo Interaktif

[Gert van der Hoek]

Indonesia reports bird flu, influenza A/H1N1 cases

2010-12-09

JAKARTA, Dec. 9 (Xinhua) -- Indonesian Health Ministry has reported one bird flu case and one influenza A/H1N1 case in West Java province, spokesperson of the ministry Tri Tarayati said here on Thursday.

A 21 year-old woman had been treated in Hasan Sadikin Hospital in Bandung the capital of the province for having bird flu (H5N1) and a 7-year old girl has also got medical treatment at the hospital for having A/H1N1 influenza virus, the spokesperson said.

The woman has started having medical treatment at the hospital since Nov. 22 and the girl on Nov. 17, she said. "All the laboratory test show that they are positive on bird flu and swine flu. Now all of them still have medical treatment in the hospital," she said.

The cases has put the total number of bird flu cases in Indonesia to 169 with 138 fatality since recent years. (edit: 141 have been fatal - WHO)

A/H1N1 Influenza virus has killed ten people in the country.


From ProMED:

This case, when officially confirmed, will represent the 171st human
case of avian A/(H5N1) virus infection to have occurred in Indonesia
since the outbreak began in 2005, and the 9th in 2010.


.

[Giuseppe Michieli]

WHO, Avian influenza – situation in Indonesia - update 5 (Dec. 09 2010, edited)


[Source: World Health Organization, full text: WHO | Avian influenza – situation in Indonesia - update 5. Edited.]

Avian influenza – situation in Indonesia - update 5


9 December 2010 -- The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza.

A 21-year-old female from Bandung City, West Java, Province developed symptoms on 14 November, was hospitalized on 22 November and is currently in hospital.

Initial investigations indicate the case resided in an area close to a business where chickens were kept and the area was found to be lacking cleanliness with chicken droppings present.

Additional investigations on the possible source of infections are being undertaken.

Laboratory tests have confirmed infection with the H5N1 avian influenza virus.

Of the 171 cases confirmed to date in Indonesia, 141 have been fatal.
-
------

[Shiloh]

Source: http://www.klik-galamedia.com/indexn...m=tatarbandung

Jumat, 10 Desember 2010
Warga Diminta Waspada
Ny. K Positif Terjangkit Flu Burung

Google translation:

Friday, December 10, 2010
Citizens Asked to Beware
Ny. K Positive Bird Flu
Pasteur, (GM) -
Ny. K (21), resident district. Bandung Kulon, Bandung tested positive for the H5N1 virus or bird flu. Results were based on sample checks are carried out repeatedly by the Agency for Health Research and Development (Balitbangkes) RI delivered at the Hasan Sadikin Hospital (RSHS).

According to a spokesman for the Infectious Diseases Special Handling Team RSHS, dr. Primal Sudjana on Thursday (9 / 12), was officially received by RSHS results on Wednesday (8 / 12). However, despite positive but no additional treatment to the mother of one child. "Treatment performed as before," he said.

Moreover, says Primal, Ny patient's condition. K gradually increased than when you arrived. At that time, on November 22, Ny. K in critical condition with pneumonia (pneumonia) weight, there are spots on the lungs, and direct entry RSHS Flamboyan Room. Patients also complained of abdominal pain, shortness of breath, and high fever.

"Yesterday you have removed the ventilator breathing apparatus. But of course, until now, we keep watching," he explained.

Above positive results, the Health Department as well as both the city of Bandung in West Java province immediately got a copy. "Before the positive or still suspect, in fact already given their report," he said.

Residents wary

Meanwhile, Bandung Health Office will conduct an intensive counseling, particularly to residents in the vicinity of the patient. Similarly to other family members.

"Actually, the source of the virus (patient Mrs. K, red) has been intensively treated with medical care at RSHS. Therefore, health offices would stay to continue what has been done before," said Head of Monitoring Disease Bandung Health Office, dr. Yorisa Sativa through his cell phone to the "GM".

DHO through district health centers in the region. Bandung Kulon will complete the extension and asked residents wary. In addition to the clinic were asked to report if there are sudden deaths of poultry animals, residents also have to improve hygienic behavior (PHBS).

"Even to this day according to a report from the Animal Husbandry Department, Bandung, no poultry that died suddenly, alert citizens do not need to worry excessively. The important thing was that, do hygienic behavior," he explained.

Mrs positive status. K, according Yorisa, carrying the first case in Bandung. In the period 2007-2009, the institute also found no positive cases in humans. "But if the poultry that died suddenly in their urban areas, the report is on Disnak," he said. (B.107) **

[Shiloh]

Source: http://tempointeraktif.com/hg/bandun...298240,id.html

Pasien Flu Burung di Bandung Sembuh Total
Sabtu, 11 Desember 2010 | 14:48 WIB

Google translation:

Bird Flu Patients Recover Total Bandung
Saturday, December 11, 2010 | 14:48 pm

TEMPO Interactive, Bandung - a double dose of antiviral drugs managed to heal a total of Ny. K, 21-year, bird flu patients in Bandung. Residents had been a patient Road Holis to-4 of the 13 bird flu patients who survived during treated at room Flamboyan Hasan Sadikin Hospital, Bandung, since 2007.

Team Leader Special Diseases and Isolation Hasan Sadikin Hospital, Bandung, Dr. Hadi Yusuf said the team doctors expressed joy over total healing Mrs. K. Patients undergoing treatment since 22 November and was allowed home yesterday. "The H5N1 virus was gone," he told Tempo, Saturday (11/12).

According to Hadi, the doctors still use the drug and the same way as last year in curing patients of bird flu. Until day 5, patients were given normal doses of Tamiflu with twice daily 75 milligrams each. On day-6, the drug is given at a dose two-fold. "Just two days ago stopped the medicine," said Hadi.

Team doctors previously agreed to use a combination of drugs amantadine and zanamivir if tamiflu not effective to kill the virus. But the import of drugs that are not yet available in Indonesia. "The drug was quicker and easier because it is injected," he said.

In addition to the handling factor, Hadi said, the recovery of the patient's condition because of the bird flu virus strain type was not Gana. Patient's immune system is strong enough. "Thank God, it usually dies," he said.

Of note a team of doctors, only 4 of 13 bird flu patients who were treated at Hasan Sadikin survived.

About the origin of the virus, a specialist in internal medicine, said the spread of the virus to humans through an intermediary poultry, like duck, duck, chicken, and birds. The animal did not die though attacked by a virus, but still carry the virus of bird flu throughout his life. So far the team of doctors and Bandung Health Office has not been able to ensure the bird flu virus in the body of Mrs. K.

From the recognition of patients and their families, the patient had no contact with poultry. From penelurusan officers and Community Health Centre, around the patient's home environment to a radius of 300-400 meters was also not found in birds died suddenly.



ANWAR Siswadi

[Laidback Al]

Originally Posted by Shiloh

Source: http://tempointeraktif.com/hg/bandun...298240,id.html

Pasien Flu Burung di Bandung Sembuh Total
Sabtu, 11 Desember 2010 | 14:48 WIB

Google translation:

Bird Flu Patients Recover Total Bandung
Saturday, December 11, 2010 | 14:48 pm

TEMPO Interactive, Bandung - a double dose of antiviral drugs managed to heal a total of Ny. K, 21-year, bird flu patients in Bandung. Residents had been a patient Road Holis to-4 of the 13 bird flu patients who survived during treated at room Flamboyan Hasan Sadikin Hospital, Bandung, since 2007.

Team Leader Special Diseases and Isolation Hasan Sadikin Hospital, Bandung, Dr. Hadi Yusuf said the team doctors expressed joy over total healing Mrs. K. Patients undergoing treatment since 22 November and was allowed home yesterday. "The H5N1 virus was gone," he told Tempo, Saturday (11/12).

According to Hadi, the doctors still use the drug and the same way as last year in curing patients of bird flu. Until day 5, patients were given normal doses of Tamiflu with twice daily 75 milligrams each. On day-6, the drug is given at a dose two-fold. "Just two days ago stopped the medicine," said Hadi.

Team doctors previously agreed to use a combination of drugs amantadine and zanamivir if tamiflu not effective to kill the virus. But the import of drugs that are not yet available in Indonesia. "The drug was quicker and easier because it is injected," he said.

In addition to the handling factor, Hadi said, the recovery of the patient's condition because of the bird flu virus strain type was not Gana. Patient's immune system is strong enough. "Thank God, it usually dies," he said.

Of note a team of doctors, only 4 of 13 bird flu patients who were treated at Hasan Sadikin survived.

About the origin of the virus, a specialist in internal medicine, said the spread of the virus to humans through an intermediary poultry, like duck, duck, chicken, and birds. The animal did not die though attacked by a virus, but still carry the virus of bird flu throughout his life. So far the team of doctors and Bandung Health Office has not been able to ensure the bird flu virus in the body of Mrs. K.

From the recognition of patients and their families, the patient had no contact with poultry. From penelurusan officers and Community Health Centre, around the patient's home environment to a radius of 300-400 meters was also not found in birds died suddenly.


ANWAR Siswadi

There is some significant information in this media report. First, the woman survived and was released from the hospital. A rarity in Indonesia where most infected individuals usually die.

Second, she was treated with Tamiflu at a double dose starting on day 6. Based on the timeline she received 1 daily dose of Tamiflu from November 22 to November 28 and then a double dose for at least another 10 days until about December 8 or 9. This apparently is now the standard treatment for H5N1 in Indonesia. Amantadine and zanamivir appear to be considered a second line of defense for H5N1, but seem to be not readily available.

Finally, there appears to be no association of the individual with sick or dying poultry. The speculation is that the infection was transmitted from an asymptomatic duck or chicken.