Two more bird flu deaths confirmed in Indonesia

[Joe Neubarth]

Two more bird flu deaths confirmed in Indonesia
Mon May 22, 2006 2:13 PM IST169

JAKARTA (Reuters) - Local tests have confirmed two more people have died of bird flu in Indonesia, a senior health ministry official said on Monday.

One of the victims belonged to a Sumatran family at the centre of fears of human-to-human transmission after six members of the family died this month of bird flu.

"One man from the same Sumatra cluster died this morning. He is the father of the child who died on May 13. He ran away after he received Tamiflu," said I Nyoman Kandun, director-general of communicable disease control at the health ministry.

"He was found in the village later but refused treatment," Kandun told reporters.

Local results on bird flu cases are not considered definitive and need confirmation from the World Health Organisation.

The WHO confirmed last week that six family members from Kubu Simbelang village in North Sumatra province were infected with the H5N1 avian influenza virus.

Kandun said there was no evidence the H5N1 virus had mutated in the Kubu Simbelang cluster case, which has drawn global concern because officials have found no definitive source of the outbreak.

Most cases of human infection worldwide have been through contact with sick poultry or their droppings. Tests on poultry in the village were positive for the H5 subtype virus but more tests are need to confirm it they were infected with H5N1.

Tests on pigs have been positive for antibodies, suggesting they were recently infected with H5N1.

Kandun said a 38-year-old man from Jakarta who died last week had also been declared positive for bird flu by local tests.

The WHO has confirmed 32 fatalities from avian influenza in the world's fourth most populous nation, the second highest number of human deaths after Vietnam.

The virus has spread in birds at an alarming rate in recent months, sweeping through parts of Europe, down into Africa and across into South Asia.

It is difficult for humans to catch, but experts fear the virus could evolve into a form passes easily from human to human, causing a pandemic that could kill millions.

[HenryN]

Commentary at

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

[HenryN]

No need to yet be done by the Extermination of the Livestock in Karo

Written by editorial staff

On Monday, on May 22 2006

Medan (SIB) The extermination (stamping out) the nonpedigreed chicken, the duck, entok and the pig in the Fortification Village Simbelang the Subdistrict three Karo Regency bows, need not yet be done. This referred in results of the team invetigasi the case of bird flu that said was not found by the indication of the virus incident avian influenza (AI) H5N1 or bird flu to the chicken livestock, the duck, entok and the pig around the house of bird flu casualties that lived in the village. The head of the Information Body and Communication of the North Sumatran Provincial Government of Eddy Syofian said Gubsu Rudolf M. Pardede, on Friday (18/5) accepted results of the investigation of Kesehatan Breakingprep Hewan Direktorat Jenderal Breakingprep Peternakan Departemen Breakingprep Pertanian RI Sjamsul Bahri Director. Was based on Director's Letter the Health of the Animal of No 4944/PD.650/F.5/05/06 dated May 19 2006 that stated, the government need not yet carry out the extermination action (stamping out) against the poultry and the other animal, except if in further investigation was proven by the virus H5N1 to these animals. At this time, the Service and the regency of province Livestock Breeding carried out the control action of carrying out the vaccination and bio security in the Kabanjahe area and surrounding area as well as continued melakukkan counselling to develop the interest and the awareness of the community about this AI illness. Moreover also will be done survellans (investigation) and the study epidemologi that more comprehensive. The team of investigation consisted of the Directorate of the Health of the Animal, the North Sumatran Livestock Breeding Service, the Karo Regional Government, as well as the Investigation Hall and the Testing Veteriner Regional I Medan. “Pemusnahan the related livestock anticipation efforts of the spreading of the bird flu virus, that the authority of the government of the centre. With the existence of Director's Letter the Health of the Animal to North Sumatran Governor, became the guide need not yet be done by the extermination of the livestock in the Fortification Village Simbelang,” said Eddy Syofian responded to Agriculture Minister's statement of Anton Apriyantono in the mass media that stated the government will destroy the animal, the chicken and the duck of the pig livestock that was in a radius of 1 kilometre (km) from suspect bird flu casualties in the Karo Land, North Sumatra. In Director's Letter the Health of the Animal was named also results of investigation in the Kabanjahe area indeed were received by results of the positive serology test to the nonpedigreed chicken, the duck, entok and the pig, but results of the test of RT-PCR (the diagnosis must be not him the bird flu virus to the animal) the negative. “Hal this showed the livestock in the Kabanjahe area indeed had been flattest by the AI Virus or was results of the vaccination to the poultry, but no longer contained the virus of AI H5N1,” said Sjamsul Bahri in his letter to Gubsu. (A12/e)

http://www.hariansib.com/index.php?o...=5234&Itemid=9

[HenryN]

More commentary

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

[HenryN]

KesehatanSenin, on May 22 2006 21:16 WIB Does Ginting, followed the Child died because of BurungFluMedan -- MOIL: Does Ginting, 32, the patient suspect bird flu from the Karo Regency, North Sumatra died, in the Kabanjahe Public Hospital, Karo, on Monday (22/5), struck 09.00 WIB. Does followed his child of Rafael Ginting, 10, that has died on Saturday.

http://www.mediaindo.co.id/berita.asp?id=100551

[HenryN]

Liputan6.com, the Karo Land: Hundreds Of traders and the chicken breeder in Kabanjahe and Brastagi, the Karo Land, demonstrated in the Building of DPRD North Sumatra, on Monday (22/5).They felt they incurred a loss by spreading him rumours of bird flu or avian influenza that caused agricultural efforts and livestock breeding was buried.The traders that the turnover beforehand reached Rp 6 million per the day, for example, currently only Rp 100 thousand.To convince the member the Council that their chicken was not affected by bird flu, demonstrators cut off a chicken and cooked him in front of them.In his oration, the traders and the poultry breeder also felt incurred a loss by the statement of Health Minister Siti Fadilah Supari.In his statement, Menkes ascertained the Karo Land as the source territory of the spread of related bird flu the death seven citizens of the Simbelang Fortification.They demanded Menkes apologised.Until this the source of the spread of the case cluster the bird flu family in the Karo Land was not yet found [read: the Source of Bird Flu in Medan was not yet known].Cluster was the spread of the sub-type virus H5N1 the cause of bird flu antarmanusia that happened in the scope of the family or the certain environment.Strangely, was based on results of the laboratory test, the poultry in the region was not infected by the virus H5N1.The case cluster bird flu in this Karo Land was the case cluster biggest the number two in the world after the similar case in Azerbaijan that killed nine people.(YYT/Tim Coverage 6 SCTV)
http://www.liputan6.com/view/7,12326...148305445.html

[Goju]

So... the people in closest contcat with poultry are gathering in large groups protesting.

Nice viral transmission and mixing opportunity

An interesting side effect of culling operations

[HenryN]

Seven from nine patients suspect bird flu in Karo, North Sumatra, died.This incident increasingly mengkukuhkan the Karo case as cluster biggest bird flu in Indonesia.
http://www.detiknews.com

[Mellie]

http://www.recombinomics.com/News/05...ties_Grow.html
Fatalities in H5N1 Cluster in Medan Indonesia Grow

Recombinomics Commentary
May 22, 2006

"One man from the same Sumatra cluster died this morning. He is the father of the child who died on May 13. He ran away after he received Tamiflu," said I Nyoman Kandun, director-general of communicable disease control at the health ministry.

"He was found in the village later but refused treatment," Kandun told reporters.

Kandun said there was no evidence the H5N1 virus had mutated in the Kubu Simbelang cluster case, which has drawn global concern because officials have found no definitive source of the outbreak.

The above comments indicate that now 7 of the 8 members of the H5N1 bird flu cluster in Sumatra have died. The possibility of further spread by the uncle is also of concern since he left the hospital prior to death.

Transparency issues are again raised because of WHO statements that there was no evidence of spread beyond the family members, but failed to mention the symptomatic uncle. A family member near death with bird flu symptoms, who has refused Tamiflu, is evidence of spread in the family and should be included in the update.

Transparency on sequences also remains suspect. The statement that there was no evidence of H5N1 mutation is not credible.. H5N1 is constantly evolving, and there are at least two distinct H5N1 sequences for human cases in the Jakarta area. Efficiency in H5N1 spread is not solely dependent or reassortment, changes in the receptor binding domain, or acquisition of PB2 E627K.

All of the human sequences sequestered at the WHO private database should be released immediately, so the human sequences can be fully analyzed and compared to animal sequences. Included in the release should be the sequences from the cluster in Sumatra, which is the most deadly reported to date, and contains the longest transmission chain reported to date.

[Mellie]

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

Growing H5N1 Transmission Chain in Indonesia Raises Concerns

Recombinomics Commentary
May 22, 2006

The growing H5N1 bird flu transmission in Medan, Indonesia has raised transmission and transparency concerns. The cluster has now grown to eight, and seven members of the cluster have died. H5N1 has been confirmed in all except the index case and the disease onset dates indicate there have been three generations of human-to-human (H2H2H) or possibly four generations (H2H2H2H).

The index case developed symptoms on April 27. There was a family barbeque on April 29 and other family members began showing symptoms in early May. This gap between the disease onset date of the index case and additional family members indicates human-to-human transmission (H2H). Seven family members developed symptoms, and six were confirmed to be H5N1 positive. However, the last member to develop symptoms died on May 13 (the index case died on May 4 followed by deaths on May 9, 10, 12, 13, 14). That family member was the nephew of the index case and may have been infected by other family members, which would represent H2H2H.

Today his father died and has been H5N1 confirmed, suggesting the transmission chain has grown to H2H2H2H, which would represent the longest H5N1 transmission chain to date.

The cluster was described in the WHO update of May 18. The update described the index case and seven family members who had symptoms, including the uncle who is still alive and the nephew who had tested negative. Although the disease onset date fro the index case was given, the update withheld the disease onset dates for the family members.

Moreover, the update failed to mention the father of the nephew who died on May 13. The uncle had symptoms, had been given Tamiflu, and had left the hospital. He refused further treatment and died. However, this travel into the community prior to his death raises concerns about additional transmissions. The WHO update indicate that there was no evidence of spread beyond the immediate family, but did not reveal the release of the uncle and potential spread. The status of additional family members with early symptoms remains unclear.

The spread of H5N1 across three or four generations of infections is cause for concern. Sequences of H5N1 from the patients has been said to contain no mutations, but there is no indications that the sequences will be released. Sequences from only one Indonesian patient has been released. The sequence was deposited on August 1, 2005, but was withheld from the public until March 26, 2006. It has a novel cleavage site, which is shared by most of the sequestered human sequences from Indonesia. At least one sequence has a wild type cleavage site, but it has not been released. The sequences in this cluster would significantly increase the number of H5N1 human sequences from Indonesia, and should be done as soon as accuracy of the sequences has been determined. The other H5N1 sequences at the private respiratory should be released immediately.

The withholding of disease onset dates and the status of the family member who died today reduces credibility and dictates release of the sequestered sequences.

[Commonground]

From Dr. Nimans commentary:

"The uncle had symptoms, had been given Tamiflu, and had left the hospital. He refused further treatment and died. However, this travel into the community prior to his death raises concerns about additional transmissions. The WHO update indicate that there was no evidence of spread beyond the immediate family, but did not reveal the release of the uncle and potential spread."

This really gives me a slow burn.......I'm so angry at WHO!

[HenryN]

Originally Posted by niman

http://www.mediaindo.co.id/berita.asp?id=100551

The writer: Yennizar Lubis
Medan -- MOIL: Does Ginting, 32, the patient suspect bird flu from the Karo Regency, North Sumatra (North Sumatra) died, in the Kabanjahe Public Hospital, Karo, on Monday (22/5), struck 09.
00 WIB. Does followed his child of Rafael Ginting, 10, that has died last Saturday (13/6) in RSU Adam the Medan Owner.
Beforehand on Thursday (18/5), Does has suffered hot high, but the family only gave alternative medical treatment without being brought to the hospital.
Finally the family brought Does to the hospital, on Monday morning, when his condition has been increasingly serious.
Unfortunately could not be treated intensive, Does died.
The section head the North Sumatran Health, Fatni Sulatni named the staff dinkes already to Karo to become tangled more far.
The "patient indeed suspect bird flu, because he from one family that beforehand indeed was diagnosed by bird flu."
"
"

Moreover, Fatni also said them really the difficulty to the Simbelang Fortification Village, the Subdistrict of three bows, Karo because of the citizen in the village refused the team of the health that will check the citizen.
"They still too much were closed, so as we the difficulty."
"
"

In the meantime, dozens of people that mengatasnamakan the Community Karo Anti Bird Flu, did the action in the Office Governor North Sumatra and DPRD North Sumatra.
They did not accept the government statement that named their territory tertular bird flu.
They demanded the request sorry the government because it was considered has caused a loss to the Karo community in a manner morale and materil.
In his action in the Building of DPRD North Sumatra, the demonstrators brought four chickens that afterwards disembelih, was fried, then was eaten.
This action was held to show if in Karo did not have bird flu.
In his oration, the demonstrators said resulting from this government statement, the community was discredited psychologically.
Moreover they also experienced the decline in the sale turnover of the poultry.
One of the Karo communities, Imanuel Ancient the sale of their chicken descended since the existence of the statement from the government about their territory that was affected by bird flu.
They said will put forward the demand in a perdata manner to President, Menteri Kesehatan, North Sumatran Governor and the Karo Regent went through the Jakarta District Court the Centre.
The "Karo community will demand justice," said Tangam Sinambela.
(YN/OL-02).