Indonesia Human Cases - April 9, 2008 - 20th June 2008

[ironorehopper]

Originally Posted by rymich13

Man, these suspect cases are popping up like wildfire, I wonder if this means that a pandemic is iniment?

If you take a brief tour into Indonesia Human Cases thread archive, you will see an enormous amount of reports about human cases, possible, probable, suspected and confirmed.

This is the 'normal' pace of case reporting rate.

A pandemic could start at every moment, but one should always be cautious to state that it is imminent or it is starting.

A statement like this competes to UN agencies (WHO, UN General Assembly or others). That one can do in the meantime, is - however - to continue media scan and try to find out a way to help the people involved.

I hope this is the case.

King Regards, IOH

[rymich13]

Thank You, but it did say it might also be malaria.

[Commonground]

rymich13, yes, I agree with ironorehopper. Please familiarize yourself with our wealth of data here at the site. You can go to the Indo Human Cases thread which is here, the Indo Poultry thread: http://www.flutrackers.com/forum/showthread.php?t=53669, and also the Indo General Information thread: http://www.flutrackers.com/forum/sho...165#post158165. The main Indonesia section can be found here: http://www.flutrackers.com/forum/forumdisplay.php?f=516

I hope you can get all the information you need

[ironorehopper]

Originally Posted by rymich13

Thank You, but it did say it might also be malaria.

It is difficult to extrapolate conclusion from newswires rather confusing. But in the next few hours or days the situation will be more clear, with new pieces collected by media sources.

Indonesian archipelago experiences a widespread epizootics of H5N1 in poultry and animals and thus further human cases are anticipated.

IOH

[rymich13]

Thank You. This sure one friendly place. Again I thank you for the warm infomation.

[Laidback Al]

rymich13, since November of 2003 more than 380 human cases of H5N1 have been confirmed. That means there have been about 7 confirmed cases each month since 2003. However, the number fluctuates and there are more confirmed cases during the "flu season" of the temperate latitudes, and fewer cases in the off season. We are now heading into the off-season.

Because of variability in tracking and reporting of suspected cases from countries around the world, increases in suspected cases does not mean that the pandemic has started.

Several months ago in Egypt dozens of suspected human cases were reported every few days.
http://www.flutrackers.com/forum/showthread.php?t=26983

And in Thailand, where that has not been a confirmed H5N1 case since 2006, they routinely have many suspected human cases because they error on the side of caution.
http://thaigcd.ddc.moph.go.th/Bird_Flu_main_en.html

A pandemic could start at any moment, but one should always be cautious to state that it is imminent or it is starting.

This is good advice. And meanwhile, there is still time now to make personal and family preparations for a pandemic.

[Commonground]

[This was posted yesterday, involving poultry die-off in South East Sulawesi]

The poultry died suddenly in Kendari, caused panic

The resident Street Lasolo Kecamatan Kendari west the Kendari-South-East Sulawesi City.
This afternoon (19/5/2008) damaged startled after dozens of chickens and birds of the resident's livestock died suddenly.
Jumrin as Chairman RT SETEMPAT at once contacted the Kendari service of City livestock breeding to inspect directly the location.
Because of the resident of panic, dozens of poultry direct in discarded to the time, because of the confused resident on this condition.
However a few moments later, the Peternakan Service joint team and the Health of the Kendari City arrived dilokasi.
Without for a prolonged period this team at once spread to carry out spraying around the location of the death of the poultry till the radius some hundred metre.

The team of the related service also carried out the resident's isolation, by collecting data on all the resident while distributing some prevention medicine terjangkit him the plague of bird flu.
From the data that was assembled by this joint team stated that the death of this poultry was positive bird flu, because of that poultry carcasses that were thrown away by the resident to the time, immediately were taken again to afterwards be stockpiled as well as burnt.
Kendari Mayor Ir. Asrun at once visited the territory that terjangkit bird flu.
The Asrun arrival to see directly the truth of information at the same time warned direct to the local resident to serious responded to this incident and followed all the prevention instructions and the stages handled early suspect bird flu
http://news.okezone.com/index.php/Re...imbulkan-panik

[Dutchy]

TT is out here, this short report from MetroTV gives some more details on the suspect patients from Kendari:

- a lot of chickens died suddenly, infected by bird flu;

- patients display bird flu symptoms, like "crowded breath".

- testresults pending.



LIMA WARGA KENDARI DIDUGA TERINFEKSI FLU BURUNG

Lima warga di Kelurahan Sanua, Kecamatan Kendari Barat, Kendari, Sulawesi Tenggara, diduga terinfeksi flu burung. Mereka terdiri dari empat anak dan seorang dewasa. Selasa (20/5), mereka dirawat di Rumah Sakit Umum Daerah Sulteng karena mengidap gejala mirip flu burung, batuk dan sesak nafas.

Sebelum dirawat di lingkungan pasien ditemukan banyak unggas mati mendadak dan diduga terinfeksi avian influenza. Sejauh ini tim dokter sudah mengambil sampel darah kelima pasien tersebut untuk diperiksa lebih lanjut.(**)

http://www.metrotvnews.com/berita.asp?id=59386

[ironorehopper]

Indonesia has confirmed its 134th bird flu
Jakarta, May 14, 2008 - News Flash -

Test results from the Health Research and Development Center of the Ministry of Health and Eijkman Institute have confirmed that Isq, 15 year old girl from North Gandaria sub-district in South Jakarta was infected by H5N1 virus.

She had the symptoms of high fever, cough and faint.

She was admitted to Gandaria Hospital on May 8 2008, where she was then referred to Persahabatan Hospital on May 11 2008.

She died on May 12 2008.

Indonesia has now recorded 134 bird flu positive cases and 109 fatalities.
-
http://www.komnasfbpi.go.id/berita_eng.php?id=54
-----

[Dutchy]

Previous report refers to (snip Jakarta Post):

Istiqomah, a 16-year-old girl from Jakarta, and her brother Ahmad Rizki. Istiqomah died on May 14, 10 days after Ahmad.

One of their family members, Alamsyah, 24, is still being treated at Persahabatan Hospital in East Jakarta for bird flu-like symptoms.



Note: KOMNAS FBI says Istiqomah died on May 12.

[Dutchy]

Edit: this map and the table do not include the latest victim # 134 / # 109 (thanks to Commonground)


From Komnas FBPI this map:



H5N1 Confirmed Human Cases as of May 19, 2008

Cases: 133

Fatalities: 108






Province / No. of AI positive Human Cases /No. of Fatalities


1 West Java 33 27

2 DKI Jakarta 32 27

3 Banten 25 22

4 North Sumatera 8 7

5 East Java 7 5

6 Central Java 11 10

7 West Sumatera 4 1

8 Lampung 3 0

9 South Sulawesi 1 1

10 South Sumatera 1 1

11 Riau 6 5

12 Bali 2 2

Total 133 108

[Commonground]

[On the 15th Supari says they are waiting for results from the lab. Yet, the confirmed case count is up by one. In the second article, which is dated the day before, confirms the results from the mentioned lab]


Post #155:

That not yet Confirmed

According to information from the Nasional Pengendalian Committee of Bird Flu and Menghadapi Pandemi Influenza Preparedness (Komnas FBPI), to Thursday (15/5), the cumulative number the positive case of bird flu in Indonesia reached 135 sufferers, and 110 people including dying.

Health Minister Siti Fadilah Supari said, specimen from the patient who it was suspected was infected by the bird flu virus was taken.
Specimen was checked in two laboratories of the Health of the Department's reconciliation, that is the Laboratory of Badan Litbang Kesehatan Department of Health and the Eijkman Agency.
"Not yet confirm, still was checked, in-sequencing again," Fadilah Supari words.

Indonesia has confirmed its 134th bird flu
Jakarta, May 14, 2008 - News Flash -

Test results from the Health Research and Development Center of the Ministry of Health and Eijkman Institute have confirmed that Isq, 15 year old girl from North Gandaria sub-district in South Jakarta was infected by H5N1 virus.

She had the symptoms of high fever, cough and faint.

She was admitted to Gandaria Hospital on May 8 2008, where she was then referred to Persahabatan Hospital on May 11 2008.

She died on May 12 2008.

Indonesia has now recorded 134 bird flu positive cases and 109 fatalities.
-
http://www.komnasfbpi.go.id/berita_eng.php?id=54

-----

[Ningtyas]

Originally Posted by Commonground

[This was posted yesterday, involving poultry die-off in South East Sulawesi]

Because of the resident of panic, dozens of poultry direct in discarded to the time, because of the confused resident on this condition.

...because of that poultry carcasses that were thrown away by the resident to the time, immediately were taken again to afterwards be stockpiled as well as burnt...

No, it means that panic residents threw away dead chicken into the small river/ditch before reporting the case to the authority. The carcasses were taken again from the river later and be burnt and buried.

[Commonground]

Post #191

Even a different case count here. As of the 19th, it's 133 with 108 fatal.

[Dutchy]

Originally Posted by Commonground

Post #191

Even a different case count here. As of the 19th, it's 133 with 108 fatal.

Yes, thank you for pointing this out. This has happened before: updated map and updated table, however without the latest victim.

[Sally Furniss]

Originally Posted by Ningtyas

No, it means that panic residents threw away dead chicken into the small river/ditch before reporting the case to the authority. The carcasses were taken again from the river later and be burnt and buried.

Thanks Ningtyas for the clarification

[Commonground]

My records show we are still waiting on a confirmation (2nd test result) on this case:

Sumedang

Almahum Tini (54) - Sym: (?) Died: 5/9

[HenryN]

Commentary

http://www.recombinomics.com/News/05..._Denial_2.html

[Dutchy]

Reaction of "The Regional People's Representative Council" (DPRD) on the news on Tini Suhartini. They support the actions undertaken by Regional Lifestock Service and Regional Health Service.


The commission B supported Dispeterpan and Dinkes Prevention efforts of the Spread of Bird Flu

The case of the death NY Tini Suhartini (54), the patient who was expected suspect bird flu (Avian Influenza-AI) and was stated positive H5, received attention seius from DPRD Sumedang, West Java.

Moreover, DPRD supported Peternakan Service efforts and fisheries (Peterpan) and the Kesehatan Service (Dinkes).

That was raised by Drs Minan Sukarnan, MBA, Chairman Komisi B to the Passage, on Wednesday (21-5).

He said, the B Commission has peeked casualties's family in the Babakan Asem Village, Desa Ranjeng, Kecamatan Cisitu, just recently.

Mentioned, in his observation, his side indeed still was seeing the existence of the kept poultry that was released.

In fact, in accordance with the suggestion from the Peterpan Service so that all the poultries in the location of the patient suspect bird flu so that dikarantina.

According to Minan, DPRD joined in concerned after hearing the existence produced by the Hall of Pelelitian Kesehatan Dinkes West Java, that stated the positive patient H5 AI.

Indeed still ought to be expected, but anticipation must continue to be carried out.

And if enabling depopulation against the poultry in the Asem Round
apparently must be carried out, he said.

Because of this, if evidently the Peterpan Service must carry out the extermination -deppulasi - the poultry there, DPRD would mensupport him.
Yes was supported by us to the best of these efforts to kebakan together, he stated.

Acknowledged, results terkahir on the sample of the throat liquid and the sample of the deceased's blood NY Tini Suhartini, at this time still was done by the inspection in the Peneletian Hall and the Development of the Department of Health Health in Jakarta.

If indeed the death of the chicken suddenly and in a mass fashion, happened again kenapan not depopulation yes was carried out, he said.

Besides this, the B Commission supported also efforts that were carried out by the Kesehatan Service rank that apart from did monitoring and took the sample of the virgin from the sides that once physical contact deang casualties.

We indeed still were waiting for results of the laboratory inspection of the end.

But we made a plea to Dinkes to continue to carry out the monitoring in the field so as when being gotten perekembangan other against casualties's family, for example, as early as possible could be detected and carried out penecegahan in order to not spread, he said.

Minan hoped, the community's participation could be realised through mengkarantina his property poultry was their respective.

Although must didepopulasi, was hoped for could the birth of the awareness of the community because of being related to the safety of the poultry and the health of humankind.

http://endynews.blogspot.com/2008/05...erpan-dan.html

[Commonground]

Commentary

Another H5N1 Cluster Denied in Indonesia
Recombinomics Commentary 12:36
May 21, 2008

According to Mahbud, last May 1 Rizki complained was sick. "His body was hot." Hands, fingertips and foot very blue, said the father. Fortune was carried to the Yakriza Clinic, Tanah Kusir. "His diagnosis typhus."

A legacy of Rizki, Istiqomah showed the similar sign. Appetite descended, the tip of the finger turned blue and breathless. Isti could be treated two nights in the Gandaria Hospital afterwards were given by reconciliation to the Persahabatan Hospital, Rawamangun. Love, medical help could not rescue the life of the girl.

Priyanti, the team's member of the control doctor of Persahabatan Hospital bird flu, said, Istiqomah positive was affected by bird flu. The girl suffered hot was accompanied by the cough and breathless. The "photograph toraks him also showed the sign" of "pneumonia," said Priyanti.

At this time RS Persahabatan was also treating Alamsyah, 26 years, the older brother Istiqomah.

"Gandaria still could not be classified as cluster bird flu because of his incident just had one case and casualties that was ascertained positive also only one person," Togi words.

The above translation describes another H5N1 cluster that has been denied in Indonesia due to a mis-diagnosis and a false negative. The index case died with bird flu symptoms, including cyanosis in extremities. However, he was diagnosed as having typhus and not considered a bird flu case. His sister had similar symptoms, including cyanosis in extremities, but she was lab confirmed as H5N1 positive. Recent reports indicate the H5N1 was confirmed by a second lab, so she is an official case. A third sibling was hospitalized with symptoms, but declared H5N1 negative.

The cluster was then declared as a non-cluster because only one of the three siblings was confirmed. This denial is the third in the last four confirmed cases in Indonesia. In the earlier cases, one cluster involved a relative who died with respiratory problems, while the index case for the other cluster was mis-diagnoses with dengue fever. The diagnosis of dengue fever was questioned in media reports, but a mis-diagnosis was denied. The denial was accepted without question in a Promed commentary.

These denials of clusters has extended an under reporting trend that is widespread, but the denial of three cluster out of the last four confirmed cases is an H5N1 record. In the 1918 pandemic the most frequent mis-diagnosis were dengue fever, typhoid, and cholera. Indonesia has previous mis-diagnosed patients with dengue fever and typhus previous, which were subsequently lab confirmed as H5N1. However, the specific denials of obvious clusters are new.

In addition to the cluster denials, confirmation of cases is also delayed. One case described in local media has not been confirmed, and there is a cluster of five family members with symptoms, but typhus has again been mentioned, even though birds in the neighborhood died suddenly.

The increase in cluster denials in Indonesia is a cause of increasing concern.

http://www.recombinomics.com/News/05..._Denial_2.html

[Commonground]

You hit the nail right on the head, Dr. Niman. Excellent commentary.

[ironorehopper]

Originally Posted by Commonground

(...)
These denials of clusters has extended an under reporting trend that is widespread, but the denial of three cluster out of the last four confirmed cases is an H5N1 record. In the 1918 pandemic the most frequent mis-diagnosis were dengue fever, typhoid, and cholera. Indonesia has previous mis-diagnosed patients with dengue fever and typhus previous, which were subsequently lab confirmed as H5N1. However, the specific denials of obvious clusters are new.

(...)

In early '900 no laboratory diagnostics existed and perhaps today misdiagnosis could help to take a certain time from the authorities perspective.
I think Indonesian physicians are well skilled - at least in the most part of advanced hospitals - and they also deserve to be recognized an hard work at the centre of a storm.
Dealy in laboratory tests' confirmations are probably due to external factors, no directly controlled by medical staff.
IOH

[sharon sanders]

I agree the health care professionals are working very hard.




From Update on Avian Influenza from NEJM - 2008

http://www.flutrackers.com/forum/showthread.php?t=49821


"..The nonspecific clinical presentation of influenza A (H5N1) disease has often resulted in misdiagnosis of subsequently confirmed cases (Table 3); influenza A (H5N1) virus infection has been suspected in only a small number of patients. Health care staff should include influenza A (H5N1) virus infection in the differential diagnosis for patients who present with epidemiologic risk factors and unusual courses of illness, especially rapidly progressing pneumonia (see Fig. 2 of the Supplementary Appendix). "


From the above supplementary appendix -

"...Note that initial manifestations of H5N1 illness may be nonspecific or atypical
(e.g. fever with or without diarrhoea)..."

[ironorehopper]

Originally Posted by Florida1

I agree the health care professionals are working very hard.




From Update on Avian Influenza from NEJM - 2008

http://www.flutrackers.com/forum/showthread.php?t=49821


"..The nonspecific clinical presentation of influenza A (H5N1) disease has often resulted in misdiagnosis of subsequently confirmed cases (Table 3); influenza A (H5N1) virus infection has been suspected in only a small number of patients. Health care staff should include influenza A (H5N1) virus infection in the differential diagnosis for patients who present with epidemiologic risk factors and unusual courses of illness, especially rapidly progressing pneumonia (see Fig. 2 of the Supplementary Appendix). "


From the above supplementary appendix -

"...Note that initial manifestations of H5N1 illness may be nonspecific or atypical
(e.g. fever with or without diarrhoea)..."

I think that a medical worker in an imaginary Jakartan hospital while he / she is visiting a patient with GIT symptoms, fever, chest RX images, haemorrhages passes in reviews in his/her mind other cases seen previously and avian influenza may be at top of the list, notwithstanding scientific or medical literature descriptions.
I think that a hand may be tend to these heroic individuals and no doubt into their honesty and professional skill should be cast.

[JJackson]

I think Dr. Niman is making a fair point.
I have no idea what the front-line HCWs conditions are like but I am sure you are correct in that they are doing a valiant job in difficult conditions. But there is a difference in saying nothing, and letting the results speak for themselves, and the head of the Ethnic Group of Dinas Kesehatan Southern Jakarta Togi Asman making 'a this is not a cluster' comment. If there is an attempt to spin this in anyway then this is 'cause for concern' (all copyrights acknowledged).

[Laidback Al]

Possible numbering sequence of positive cases

Indonesian Case #		Name	Sex		Age		Symptom onset	Hospital Admission	Death	Outcome
131		Anisa Chamsah (Alifah Qansa)	F		1		3/17/2008	3/22/2008		R
132		ZAH	F		11		3/19/2008	3/23/2008	3/28/2008	D
133		Muhammad Saiful Hidayat (MSH)	M		3		4/17/2008	4/21/2008	4/23/2008	D
134		??? Tini Suhartini	F		54		reported positive			D
135		??? Siti Istiqomah	F		16		reported positive			D

http://www.flutrackers.com/forum/showthread.php?t=18639

[Commonground]

5 Residents Kendari Suspected Infected Flu Burung

-snip-
All 5 people that suspected infected virus Avian Influensa (H5N1) that are Asdar, 8 tahun, Andika Saputra (1,3), Sarminda (10), Nuraminah (4) as well as Dg Sholeh (53).

Side RS already take sample blood medical patient in order that was researched. "We not yet can determine what all five medical patients that infected flu burung or not," words doctor Musawarah that treat all five patients those.

Menurut Dewaty mother Asdar her child enter RS because fever that high temperature reach 38 degrees celciau. After given medicine not descend, she also carry her child to RS. "We still to guard results exam laboratorium," said Dewaty.
-snip-
http://www.tempointeraktif.com/hg/nu...123427,id.html

[Commonground]

Video available.

http://www.metrotvnews.com/berita.asp?id=59386

[HenryN]

Commentary

http://www.recombinomics.com/News/05...H5_Denial.html

[Dutchy]

KOMNAS FBPI updated their website with 1 more bird flu victim listed.
In total 135.

However as far as I know 134 were confirmed? # 135 probably would TS/ Tini Suhartini from West Java, not confirmed by Dep of Health or by Komnas FBPI.
TS was confirmed positive through local PCR test from West Java lab.


Compared to the list in post # 191, we see 1 more in West Java (TS?) and 1 more in Jakarta District ( Isq).


http://www.komnasfbpi.go.id/situationupdate.html


The number of human cases in Indonesia has reached 135, of which 110 have died.


Province / No. of AI Positive Human Cases / No. of Fatalities


1 West Java 34 28

2 DKI Jakarta 33 28

3 Banten 25 22

4 North Sumatera 8 7

5 East Java 7 5

6 Central Java 11 10

7 West Sumatera 4 1

8 Lampung 3 0

9 South Sulawesi 1 1

10 South Sumatera 1 1

11 Riau 6 5

12 Bali 2 2

Total 135 110


http://www.komnasfbpi.go.id/utama_eng.php