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Discussion: Expanding Bandung Cluster

Re: Expanding Bandung Cluster

Re: Expanding Bandung Cluster

Wasnt the increase in the number of clusters - not just cluster size- an important clue that the virus was evolving? and thus something to watch for?

What type of scenario would fit that?

I'm not quite sure I really understand the size of the outbreaks that are occurring in that area... I'll reread it- but the clusters sizes of total and possible or suspected seem larger than I was gleaning from news reports. Y'all do a great job putting the puzzle pieces together, thanks much.

I'm looking at a map of the area. I'd love to try to put one together that has the numbers of each cluster markd on it. That way we could see any relationships in distance between slusters, and timing. Anyone have any ideas of the confirmed and suspected and "not offical but suspicious" cases in the three areas? and th etiming. I could play around with it and see if its of value to us. I need to find a good interactive map program, but I;ll search up soemthing, unless you can recommend a map site that would work for this. Thanks
 
Re: Expanding Bandung Cluster

Re: Expanding Bandung Cluster

LMonty said:
Wasnt the increase in the number of clusters - not just cluster size- an important clue that the virus was evolving? and thus something to watch for?

What type of scenario would fit that?

I'm not quite sure I really understand the size of the outbreaks that are occurring in that area... I'll reread it- but the clusters sizes of total and possible or suspected seem larger than I was gleaning from news reports. Y'all do a great job putting the puzzle pieces together, thanks much.
Click to expand...
Yes, the number of clusters is key to telling us how suited the virus is to human transmission. It is definitely increasing in Indonesia. That is obvious. The size and number of the clusters is unclear however, and it's constantly changing. The data we are getting on each cluster is hit and miss, random almost, negative one minute, positive the next, screening of contacts is haphazard, and generally people who recover or are taking a lot of Tamiflu already almost always test negative, regardless. And in cases where they're not tested because they already died or aren't even known about (except mentioned in a local newspaper article), they're not included in the cluster size. And only if the hospital is reporting on suspected cases, do we ever hear about it. That means that we're only going to hear about cases from about 4 or 5 cities--Medan, Jakarta, Bandung, Tasikmalaya, Surabaya, etc. In the last ten days, there have been several clusters--I can't quantify them exactly though. One or more east of Karo, one or two in southern Jakarta, this one in Bandung, the Garut cluster, Tasikmalaya, unknown number of clusters in southern Sulawesi, and one in eastern Java. Who knows how many others we're not hearing about. Whatever it is, it's bad.
 
More on Taufik's cousin, San

More on Taufik's cousin, San

toggletext-ed from Indonesian:

Following the Cousin entered Poinciana Tree Space RSHS
The Patient Bird Flu had Finally died
Sept 29, 2006

After undergoing the maintenance for four days in the Handsome Sadikin Hospital (RSHS) Bandung, the patient T (20), the citizen [*snip*] Kel. Kebonwaru, Kec. Batununggal, the Bandung City that was stated positive was affected by bird flu, died, on Thursday (28/9) approximately struck 02.20 WIB. Not more than 12 hours after the patient T died, to be precise struck 13.30 WIB, his cousin that had the initials San (18) also was run off with to RSHS Poinciana Tree Space because of experiencing the sign that resembled the bird flu illness.

The death of the patient T made his two parents, Ahmad Kosasih (50) and Nurjanah (43) really was stricken. Why not, four the previous day, their first child, IJ (23) died and it was suspected was affected by bird flu. Currently, their sweetheart was kept remaining a person, namely IM (15) that at this time still was receiving the maintenance in RSHS Poinciana Tree Space.

When waiting for his child to be bathed, dikafani, and was wrapped plastic in the RSHS Morgue, Ahmad and Nurjanah appeared to be able to not hide the feeling of the sadness. Both of them continually cried. Approximately struck 05.50 WIB, when the body was put into the ambulance that accompanied him to the place of the funeral in Kp [hamlet] Jolokbatu, the Sukaratu Village, of Kec. Banyuresmi, Kab. Garut, Ahmad and Nurjanah were still staying sad. The reporter that came to be enough the difficulty interviewed both of them.

During the day him, the Managing Director RSHS, Dr. Cissy B. Kartasasmita, to the reporter in RSHS explained the story of the death of the patient T. "Five Hours Before died or approximately struck 21.00 WIB, his situation became increasingly bad. Struck 01.00 WIB, he began to experience the disturbance of breathing. The team of the doctor could do resusitasi, but the patient had finally died struck 02.20 WIB. Approximately struck 05.00 WIB, the family brought him was buried in Garut, said Cissy.

He explained, the death of the T patient was caused failed the heart and the lungs. He had pneumonia that so difficult. Moreover, on his thoracic cavity was gotten the liquid that was caused by the complication pneumoni the inflammation of the lungs. "His condition was indeed very difficult. Moreover, his body endurance indeed not all that. So that caused the patient T to die," said Cissy.

In the meantime, the Chairman Tim [team] the Handling of the Case of Bird Flu in RSHS Bandung, Dr. Hadi Yusuf, Sp.P.D.K.P.T.I. said, the cause of the death of the T patient because of failing breathing that very difficult. Beforehand, said Hadi, his side indeed already memprediksikan the T death will happen. "That 70-80% already we the prediction. But, we continued to try so that the patient T could be rescued," he said.

Touched on the condition for the patient IM, both Cissy and Hadi together stated, at this time his [her] condition has improved with the temperature of the body 36 Celsius levels. IM did not experience breathless and his [her] cough has also decreased. "From produced by twice the inspection stated the bird flu negative," said Cissy, while added, to confirm positive or not the patient IM was affected by bird flu, the inspection was carried out by as many as three times.

The Baru patient

Approximately struck 13.30 WIB, one of the cousins T, San (18) to suspect bird flu and was treated in Poinciana Tree Space RSHS. Beforehand, San could be checked in UGD RSHS. But, the UGD side suggested San was brought to Space of the Poinciana Tree Isolation.

One of the patient's cousins, Dede Supriatna, when accompanying San to RSHS Bandung said, San was brought to UGD because experienced breathless, the cough, and rather hot. The sign was experienced by him after attending the T funeral in Kab. Garut, the following [preceding] morning. "Worriedly his sign like bird flu, I brought him here (RSHS, red) to be checked," he said, while said, the patient San remained [lived] a house with T in [*snip*] Kel. Kebonwaru, Kec. Batununggal, the Bandung City.

The chairman Tim the Handling of the Case of Bird Flu in RSHS, Dr. Hadi Yusuf, Sp.P.D.K.P.T.I. confirmed the existence of the patient just had the initials San. According to him, the patient entered Poinciana Tree Space with the condition for the temperature of the body approximately 39 Celsius levels were accompanied by the cough and pilek. "After being checked in UGD and having the sign of bird flu, I suggested so that he is treated inap," he said.

Accompanied tangisan

In the meantime, the atmosphere of the T funeral (20) in TPU Jolokfauzan Des. Sukaratu, Kec. Banyuresmi, Kab. Garut, on Thursday (28/9), appeared moving. The sobbing and the relative of the family's crying accompanied the funeral of the T body that was brought with the coffin was accompanied by the guarding of the medical official RSHS Bandung.

The T coffin arrived by the ambulance in Kp. Jolokbatu approximately struck 08.30 WIB and immediately was buried in TPU Jolokfauzan, approximately twenty metre to the east from his full sibling's grave, IJ (23) that also died it was suspected was affected by bird flu. Apparently delivered the T body, his two parents, Ahmad Kosasih and Nurjanah.

Although appearance was stricken on the disaster that struck his children, Ahmad Kosasih and Nurjanah was seen made a strong effort. Both of them did not often comment. Ahmad Kosasih personally at once lay downed his body had a rest in his house, Kp. Jolokbatu that everyday was guarded by his wife's brother, Agung, several times ended the funeral T. Whereas Nurjanah was seen busy arranging his [her] relative to depart back to Bandung picked up the child the three of them, IM that was said by the side of RSHS Bandung could be taken and treated the road.

One of the uncles T, Agung (29), acknowledged that T and his relatives atah anjang so as both relatives, the family, and the citizen Kp. Jolokbatu like that did not know close the life of children from the husband and wife's couple Ahmad Kosasih and Nurjanah. "I did not know how daily they because they rarely came here." "Atah anjang upami the elder's predawn meal tea Ma." Most came to the village a year very much, during Idul Fitri Lebaran, said Agung.

http://www.klik-galamedia.com/20060929/kolomlengkap.php?kolomkode=20060929085442
 
Re: Discussion: Expanding Bandung Cluster

People to be concerned about include, apart from San

Everyone at that funeral! (Time and again, funerals of H5N1 patients have shown themselves to be dangerous places.)
Other cousin: Dede Supriatna
Uncle Agung
Ahmad and Nurjanah
All these reporters
Dr. Cissy (he is treating way too many H5N1-infected people)
Dr. Yusuf
Roses (other cousin of the boys)
The Bandung family's neighbors.
 
Re: Discussion: Expanding Bandung Cluster

On the Ro thread, I posted a calculation of how many people would be affected if the virus was spreading very slowly, but persistently, instead of very fast. Based on that calculation, I found that after about two months, even at a very low rate, a hundred or two people would test positive. I said at that time that if this is an example of continuous but very slow spread, it would soon have a lot of cases. The sheer number of cases starts to mount up, and I think it's going to make it increasingly hard to spot when a switch is made from slow to fast spreading.
I don't think it is spreading any faster than it has since July 1; it's just that we are to the point where instead of just one person spreading it, there are now several, so it adds up. I just re-read what I wrote, and maybe it doesn't make much sense. Ok, let me try again: It looks to me like, on average, one person infects just over one person, not 2 or 3 people. That person infects just over one person, and so on. Just enough to carry on the chain, plus a bit, but not enough to explode. It's that slow rate of spread, over two months, that has led to the current cluster of clusters. I think over the next couple of weeks we will see an increasing number of cases. But according to the math, even if we see 100 suspect cases over a week, it still isn't mathematically exploding yet. It would take like 1000 cases to do that. So try to remember the math, and look through the noise for the signal. I think identifying the start is going to be a lot harder than I thought it would be.
 
Re: Discussion: Expanding Bandung Cluster

I'm surprised at the numbers you are using, wetdirt! Its almost an order of magnitude higher than my own personal sphincter factor. If there were 100 cases in a small geographic are, say 20 miles or so, in one week, I'd be very concerned, and making good on some late preps. A thousand, and I'd be putting away the Sams Club Last Minute Marathon booty!

My reaction makes me wonder about the differnces in how we see that. After all, we ( the Medical, Public Health, "We") really arent sure just what the green light looks like. What makes me nervous may well be no big issue! You may well be right. But it made me wonder just what are the triggers that others are using?

I guess I really havent defined mine completely. Subconsciouly i think I've had some vague expectation that we'll somehow just know when its time to put last minute plans in order.

Instead of my vague and probably unreliable approach :) is there a more scientific and reliable way to quantify the early phases? What are the real markers we should be reacting to, and how?

Does this question have any value as a seperate thread?
 
Re: Discussion: Expanding Bandung Cluster

this is a paper from last year, however the comments about increasing clusters is interesting.....

http://www.cdc.gov/ncidod/EID/vol11no11/05-0646.htm

Letter
[FONT=Arial, Helvetica, sans-serif]Family Clustering of Avian Influenza A (H5N1)[/FONT]

Sonja J. Olsen,*<SUP></SUP> Kumnuan Ungchusak,? Ly Sovann,? Timothy M. Uyeki,? Scott F. Dowell,* Nancy J. Cox,? William Aldis,? and Supamit Chunsuttiwat?
*International Emerging Infections Program, Nonthaburi, Thailand; ?Ministry of Public Health, Nonthaburi, Thailand; ?Ministry of Health, Phnom Penh, Cambodia; ?Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and ?World Health Organization, Nonthaburi, Thailand
[FONT=Arial, Helvetica, sans-serif]Suggested citation for this article[/FONT]
<HR>To the Editor: The unprecedented epizootic of avian influenza A (H5N1) in Asia poses a serious threat of causing the next global influenza pandemic. H5N1 viruses, to which humans have little or no immunity, have demonstrated the capacity to infect humans and cause severe illness and death (1?4). Fortunately, these viruses have not yet demonstrated the capacity for efficient and sustained person-to-person transmission, although limited person-to-person transmission was the cause of at least 1 family cluster of cases (5). Since family clusters of H5N1 illness may be the first suggestion of a viral or epidemiologic change, we have been monitoring them with great interest.

Through our regional contacts and public sources, we have monitored family clusters and other aspects of H5N1 in Southeast Asia. A cluster was defined as >2 family members with laboratory-confirmed H5N1 or >2 family members with severe pneumonia or respiratory death, at least one of which had confirmed H5N1. To determine if family cluster events had increased over time, we divided the number of cluster events by the total number of days in 2 discrete periods and calculated rate ratios (RR) and 95% confidence intervals (CI). To determine whether the increase in family clustering was attributable to an increase in the number of cases, we divided the number of family units with >2 laboratory-confirmed cases by the total number of family units in the period. Percentage of deaths was also compared.

From January 2004 to July 2005, 109 cases of avian influenza A (H5N1) were officially reported to the World Health Organization (WHO) (6). During this time, 15 family clusters were identified (Table). Of the 11 (73%) clusters that occurred in Vietnam, 7 were in northern Vietnam. Cluster size ranged from 2 to 5 persons, and 9 (60%) had >2 persons with laboratory-confirmed H5N1. Cluster 6 in Thailand was well documented and was likely the result of limited person-to-person transmission (5). For the other clusters, epidemiologic information was insufficient to determine whether person-to-person transmission occurred. In at least 3 clusters in Vietnam (Table; clusters 5, 7, and 11), >7 days occurred between the onset of the first and the next case, suggesting that simultaneous acquisition from a common source was unlikely. In cluster 11, 2 nurses assisted in the care of the index case-patient and subsequently were hospitalized with severe pneumonia; 1 had laboratory-confirmed H5N1.

Family clusters were slightly more likely to have occurred between December 2004 and July 2005 than in the first year of the outbreak (9 clusters in 243 days or 3.7 per 100 days vs. 6 clusters in 365 days or 1.6 per 100 days, respectively; RR 2.3, 95% CI 0.8?6.3). The difference was similar when the periods were limited to the same 8 months, 1 year apart (RR 1.8, 95% CI 0.6?5.4). Twenty-five (61%) of the 41 patients in the 15 family clusters died; the 7 persons who recovered or were not ill experienced secondary cases.

Family clusters are still occurring; however, they do not appear to be increasing as a proportion of total cases. The proportion of families that were part of a cluster was similar from December 2004 to July 2005 to the proportion in the first year (6/55, 11% vs. 3/41, 7%, respectively, p = 0.7). However, the proportion of deaths dropped significantly, from 32 of 44 (73%) during December 2003 to November 2004, to 23 of 65 (35%) during December 2004 to July 2005 (p<0.0001).

Although reports of H5N1 family clusters slightly increased, the increase was not statistically significant. Nevertheless, we believe any cluster of cases is of great concern and should be promptly and thoroughly investigated because it might be the first indication of viral mutations resulting in more efficient person-to-person spread. Family clustering does not necessarily indicate person-to-person transmission, as it may also result from common household exposures to the same H5N1-infected poultry or from other exposures, such as to uncooked poultry products.
The decrease in proportion of deaths during 2005 is another epidemiologic change that should be monitored closely because it may reflect viral adaptation to the human host. Surveillance for human cases of avian influenza has been intensified in recent months, perhaps resulting in the identification of less severe cases. Alternatively, more widespread laboratory testing may be associated with false-positive results. No evidence to date shows genetic reassortment between H5N1 and human influenza A viruses (7). Viruses isolated from case-patients need to be immediately sequenced and characterized in relation to previously circulating viruses to see whether they are evolving.

Recent modeling studies suggest that containing a pandemic at its source may be possible because emergent pandemic viruses may be less transmissible than commonly assumed (8), and antiviral treatment and chemoprophylaxis may slow the spread (9). Although the logistics of an attempt to contain the beginning of a potential influenza pandemic are formidable, we believe it is not beyond the capability of the modern global public health system. As WHO (10) has called for, countries should intensify their pandemic preparedness plans and strengthen international collaborations.
[FONT=Arial, Helvetica, sans-serif]References[/FONT]

  1. Hien TT, de Jong M, Farrar J. Avian influenza?a challenge to global health care structures. N Engl J Med. 2004;351:2363?5.
  2. Centers for Disease Control and Prevention. Cases of influenza A (H5N1)?Thailand, 2004. MMWR Morb Mortal Wkly Rep. 2004;53:100?3.
  3. Chokephaibulkit K, Uiprasertkul M, Puthavathana P, Chearskul P, Auewarakul P, Dowell SF, et al. A child with avian influenza A (H5N1) infection. Pediatr Infect Dis J. 2005;24:162?6.
  4. Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, Chunsuthiwat S, Sawanpanyalert P, Kijphati R, et al. Human disease from influenza A (H5N1), Thailand, 2004. Emerg Infect Dis. 2005;11:201?9.
  5. Ungchusak K, Auewarakul P, Dowell SF, Kitphati R, Auwanit W, Puthavathana P, et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med. 2005;352:333?40.
  6. World Health Organization. Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO. Vol. 2005. Geneva: The Organization; 2005. [cited 2005 Sep 22]. Available from http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_07_27/en/index.html
  7. World Health Organization. Evolution of H5N1 avian influenza viruses in Asia. Emerg Infect Dis. 2005;11:1515?21.
  8. Mills CE, Robins JM, Lipsitch M. Transmissibility of 1918 pandemic influenza. Nature. 2004;432:904?6.
  9. Longini IM Jr, Nizam A, Xu S, Ungchusak K, Hanshaoworakul W, Cummings DA, et al. Containing pandemic influenza at the source. Science. 2005 Aug 12;309:1083?7. Epub 2005 Aug 3.
  10. World Health Organization. Influenza pandemic preparedness and response. Geneva: The Organization; 2005. [cited 2005 Sep 22]. Available from http://www.who.int/gb/ebwha/pdf_files/EB115/B115_44-en.pdf
<TABLE cellSpacing=0 cellPadding=3 width="100%" border=0><TBODY><TR><TD vAlign=bottom colSpan=8>Table. Family clusters of influenza A (H5N1) in Southeast Asia, January 2004?July 2005*
</TD></TR><TR><TD colSpan=8><HR noShade SIZE=1></TD></TR><TR><TD vAlign=bottom>Cluster
</TD><TD vAlign=bottom>
Onset of index case​
</TD><TD vAlign=bottom>
Country​
</TD><TD vAlign=bottom>
Age (y)/Sex​
</TD><TD vAlign=bottom>
Relation to index case​
</TD><TD vAlign=bottom>
H5N1​
</TD><TD vAlign=bottom>
Onset​
</TD><TD vAlign=bottom>
Outcome​
</TD></TR><TR><TD colSpan=8><HR noShade SIZE=1></TD></TR><TR><TD vAlign=top rowSpan=2>1
</TD><TD vAlign=top rowSpan=2>
Dec 03​
</TD><TD vAlign=top rowSpan=2>
Vietnam (N)​
</TD><TD vAlign=top>
12/F​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Dec 25​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
30/F​
</TD><TD vAlign=top>
Mother​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 1​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top rowSpan=2>2
</TD><TD vAlign=top rowSpan=2>
Dec 03​
</TD><TD vAlign=top rowSpan=2>
Vietnam (N)​
</TD><TD vAlign=top>
5/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Dec 29?​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
7/F​
</TD><TD vAlign=top>
Sister​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
NN​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top rowSpan=4>3
</TD><TD vAlign=top rowSpan=4>
Jan 04​
</TD><TD vAlign=top rowSpan=4>
Vietnam (N)​
</TD><TD vAlign=top>
31/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
Jan 7?​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
30/F​
</TD><TD vAlign=top>
Sister​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 10​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
28/F​
</TD><TD vAlign=top>
Wife​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 10​
</TD><TD vAlign=top>
R​
</TD></TR><TR><TD vAlign=top>
23/F​
</TD><TD vAlign=top>
Sister​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 11​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top rowSpan=2>4
</TD><TD vAlign=top rowSpan=2>
Jan 04​
</TD><TD vAlign=top rowSpan=2>
Thailand​
</TD><TD vAlign=top>
6/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 8​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
33/F​
</TD><TD vAlign=top>
Mother​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
Jan 8​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top rowSpan=3>5
</TD><TD vAlign=top rowSpan=3>
Jul 04​
</TD><TD vAlign=top rowSpan=3>
Vietnam (S)​
</TD><TD vAlign=top>
19/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
Jul 23​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
22/F​
</TD><TD vAlign=top>
Cousin​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
NN​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
25/F​
</TD><TD vAlign=top>
Sister​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jul 31​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top rowSpan=3>6
</TD><TD vAlign=top rowSpan=3>
Sep 04​
</TD><TD vAlign=top rowSpan=3>
Thailand​
</TD><TD vAlign=top>
11/F​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
Sep 2​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
26/F​
</TD><TD vAlign=top>
Mother​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Sep 11​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
32/F​
</TD><TD vAlign=top>
Aunt​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Sep 16​
</TD><TD vAlign=top>
R​
</TD></TR><TR><TD vAlign=top rowSpan=3>7
</TD><TD vAlign=top rowSpan=3>
Dec 04​
</TD><TD vAlign=top rowSpan=3>
Vietnam (N)​
</TD><TD vAlign=top>
46/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Dec 26​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
42/M​
</TD><TD vAlign=top>
Brother​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 10?​
</TD><TD vAlign=top>
R​
</TD></TR><TR><TD vAlign=top>
36/M​
</TD><TD vAlign=top>
Brother​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Not ill​
</TD><TD vAlign=top>
Not ill​
</TD></TR><TR><TD vAlign=top rowSpan=2>8
</TD><TD vAlign=top rowSpan=2>
Jan 05​
</TD><TD vAlign=top rowSpan=2>
Vietnam (S)​
</TD><TD vAlign=top>
17/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 10?​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
22/F​
</TD><TD vAlign=top>
Sister​
</TD><TD vAlign=top>
NN​
</TD><TD vAlign=top>
NN​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top rowSpan=2>9
</TD><TD vAlign=top rowSpan=2>
Jan 05​
</TD><TD vAlign=top rowSpan=2>
Vietnam (S)​
</TD><TD vAlign=top>
35/F​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 14​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
13/F​
</TD><TD vAlign=top>
Daughter​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 20​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top rowSpan=2>10
</TD><TD vAlign=top rowSpan=2>
Jan 05​
</TD><TD vAlign=top rowSpan=2>
Cambodia​
</TD><TD vAlign=top>
14/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
NN​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
25/F​
</TD><TD vAlign=top>
Sister​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jan 21​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top rowSpan=3>11
</TD><TD vAlign=top rowSpan=3>
Feb 05​
</TD><TD vAlign=top rowSpan=3>
Vietnam (N)​
</TD><TD vAlign=top>
21/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Feb 14​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top>
14/F​
</TD><TD vAlign=top>
Sister​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Feb 23​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top>
80/M​
</TD><TD vAlign=top>
Grandfather​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Not ill​
</TD><TD vAlign=top>
Not ill​
</TD></TR><TR><TD vAlign=top rowSpan=2>12
</TD><TD vAlign=top rowSpan=2>
Feb 05​
</TD><TD vAlign=top rowSpan=2>
Vietnam (N)​
</TD><TD vAlign=top>
69/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Feb 19​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
61/F​
</TD><TD vAlign=top>
Wife​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Not ill​
</TD><TD vAlign=top>
Not ill​
</TD></TR><TR><TD vAlign=top rowSpan=3>13
</TD><TD vAlign=top rowSpan=3>
Mar 05​
</TD><TD vAlign=top rowSpan=3>
Vietnam​
</TD><TD vAlign=top>
13/F​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
Mar 9?​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
5/M​
</TD><TD vAlign=top>
Brother​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Mar 12?​
</TD><TD vAlign=top>
R​
</TD></TR><TR><TD vAlign=top>
Adult/F​
</TD><TD vAlign=top>
Aunt​
</TD><TD vAlign=top>
P​
</TD><TD vAlign=top>
NN​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top rowSpan=5>14
</TD><TD vAlign=top rowSpan=5>
Mar 05​
</TD><TD vAlign=top rowSpan=5>
Vietnam (N)​
</TD><TD vAlign=top>
39/M​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Mar 22?​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top>
Adult/F​
</TD><TD vAlign=top>
Wife​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Mar 22?​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top>
4 mo/NN​
</TD><TD vAlign=top>
Child​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Mar 22?​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top>
3/NN​
</TD><TD vAlign=top>
Child​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Mar 22?​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top>
10/NN​
</TD><TD vAlign=top>
Child​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Mar 22?​
</TD><TD vAlign=top>
Unknown?​
</TD></TR><TR><TD vAlign=top rowSpan=3>15
</TD><TD vAlign=top rowSpan=3>
Jul 05​
</TD><TD vAlign=top rowSpan=3>
Indonesia​
</TD><TD vAlign=top>
8/F​
</TD><TD vAlign=top>
Self​
</TD><TD vAlign=top>
+?​
</TD><TD vAlign=top>
Jun 24​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
1/F​
</TD><TD vAlign=top>
Sister​
</TD><TD vAlign=top>
NT​
</TD><TD vAlign=top>
Jun 29​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD vAlign=top>
38/M​
</TD><TD vAlign=top>
Father​
</TD><TD vAlign=top>
+​
</TD><TD vAlign=top>
Jul 2​
</TD><TD vAlign=top>
D​
</TD></TR><TR><TD colSpan=8><HR noShade SIZE=1></TD></TR><TR><TD vAlign=top colSpan=8>*D, respiratory death; N, north; NT, not tested; NN, not noted; P, pending; R, recovered; S, south.
</TD></TR><TR><TD vAlign=top colSpan=8>?Date of hospitalization.
</TD></TR><TR><TD vAlign=top colSpan=8>?Had respiratory symptoms, was hospitalized (unknown for #13), and outcome was unknown.
</TD></TR><TR><TD vAlign=top colSpan=8>?Date of death.
</TD></TR><TR><TD vAlign=top colSpan=8>?Serologically confirmed; classified as a probable case by the World Health Organization.
</TD></TR></TBODY></TABLE>
 
Re: Discussion: Expanding Bandung Cluster

I agree, WetDirt, it does appear that way--the rate of spread from one person to the next is still the same, but the number of people infected is rising. The problem comes from that very fact--that the number of people infected is rising--because increased passage through people will result in increased evolution towards a human strain, and faster spread. Rarely, there will be a dramatic change in the rate of spread, but most of the time it's going to be small, gradual changes.


wetDirt said:
On the Ro thread, I posted a calculation of how many people would be affected if the virus was spreading very slowly, but persistently, instead of very fast. Based on that calculation, I found that after about two months, even at a very low rate, a hundred or two people would test positive. I said at that time that if this is an example of continuous but very slow spread, it would soon have a lot of cases. The sheer number of cases starts to mount up, and I think it's going to make it increasingly hard to spot when a switch is made from slow to fast spreading.
I don't think it is spreading any faster than it has since July 1; it's just that we are to the point where instead of just one person spreading it, there are now several, so it adds up. I just re-read what I wrote, and maybe it doesn't make much sense. Ok, let me try again: It looks to me like, on average, one person infects just over one person, not 2 or 3 people. That person infects just over one person, and so on. Just enough to carry on the chain, plus a bit, but not enough to explode. It's that slow rate of spread, over two months, that has led to the current cluster of clusters. I think over the next couple of weeks we will see an increasing number of cases. But according to the math, even if we see 100 suspect cases over a week, it still isn't mathematically exploding yet. It would take like 1000 cases to do that. So try to remember the math, and look through the noise for the signal. I think identifying the start is going to be a lot harder than I thought it would be.
Click to expand...
 
Re: INDONESIA - Expanding Bandung Cluster

Re: INDONESIA - Expanding Bandung Cluster

This is human to human transmission and it's phase 4.

Excerpt from Jakarta Post today:

The Hasan Sadikin hospital has admitted another relative of the family showing bird flu infection symptoms. The 18-year-old is a niece of the brothers who lived with them at Kebonwaru, Batununggal district, Bandung.

The girl complained of high fever upon returning from the burial of the man's brother in the West Java town of Garut. She constituted one of about 20 people living near the dead patient, from whom employees of the local health office took their blood samples for examination.

Based on data at the West Java Health Office, the patient who died Thursday was the 22nd man person with the bird flu virus of the H5N1 variant and the 17th victim to die of the disease.


:(

http://www.thejakartapost.com/detailheadlines.asp?fileid=20060929.A06&irec=5
 
Re: INDONESIA - Expanding Bandung Cluster

Re: INDONESIA - Expanding Bandung Cluster

PonyGirl said:
This is human to human transmission and it's phase 4.

Excerpt from Jakarta Post today:

The Hasan Sadikin hospital has admitted another relative of the family showing bird flu infection symptoms. The 18-year-old is a niece of the brothers who lived with them at Kebonwaru, Batununggal district, Bandung.

The girl complained of high fever upon returning from the burial of the man's brother in the West Java town of Garut. She constituted one of about 20 people living near the dead patient, from whom employees of the local health office took their blood samples for examination.

Based on data at the West Java Health Office, the patient who died Thursday was the 22nd man person with the bird flu virus of the H5N1 variant and the 17th victim to die of the disease.


:(

http://www.thejakartapost.com/detailheadlines.asp?fileid=20060929.A06&irec=5
Click to expand...

This girl could be "Santi" :

http://www.flutrackers.com/forum/showpost.php?p=34922&postcount=2
http://www.flutrackers.com/forum/showpost.php?p=34839&postcount=76
 
Re: Discussion: Expanding Bandung Cluster

It's like watching H5N1 in Indonesia.

BTW - Tractor thing is not frm me... i think.
 
Re: Discussion: Expanding Bandung Cluster

In the meantime, the Handsome Hospital of Sadikin Bandung was again visited by two assumption patients was infected by bird flu.
A patient among them still had your relations or the cousin with the deceased Zakaria Divine Guidance that died yesterday resulting from the deadly illness.

He was Santi Susanti, the citizen of the Gardener's District Waru, Bandung [read: Divine Guidance It Was Suspected was affected by Bird Flu in Garut].
Santi was reconciled to RSHS because of experiencing the clinical sign like bird flu.
Whereas Amas, the citizen of the Sapan Village, entered this hospital because of experiencing the high fever.

In the meantime, the Diamond, the deceased's brother Divine Guidance, that also underwent the maintenance evidently is stated by the bird flu negative and his condition currently increasingly improved.
Beforehand the Diamond underwent the blood inspection totalling twice and results of the negative.
However the Diamond must continue to be treated to the third blood inspection.
If this further inspection stayed negative then he was permitted to come home.
(ZIZ/Tim Coverage 6 SCTV)

http://www.liputan6.com/view/3,129976,1,0,1.html


Dutchy or anyone else,

Here they are referring to a male and the article we are discussing supposedly involves a female. Its really hard to keep all the cases straight.
Does that sound correct..?

:rolleyes:
 
Re: Discussion: Expanding Bandung Cluster

My apologies Goju..you're correct it was from a meeting that GuadiaRay attended that LaidbackAl posted.
Goju said:
It's like watching H5N1 in Indonesia.

BTW - Tractor thing is not frm me... i think.
Click to expand...
 
Re: Discussion: Expanding Bandung Cluster

i calculated the numbers for my 4 towns
and it looks like this...

60,000 residents W/W/W + New Canaan
30% infected = 18,000
80% = 14,000
50% = 9,000
25% = 4,500
10% = 1,800
5% = 900
2.5% = 450

Now i ask a question... 1918 - they say it was 2.5%... was that 2.5% of the infected (like we hear 50-80% in indonesia) or is that of the entire population ill and well?

If wit was 2.5% of the entire population what would the CFR be in 1918?

I am confused
 
Re: Discussion: Expanding Bandung Cluster

Tractor comment was from Osterholm. He was talking about his grandfathers J.D. tractor.
 
Re: Discussion: Expanding Bandung Cluster

CFR (case fatality rate) is the per cent of total cases that are fatal. Usually case means infected and ill.
JT
 
Re: Discussion: Expanding Bandung Cluster

PonyGirl said:
Here they are referring to a male and the article we are discussing supposedly involves a female. Its really hard to keep all the cases straight.
Does that sound correct..?

:rolleyes:
Click to expand...
PG: I think in Bahasa Indonesia there is only one pronoun for the words 'he' and 'she'. This pronoun is usually automatically (and sometimes incorrectly) rendered as 'he' by machine translation. It's like our English word 'they' which can mean males or females (not to mention both).

I'm not sure if that helps clarify the situation any??:confused:
 
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