Will two flus mix in Indonesia? Experts worry

[FrenchieGirl]

Will two flus mix in Indonesia? Experts worry

Mon Jun 29, 2009 4:14pm EDT

* H5N1 circulates freely in Indonesia

* Flu viruses cause more deaths in poorer countries

By Olivia Rondonuwu

JAKARTA (Reuters) - Indonesia's first cases of the new H1N1 flu have raised concerns that if the virus spreads it could combine with the entrenched and deadly H5N1 avian influenza to create a more lethal strain of flu.

Even if this worst-case scenario did not occur, experts say populous, developing countries such as Indonesia, India or Egypt, where healthcare systems can be rudimentary, will suffer more deaths from the new virus.

Indonesian Health Minister Siti Fadillah Supari, who confirmed six new H1N1 cases on Sunday, said she was concerned about H1N1, widely known as swine flu, "marrying" with H5N1 avian flu.

Influenza viruses not only mutate quickly and unpredictably, but they can swap genes, especially if a person or animal becomes infected with two strains at once. The new H1N1 strain is itself a mixture of various strains, genetic tests show.

H5N1 bird flu has been circulating in Asia for years and has hit Indonesia harder than any other country. Although it only rarely infects people, it has killed 262 out of 433 infected globally since 2003, with 141 of those cases in Indonesia.

"We are scared because we are the warehouse of the world's most virulent H5N1," Supari said.

"I am worried if the viruses encounter each other in the field," C.A. Nidom, the head of the Avian Influenza lab at Airlangga University in Surabaya, said.

The World Health Organization declared a pandemic of H1N1 swine flu earlier this month and said the virus causes a moderately severe flu, spreading very easily from person to person. H5N1 spreads mostly from a bird to a person and stops there, but is far deadlier.

The mortality rate for H1N1 is 0.2 percent, according to a study in the New England Journal of Medicine, while for H5N1 it is just over 60 percent.

SERIOUS THREAT

Scientists say usually as a virus becomes more transmissible from one human to another it also becomes less deadly, although this is not guaranteed.

But Kamaruddin Zarkasie of Indonesia's Bogor Agriculture University said he felt the risk the two viruses might combine was only a random possibility.

Even if they do not, H1N1 may be a serious threat, other experts said.

Ben Cowling, public health expert at the University of Hong Kong, said people with serious infections who would be admitted to hospitals in developed countries and survive might die in poorer countries.

"It would be reasonable to say the mortality rate in underdeveloped settings is likely to be more comparable to the ICU (admission) rate in developed settings, or five times higher than the mortality rate in developed settings," Cowling said.

"In poorer parts of India and China ... people are nutritionally less able to fight infection and they don't have the drugs that we have in major cities," said Robert Booy, head of clinical research at the University of Sydney's National Center for Immunization Research & Surveillance.

H1N1 has killed more than 300 people and there have been at least 67,000 confirmed cases worldwide.

(Additional reporting by Karima Anjani and Tan Ee Lyn in Hong Kong; Editing by Ed Davies and Maggie Fox)

 

[Gert van der Hoek]

Re: Will two flus mix in Indonesia? Experts worry

caution, google translated

Dr. Nidom urges for more and better surveillance of H5N1.

Dangerous, interfusion Flu A-H5N1 and H1N1

Wednesday, 15 July 2009


Jakarta, (ANTARA News) - The government still required intensify the monitoring of avian influenza virus H5N1 (bird flu) and mapping sebarannya to prevent the occurrence of mixing with the influenza virus A (H1N1), which is feared could create a new type of influenza virus is more vicious and more death.

"For the influenza virus A (H1N1) is still unstable in the environment, and we still have the possibility of H5N1 AI virus. If mediator, they can mix and create a new type of virus may be more violent," said the Head of Laboratory Research Bird Flu Airlangga University Chairil Anwar Nidom when contacted from Jakarta, on Wednesday.

Therefore, the molecular biologist is emphasized, the government must make more of H5N1 AI virus in poultry and humans, and take the necessary action to prevent the occurrence of mixing.

"Co - mingling can occur if there are mediators, these mediators can the human body or the body of pigs. If there is a map of bird flu, the government can maximize the monitoring and prevention efforts so that there can be potential interfusion minimized," he explained.

He added, mixing between the sub-sub-type of influenza virus A (H1N1) and H5N1 can bring a lot of influenza A virus variants that may be one more death, and potentially cause a pandemic.

"If it is so, not only Indonesia are threatened, the whole world will also participate threatened," he said.

Separately Disease Control Director-General and the Department of Environmental Health Penyehatan Tjandra Yoga Aditama says the government continues to monitor the spread influenza A (H1N1) and attempt to control distribution.

"We watched and analysis of the day to day to see if changes need to be on policy and strategy," he said.

Previous infection of influenza virus A (H1N1) have stated no more dangerous of the common influenza virus. According to Tjandra, 95 percent of people with flu A (H1N1) does not require medical treatment in hospital and recovery time in the average sepekan.

"The fact is, some penderitanya died. Level deaths due to disease is about 0.4 percent, there are 400 people from the number of patients infected in the world who died. But flu also result in death and fatalities not much different from the flu A H1N1, "he explained.

A number of countries began to loosen terdampak prevention activities. Singapore is no longer treating patients bergejala light in the hospital and check all the people who make contact with the patient.

United States to handle patients' flu A (H1N1) influenza patients as usual and Australia no longer install equipment to scan the body temperature of people suspected of selectivity infected.

Health Minister Siti Fadilah Supari has also previously said that the government will still apply procedures influenza A (H1N1) to prevent the possibility of mixing between the occurrence of influenza A virus H1N1 and H5N1.

Until 14 July 2009, the cumulative number of cases of influenza A (H1N1)-positive as 112 people consisting of 63 men and 49 women.

The case was reported going on in Bandung, Banten, Jakarta, Medan, Balikpapan, Surabaya and Yogyakarta.

While the number of cumulative cases of bird flu in humans up to now as much as 145 cases with 119 deaths. ( Comment: these numbers were mentioned on a press conference in feb by KOMNAS FBPI. Other officials said 121 deaths. Official sources did not update this year. Based on local press reports there are at least 10 more confirmed cases of H5N1 flu).

Although there is no region that can claim truly free from bird flu but in the last one and a half years is not avian influenza found in most areas that were previously infected.

Of bird flu in the last reported human bird flu transmission of disease in humans only occur in the five provinces of Jakarta, West Java, Central Java, Banten and West Sumatra. (*)

http://www.antaranews.com/view/?i=1247635044&c=NAS&s=KES

 

[Commonground]

Re: Will two flus mix in Indonesia? Experts worry

Toggletext version of Post #2:

The government was asked to continue to intensify the monitoring of the spread of the virus avian influenza H5N1 (bird flu) as well as mapped his distribution to prevent the occurrence of the mix with the A influenza virus (H1N1) that it was worried about could show the more cruel and deadlier new kind of the influenza virus. "Because of the A influenza virus (H1N1) still was labile and in our environment the possibility was still having the virus of AI H5N1." If having the mediator, both of them could be mixed and show the new virus kind that possibly crueller, the headword the Laboratory of Penelitian Flu Burung Universitas Airlangga Chairil Anwar Nidom when being contacted from Jakarta, on Wednesday.

Therefore, the molecular biological expert stressed, the government must map again the distribution of the virus of AI H5N1 to the poultry and humankind as well as took the action that was needed to prevent the occurrence of the mix. The "mix could happen if having the mediator, his mediator could the human body or the pig body." If having the map of the distribution of bird flu, the government could maximise the monitoring and prevention efforts there that the possibility of the occurrence of the mix could be minimised, he explained. He added, the mix between sub-sub the type of the A influenza virus (H1N1) and H5N1 could show many variants of the A influenza virus that one of them was possibly more deadly and potential caused the pandemic.

"If that is the case, not only Indonesia that was threatened, all the world will also take part in being threatened," he said. Separately Director General Pengendalian of the Illness and Lingkungan Departemen Sanitation of the Tjandra Yoga Aditama Health said the government continued to monitor the spread of A influenza (H1N1) and tried to control his spreading. "Monitored by us and the analysis day after day to see whether must be carried out by the change" in the "policy and the control strategy," he said. Beforehand the A infection of the influenza virus (H1N1) has been stated was not more dangerous than the common influenza virus. According to Tjandra, 95 percent A of the flu sufferer (H1N1) did not need the medical maintenance in the hospital and recovered in time in general a week.

The "other fact was, some of his sufferers died." The mortality rate resulting from this illness around 0.4 percent, there was 400 people from the number of patients who was infected all over the world that died. But common flu also resulted in the death and his fatality far was not different from flu of A H1N1, he explained. Several countries were collided with began to alleviate the prevention activity. Singapore no longer treats the patient bergejala light in the hospital and checked everyone who carried out contact with the patient. The United States handled the A flu patient (H1N1) as the common influenza patient and Australia no longer install the implement pemindai the temperature of the body to catch the person who it was suspected was infected. Health Minister Siti Fadilah Supari beforehand also said that the government will continue to apply the control procedure of A influenza (H1N1) to prevent the possibility of the occurrence of the mix between the influenza virus of A H1N1 and H5N1.

Up until July 14 2009, cumulatively the number of cases of A influenza (H1N1) positive as many as 112 people consisted of 63 men and 49 women. This case it was reported happened in Bandung, Banten, the Special Capital District of Jakarta, Medan, Balikpapan, Surabaya and Yogyakarta. Now the cumulative number the case of bird flu to humankind up to now totalling 145 cases with 119 deaths. Although not yet having the area that could say really free from bird flu but in one half of the last year bird flu is no longer found in most areas that beforehand terjangkit. The spread of bird flu was to last humankind reported by the spread of the bird flu illness in humankind only happened in five Special Capital District of Jakarta provinces, West Java, Central Java, Banten and West Sumatra. (*)

 

[Treyfish]

Re: Will two flus mix in Indonesia? Experts worry

Waspadai mixing Bird Flu Virus Flu and Pigs (H1N1 disease. /
Related Articles:

Wednesday, 15 July 2009 | 11:56 WIB
KOMPAS.com - prompted the Government still intensify the monitoring of avian influenza virus H5N1 (bird flu) and mapping sebarannya to prevent the occurrence of mixing with the influenza virus A (H1N1), which is feared could create a new type of influenza virus is more vicious and death.
"For the influenza virus A (H1N1) is still unstable in the environment, and we still have the possibility of H5N1 AI virus. If mediator, they can mix and create a new type of virus may be more violent," said the Head of Laboratory Research Bird Flu Airlangga University Chairil Anwar Nidom when contacted from Jakarta, Wednesday (15 / 7).

Therefore, the molecular biologist is emphasized, the government must make more of H5N1 AI virus in poultry and humans, and take the necessary action to prevent the occurrence of mixing.

"Commingling can occur if there are mediators, mediatornya can the human body or the body of pigs. If there is a map of bird flu, the government can maximize the monitoring and prevention efforts so that there can be potential interfusion minimized," he said.

He added, mixing between the sub-sub-type of influenza virus A (H1N1) and H5N1 can bring a lot of influenza A virus variants that may be one more death, and potentially cause a pandemic.

"If it is so, not only Indonesia are threatened, the whole world will also participate threatened," he said.

Separately, Director General of Disease Control Ministry of Environment and Health Penyehatan Tjandra Yoga Aditama, said the government continued monitoring of influenza A (H1N1) and attempt to control distribution.

"We watched and analysis of the day to day to see if changes need to be on policy and strategy," he said.

Previously, infection of influenza virus A (H1N1) have stated no more dangerous of the common influenza virus. According to Tjandra, 95 percent of people with flu A (H1N1) does not require medical treatment in hospital and recovery time in the average sepekan.

"The fact is, some penderitanya died. Level deaths due to disease is about 0.4 percent, there are 400 people from the number of patients infected in the world who died. However, the flu usually also result in death and fatalitasnya is not far different from the flu A H1N1, "he said.

A number of countries began to loosen terdampak prevention activities. Singapore is no longer treating patients bergejala light in the hospital and check all the people who make contact with the patient. United States to handle patients' flu A (H1N1) influenza patients as usual and Australia no longer install equipment to scan the body temperature of people suspected of selectivity infected.

Health Minister Siti Fadilah Supari has also previously said that the government will still apply procedures influenza A (H1N1) to prevent the possibility of mixing between the occurrence of influenza A virus H1N1 and H5N1.:tiphat:http://kesehatan.kompas.com/read/xm...dai.Pencampuran.Virus.Flu.Burung.dan.Flu.Babi

 

[Giuseppe]

Re: Will two flus mix in Indonesia? Experts worry

Question:

Why should pandemic H1N1 2009 virus reassort with indonesian A/H5N1 in pigs and why should this reassortment with another influenza subtype both in pigs and humans not happen in any other regions?

I mean, we in Italy have a huge pigs population and a big poultry industry as well.

Now we have several epizootics by A/H7 avian influenza virus in poultry in a densely populated area (Emilia-Romagna).

Pigs farms and poultry industries are sometimes neighboring.

Pandemic H1N1 2009 is circulating in Italy as other part of Europe.

How likely is a reassortment between A/H7 and a/H5 with H1N1 in Italy and Europe in contrast with Indonesia?

I will enjoy a prompt response by experts.

My thinks are however that a such reassortment may happen eveywhere and unrespective of presence of H5N1 or H7N3 or any other subtype.

I would also like to remind to readers that a animal-to-humans and perhaps human-to-human avian influenza virus A/H7 (low-path) happenend several months ago in Wales, while this particular virus was not considered as a pandemic candidate.

So, I think that if a kind of reassortment would actually happen, the location may be an highly intensive combined farm in Europe...

 

[Shannon Bennett]

Re: Will two flus mix in Indonesia? Experts worry

Ironorehopper, the key distinction is the endemic nature of the H5N1 virus in Indonesia. It isn't the only only place H5N1 is endemic, however. We are monitoring Egypt for the same reason. We also suspect China has a significant but unreported number of H5N1 cases. But, you are also right that yet another candidate flu may be waiting in the wings. While A/H7 may recombine or reassort it does not have the history of an 80% CFR as H5N1 does in Indonesia.

 

[Giuseppe]

Re: Will two flus mix in Indonesia? Experts worry

As nobody was able to predict pandemic H1N1 2009 emersion and global spread, also nobody can predict the results of a dual infection by this variant and other influenza A subtypes.

So, the suggested higher risk of such events occurrence in Indonesia, China or Egypt is at least solid as mine: that is a reassortment may happen in Indonesia, China, Egypt, Italy, Germany, Wales...

A final annotation: at least one human case of H7 avian influenza virus infection in Wales required hospitalization for complications...

Yes. I am not a sympathetic individual sometimes, when media outlets start to spread illness more fast than pathogens themselves.

 

[Auburn Boy]

Re: Will two flus mix in Indonesia? Experts worry

I suppose this is news related to THIS particular thread?

This from TempoInteractiv.

(Hat tip to Crawford at H5N1 BLog and to Bird Flu Information Corner:

http://crofsblogs.typepad.com/h5n1/2009/07/indonesia-h5n1-or-h1n1.html#comments

http://birdflucorner.wordpress.com/2009/07/15/tangerang-banten-vets-family-infected-by-ah1n1-virus/ )

http://www.tempointeraktif.com/hg/layanan_publik/2009/07/15/brk,20090715-187339,id.html
___________________________________________

Satu Keluarga Dokter Hewan Diserang Flu Meksiko
Rabu, 15 Juli 2009 | 17:01 WIB


TEMPO Interaktif, Tangerang- Satu keluarga yang terdiri dari bapak, ibu dan dua anak di Kecamatan Curug Kabupaten Tangerang terkena serangan virus flu Meksiko (H1N1).

?Hasil pemeriksaan labaroatorium Departemen Kesehatan mereka positif H1N1,? ujar Kepala Dinas Kesehatan Kabupaten Tangerang Hani Haryanto kepada Tempo, Rabu (15/7).

Hingga berita ini ditulis, keluarga itu masih dirawat diruang isolasi Rumah Sakit Umum Daerah Tangerang. Mereka adalah W (44), I (3, R (4) dan L (14). W merupakan seorang dokter hewan dan Pegawai Negeri Sipil yang bertugas di Dinas Kesehatan Kabupaten Tangerang.

Hani mengatakan, sebelumnya W ditugaskan untuk memeriksa unggas yang sakit disebuah peternakan ayam di kawasan Curug. Setelah pulang dari memeriksa unggas itu, W mengalami demam tinggi dengan gejala seperti flu burung (H5N1) .?Karena kontak dengan unggas sakit kami kira dia terkena virus flu burung, saat itu langsung diberikan tamiflu,? ujar Hani.

Namun, kondisi W tidak kunjung membaik, bahkan dengan cepat istri dan dua anaknya cepat tertular. Ahad (12/7) lalu, mereka dilarikan ke RSUD Tangerang dan hingga kini masih dirawat diruang isolasi.

Hani mengaku heran karena hasil labaroatorium Departemen Kesehatan meleset jauh dari yang mereka kira. ?Kami mengira tadinya H5N1, tapi kok hasilnya H1N1,? ucapnya. Karena hasil tersebut, Dinas Kesehatan Kabupaten Tangerang langsung mengambil sampel darah orang-orang yang pernah kontak dengan W dan keluarganya.

Menurut Hani, saat ini pihaknya masih terus mengawasi kondisi kesehatan pasien dan keluarga terdekat pasien.

Kepala Bidang Pencegahan Penanggulangan Penyakit dan Lingkungan (P2PL) Dinas Kesehatan Kabupaten Tangerang, dr Yully S Dewanti menyatakan, keempatnya masih dalam satu keluarga yang tinggal dalam satu rumah kemudian terserang flu babi dalam waktu yang cepat.

JONIANSYAH

________________________________________

TRANSLATED from BFIC:
________________________________________
Tangerang, Banten ::: Vet?s family infected by A/H1N1 virus
Tangerang, Banten ? A family of four in Kecamatan Curug, Kabupaten Tangerang infected by H1N1 Mexico flu.

?Ministry of Health laboratory test showed positive H1N1,? said the head of Health Service, Kabupaten Tangerang, Hani Heryanto, on Wednesday (15/7).

Until now, this family is still being treated at isolation unit Tangerang public hospital. The family members are W (44), I (39), R (4) and L (14). W is a veterinarian who?s working for Health Service of Kabupaten Tangerang.

Hani said, W was assigned to check sick birds in a chicken farm located in Curug. After visiting the farm, W developed high fever with bird flu-like (H5N1) symptoms. ?Because he had contact with sick birds, we suggested that he had bird flu infection, and gave him tamiflu administration,? said Hani.

Because W didn?t get better, in particular his wife and two children also developed symptoms; they were rushed to Tangerang hospital last Sunday (12/7) and treated at isolation unit.

Hani admitted that the test result was surprising. ?We thought of H5N1, but the result showed H1N1 instead,? said Hani. Following to the result, Health Service of Kabupaten Tangerang collected samples from people who had contact with W and family.

JONIANSYAH

___________________________

My thoughts on this are:

Vet checks sick birds, vet gets sick.

Docs think H5N1.

Administer Tamiflu.

Tami does NOT WORK.

Vets family takes ill.

Vet and family test positive for H1N1.

All are in isolation..,

FULL STOP.

 

[wotan]

Re: Will two flus mix in Indonesia? Experts worry

I was just about to post this. Some interesting things from that post on bird flu corner. We have a vet who was treated for suspected bird flu with Tamiflu and did not get better. So on further testing he was positive for H1N1. Are we sure this was pandemic H1N1 and not a seasonal strain? If it was pandemic H1N1 this would indicate that we might have another case of Tamiflu resistance.

 

[Auburn Boy]

Re: Will two flus mix in Indonesia? Experts worry

I was just about to post this. Some interesting things from that post on bird flu corner. We have a vet who was treated for suspected bird flu with Tamiflu and did not get better. So on further testing he was positive for H1N1. Are we sure this was pandemic H1N1 and not a seasonal strain? If it was pandemic H1N1 this would indicate that we might have another case of Tamiflu resistance.

I've got this posted in several places now. I was alerted by BFIC, and H5N1 (Hat tips to both those fine sites!)

What I am MOST worried about in this case is the mixing.

If this is Human Influenza with H1, N1, and internal H5N1 genes re-assorted??