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Monday, September 26, 2005

Bird Flu (H5N1) Update - Indonesia

Today Bloomberg conveyed the cheery news that patients under observation for bird flu in Indonesia were dropping:
Indonesia's suspected bird flu cases among humans declined to 21 as some patients tested negative for the virus and five people will be released from a Jakarta hospital after showing signs of recovery, a doctor said.

Jessica, a two-year-old girl who died last week, tested negative for the H5N1, a deadly strain of the avian influenza virus, said Sardikin Giriputro, a director at Sulianti Saroso hospital, one of 44 hospitals in the country which have been designated to treat bird flu patients.

Twenty-one patients, including two new ones who were admitted yesterday, remain under observation for avian flu because they were exposed to live chickens or birds shortly before developing bird flu symptoms, Giriputro said.
Later on they also list five dead in Indonesia. They're wrong on both counts. Another patient died, bringing the total to six, and hospitalized cases are up to 42:
There are 42 reported human cases of bird flu across Indonesia but only 10 patients have been tested positive of bird flu, Minister of Health Siti Fadillah Supari said here Monday.

Six of the ten people infected with bird flu have died recently,the minister said.

Supari said bird flu cases have been reported from at least eight provinces in the country, with Jakarta having the highest case number of 28.
Not so good. There are real questions about how good testing for H5N1 really is. See this autopsy report, which notes that the virus doesn't seem to be replicating the upper respiratory tract, so swab testing won't work very well. Anyway, 12 of the patients are associated with Ragunan Zoo. It's hard to know exactly what is happening. Plenty of sick people have been turned away from hospitals in Indonesia. It seems as if they are only hospitalizing the very ill.

The first case in Indonesia was in July. A father and his two daughters died. Then RD, a woman who worked at the airport, died. Her nephew has now been confirmed as having H5N1. See this Recombinomics commentary:
There is considerable concern over false negatives or misdiagnosis. Rini Ignoble's (Rini Dina's) nephew, Paradise initially was H5N1 positive by PCR, but is now being discharged and is H5N1 negative, He will be the first discharged positive patient. Thus, collections from patients after the H5N1 has been cleared from serum will fail to detect the infection. Similarly, misdiagnosis is common. Karwati was initially diagnosed as having typhus, which was changed to Dengue Fever when she vomited blood and was bleeding from her nose. This presentation sounds similar to the index case in Thailand, who subsequently infected her mother and aunt.
It's hard not to see some H2H in this. I don't think anyone really knows what's going on, but Australia (very close to Indonesia) is quite worried and is providing 50,000 courses of Tamiflu to Indonesia:
INDONESIA was struggling to contain an outbreak of bird flu and had been slow in distributing drugs to counter the disease, Foreign Minister Alexander Downer said today.
...
The Federal Government has increased the amount of anti-flu medication Tamiflu it is sending to its northern neighbour from 10,000 to 50,000 courses as Indonesia confirmed its sixth death from bird flu.

Asked if he was happy at how quickly the first batch of 10,000 courses of Tamiflu had been distributed, Mr Downer said: "I think it's been a little slowly, a little more slowly than we would have liked.
In theory, if you consistently catch severe strains beginning to go H2H that produce high death rates, a milder strain of H2H H5N1 should evolve that is less of a threat to humans. I suppose that is all we can hope for now.


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