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Wednesday, September 28, 2005

Indonesian Bird Flu (H5N1) Update 3

Update: Here's a rather dire financial projection of the effect of an H5N1 pandemic, thoughtfully provided by Ilona of True Grit. I think it is too dire, because we should be able to lessen the effect of a flu pandemic if we prepare for it. It should motivate everyone to do that, however. End Update.

. This doesn't sound good:
At least 57 people were being treated for suspected bird flu in Indonesia, where the disease has already claimed six lives, officials said.

OF the total, 20 patients were under observation at Jakarta's Sulianti Saroso hospital for infectious diseases, a doctor there, Ilham Patu, said.

The latest suspected case, a 23-year-old man from the capital, was admitted late Tuesday.
Overall that is an increase of 15 suspected cases from two days ago. What concerns me are reports that cases are testing positive and then being dismissed and moved to the negative column. See Testing Problems for background. See Influenza Surveillance in Indonesia:
For each patient enrolled in the study, a throat and lower nasal swab are taken, and isolates are identified using monoclonal antibodies for typing Influenza A or B, and using Hemagglutination Inhibition for serotyping them according to the antigens provided.

Lower nasal and throat swabs obtained are also analyzed for the presence of Influenza virus using the Polymerase Chain Reaction (PCR), and lower nasal swabs are also tested using Direchgen Flu a + b ® rapid kits.
PCR from swabs will not necessarily show positive from H5N1, because the virus doesn't appear to be replicating that well in the throat. Blood work showing antibodies (which develop later) would be more reliable. Now see this report in the CurEvents.com translation thread of a girl with positive bloodwork being released from the hospital and cited as being negative for H5N1:
Jemima Napitupulu, 9 / F, initial hospitalised at Cempaka Ward, SSIDH 210905 (21st Sept 2005). +ve Serology but –ve PCR (Indonesian) released 270905. Pending further testing in Hongkong. Full address Perumaban Kranggan Permai, RT 011 RW 015, Jaya Sampurna, Bekasi, West Java. Ragunan visitor, date unknown. Suspected contact with birds.
After hospitalized at Saroso hospital, 9 suspects[1] of bird flu patient may return home. Their test result is negative.

Nine of them are Raka Detyo Alif Purnomo (8 yo), Jemima Napitupulu (9 yo), Johana Tanial (2 yo 4 mo.), Elizabeth Evita (1 y 5 mo), Mrs. Erwin atau Mugi Rahayu (26 yo), Dodi (15 yo), Alfa (2yo), Ravi (2yo), dan Kalim (23 yo).

"Second test by research department of health ministry shows negative, they can be home by tomorow." said. Dr. Ilham Patu at Saroso Hospital Wednesday 29 September.
This is disturbing. They are being treated with Tamiflu, which will change test results. I think the actual infections might be grossly underreported. See also this autopsy report. One encouraging sign is that the deaths are dropping as the case count appears to be increasing. This may indicate that early treatment with amantadine and Tamiflu works.

See also this:
Yemima Napitulu, 9, the Bekasi citizen, was stated positive birds flu was based on results of the laboratory of Research And Development serology (Research And Development) the Department of the RI. Yemima Health that was registered on behalf of Jeremiah beforehand had visited the Gardener the Ragunan Animal. Currently, he was still being treated in Cempaka RSPI Sulianti Saroso isolation space and his condition increasingly improved.

Therefore, at this time RSPI Sulianti Saroso was treating three patients of birds flu. They were Yemima Napitulu, Anik Setyorini, and Gayatri pearls.

That was said by the Chairman Tim the Extraordinary Incident (KLB) birds Flu, Sardikin Giri Putro was accompanied by the Team Leader Information and Surveillance KLB birds Flu, the Patu Inspiration, Tuesday (27/9).

"Was based on results of the serology laboratory, the three patients were stated positive." But produced by Polymerase Chain Reaction (PCR) the three of them the negative of birds flu, said Sardikin.
If they are doing PCR from swabs that is not too surprising.

This article lists the symptoms of bird flu and the treatment:
Symptoms of Infection

* In humans: high fever (body temperature more than 38o Celsius), coughing and sore throat, infection in the upper respiratory system, pneumonia, eye infection and sore muscles
* In poultry: blue-colored comb, foot ulcers, sudden death

Treatment for Infected Patients

* Oxygen for patients with breathing difficulties
* ID for hydration
* Medication of 75 mg Oseltamivir for seven days
* Amantadin injection during the early hours (48 hours) of infection, for the next three to five days with a dosage of 5 mg per kg of body weight each day, divided into two dosages. If body weight is more than 45 kg, patients will be given 100 mg, injected twice a day
It's noticeable that the article's list of "at-risk" people doesn't correspond with the first cases in Jakarta, which were in none of the high-risk categories. Dual treatment with amantadine and Tamiflu may be working to save people's lives if administered quickly enough.

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