Indonesia says 17 under observation for bird flu

Well now 17 people are being held for observation. The US military in the Pacific is apparently also begining to take steps and plan (from the same article)

The United States military was planning for a possible bird flu pandemic to ensure its forces could respond quickly, Admiral William Fallon, the U.S. Pacific military commander, told reporters in Canberra on Friday.

JAKARTA (Reuters) - The number of Indonesians under observation for bird flu symptoms has risen to 17, health officials said on Friday, but added that local tests confirmed a five-year-old girl who died this week did not have the virus.

Four Indonesians are confirmed to have died from the highly pathogenic H5N1 strain of bird flu since July.

But U.N. health experts have said the growth in possible cases in Indonesia -- a big producer and consumer of chickens -- did not mean the outbreak was worsening, and that there was still no sign the virus could be passed easily among people.

Sardikin Giriputro, deputy head of the government-designated hospital in Jakarta to treat bird flu, said nine of his 17 patients had been to Jakarta's Ragunan zoo, shut this week after tests showed some exotic birds had avian flu.
Avian Flu

Snip....The latest confirmed H5N1 fatality was initially misdiagnosed as having dengue fever. She was transferred to Sulianti Saraos because she had eaten a bird that had died suddenly. Thus, had that history not been revealed, or if the bird appeared healthy because of an asymptomatic H5N1 infection, it is likely that the H5N1 would have been recorded as another dengue fever death in Indonesia. Thus far this year Indonesia has recorded 538 fatalities from dengue fever.

The entire area is reporting unusually high number of cases of dengue fever. The Philippines has recorded 259 dengue fever deaths.

Last year the index case of human-to-human transmission in Thailand was diagnosed as dengue fever because she vomited blood and had a nose bleed. She fatally infected her mother, who was H5N1 positive. Her aunt was also H5N1 positive.

The confusion of pandemic influenza with dengue fever was also seen in the 1918 flu pandemic. Many patients had internal bleeding and bleeding under this skin. This led to mis-diagnosis of dengue fever, typhoid, and cholera.

The spread of H5N1 in Indonesia suggests monitoring efforts in the region are far from adequate. Indonesia now has 10 acknowledged H5N1 cases. Six have died and one has been discharged. Two are in South Sulaweto, indicating H5N1 in humans has spread far and wide.

The number of H5N1 cases in Indonesia and the area in general is unknown because of the lack of H5N1 testing combined with false negatives. Indeed, only one of the three family members in Tangerang is an official H5N1 cases, although all three clearly died from H5N1 infections.

An increased screening of patients is long overdue, and the latest fatality should make it clear that the number of H5N1 case misdiagnosed as dengue fever may be very large.

www.recombinomics.com...

Considering the number of Dengue cases reported in SouthEast Asia, this is a distrubing addmission. How many other true H5N1 deaths have attributed to other disease's?

Good to hear you again Gman. You have been quiet lately. I was just reporting this on another thread about the Dengue fever and the possible misdiagnosis.
People are waking up but not as many as should be.
As little as 3 months ago give or take you and I have been throwing out the info about this flu and now people are taking notice.

What I find interesting and scary are the cases that haven't been reported and/or misdiagnosed. In less than a month flu season will begin in the US and abroad and this virus is going to get alot to choose from in the way of genome swapping.

Thanks to Dr. Niman for his commentary on this very important subject.

Quote..It seems that much of the testing in Indonesia is destined to give false negatives. Detecting H5N1 by PCR or serum antibodies requires collection of the right sample at the right time. For PCR, samples from the throat should be collected early, before the virus has moved to the lungs. Alternatively, H5N1 can be detected at autopsy by collecting infected tissues. For antibody, samples need to be collected late, such as 30 days after symptoms which allows for antibody levels to rise. For WHO confirmation, a titer rise of greater than 4 X is required, so at least two collections need to be made. An early collection followed by a late collection would clearly show the required 4X titer increase.

However, the patients in Indonesia have been going to local facility, which do not collect samples. By the time the patient is referred to the infectious disease hospital, H5N1 has moved out of the throat and into the lungs. Thus, PCR test are negative. If the patient recovers, there is no autopsy. If the patient dies, there ay be no autopsy because of religious prohibition. Thus, positive PCR results are unlikely.

For serum, the antibody levels are not high enough when transferred, so they also are negative most of the time. If positive, they still won't be confirmed unless another sample is collected and its level is at least 4 X higher than the first.

Thus, the lack of testing at the primary care center coupled with late PCR testing and early antibody testing at the referral center, produces false negative results.

In the June/Jily family cluster, only the father was PCR positive because by the time he was admitted both of his daughters were dying, so they took a throat sample early (at the correct time). For his older daughter, both of her serum samples were strongly positive, but they were collected just 3 days apart so the second samples was not 4X the first (and therefore she was not a confirmed case).

In the second familial cluster, the sample from Rini Dina was collected at the right time (possibly because she worked at the airport and concern levels were high). Her nephew developed symptoms a week later so he was also tested early and was also PCR positive, but has recovered and has been discharged. Although PCR positive, he was never that sick.

Thus, the sample collection procedures are destined to return false negatives and the true level of H5N1 infections in humans in Indonesia is largely unknown.
End Quote.

So basically, we might already be in sustained human-to-human transmission. I think that the WHO should mandate that all samples and tests be turned over to a reliable source. It would be nice to have a qualified testing center on site. This might clear up some of the misdiagnosed cases also.

Fred, I guess this is the update on the numbers:

Bird flu: 54 Indonesians ill

Jakarta - At least 54 people were being treated on Wednesday for suspected bird flu in Indonesia, where the disease had already claimed six lives, said officials.

Deputy director of Jakarta's Sulianto Saroso hospital, Sardikin Giriputro, said they would soon discharge three of 20 suspected bird flu patients after tests gave them a clean bill of health.

He said the three, two adult men and one two-year-old infant would be able to leave the hospital once a clearance was obtained from the health ministry.

and

Reports of Widespread H5N1 Cases in Indonesia

Till Wednesday struck 14.00 WIB, four new patients who it was suspected were infected by birds flu underwent the maintenance in RSPI Sulianti Saroso.

The number of patients admitted to hospitals throughout Indonesia continue to rise. Media accounts described 12 recent admissions. At Sulianti Saroso there were four admissions yesterday and three more today.

However, there has also been reports of recent admissions in East Java (35F), central Java (58M), Bandu (1.5 F), and Bandar Lumpung (20 M and brother)

Where is the warning not to travel to Indonesia??? Did the CDC or State Dept issue one yet??

I haven't heard anything yet, but is it THAT widespread? IT still sounds like more isolated incidents, not enough to alert travelers beyond the "careful".

We have another zoo closing in Java.

Tinjomoyo Semarang will be closed for 21 days.

H5N1 bird flu was detected in at least eight birds at the Tinjomoyo Zoo in Semarang in Central Java. This closure has parallels with the Rangunan Zoo in Jakarta. The birds there were massively infected with H5N1 and both zoo workers and visitors tested positive for H5N1 (see Jakarta map). The number of infections is unknown, but recently a baby of a mother who had visited the zoo in Jakarta was just admitted to the Salianti Saroso infectious disease hospital in Jakarta.

www.recombinomics.com...

Now it's just a question of how many people visited this zoo and watch the poor victims pour into the hospitals.

What I did find interesting in this article is that it states that a baby of a mother that visited the zoo is infected. But it isn't clear whether the child was also at the zoo.

This lends strong credibility that this virus has already begun being transmissable amongst human to human.




[edit on 29-9-2005 by DDay]