Indonesia plays down bird flu cluster as family takes child home with suspected bird flu

Aug 21 2006

The Indonesian Ministry of Health has confirmed the country’s 59th case of human infection with the H5N1 avian influenza virus in a 35-year-old woman from the district of Cikelet, in West Java Province.

The woman was hospitalized with severe respiratory disease on 17 August and died shortly after admission and is the third confirmed case from the area to be reported in the past week and the 46th Indonesian to die from the virus.

A 4-year-old girl from the same village who was suspected of having bird flu has been removed from hospital by her family against the advice of doctors.

The family is reportedly now going to treat her at home with traditional medicine.

The disease was confirmed in two other people from Cikelet in the past week: a 9-year-old girl who died Aug 15 and a 17-year-old boy who is still alive.

Authorities say the girl was one of 11 people from the small remote village of Cikelet southeast of the capital Jakarta, suspected of having or confirmed to have bird flu.

The girls family have decided to remove her from Dr. Slamet General Hospital in Garut West Java despite the fact that laboratory test results for the child have as yet not been completed.

The hospital does say however that the girls condition did appear to be improving.

According to official sources test results are also pending for three additional patients hospitalized with bird flu symptoms.

The World Health Organization says to date the H5N1 virus has killed at least 141 people worldwide since it began ravaging Asian poultry stocks in late 2003, and Indonesia is the worst-affected country.

64 people have died of the illness so far this year, compared with 41 for all of last year.

Almost all human cases have been the result of close contact with infected birds but there is the ever-present concern that the virus could mutate into a form that spreads easily among humans, potentially sparking a pandemic.

When multiple cases in close proximity occur it raises the possibility of human-to-human transmission.

An investigation was launched in Cikelet on Aug 17 by international and local health officials, in order to discover if the rapid rise in cases in the area is a signal that a new human bird flu cluster is now involved which would heighten the chance of the virus mutating.

The WHO says investigators believe the human cases are related to poultry outbreaks that began in late June and laboratory test results have already confirmed that two people from the area died of bird flu and that one was sickened; another four died before swab samples could be taken.

According to the WHO no mass poultry deaths are known to have occurred in the area before late June, when some chickens were bought from an outside market and added to local flocks and large numbers of chickens began dying shortly afterwards, in an outbreak that continued through July and the first week of August.

The Cikelet area is a remote mountain district with winding tracks which do not provide easy access and mortality from endemic diseases, especially malaria, is common, access to health care is poor, and medical records of deaths are scanty or non-existent.

The villagers had no prior experience of dealing with the disease and high-risk behaviours commonly occurred during the disposal of carcasses or the preparation of sick or dead birds for consumption.

These exposures are, at present, thought to be the source of infection for most confirmed or suspected cases.

Deaths from respiratory illness are known to have occurred in late July and early August, but no samples were taken.

Though some of these undiagnosed deaths occurred in family members of confirmed cases, the investigation has found no evidence of human-to-human transmission and no evidence that the virus is spreading more easily from birds to humans.

The cooperation of residents is good, house-to-house surveillance for febrile illness is continuing, and specimens have been taken from symptomatic persons and sent for testing.

The team is well-supplied with antiviral drugs, and these are being administered prophylactically to close contacts of cases and therapeutically to persons showing symptoms of influenza-like illness.

The Cikelet outbreak follows 3 months after seven confirmed avian flu cases and one probable case occurred in an extended family in the Indonesian province of North Sumatra.

The cluster brought the first laboratory-confirmed instance of human-to-human transmission and the first three-person chain of cases but the WHO reached the conclusion that the disease did not spread outside the family.

Experts on the ground feel that Indonesian officials have underplayed the likelihood of a case cluster in Cikelet.

Elsewhere, the United Nations Food and Agriculture Organization (FAO) has warned that though the spread of avian flu among poultry has slowed in most countries, the southern Balkan countries and the Caucasus are a "high-risk region" for more outbreaks.

The FAO says the region is not only a prime resting ground for migratory bird species, but poultry production in rural areas and backyards has little in terms of biosecurity and strong regulatory inspection.

The agency says that H5N1 has been confirmed in 55 countries, up from 45 in April, but the spread of the virus among poultry has been slowed by efforts to improve surveillance, strengthen veterinary services, and, in some cases, vaccinate poultry.

The FAO says more than 220 million birds have died from the virus or have been culled with the aim of stopping the spread of the disease.

To fight avian flu, the agency said it has received U.S. $67.5 million so far and has signed agreements with donors for another $29 million.

An additional $25 million has been promised.

The FAO has disbursed $32.5 million since donor countries at a conference in Beijing last January pledged $1.9 billion for the campaign to stop the virus.