Reports Of Widespread
H5N1 Cases In Indonesia

By Dr. Henry L. Niman, PhD
Note - This first paragraph is a software translation of an Indonesian news story.
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)
The four admissions at Sulianti Saroso yesterday included two brothers, Arir Nurwitano and Fuazan Tonq, (10M and 8M) who had been to Rangunan Zoo, a 3 year old child, Ni Made Superior, who lived near a chicken slaughterhouse, and Ahmad Zaenudin (23M), whose doves had died.
Today, Syifa, a 10 month old girl, 25 year old Salmet Wibodo, and 27 year old Adam Budi were admitted. They also had ties to poultry.
The large number of cases, spread across Indonesia is cause for concern. Most of these patients initially check into primary care facilities where no clinical samples are collected. By the time they are referred to a facility specializing in infectious diseases, the virus has moved from the upper respiratory tract to the lower respiratory tract, so PCR tests are negative. Similarly, serum samples are then collected too early for significant antibody titers to have developed, so those HI tests are also negative.
Thus, sample collection is far from ideal, and most tests are negative even though it is likely that many of the patients are H5N1 positive. If the patient recovers, there is no autopsy material, and in many cases autopsies are not preformed on fatal cases because of religious prohibitions.
Thus, many of the H5N1 infections are not detected by initial lab tests, so the true extent of H5N1 infections in Indonesians is largely unknown.
Indonesia Now Reports 61 Cases Of H5N1 Bird Flu
From Patricia Doyle, PhD
JAKARTA (AFP): At least 63 people have been infected with or are suspected to have contracted bird flu in Indonesia this year, a health official said Thursday.
"For the whole of Indonesia, a total of 63 people have been suspected of infection or diagnosed as infected with bird flu since the first human infection case was found," said the official.
Of the 63, six have died but further tests are still being carried out on the latest fatality to confirm that the victim died of the virus.
Some of those infected with the virus have not shown any symptoms and others have made a full recovery, officials said.
Bird flu has killed 43 in Vietnam, 12 in Thailand and four in Cambodia.
The health ministry official said that the 63 cases of bird flu could be broken down into three categories -- confirmed, probable and suspected cases.
A patient is suspected to have bird flu if the person showed clinical symptoms of the disease such as high fever, said Sardikin Giriputro, deputy director of Sulianti Saroso hospital, the main hospital treating bird flu patients.
Probable cases refer to those who have had initial tests that strengthened suspicion of infection, including X-rays showing that pneumonia had developed, he said.
Confirmed cases refer to cases which had been clinically and serologically tested positive, and had the results confirmed by the World Health Organization through further tests in Hong Kong.
Only five of the 63 were confirmed bird flu cases, nine were probable cases, while the rest were suspected. (***)
Patricia A. Doyle, PhD
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