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Confirmed H5N1 Case in Indonesia Lacks Poultry Link
Recombinomics Commentary 09:11
January 29, 2009

Urip said the hospital's medical team had doubted she was infected with the disease after learning the patient was not exposed to poultry at her work place or in her home village in Lumajang.

The above comments describe the latest lab confirmed H5N1 case in Indonesia (see updated map).  The absence of a poultry link is cause for concern.  The level of H5N1 in poultry in Indonesia is high, but the lack of OIE reports since 2006 from Indonesia limits specifics.

Similarly, the delays in reporting confirmed cases by Indonesia and WHO complicates analysis in humans.  The WHO has not issued a situation update for confirmed cases, and since Indonesia has imposed a news blackout on cases, the updates lag disease onset dates by weeks or months.

Moreover, misdiagnosis of cases in clusters has also contributed to a serous undercounts.  The Ministry of Health has denied index cases diagnosed as lung inflammation, dengue fever, or typhus, even after family members have been H5N1 confirmed.

The latest lab confirmation of a patient without known poultry exposure suggests the undercount in Indonesia is markedly higher than reported confirmed or suspect cases.

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