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Suspect H5N1 Cluster and Tamfilu Blanket in Bogor Indonesia
Recombinomics Commentary 14:37
February 2, 2009

Post the death two related Nurul Hikmah and her older sister of Ruslani (30), the resident Cilendek West RT 3/8 Bogor West the Bogor City that was expected because suspect bird flu, the Team of the Centre of the Control of the Department's Bird Flu of the RI Health yesterday carried out the taking test of the sample of the resident's blood around casualties's house.

"While being waiting for results" of the "laboratory test, we gave Tamiflu to all the person that contact with the patient." Including the official RS Karya Bhakti and RS Persahabatan, also all of the patient's family, he revealed.

After two Bogor inhabitants died with the assumption of bird flu, yesterday the resident was again thrown into turmoil with the discovery of the positive poultry bird flu.

The above translations describe a familial H5N1 fatal, cluster south or Bogor, and H5N1 confirmed poultry north of Bogor (see updated map).  Although the fatal cases have not yet been lab confirmed, contacts have been placed on prophylactic Tamiflu.

Clusters of H5N1 cases raise concerns, as does the liberal use of Tamiflu, now that H1N1 has been confirmed to be Tamiflu resistant throughout Asia.  The H1N1 resistance increases the likelihood of dual infections involving H5N1 and H1N1, which would lead to Tamiflu resistant H5N1 due to selection via Tamiflu treatment.

Tamiflu usage in Indonesia has been highly touted as reducing H5N1 cases, suggesting that H5N1 human to human transmission is widespread, or Tamiflu treatment drives down viral load to levels that are below detection.  The number of suspect cases who test negative is high, and recently there have been cases that were lab confirmed locally, but were not confirmed at government labs.  These suspect cases recovered raising concerns that the number of H5N1 infections is markedly higher than the reported cases.  Moreover, milder cases are encouraged to take Tamiflu in the absence of hospital admissions or H5N1 testing.

These approaches also raise concerns of the selection of H274Y in H5N1, which could lead to a serious escalation of human H5N1 cases in Indonesia and beyond.

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