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More H5N1 Bird Flu Clustering in Bekasi Indonesia
April 10, 2006
Rina Nurfatmarini (29 years) of Kali Abang Bahagia in the town of Bekasi died at 1.30 a.m. local time. She had been treated at Sulianti Saroso Hospital since Thursday after four days at Hermina Hospital, Bekasi.
Nine hours later, Tri Abadi Heri Wibawa (24 years) died. Tri, a resident of Perumnas I in the Jakasampurna subdistrict of Bekasi, had been treated at Sulianti Saroso Hospital since Wednesday after three days at Mitra Keluarga Hospital in Bekasi.
The additional fatalities from Bekasi, Indonesia are cause for concern. Clustering of H5N1 cases in Bakasi has been clear since the fall of 2005, and the clusters have been clear in more recent reports. Although most reports report H5N1 infections in birds in the area, the large number of cases that cluster geographically and familially raises serious questions about control of H5N1 in Indonesia and transmission to humans, especially in the Bekasi area.
As noted above, patients are usually treated at primary facilities, and transferred to Sulianti Saroso after their conditions worsen. Thus, milder cases that recover are not tested for H5N1 and the case fatality rate for Indonesia is extremely high. 12 of the 13 official case reported by WHO this year, through April 6, have died. Thus, although it is not clear if the true rate is lower because milder cases are not tested, but the continuous reporting of H5N1 fatalities from the Bekasi region just east of Jakarta, is cause for concern.