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Five Fatal H5N1 Cases in Sumatra Raise Pandemic Concerns

Recombinomics Commentary

May 13, 2006

The fatal H5N1 bird flu infections of five family members in Karo in North Sumatra has raised pandemic concerns.  2-3 additional family members are hospitalized, but 12 other suspect patients are of even greater concern.

Media reports have provided no detail on these other 12 patients.  The hospital is 170 km from the family residence, so it is unclear why there are 12 more suspect patients at the hospital in Medan.  Least worrisome would be hospital quarantine due to exposure to the family.  However, transporting these patients 170 km as a precaution suggests the local level; of concern is high.  Media reports had described panic in the region, but the panic is more likely to be in Karo than Medan.

If the 12 are casual contacts or hospital contacts, than the cause for concern would be increased.  The five fatalities have already set a record for H5N1 clusters and so far none of the family members have been discharged.  Two fled from the hospital, but they have been returned to a private hospital and their current medical condition is not clear.

The family members most severely affected have died, and the spread in the dates of death suggests human-to-human transmission from the index case to the other family members.  Although fertilizer may have contributed to the infection of the index case, infection of the other family members from the fertilizer seems unlikely, unless the other 12 suspect cases also are linked to the fertilizer, which originated in areas that are H5N1 positive.

In any event, more information on the 12 Indonesian suspect cases would be useful.

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