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Another Fatal H5N1 Case in North Sumatra Indonesia

Recombinomics Commentary

May 14, 2006

five patients suspect bird flu from the Simbelang Fortification Village, the Subdistrict of three bows, the Karo Land Regency died in Adam's Public Hospital the Owner, Medan, North Sumatra.One of the patients suspect bird flu that meningal the world was Rafael Ginting, 10, that blew out the last breath, on Saturday, struck 14.00 WIB after getting the maintenance for five days.Four patients suspect other bird flu that died that is Bony Karo-Karo, 18, Anta br Ginting, 29, Fuji br Ginting, 40 and Roy Karo-Karo, 19.Whereas the patient suspect bird flu that at this time still was treated that is Brenata br Tarigan, 1,5 and Jonnes Ginting, 25,

The above translation describes the death of another family members in the cluster from Karo.  It contradicts an earlier report that indicated Brenata br (aka Reneita) Ginting had died on Friday.  Other reports also indicated the baby is still alive, but her condition is deteriorating and she is on a respirator.  Similarly, Jonnes Ginting was returned to the hospital after his condition also began to worsen.  The only family member who is alive and not hospitalized is Obvious Ulina Gintining, who is being treated at her home in Karo.

Media reports also indicate that the first four fatalities and Jonnes Ginting have tested positive for H5N1 bird flu.  At least three of the positive samples have been sent to Hong Kong for confirmation.  In the past, virtually all samples that have been positive when tested in Jakarta have been confirmed by Hong Kong.  Thus, if samples from all eight family members are properly collected, the number of WHO confirmed cases in Indonesia would increase by eight.  Currently WHO has reported confirmed 33 cases and 25 deaths.  Thus, these 8 cases would dramatically increase the number of confirmed Indonesian cases and would represent the largest and most fatal cluster confirmed to date in Indonesia.

In the past, many of the confirmed cases from Indonesia have been linked to familial or geographic clusters and most of these cases have been in or around Jakarta.  The cluster described above is in North Sumatra and raises pandemic concerns

Infection of eight members of one family indicates the efficiency of transmission to humans has increased.  Moreover, five members of the cluster have already died (on May 4, 9, 10, 12, 13) and two more are hospitalized in declining health. 

Although some "worst case" pandemic scenarios have used a case fatality rate of 2-5%, the current outbreak indicates the rate could be markedly higher for H5N1 that is more efficiently transmitted.  Although there still is no evidence that H5N1 is easily transmitted between humans, media reports of 12 additional patients hospitalized in Medan with bird flu symptoms is cause for concern.

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