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Sulawesi Poultry Worker Inconclusive for H5N1

Recombinomics Commentary

May 18, 2005
>>  "Out of 63 specimens, one was unclear and we are trying to find that
person to do another test," Umar Fahmi, the health ministry's director
general of communicable disease eradication, told reporters.

Fahmi said the poultry worker who required re-testing was in South
Sulawesi province in eastern Indonesia, where outbreaks have been
reported in poultry since the start of the year. <<

The inconclusive test result for a poultry working in Sulawesi is cause for concern.  H5N1 infections in poultry in Indonesia have been widespread.  In addition, media reports have indicated that H7N1 infections in Indonesia have also been detected.  Human-to-human transmission of H7N7 in the Netherlands in 2003 was efficient, so human infections may involve H5N1 / H7N1 recombinants.  Moreover, recent reports indicate H5N1 infections in asymptomatic pigs in Indonesia have been detected.  In Vietnam and Thailand H5N1 isolates have polymorphisms usually found in mammalian isolates.  Therefore, isolates in Indonesia that infect humans may be swiminized.  All of these potential changes in H5N1 may produces weaker activity in an H5N1 anitibody test, which could result in an inconclusive result.  Moreover H5N1 antibody tests in Japan had to be modified to detect H5N1 in farm workers there and the antibody levels were very low.

The H5N1 detected in Indonesia is the Z genotype, which is the same genotype as the human isolates from Vietnam and Thailand.  The inconclusive result among 63 workers dictates a retest of that worker and an expanded screening.  Similar testing should also be done among poultry workers in India where 3 serum samples collected in 2002 were also H5N1 positive.

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