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Suspect H5N1 Clusters in  Surabaya Indonesia Cluster

Recombinomics Commentary

May 20, 2006

A suspected 20-year male bird flu sufferer who has been treated in Budi Mulia hospital since May 9, died here at 8.3. am on Saturday.

Two patients beforehand were a woman was the citizen's approximately 30 years old Pucang Young Ii Surabaya and AP one of the citizen's Kediri students

The patient of the citizen's woman Pucang Young Ii Surabaya had finally died, after could be treated by RKZ because his condition has been serious enough. While the patient from Kediri that is reconciled to RSUD Dr Soetomo, currently still in the intensive maintenance in this hospital.

one casualty died with the assumption of bird flu. The Lily, the Surabaya citizen, died on Friday last week.

the child the Lily is currently treated in the hospital with the sign similar to bird flu.

The above translations define a new cluster of confirmed or suspect H5N1 bird flu cases in Surabaya.  The confirmed case (38F) was describe in the WHO update.  She developed symptoms on May 2, was hospitalized on May 7, and died May 11.  The above report indicates her child is now hospitalized with bird flu symptoms, consistent with human-to-human transmission within a family.

Another suspect case (20M) died today, but the same hospital has admitted two additional suspect cases, a teacher (30F) who died earlier, and her student (18M) who is in critical condition and on a respirator.


The teacher decribed above appears to be another media description of the confirmed fatality (38M) and therefore there is no infected teacher and no relationship between a fatally infected teacher and the H5N1 confirmed student.

The geographical cluster in Surabaya thus has one confirmed and four suspect cases.  Two of the suspect cases have died, and the student of one has been hospitalized. Similarly, the child of the confirmed case has also been hospitalized.

Familial clusters in Indonesia have been common. Almost all have a 5-10 day gap between the index case and family member. Recently a seven member cluster in North Sumatra was described. H5N1 has been confirmed in all but the index case, and six of the seven have died,  This cluster, the largest to date, has fueled concern about increased efficiency of human-to-human transmission.  This cluster may be extended because one of the family members (10M) developed symptoms later than the other family member, and now the father of that fatal case has been hospitalized.

The growth in the number and size of the clusters has focused attention on the sequences of the H5N1 isolated from the patients.  However, sequences from only one of the human H5N1 isolates has been released. It has a novel cleavage site, RESRRKKR, that has not been reported in any of the publicly available bird sequences from Indonesia or elsewhere.

These data suggest that the majority of the reported humans cases in Indonesia have not been linked to an avian sequence.  Most of the sequences human isolates have been from West Java, including various locations in Jakarta and suburbs. Some of the avian sequence also are from West Java (see below)

The lack of a connection with bird H5N1 sequences and the increasing size and number of human clusters has raised pandemic concerns.

DQ320932    A/chicken/Bantul/BBVet-I/2005                  2005    H5N1
DQ497667    A/chicken/Dairi/BPPVI/2005                      2005    H5N1
DQ497668    A/chicken/Deli Serdang/BPPVI/2005        2005    H5N1
DQ497651    A/chicken/Gunung Kidal/BBVW/2005        2005    H5N1
DQ497652    A/chicken/Kulon Progo/BBVW/2005          2005    H5N1
DQ497643    A/chicken/Magetan/BBVW/2005                2005    H5N1
DQ497648    A/chicken/Purworejo/BBVW/2005              2005    H5N1
DQ320928    A/chicken/Salatiga/BBVet-I/2005                2005    H5N1
DQ497669    A/chicken/Tarutung/BPPVI/2005                 2005    H5N1
DQ497666    A/chicken/Tebing Tinggi/BPPVI/2005         2005    H5N1
DQ320933    A/chicken/Wajo/BBVM/2005                        2005    H5N1
DQ497659    A/duck/Parepare/BBVM/2005                     2005    H5N1
DQ497655    A/chicken/Bangli Bali/BBPV6-1/2004         2004    H5N1
DQ497656    A/chicken/Bangli Bali/BPPV6-2/2004         2004    H5N1
DQ497657    A/chicken/Jembrana/BPPV6/2004              2004    H5N1
DQ320931    A/chicken/Kulon Progo/BBVet-XII-1/2004   2004    H5N1
DQ497650    A/chicken/Kulon Progo/BBVet-XII-2/2004   2004    H5N1
DQ497662    A/chicken/Kupang-1-NTT/BPPV6/2004      2004    H5N1
DQ497660    A/chicken/Kupang-2-NTT/BPPV6/2004      2004    H5N1
DQ497661    A/chicken/Kupang-3-NTT/BPPV6/2004      2004    H5N1
DQ497642    A/chicken/Malang/BBVet-IV/2004                2004    H5N1
DQ497658    A/chicken/Mangarai-NTT/BPPV6/2004       2004    H5N1
DQ497644    A/chicken/Ngawi/BPPV4/2004                     2004    H5N1
DQ497663    A/chicken/Pangkalpinang/BPPV3/2004      2004    H5N1
DQ497653    A/chicken/Purwakarta/BBVet-IV/2004         2004    H5N1
DQ320930    A/chicken/Yogjakarta/BBVet-IX/2004          2004    H5N1
DQ497647    A/quail/Boyolali/BPPV4/2004                       2004    H5N1
DQ497654    A/quail/Tasikmalaya/BPPV4/2004               2004    H5N1
DQ497645    A/chicken/Pekalongan/BPPV4/2003           2003    H5N1
DQ497646    A/chicken/Sragen/BPPV4/2003                   2003    H5N1
AY651324    A/Ck/Indonesia/4/2004                                   2004    H5N1
AY651325    A/Ck/Indonesia/5/2004                                   2004    H5N1
AY651322    A/Dk/Indonesia/MS/2004                               2004    H5N1
AY651323    A/Ck/Indonesia/2A/2003                                2003    H5N1
AY651321    A/Ck/Indonesia/BL/2003                                2003    H5N1
AY651320    A/Ck/Indonesia/PA/2003                                2003    H5N1

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