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Fatalities in H5N1 Cluster in Medan Indonesia Grow

Recombinomics Commentary

May 22, 2006

"One man from the same Sumatra cluster died this morning. He is the father of the child who died on May 13. He ran away after he received Tamiflu," said I Nyoman Kandun, director-general of communicable disease control at the health ministry.

"He was found in the village later but refused treatment," Kandun told reporters.

Kandun said there was no evidence the H5N1 virus had mutated in the Kubu Simbelang cluster case, which has drawn global concern because officials have found no definitive source of the outbreak.

The above comments indicate that now 7 of the 8 members of the H5N1 bird flu cluster in Sumatra have died.  The possibility of further spread by the uncle is also of concern since he left the hospital prior to death.

Transparency issues are again raised because of WHO statements that there was no evidence of spread beyond the family members, but failed to mention the symptomatic uncle.  A family member near death with bird flu symptoms, who has refused Tamiflu, is evidence of spread in the family and should be included in the update.

Transparency on sequences also remains suspect.  The statement that there was no evidence of H5N1 mutation is not credible..  H5N1 is constantly evolving, and there are at least two distinct H5N1 sequences for human cases in the Jakarta area.  Efficiency in H5N1 spread is not solely dependent or reassortment, changes in the receptor binding domain, or acquisition of PB2 E627K.

All of the human sequences sequestered at the WHO private database should be released immediately, so the human sequences can be fully analyzed and compared to animal sequences.  Included in the release should be the sequences from the cluster in Sumatra, which is the most deadly reported to date, and contains the longest transmission chain reported to date.

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