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Confirmed H5N1 Bird Flu Cases Increase Across Indonesia

Recombinomics Commentary

May 29, 2006

One of them was an 18-year-old man from Bandung on Java island who had tested negative earlier in Hong Kong. The latest result classified him as a H5N1 case, said I Nyoman Kandun, director-general of communicable disease control.

He was the brother of a 10-year-old girl, who was tested positive for H5N1 by the Hong Kong laboratory last week. Both died last Tuesday.
Kandun said a 15-year-old girl from Solok in western Sumatra, who is fighting for her life, also tested positive, according to results from the Hong Kong laboratory.

The above comments add to the WHO list of confirmed H5N1 bird flu cases in Indonesia.  In addition to the large cluster on North Sumatra and another case in Bekasi, which have been described in updates. Seven more confirmed cases have been announced in media reports in the past few days.  Two siblings in Bandung in Western Java have been confirmed in addition to three cases in nearby Jakarta.  There has also been confirmation in East Java as well as western Sumatra.

These new cases cover large geographical regions in Indonesia and involve at least two different versions of H5N1.  The cases in West Java have a novel cleavage site RESRRKKR, which has not been reported in poultry, raising concerns of Mammalian reservoir.  In contrast the large cluster in Sumatra appears to be related to the wild type H5N1 cleavage site sound in birds in Indonesia, RERRRKKR, which has bee found throughout Asia.

The analysis of changes in these two versions has been hampered because they are sequestered in a private WHO database and not publicly available.  The recently reporting of new cases in Indonesia has led to the deployment of Tamiflu by the United States and warning to Tamiflu maker Roche.  In addition, WHO has announced a revision in the definition of pandemic phases, with a distinction between human-to-human transmission within families and more casual transmission.

The increase in the number of cases is cause for concern, and the sequences should be released immediately.
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