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New Confirmed H5N1 Bird Flu Fatality in Bandung Indonesia

Recombinomics Commentary

May 31, 2006

A 15-year-old boy from Tasikmalaya town was rushed to Bandung's Hasan Sadikin hospital late Monday after showing symptoms of avian influenza commonly known as bird flu.

The boy, a resident of Cangkuang Karangninggal hamlet in Tasikmalaya, some 100 kilometers east of Bandung, arrived at the hospital with serious breathing problems and a high fever.

Doctors said the boy was likely infected with bird flu, because he had history of direct contact with dead chickens.

The suspect's father said the second year junior high school student fell ill last Wednesday, a week after six of their chickens died suddenly.

"Hundreds of chickens have died since May, with bluish marks on their bodies and fluid coming out of their beaks," the suspect's father said at the hospital Tuesday.

The above description of another confirmed H5N1 bird flu case in the West Java region near Bandung is cause for concern.  Wire service reports have indicated that local tests have confirmed that the patient is H5N1 positive.  Earlier local; media reports described the clinic and local hospital admissions prior to transfer to Hazan Sadikin.  The teenage student arrived late Monday and died on Tuesday.

The announcement that he tested positive for H5N1 suggests that samples were not collected until he was transferred on Monday.  He developed symptoms last Wednesday and was hospitalized in Tarikmalaya after a visit to a local clinic.  When his condition deteriorated further, he was transferred to Bandung.  This series of transfers prior to testing is similar in Jakarta.  Thus, only the most ill are tested which might contribute to the high fatality rate.

The recent spike in cases in West Java and Jakarta are cause for concern.  A pair of siblings are the most recent cases confirmed in Hong Kong.  However, there were two additional admissions who are still being tested.  Thus, there have been five patients near Bandung admitted in the past week and the three that were lab confirmed have died.

Although the most recent case is linked to dying poultry with bird flu symptoms, testing and sequencing of the birds would be useful.  Human cases in West Java (see map) have been infected by H5N1 with a novel cleavage site, which has not been reported for the H5N1 isolated from poultry, including poultry in West Java.

The failure to link the human H5N1 with poultry H5N1 is cause for concern.  Both the lab in Hong Kong and the CDC have the earlier sequences with the novel cleavage site.  These sequences should be released immediately.

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