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H5N1 Bird Flu Transmission in Indonesian Refugee Shelters?

Recombinomics Commentary

June 3, 2006

More than 50 people were staying Saturday in two large empty chicken coops in Pentong in Bantul district. Flies buzzed everywhere, and children played barefoot on bamboo slats encrusted with chicken droppings.

Parji, the 60-year-old owner of one of the coops, told The Associated Press that he wasn't afraid of bird flu.

"There is a slight smell from the dung, but I look after the health of my birds. I am certain there is no bird flu here," he said. No officials had advised them to leave, he said.

The above comments raise additional concern about transmission of H5N1 to and among refugees from the earthquake and nearby active volcano.  Bird flu is widespread throughout Java and H5N1 has been isolated from birds the area in the past.  The H5N1 isolated in Yogjakarta is closely related to the only public human sequence from Indonesia, A/Indonesia/5/2005(H5N1).

Most of the reported human cases in Indonesia are in the West Java region (see map) and the vast majority of the human cases have a novel cleavage site suggesting another reservoir for H5N1.  Displaced people sheltered in crowded chicken coops may be exposed to an avian source of infection.  However, other sources such as swine have not be extensively tested.  The failure to match the H5N1 from humans with the sequences from birds leaves the source of infection open.

Moreover, human-to-human transmission among close contacts, such as family members, is common, and the familial clusters are most common in Indonesia.  The recent large cluster in north Sumatra involved a least two chains of transmission, which was thought to be due to close contact and high levels of H5N1 in the nose and throat.

Recently, a growing family cluster in Tangerang and a growing geographical cluster in Bandung have raised concerns that transmission of H5N1 in the West Java area may be on the rise.  Sheltered refugees may present close contact opportunities fro H5N1 transmission, so even if H5N1 does not pass easily from person-to-person, the close quarters could provide opportunities for human transmission.

The transmission can also be facilitated by the wet conditions, which creates an unstable transmission environment in the refugee camps or shelters.

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