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Indonesia H5N1 News Blackout Increases Pandemic Concerns
Recombinomics Commentary 12:37
June 5, 2008

A 15-year-old girl died of bird flu last month, becoming Indonesia's 109th victim, but the government decided to keep the news quiet. It is part of a new policy aimed at improving the image of the nation hardest hit by the disease.

Health Minister Siti Fadilah Supari said Thursday she will no longer announce deaths immediately after they are confirmed. But she promised to make the information available on a regular basis eventually, several cases at a time.

“How does it help us to announce these deaths?” she said after confirming that the girl from southern Jakarta tested positive on May 13 and died one day later. “We want to focus now on positive steps and achievements made by the government in fighting bird flu.”

The above comments on reporting delays and government control of unfavourable H5N1 information extend a trend which was becoming increasingly obvious with regard to denials of human clusters.  The 15F above was part of a cluster that has still not been acknowledged.  Her brother died with bird flu symptoms a week before she died and which was diagnosed as typhus.  Another brother was hospitalized with symptoms, but was said to be negative.

Earlier, two other clusters were denied.  In one case the relative who died just before the confirmed case died was said to have died of respiratory disease.  The brother of another confirmed case was said to have died of dengue fever.  When questioned by the media, the director general of communicable disease control confirmed the dengue diagnosis.  This confirmation was accepted at face value in a ProMED commentary, allowing this highly suspect statement to go unchallenged.  Similarly, there has been no update on a recent large suspect cluster.

The latest statement by the health ministry above adds to concerns over cluster denials and the high case fatality rate, which suggests milder cases are also unreported.

In the past, mis-diagnosis of cases, especially when the mis-diagnosis was linked to clusters, was corrected.  However, the above statements on improving Indonesia’s image, raises concerns that do little to improve Indonesia’s image or transparancy.

Indonesia currently has the highest number of confirmed H5N1 cases, and an associated case fatality rate that exceeds 80%.  Concerns that these numbers reflect serious under-reporting are now increased by confirmation of news blackouts to improve Indonesia’s image.

These actions remain hazardous to the world’s health.

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