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Human to Human Transmission of H5N1 in Jakarta Indonesia

Recombinomics Commentary

July 25, 2005

Neighbors anxiously traded rumors across the metal fences surrounding their neatly landscaped yards. Mothers kept their children from playing on the palm-lined streets. Some families in this quiet California-style subdivision of bankers, businessmen and doctors considered packing up their belongings in their SUVs and abandoning their homes.

Most residents of the Villa Melati Mas bedroom community on the western outskirts of Jakarta had paid little mind to reports of avian influenza, which has devastated poultry flocks across Indonesia during the last two years and killed dozens of people in other Southeast Asian countries.

Then the horror came home to 7 Pondok Cempaka St……..

Rafei's wife and his mother, speaking in interviews outside their house, said they did not know how he and the daughters got sick. Rafei was a busy professional who set out early every morning on his two-hour commute to Jakarta's downtown financial district and returned late in the evening, leaving little time for side trips to farms or chicken markets, they explained. His wife, Lin Rosalina, eyes red from crying, said she was also certain her children had not come into contact with live poultry.

"I'm very sure," she added, switching from Indonesian to English to make the point.

Sunaryo, the neighborhood leader, said he also remained skeptical about official reports that Rafei and his daughters caught the virus from birds.

The above details of the neighborhood and three family members who died from H5N1 bird flu cast more doubt on the unsupported speculation by Indonesia and the WHO that these fatalities did not involve human-to-human transmission.  The evidence within the family is overwhelming.  Like virtually all familial clusters in Vietnam, Thailand, and Cambodia, the disease onset dates makes a common source highly unlike for each cluster, and virtually impossible for most or all.

However, in this cluster, like many in Vietnam, it is also difficult to identify a bird source as the cause of the infection in the index case, the 8 year old daughter who developed symptoms on June 24.  Her 1 year old sisters developed symptoms almost a week later and her father developed symptoms on July 2.  As her mother indicates, there was no contact with live poultry.

Live poultry or pigs may have been the source of an initial infection in the region, since both species have tested positive for H5N1, but only a television reporter who visited a poultry farm has been identified as a case with a known link to poultry, although the Malaysian cook, who is a suspect case in the same Tangergang region may have had an occupational exposure.

The number of confirmed and suspect cases in the Jakarta suburban region is now up to six.  The climbing numbers and upcoming migration of birds into Indonesia from northern nesting areas in China and Russia are cause for concern.

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