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Hospitalized Suspect H5N1 Cases Increase in Karo Sumatra

Recombinomics Commentary

August 2, 2006

Another health official identified as Nyoman Kandun told AP, "There are two clusters, one with two sisters, the other with three family members, and another two of their neighbors."

Its widely believed that chickens in the area where the suspected victims live, tested positive for the virus.

The above comments represent the media consensus on the number of hospitalized patients in Karo, although some reports indocate as many as nine patients have been hospitalized.  The three patients with the most severe symptoms have been transferred to Adam Malik and have been given Tamiflu.  These three include the six year old index case, as well as a 10 year old sibling and 18 month old neighbor.  Lung involvement has been described for all three, although the involvement appears to be most severe for the index case.  Some reports indicate three of the patients at the local hospital have been discharged.

Several reports describe poultry deaths and at least one report has indicate some of the poultry has tested positive for H5N1 bird flu, Reports indicate WHO is aware of the situation, but has declined comment,  If the three patients at Adam Malik test positive, they will represent another example of bird flu in cluster members that are not blood relatives, assuming the toddler is not related to the two other cases.

Positive results would also sound alarm bells, since this is the same general area as the earlier Karo cluster in which 7 of the 8 infected family members died. Although the sequences from the H5N1 isolated from patients in the earlier cluster have not been released, they are distinct from the majority of H5N1 cases in Indonesia which are infected with an H5N1 with a novel cleavage site and form a separate branch on the phylogenetic tree that does not have other avian isolates. 

In the current cluster, even the more advanced cases are in stable condition, suggesting the current infections are not linked to an H5N1 that is as lethal as the isolates from the earlier cluster.

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