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WHO Investigates Growing Garut H5N1 Bird Flu Cluster
Recombinomics Commentary

August 17, 2006

Three hamlets within the village are currently under investigation. An additional case from the village, but from another hamlet, was confirmed by the Ministry of Health on 14 August. This 17-year-old male developed symptoms on 26 July and is now recovering. Another death from severe respiratory disease occurred on 5 August in a 20-year-old neighbour, who is also now known to be a cousin.

Teams from local health authorities, the Ministry of Health, and WHO are currently in the three hamlets investigating these cases and assessing the overall situation. Team members include experts in animal health. Recent die-offs of poultry are known to have occurred in the village, and all three cases described above had documented exposure to diseased chickens.

Heightened awareness in the hamlets, supported by the presence of well-equipped teams, has led to the presentation of additional persons for medical evaluation. Specimens have been taken and tests are being conducted. Rumours of additional deaths from respiratory disease in the hamlets in late July and early August are also being investigated.

The above comments for today's WHO update are similar to most media reports, including rumors of additional fatalities.  The case total from media reports stands at eight, although test results from only two have been made public and both were positive for H5N1 bird flu.  Since both cousins developed symptoms on July 26, it is unlikely that one infected the other.  However, the common source remains unclear.  Although media reports have indicated some of the dead poultry is also H5N1 positive, there has not been any sequence data linking the two infections.  This failure to match applies to all but one human case on Java.  The presence of an investigative team should provide an opportunity to isolate H5N1 from the poultry.  Since media reports describe feeding of dead poultry to dogs, a comprehensive screen of multiple species in the village would be warranted.

The investigation covers four hamlets within the village, suggesting the transmission to humans is more efficient than prior reports from Indonesia.  Genetic relationships have only been described fro the two cousins and the two confirmed positives do not appear to be related.  Similarly, one of the recent cases is a neighbor of the 9F, and presumably also not a relative.  The presence of 8 patients in one small region is cause for concern.

Local media now indicate that both recent admissions are neighbors and are in critical condition.  Moreover, the mother of the 9F described above has died.  Thus, there are now 6 deaths out of 8 outcomes.

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