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Clusters in H5N1 Garut Cluster Raise Pandemic Concerns
Recombinomics Commentary

August 19, 2006

Four other people who died and were it was suspected attacked by bird flu were Euis Lina, Rubiah, Misbah, and Sardi. The four citizens, remained was not far from the house of Ai Siti the message in the Village and the Cikelet Subdistrict,

Therefore, suspect and positive bird flu in Garut numbering 9 people. Umar and Ai Siti Amanah, has been stated positive bird flu. Umar has recovered. Whereas Ai Siti, died, on Tuesday (15/8). Three suspect other currently in the maintenance. Is (5) and S (8) was treated in Poinciana Tree Space of RSHS Bandung. Whereas K since Friday (18/8) was treated in RSU Dr. Slamet Garut. However last night has been moved to RSHS.

Dinkes West Java with Tim [team] the Department of the RI Health, also carried out the taking of the sample of the citizen's blood with the sign of the fever and breathless. Two including being the sibling the Rubiah who has died.

The above translation details nine suspect H5N1 bird flu patients from Cikelet Village in Garut, West Java who have either died or are hospitalized.  Additional media indicate the nine year old daughter of Euis Lina, Dea, has also died.  She was initially diagnosed as a typhus patient, but had bird flu symptoms.  Thus, the total number of reported cases, including the two siblings who are not hospitalized but have symptoms, is now twelve.

However, it is becoming clear that there are geographic and familial clusters within the clusters.  It is also clear that at least four of the cases would not have been reported if there was not a cluster which increased awareness of H5n1 infections.

The initial confirmed case, Umar Asp (17M) is recovering, but his cousin, Misbah (20M) died on August 5 with bird flu symptoms but no sample was collected.

Two others, who lived near Ai Siti Aminish, the second confirmed case, died without sample collection.  Although samples were not collected from Sardi or Rubiah, Rubiah's two siblings have symptoms and samples have been collected from them, although they are not hospitalized.

Ai Site Aminish (9F) has also died and has also been confirmed to be H5N1 infected.  A cousin Isamawati (5F or M?) and neighbor/playmate Santi (8F) attended her funeral and both are hospitalized in Bandung.

Euis Lina (35F) has also died, and her 9year-old daughter, Dea, has died earlier but no samples were collected because she was misdiagnosed as having typhus.

The most recent admission is Kuraesin (35F), who is three mons pregnant.

Thus, although there have only been two confirmed cases, the additional 10 patients with symptoms indicates the H5N1 infections are much more widespread and have formed several clusters within clusters. 

The failure to collect samples on four of the patients, delay of release test results on the samples already collected, and failure to acknowledged human to human transmission, and the increase efficiency of transmission to humans, are all cause for concern, as are reports of a new sequence.

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