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H5N1 Cluster in South Sulawesi Indonesia
Recombinomics Commentary

September 8, 2006

A student was 14 years old was named Akhira, was stated positive suffered bird flu. Akhira died on June 24, in the last three months, but results of his laboratory were just known, on Thursday (7/9).

Akhira personally, one among three insiders of one family that died. In a period less than two weeks, the domiciled simple family in……, Makassar, this hatus lost Andri Winarti (17) and his mother Hj Sukria (56).

All of them died after being treated with the complaint and the same sign, namely the fever, breathless, and the chest was sick. Kadis the South Sulawesi Health, Dr Andi Muhadir said, the hospital side when treating the three patients only took sample the bribe and blood from Akhira.

While Andri and his mother were not taken sample blood and his bribe to be researched in the laboratory.

The above translation indicates the confirmed H5N1 positive case announced by WHO today was a member of a family cluster (which was not mentioned in today's WHO Indonesian update).  This latest result is simply more evidence that the monitoring of H5N1 in Indonesia remains scandalously poor and this poor surveillance is aided and abetted by the WHO.

In the same update, WHO acknowledged that the index case for Indonesia, an 8 year old girl who died over a year ago in July, 2005, is a confirmed case.  Although this cluster has been obvious for over a year, WHO is confirming the index case a year after the fact, and the 1 year old dead sister is still not an official (or even suspect) case. 

Disease onset dates suggest the index case infected her baby sister and father.  All three died within days of each other in July, 2005 and the first human H5N1 isolate, A/Indonesia/5/2005, came from the father, who prior to today was the official index case for Indonesia.  All three family members were in initially diagnosed as bacterial pneumonia cases.  However, eventually a sample was collected from the father that was H5 positive.  The samples collected from the index case were negative for H5N1, but the patient had a titer of 320 as determined by Hong Kong and CDC.  As second sample had an even higher titer (of 640), but since it was not 4 fold higher than the earlier collection (which was collected 3 days after the first sample), WHO considered the cases as “probable”. This classification made little sense since H5N1 had already been isolated and sequenced from the father by both Hong Kong and the CDC and there was little doubt that all three family members died from H5N1.

Unfortunately, even though this remarkable poor surveillance was in July, 2005, the same sequence of events is repeated again and again.  The Karo cluster is officially the largest in Indonesia, but no sample was collected from the index case.  More recently, media reports and the WHO update on the Garut cluster acknowledge the deaths of 3-4 contacts of H5N1 confirmed patients, but the earlier victims were never tested for H5N1 because they were misdiagnosed as typhoid cases.

The latest cluster above, appears to be more of the same.  Although local media claims that this is the first case in South Sulawesi, a similar cluster in 2005 suggests H5N1 has been killing people in South Sulawesi for over a year, and poor surveillance / collection/ or testing has created yet another illusion on H5N1 in patients in Indonesia. 

Clusters are again not reported because samples are not collected and WHO updates appear to once again be out of touch with reality.  Time and time again relationships between cluster members are described in local media, but absent from WHO updates. 

WHO failure to provide the most basic information (contacts or relatives who died and had bird flu symptoms), remains a hazard to the world’s health.

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