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Fourth Human H5N1 Bird Flu Fatality in Jakarta Indonesia

Recombinomics Commentary

September 11, 2005

The woman, 37, died on Saturday night in a hospital in south Jakarta, after suffering from pneumonia and flu-like respiratory problems since Sept. 6.

"We had taken samples for tests and one showed it was positive (for the H5N1 strain)," Health Minister Siti Fadillah Supari told El Shinta radio, adding that more tests were being done.

The above information on Indonesia's fourth H5N1 bird flu fatality is cause for concern.  Like the H5N1 cases in Cambodia, all confirmed cases have proved to be fatal.  This high fatality rate is similar to south Vietnam.  Recent sequence data has shown that H5N1 in 2004 was virtually identical in Vietnam, Thailand, Laos, and Malaysia.  In 2005, these similarities were clear in southern Vietnam, Cambodia, and Thailand.

The fourth fatality in Indonesia is again in Jakarta, where there have also been reports of H5N1 in swine.  The swine sequences were similar to H5N1 in Yunnan China.  The three earlier cases formed a familiar cluster with a bimodal distribution of onset dates, provide solid evidence for human-to-human transmission.  This transmission profile matches earlier familial clusters in Thailand, Cambodia, and Vietnam.

Sequence data from the earlier cluster would be useful.  Earlier H5N1 isolates from Indonesia were the Z genotype, but there are regional differences and early sequences from Indonesia are distinct from those for fatal cases in Vietnam, Thailand, and Cambodia.

The H5N1 source of the earlier cluster in Tangerang, a Jakarta suburb was not conclusively determined.  The closest sample that was a H5N1 positive was found in the bottom of a neighbor's pet birdcage.

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