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H5N1 Fatality Was Immigration Agent in Jakarta Indonesia
September 12, 2005
The woman was an immigration agent and dealt with many expatriates. Inquiries so far had found that people she had contact with were healthy, Mrs Siti said.
Unlike most bird flu victims, she rarely had contact with animals, but reportedly lived near a chicken slaughterhouse.....
Dr Bjorge said there was no evidence of the virus mutating to one that could easily pass between humans, but results of tests on the latest victim were yet to be received from a specialist laboratory in Hong Kong.
"We won't know until we sequence the virus," he said. "Because there have been so few cases there is certainly no clinical data or evidence on the course of the virus in humans … there are many things we still don't understand about the progress of this infection."
The above comments increase concerns over the latest H5N1 bird flu case in Indonesia. Like the earlier three cases, the index case is in a metropolitan area. Jakarta is adjacent to Tangerang and all of the cases appear to be southwest of the center of Jakarta. Sequence data would help determine the relationship of the human sequences to those found in Indonesia and in other human cases in Vietnam. Thailand, and Cambodia.
H5N1 has been declared to be endemic in all regions where there have been reported human cases, but Indonesian cases have all been urban in people that have little contact with poultry. The familial cluster was in a family from suburban Tangerang. The head of the household was an auditor who worked in government.
The latest case is another government office worker. These case raise questions about human-to-human spread. In other countries, most victims are farmers. If the H5N1 is coming from poultry or swine, it seems likely that there would be human rural cases. None have been reported suggesting the origin of infection in Indonesia is different, or rural cases are not being reported.
Indonesian surveillance has been lacking and government responses have lacked transparency. After the earlier outbreak, the government announced that there was no pathological evidence for bird flu and the cause of death was bacterial pneumonia. The story changed with the H5N1 positive lab data, but that would not affect the original announcement that the pathology was inconsistent with bird flu. Similarly, the bimodal distribution of onset dates strongly suggests the H5N1 was passed human-to-human, in spite of government denials, which persist today.
In the Indonesian OIE report, the number of animals tested was extremely low. However, even with limited testing, H5N1 was found in a pet birdcage across the street from the family of the index cases as well as in poultry and swine in nearby sub-sections of Tangerang. The positive results support the endemic nature of H5N1 in the Tangerang / Jakarta area, yet culling was extremely limited.
The announce of no H5N1 in a 100 meter radius of the house of the index case again raises questions about Indonesian investigative approaches, which have yet to report a cause for the earlier cluster.
The continued reporting of fatal cases in government workers who live and work in urban settings is cause for concern, as is the surveillance and investigative approaches of Indonesia.