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H5N1 Investigation Concerns in Jakarta Indonesia

Recombinomics Commentary

September 13, 2005

Siti said she expected an increase in the number of suspected human infections in the country due to the rising alert level. She called on people not to panic because while the source of the virus in either case had not been found, there was no case of human-to-human transmission of the virus……………

Her husband, Agus Mardeo, said he was baffled by the media coverage saying that his wife had died of bird flu, as the Bintaro International Hospital indicated that pneumonia was the cause of death.

"I'm confused. I'd like to report the media to the Indonesian Broadcasting Commission. And I want the government to explain to me the cause of my wife's death," said Agus, who looked weary and upset………..

Bjorge said that WHO has no criticism of the Indonesian side as this was a complicated and unprecedented matter.

"As for my confidence in the Indonesian response from the health side, I know that people are working very hard. Every lead is being followed."

The above comments are cause for concern.  The Prime Minister of Health is offering assurances without foundation.  Thus far the three fatal H5N1 cases independently confirmed are from the same family, but have different disease onset dates.  This characteristic is a strong indicator of human-to-human transmission,  Statements that there was no case of human-to-human H5N1 bird flu transmission are without foundation.

Unfortunately, such misrepresentations have been the norm.  The initial cases were said toi no have bird flu symptoms and death was said to be from bacterial pneumonia.  These initial statement approved to be false as were comments on travel history.  All of these limit effective tracing of the H5N1 infection.

The husband of the current fatal case is unaware of the fact that his wife's pneumonia were characteristic of bird flu symptoms and she has tested positive for bird flu at least once, strongly indicating that she died of H5N1 bird flu.

If the husband is unaware of this, then it is hard to see how "every lead is being followed".  Since the patient is dead, it would seem that the best source of her contacts and routine would be her husband, but a failure to notify him of the likely cause of his wife's death would limit leads.

The situation in Indonesia is cause for concern at almost all levels.  Indonesia has been declared endemic for H5N1 and testing of sub-districts in Tangerang after the last cluster showed that H5N1 was widespread.  It was detected in a birdcage across the street from the fatal infections as well as in two of three nearby sub-districts.  Positive pigs and domestic waterfowl were detected,  In the only reported negative sub-district, only three chickens were reported as being tested.  Media reports indicate the current investigation has been limited to 100 meters from the victim's home.

Clearly investigations of H5N1 and culling of nearby animals is not being taken seriously.  The urban location of both sets of cases in the absence of interactions with domestic poultry or pigs raises concerns about unreported cases.  Both reported families were involved in government office positions, raising questions about farm workers who are in daily contact with H5N1 infected poultry or pigs.

A more aggressive investigation and culling is required.

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