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Confirmed H5N1 Bird Flu Cases In Indonesia Rise
Recombinomics Commentary

September 13, 2006

Sulianti Saroso again received an assumption patient of bird flu, on Wednesday afternoon (15/3).The patient suspect bird flu that had the initials BS was the citizen of Housing Tarogong Beautiful, Bekasi, West Java.Casualties were 5.5 years beforehand old was treated for a week in the Hermina Hospital, Bekasi

The family admitted to not maintaining the poultry

Tests on the boy, from Bekasi in West Java, reported by the U.S. Centers for Disease Control and Prevention in Atlanta confirmed the H5N1 infection, said Runizar Ruesin, head of the health ministry's avian flu information center. The child died on March 19 and poultry deaths were recorded in the boy's neighborhood, Ruesin said.
Almost all human H5N1 cases have been linked to close contact with sick or dead birds, such as children playing with them or adults butchering them or plucking feathers, according to the WHO.

The above translation from March, 2006 appears to describe the most recent confirmed H5N1 bird flu case in Indonesia.  Like the most recent current case, it involves a child from Bekasi who is from a family that does not have a link to poultry.  The number of cases in Bekasi continues to rise, but the link to poultry remains suspect.

All reported human H5N1 isolates from Bekasi have a novel cleavage site, yet none of the poultry isolates from Bekasi have this feature.  To date only one avian isolate, from a duck from Indramayu has this change.  However, although the bird isolate is from 2006, it is closely related to H5N1 from human cases from 2005.  The more recent human isolates, including four from Indramayu in early 2006, have multiple changes that are not in bird isolates.

Thus, the linkage to poultry may stem from the testing, which is largely limited to those who have bird flu symptoms and have a link to dead or dying poultry.

Recently, the number of confirmed H5N1 cases in Indonesia has been limited to earlier cases.  However, there have been reports of H5N1 positive poultry deaths throughout Indonesia in the past few weeks.

The lack of human cases may be due to testing delays or false negatives linked to aggressive use of Tamiflu.

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