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New H5N1 Familial Clusters in Sumatra and Sulawesi?
Recombinomics Commentary

September 13, 2006

Kandun said two other patients had fallen ill with bird flu, a 27-year-old woman from West Sumatra - whose sister earlier tested positive for H5N1 - and a 14-year-old girl from South Sulawesi.

Both were receiving the anti-viral drug Tamiflu and under close observation, he said.

The above comments identify three additional H5N1 confirmed cases in Indonesia which have not been announced.  The WHO update of May 29 describes a 15F from West Sumatra who developed symptoms on May 17 and was still hospitalized on May 29.  However, H5N1 confirmation or her current status has not been announced [Correction: The 15F was confirmed in the May 29 update].  The above comments suggest that she tested positive and now her 27 year old sister has also tested positive.  These two patients would represent a new family cluster in West Sumatra.

Similarly, there has been no report of a recent H5N1 confirmed infection in South Sulawisi.  There was a confirmation of a 14F who died on June 24Her mother and old sister also died with bird flu symptoms prior to the June 24 death, and several additional family members were hospitalized, but media reports suggested that they tested negative and were discharged.  The above comments suggest that a family member or another resident in South Sulawesi is receiving Tamiflu and is H5N1 positive.

Although H5N1 bird flu outbreaks in poultry have been reported in North Sumatrra and several locations in Sulawesi, the hospitalized patients were said to have tested negative.  The latest comments, coupled with the delayed report of the patient who died June 24 and lack of testing of the relatives who also died in June raise serious questions about H5N1 surveillance and reporting.

The absence of reported confirmed human cases at a time when H5N1 is widespread in birds and many patients who have symptoms have been hospitalized remains a cause for concern.

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