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Fifth H5N1 Fatality in Jakarta Indonesia

Recombinomics Commentary

September 14, 2005

Meanwhile, a resident identified as Rustini, 29, said that her two-month-old baby died eight days ago because of lung problems.

"His name was Livo. He had a cough and respiratory problems. A specialist said that he had pneumonia," Rustini, who stays in the upper story of a slaughter house told the Post just before her blood was taken.

Tato said his officials would examine Rustini, her husband Badru and their children to decide whether the baby died because of bird flu or not.

"The symptoms are similar to those found in people suffering from bird flu..."

The above comments provide a possible explanation for the lack of H5N1 in people most at risk for bird flu.  Like other countries with H5N1 human H5N1 cases it is simply a lack of testing.  It is unclear if this chicken slaughterhouse is the same one that is 100 meters from the latest H5N1 bird flu victim, but the residents of the building would be at increased risk because H5N1 is endemic to Indonesia and present in several sub-districts if Tangerang, location of the lab confirmed outbreaks.

The lack of testing remains scandalous, but the examples of under-reporting and under-testing begins at the top with WHO. WHO excludes clear-cut bird flu patients from their official tallies, which also excludes examples of human-to-human transmissions.

There are many examples but the example in Indonesia is particularly obvious.  The initial cases in Indonesia were three family members from Tangerang.  All three died with bird flu symptoms and the father (38M) tested positive for H5N1 by PCR.  The index case was his eight year old daughter who tested positive for a rising titer of H5N1 antibodies. The third family member died with symptoms, but has not been reported to be laboratory confirmed, although the lack of sample collection contributed to the limited number of lab tests.

As noted at the WHO website, the index case was tested by two independent labs (Hong Kong and Atlanta) and both found increasing titers in sequential blood samples leaving little doubt that the fatality was due to H5N1 infection.  Similarly, there is little doubt that the 1 year-old sister also died of H5N1 avian influenza.  This were the first three fatalities in the country from a laboratory confirmed cluster, yet the WHO website lists only one H5N1 infection in Indonesia.

The disease onset dates strongly suggest that the index cases, who developed symptoms on June 24, infected her sister who developed symptoms on June 29 and her father who developed symptoms on July 2.  However, because there is only one official case, WHO and the Indonesian health minister repeatedly tell the media that these is no evidence of human-to-human transmission, which is clearly false and misleading.  In Indonesia, as with the three other countries with familial clusters, family members of H5N1 victims are at exceptionally high risk of contracting the H5N1 infection from the infected relative.

In the most recent lab confirmed cases, this risk is compounded by medical personal who fail to notify the spouse of the deceased that she tested posited for H5N1.  He was told that she died of pneumonia and is concerned that the media is spreading false rumors about the cause of his wife's death.

The Indonesia government compounds the misinformation by announcing that no H5N1 was found with 100 meters of the residence.  This distance was curious, since WHO recommends culling within a 3 kilometer radius.  Subsequent media reports indicate that a chicken slaughterhouse is located 100 meters from the residence, so by limiting the testing distance, the all clear can be given without testing the slaughterhouse.

This limited testing extends the results from the Indonesia OIE report.  Again the testing was minimal.  In the only sub-district that tested negative for H5N1, only three chickens were tested.  Such limited testing mocks the entire testing procedure.  In test from two additional sub-districts H5N1 sequences were detected in pigs and poultry. In addition, one of two samples from the birdcage across the street from the family was H5N1 positive. However, as indicated in the OIE report as well  as media reports the stamping out in positive sub-districts was only partial.

WHO's pandemic intervention plan remains a cruel hoax.  WHO actively reduces the number of cases and examples of human-to-human transmission, which leads to under-reporting and limited testing of high risk fatal cases.  Screening of healthy individual further minimizes the perceived risk to a population where H5N1 infections are widespread and fatal human cases are clustered.

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