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Geographical Clustering of H5N1 Cases in Jakarta Indonesia

Recombinomics Commentary

September 16, 2005

The health ministry also said that a neighbour of the woman had been hospitalised with symptoms consistent with bird flu. But authorities said they were still awaiting lab results before confirming she had been sickened by the virus.

Kandun warned that Indonesia would continue to report cases because the virus was rife in poultry farms across the country. "It will be like in Vietnam and Thailand," he said.

The above comment citing a neighbor with symptoms suggests that the clustering in Indonesia is higher than Vietnam or Thailand, especially for fatal H5N1 cases.  In Vietnam there was an increased clustering in the north, but those cases were milder and most survived.

In Indonesia, the initial cluster was a familial cluster that involved three family members.  All three cases were fatal and the disease onset dates suggested that cluster was due to human-to-human transmission within the family.

The latest confirmed case lived in the same general area, southwest of the center of Jakarta.  No source has been identified, but the fatality lived about 100 meter from a chicken slaughterhouse. Another suspected fatality was a two month old baby who died of pneumonia and live above a chicken slaughterhouse.  It is unclear if it is the same slaughterhouse, but the child was from the same area because residents were offered free H5N1 tests and the mother of the child was at the test center.

The above comment indicates that the latest suspect case also lives in the same neighborhood.  Thus, there are 5 fatal cases, 4 of which have been confirmed as well as a sixth suspect case.  None of the cases thus far have been described as having active involvement with poultry although the three most recent cases live near a chicken slaughterhouse.

This heavy concern of confirmed or suspect cases raises questions about unreported cases in those who come into daily contact with H5N1 infected chickens and pigs which are common in several sub-districts in Tangerang.  In the OIE report the only sub-district negative had only tested three chickens.  The positive H5N1 results in poultry, pigs, and pet birdcages in spite of very limited testing demonstrated the widespread nature of the H5N1 infections.

More testing of patients with symptoms is required to begin to determine the true extent of H5N1 infections in the area.

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