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False Negative on Sixth H5N1 Fatality in Jakarta Causes Concerns
September 21, 2005
An Indonesian girl, who died today after suffering from bird flu symptoms, may not have had the virus, Health Minister Siti Fadilah Supari said.
The failure of Indonesia to confirm H5N1 in the sixth reported fatal case of bird flu is cause for concern. Thus far Indonesia has had a positive PCR result on only two of the first six fatalities, raising serious questions about the reported negative H5N1 tests on the 20 suspect cases between the initial familial cluster in June / July and the current series of cases, which involve casual contacts.
The latest fatality was initially hospitalized at the RS Salom Cempaka White facility in Jakarta on September 8. She was diagnosed as having the measles and was released on September 14. She re-entered the hospital on September 15 with breathing difficulties. Her white cell count dropped from 21,500 to 2,700 and her hematocrit was only 13 (normal is 25). She was transferred to Sulianti Saroso at 2:30 PM on September 20 placed on a ventilator. She died later that day.
The collection of serum was probably too late in the progression of the H5N1 infection to detect virus in serum via PCR. The situation may be similar to the index case in June / July who was admitted on June 24 and died July 16 but was PCR negative (although two serum samples were positive for H5N1 antibody).
Obtaining the proper samples for testing to meet WHO requirement of a confirmed case has been problematic and the lack of confirmation has been used by WHO to exclude cases. The WHO list of confirmed cases is limited to two, both of whom were PCR positive and part of familial clusters.
The first six fatalities had similar bird flu symptoms and were either part of a lab confirmed H5N1 familial cluster or a neighbor of an H5N1 lab confirmed case. Exclusion of these obvious cases by WHO only complicates the management of H5N1, which is threatening to quickly spin out of control.