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Another Fatal H5N1 Bird Flu Case in Tulungagung Indonesia
Recombinomics Commentary
September 22, 2006

The child was 11 years old blew out the breath the last time around struck 22.45 WIB. That is when being treated intensively in the room of the isolation in RSUD Tulungagung Orchid space.

The casualty arrived in the Serious Installation the Emergency (IRD) RSUD Dr Iskak Tulungagung on Monday struck 19.00. When being brought to the hospital, his condition was very critical. The temperature of his body was very high, achieved 39 levels celcius. The casualty also experienced breathless and coughs.

claimed still could not confirm whether casualties really tertular bird flu or not. The reason is, when being brought to casualties's hospital in the diarrhoea situation

Initially, Abram only fevers to Jum’at then. And the illness subsided after taking medicine to the village midwife. The midwife's words, Abram was sentenced only was ill typus.

"But suddenly on Monday early afternoon was sick my child suddenly relapsed again. Because of his condition apparently serious finally was brought by me to this hospital,"

The above translation provides more detail on the latest confirmed H5N1 bird flu fatality in Indonesia.  The patient was diagnosed as having typhus initially, and an H5N1 infection was questioned because the fever was associated with diarrhea.  However, two local tests confirmed the H5N1.

Wire reports mention association with dead or dying poultry, but to date there has been no reported poultry isolates with the novel cleavage site in East Java.  The isolate A/Indonesia/554H/2006 from an earlier case in Kediri in East Java is listed on the HA phylogenetic tree, and it is clearly on the arm with the other human cases from Java. 

Although the sequence has not been released from East Java, a partial sequence of A/Indonesia/177H/2005 has been released, and the sequence is an exact match of the two chicken isolates on Sumatra, and includes the novel cleavage site.  The sequence of the other closely related isolate A/Indonesia/557H/2006 has also not been released, but the location on the tree and the identity with 177H, including the HA cleavage site, indicates that the human sequence is in East Java, in the absence of any reported match in poultry.  Moreover, this is the second confirmed case in Tulungagung.

Thus, the number of human cases in Java continues to increase, and contact with poultry continues to be cited, yet the absence of matching sequences in a significant portion of poultry isolates on Java continues to be cause for concern.

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