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Confirmed H5N1 Bird Flu Deaths In Jakarta Increase to Six

Recombinomics Commentary

September 26, 2005

From 10 positive cases of birds flu, six people including dying namely Iwan Siswara, his two daughters Sabrina and Thalita, Rini Ignoble, Riska and Karwati. Whereas four positive patients birds flu that still was living namely Paradise, Gayatri pearls and two patients from South Sulawesi. The "complete name that from South Sulawesi, I forgot," said Kandun.

The machine translation above includes two recent H5N1 bird flu deaths in the Jakarta area.  The most recent is Karwati a mother of two who has been described in media repots as being 27 or 30.  One report indicates she has a connection with the Ragunan Zoo, but most reports link her exposure to 15 birds that died near her home, including one or more that was eaten.  Another was given to neighbors and they are undergoing testing.  Her death is the first strongly linked to birds who had suddenly died.

The other case, Riska, died last week and was just confirmed to be H5N1 positive.  She also had contact with dead birds, but also had a pet bird, which again focuses attention on pet birds.  The first three H5N1 reported fatalities were in a family from Tangerang.  The birdcage across the street from their residence was H5N1 positive.

The above report also indicates H5N1 patients have been identified in South Sulawesi.  These data indicate that the H5N1 in humans in Indonesia is widespread,  In addition to the 10 confirmed cases, there are 32 cases being investigated.

There is considerable concern over false negatives or misdiagnosis.  Rini Ignoble's (Rini Dina's) nephew, Paradise initially was H5N1 positive by PCR, but is now being discharged and is H5N1 negative,  He will be the first discharged positive patient.  Thus, collections from patients after the H5N1 has been cleared from serum will fail to detect the infection.  Similarly, misdiagnosis is common. Karwati was initially diagnosed as having typhus, which was changed to Dengue Fever when she vomited blood and was bleeding from her nose.  This presentation sounds similar to the index case in Thailand, who subsequently infected her mother and aunt.

The above negatives and mis-diagnosis of Dengue Fever raise serious questions about the monitoring of H5N1 in Indonesia and throughout the region.

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