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Confirmed Fatal H5N1 Cluster in Bandung Indonesia Grows
Recombinomics Commentary
September 26, 2006

patient suspect bird flu that was treated in RS Handsome Sadikin (RSHS) Bandung since Sunday night (24/9), Zakaria Divine Guidance, 20, positive was infected by the virus H5N1.

Monday night (25/9), around struck 20.00 WIB, the brother of casualties's youngest child, the precious stone Diamond, 15, (Intan Mustika,)also was run off with to RS Handsome Sadikin Bandung because he complained suffered breathless, had a headache and hot. The "diamond complained was sick sepulang from delivering his older brother's body was buried in Garut."Because frightened of suffering the illness like his two older brothers, he was at once run to RSHS off with, explained the mother of the two casualties, Nurjanah, 43.

The above translation confirms an H5N1 bird flu cluster in Bandung.  The index case (23M) has died with symptoms, but no sample was collected for testing.  One of his brothers (20M) has now tested positive for H5N1, while another brother (15M) as been hospitalized with milder symptoms.

The index case was buried in Garut, where a dead chicken had been bought and fed to their dog.  This cluster is similar to one of three clusters in Cikelet in Garut regency.  That cluster also was linked to the feeding of dead chickens to dogs.  In those linked clusters, three patients were confirmed, but like the cluster above, several relatives died prior to sample collection, and many additional contacts or relatives developed symptoms.  A Tamiflu blanket was applied and most contacts recovered and tested negative for H5N1.  However, the Tamiflu treatment may have masked the H5N1.  The initial cases developed symptoms at the end of July, so testing of recovered patients for neutralizing H5N1 antibodies would be useful at this time.  The cluster exceeded 20 and would be the largest reported to date if these patients tested positive for antibodies, because initial tests were negative, and a positive would signal sero-conversion and the patients would be confirmed cases.

The sequence of the H5N1 from one of the fatal cases in the earlier cluster was similar to the H5N1 found in patients on Java.  These sequences have a novel cleavage site and do not match poultry isolates from Java, strongly suggesting an alternate reservoir of H5N1.  Testing of dogs and other mammals in the Garut regency would be useful.

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