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Suspect Fatal H5N1 Cluster in Medan North Sumatra
Recombinomics Commentary
September 26, 2006

They that is BS, 33 (the father), LT, 31, (the mother), his children, RS, 12, TU 5 and JS, 1,2, that was brought by his family to RS Adam the Owner on Friday (22/9) was based on reconciliation from the Pakam The Deepest Part Hospital.

The suspicion improved when getting information that in their house region was gotten the poultry that died. Moreover, one of his children that other, RS, 11 died, but not yet clear his cause.

The above translation describes six family members who form a suspect H5N1 bird flu cluster in Medan, North Sumatra .  The index case has already died, but no sample was collected for testing.  The two youngest family members have been discharged.  The mother, father, and oldest sibling however, remain hospitalized under Tamiflu treatment.  Their fevers have begun to come down and test results have not been reported.  However, it is likely that they will test negative for H5N1 by PCR test, because Tamiflu reduces the level of circulating virus.

The profile of this cluster is similar to many clusters in Indonesia and elsewhere.  Because of the large number of clusters and high fatality rate, the use of Tamiflu has become more common.  However, the extent of H5N1 infections and transmission in Indonesia is clouded because of the lack of data on convalescent antibody levels in recovered contacts.

This pattern became very clear in the Garut cluster.  Although three patients did test positive to H5N1, each was linked to patients who died earlier and were not tested, or patients who were aggressively treated with Tamiflu after they developed symptoms.  These patients largely tested negative for H5N1, but there has been no reports on neutralizing antibody levels in recovered patients.  The antibody levels typically peak 3-4 weeks after symptoms, so testing of these patients at this time would define the size of the cluster, which involved over 20 hospitalized contacts.

The H5N1 from the Garut cluster was similar to the H5N1 from all but one of the human isolates from Java.  This sequence does not match poultry isolates on Java.

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