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Hospitalization of Brothers and H5N1 Positive Zoo Visitor

Recombinomics Commentary

September 27, 2005

Jemima's assurance flattest birds flu was received from results of the inspection Litbangkes the Department of the RI Health that was accepted by RSPI Sulianti, on Tuesday (27/9/2005).

"Litbangkes results showed his serology was positive, but PCR him was negative."

While two older brothers were siblings, M. Arir Nurwiyono (10) and M. Fauzan Toriq (8), that it was suspected is affected by birds flu currently his condition began to improve. Both of them were treated in RSPI Sulianti since Monday, yesterday. As in the case of Jemima, both of them could also visit to Ragunan FAMILY PLANNING.

Article edited to reflect the fact that H5N1 positive visitor is not related to the two brotehrs.

The above machine translation indicates that 9 year old Jimima Napitutupulu has tested positive for H5N1 bird flu.  She is the first visitor to Ragunan zoo to test positive for H5N1.  She transferred to Suliani Saros on September 21 from the Bekasi region.

Two other zoo visitors, M Ari Nurwiyano and M Fauzan Toriq were admitted to Suliant Sarosos yesterday wth bird flu symptoms.  The three visitors demonstrate that the transmission of H5N1 to humans is becoming increasingly efficient. 

The H5N1 positive patient is not on a ventilator and appears to be a relatively mild case.  This raises the possibility than many of the 115 zoo visitors or members of the high school class may inb fact be H5N1 infected, but may have milder cases.  Some of these cases may eventually sero convert.  Most of the lab confirmed H5N1 cases have been for H5N1 antibody.  The number of PCR positive cases has been limited to the father of the two daughters who formed the first familial cluster.  The second familial cluster, Rini Dina and her nephew where the other two cases that were H5N1 positive by PCR test.  The other positive cases had H5N1 antibodies, including Riska Ardian who died last week and Karwati who died this week.  Zoo tour guide, Ari Setyorini has also tested positive for H5N1 antibodies.

The growing number of H5N1 positive cases suggests that H5N1has moved to stage 5 in Indoinesia.  The clusters of cases is growing, both within families as well as those who visited the zoo.  However, clear linkage between the clusters has not been established, indicating widespread infections from multiple sources.

Since some of these cases have been mild, while others have been misdiagnosed as dengue fever, a widespread screening of serum samples collected 30 days after exposure is required to determine the true extent of H5N1 infections.

It seems likely that the number infected at the zoo is large, and only the most severe cases are being admitted.  The possibility of widespread silent transmission of H5N1 has not been adequately addressed.  Zoo visitors with symptoms appear to be increasingly likely to be H5N1 positive.

Monitoring of H5N1 in humans in southeast Asia remains scandalously poor.


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