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Reports of Widespread H5N1 Cases in Indonesia

Recombinomics Commentary

September 28, 2005

Till Wednesday struck 14.00 WIB, four new patients who it was suspected were infected by birds flu underwent the maintenance in RSPI Sulianti Saroso.

The number of patients admitted to hospitals throughout Indonesia continue to rise.  Media accounts described 12 recent admissions.  At Sulianti Saroso there were four admissions yesterday and three more today.

However, there has also been reports of recent admissions in East Java (35F), central Java (58M), Bandu (1.5 F), and Bandar Lumpung (20 M and brother)

The four admissions at Sulianti Saroso yesterday included two brothers, Arir Nurwitano and Fuazan Tonq, (10M and 8M) who had been to Rangunan Zoo, a 3 year old child, Ni Made Superior, who lived near a chicken slaughterhouse, and Ahmad Zaenudin (23M), whose doves had died.

Today, Syifa, a 10 month old girl, 25 year old Salmet Wibodo, and 27 year old Adam Budi were admitted.  They also had ties to poultry.

The large number of cases, spread across Indonesia is cause for concern.  Most of these patients initially check into primary care facilities where no clinical samples are collected.  By the time they are referred to a facility specializing in infectious diseases, the virus has moved from the upper respiratory tract to the lower respiratory tract, so PCR tests are negative.  Similarly, serum samples are then collected too early for significant antibody titers to have developed, so those HI tests are also negative.

Thus, sample collection is far from ideal, and most tests are negative even though it is likely that many of the patients are H5N1 positive.  If the patient recovers, there is no autopsy material, and in many cases autopsies are not preformed on fatal cases because of religious prohibitions.

Thus, many of the H5N1 infections are not detected by initial lab tests, so the true extent of H5N1 infections in Indonesians is largely unknown.

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