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Fatalities in H5N1 Cluster in Bandung Indonesia Grow
Recombinomics Commentary
September 28, 2006

Divine guidance and Indra in daily him maintained several dogs that were trained to go hunting. To give ate, they bought chicken that has died, that was bought in the traditional market.

The above translation provides additional detail on the dogs raised by the two fatal cases in Bandung.  Earlier reports indicated that had traveled to Garut to buy some chickens for the dogs.  The first cluster in the Cikelet in Garut also was linked to the collection of dead poultry for food for dogs.

Poultry around the household of the dead patients has tested positive for H5N1, and such infections are widespread.  However, the poultry isolates from Java do not match the vast majority of human isolates, including those from Bandung and Garut.

The match failure indicates that there is an alternate reservoir leading to the human cases.  The only match on Java is with an isolate from a cat in Jakarta.  This finding, as well as H5N1 isolates from a variety of carnivorous mammals raises the possibility that these mammals act as a reservoir and the infections may give rise to H5N1 selected for growth in mammals.

Some media reports have indicated that 11 dogs in the neighborhood of the above fatal cases are being tested.  Other reports indicate the dogs were penned with a boar, which would be another host for selection of a mammalian version of H5N1.

Clearly, more widespread testing and sequencing is required.  A younger sister of the above cluster has also been hospitalized and has tested positive for H1N1.  However, a positive H1N1 test would not exclude a dual infection.  Since the patient is being treated with Tamiflu, the H5N1 levels may be below detection levels.  This was seen in a patient in Thailand who was tested 9 times for evidence of H5N1, which was not detected until autopsy. 

These data highlight the need for follow-up antibody testing on recovered patients, such as those in the cluster above as well as those who recovered after Tamiflu treatment in Garut.

More testing of mammals and wild birds in the area of these clusters is warranted, as is H5N1 isolation from associated poultry.  The match failures indicate that H5N1 positive poultry in the area of the H5N1 positive patients may simply lead to H5N1 testing in patients and infection of alternate hosts in the area, rather than directly to humans, which have an H5N1 that fails to match the poultry sequences.

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