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Sister Confirmed in H5N1 Cluster in Tulungagang Indonesia
Recombinomics Commentary
September 29, 2006

An Indonesian woman whose brother died of bird flu this month is also sick with the virus, a senior Health Ministry official said Friday, confirming the country's latest family cluster of infections.

The 21-year-old woman is being treated in a hospital in Surabaya city in east Java province, said Nyoman Kandun. Her 11-year-old brother died from bird flu on Sept. 18. He was suspected of contracting the virus from infected chickens close to his house.

"This is a family cluster," said Nyoman, adding that the source of the woman's infection was not yet known.

The above comments indicate that there are now two confirmed cases in Tulungung cluster. The time gap in onset dates indicate the index case, who died on September 18, infected his sister, who was transferred September 25, prior to the WHO update on her brother, which did not mention her hospitalization.  Although stable, she remains on a respirator ad in isolation.

This cluster is in addition to the confirmed cluster in Bandung, as well as suspected clusters in Sumatra and Tasikmalaya.

In the East Java cluster, the grandmother of the two confirmed cases has been hospitalized and samples have been collected from other family members as well as six classmates of the index case.

In the past, H5N1 was isolated from a patient in Kedari, and the sequence of that isolate matched the other human H5N1 bird flu isolates from Java.  These sequences do not match the poultry isolates on Java.  It is likely that the human cases are being infected by H5N1 evolving in a reservoir other than domestic poultry.

The presences of concurrent multiple clusters throughout Indonesia remains a cause for concern.

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