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H5N1 PCR Positive Fatality in Bogar Indonesia

Recombinomics Commentary

October 5, 2005

Other the positive patient birds flu died in RSPI Sulianti Saroso, Jakarta. Slamet Wibowo (23 years) that entered RSPI Sulianti Saroso last September 28 finally blew out the last breath.

Slamet that was the citizen Street Pahlawan Breakingprep Sanja, Citeureup, of Bogor, was stated died to last September 29 struck 00.30 WIB.

"After being done by the inspection of the sample of his blood, results stated PCR (polymerase chain reaction) him was positive, this meant him was positive birds flu, the" headword "of the" Information" Part RSPI the Patu Inspiration, in RSPI, Sunter, Jakarta North, Wednesday (5/10/2005).

The machine translation above describes another PCR confirmed H5N1 bird flu fatality.  The patient was from Bogar and had contact with chickens.  Although this case has not yet been confirmed in Hong Kong, thus far all PCR positive cases from Indonesia have been confirmed.

The discrepancies have been in cases that were positive for antibodies, but the negative PCR data in Indonesia and Hong Kong is almost certainly due to sample collection. 

The most conclusive examples of the false negatives is from the initial family cluster, where three family members died with bird flu symptoms.  Both serum samples from the index case were strongly positive for H5N1 when tested by the lab in Hong Kong as well as the CDC in Atlanta, but WHO did not add the index case to the list of confirmed cases because although the titer was rising, the second sample was not four fold higher than the first, which was because the samples were collected just 3 days apart.  There were also sample collection problems with the sister of the index case, so although all three family members clearly had fatal H5N1 infections, only the father was PCR positive and considered a confirmed case. 

The above case is the 7th confirmed H5N1 case in the Jakarta area (see map) (including the two family members described above), and adds to the evidence that many of the PCR negative cases are false negatives.  Collection of samples at the primary hospitals would improve the H5N1 detection rate and help in the isolation of additional H5N1 from patients.  There is evidence for co-circulation of two distinct H5N1 strains in Jakarta, which is cause for concern.  The potential for widespread mild cases silently spreading in Indonesia also provides additional opportunities fro recombination and more efficient human-to-human transmission.


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