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H5N1 Confirmed Familial Cluster in Lampung Indonesia
October 9, 2005
The boy, Herdi Setiawan, is from Lampung province on Sumatra, officials said. Initial tests were performed in Jakarta, and blood samples have been sent to Hong Kong for confirmation of the results.
The positive H5N1 lab results on the boy above generates yet another confirmed familial cluster in Indonesia. The boys uncle, Hendriansyah (21M) was admitted on September 25 and also tested positive for H5N1. He is still in the hospital. However, another uncle, Hesiyansyah (5M) tested negative and was release with a diagnosis of "typhus". The two positives however, cast serious doubts on the "negative" test results, since the brother and nephew of the negative case have tested positive for H5N1.
All three family members however, had mild cases. Herdi (4M) no long has a fever, and his admission was likely connected to the fact that his uncle was hospitalized and had tested positive for H5N1. This family cluster raises additional questions about false negatives in Indonesia.
The large number of admissions linked to visits to Ragunan zoo identified several H5N1 positive cases, but all of these cases were also mild.
Mild cases are more difficult to detect, and Indonesia's policy of not collecting samples at the primary hospitals almost certainly leads to a high number of false negatives. By the time the patient is transferred to an infectious disease hospital. The H5N1 has moved from the nose and throat to the lungs. Therefore, swabs from the upper respiratory tract test negative.
The large number of familial clusters in Indonesia suggests that H5N1 is spread relatively easily among family members. The number of zoo visitors with symptoms or positive lab results indicates H5N1 is transmitted by casual contact.
The testing procedures remain scandalously poor, and H5N1 is clearly silently spreading in humans in Indonesia.