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Hong Kong Confirms H5N1 Positive Uncle in Lampung Indonesia
October 10, 2005
The Hong Kongese laboratory again gave the report on a patient from Indonesia positive was infected by birds flu. The patient namely Hendriansyah (21) that currently still is treated in RS Abdul Moeloek, Banda Lampung.
The above machine translation indicates H5N1 has been confirmed in the uncle of the latest case confirmed case in Lampung. Thus, the uncle has now been lab confirmed in Lampung and Hong Kong, while the nephew has been confirmed in Lampung. Results from Hong Kong will likely also confirm.
Both of these cases were mild, as was the 5 year old brother, Hesiyansyah, of the Hong Kong confirmed case. However, the brother was released with a diagnosis of "typhus". Testing of the released brother's serum from antibodies to H5N1 would be useful. False negatives are common, and such negatives can be easily generated.
In the current familial cluster, the uncle had exposure to dying chickens. However, there was no mention of dying chickens in the description of his 4 year old nephew. The nephew developed a fever and the family physician suggested he be admitted to the infectious disease hospital and showing symptoms for 3 days. Testing in Lampung has confirmed H5N1, but the nephew's temperature has already returned to normal and the case appears to be very mild.
Because the case was so mild, it is unlikely that the case would have been admitted had there not been the connection with his hospitalized uncles. It seems likely that there are many more mild cases who are misdiagnosed as human flu. When 115 zoo visitors came to the infectious disease hospital with mild symptoms, they were turned away. It is not clear that samples were collected from any of these patients. Nor is it clear that they were hospitalized or followed.
The mild cases in Jakarta and throughout Indonesia and the world are easily missed. Monitoring of these patients remains scandalously poor. It is unknown how many of the zoo visitors were H5N1 positive, or how many passed H5N1 on to others. The situation in Indonesia demands a serious screening effort, yet it would appear that efforts are being imposed to limit cases.
The latest suspect case, Cahyadi (50M) died 20 minutes after transfer to the infectious disease hospital, Sulianti Saroso, in Jakarta. He had been hospitalized for 3 days at the primary care facility, RS Budhi Asih. The number of cases at the primary facilities who recover and are sent home without testing is unclear.
However, it would appear that casual transmission of H5N1 in Indonesia is common and it is not being properly monitored.