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H5N1 Fatality in Banyumas Central Java
Recombinomics Commentary
October 16, 2006

startled by the death of the patient with the sign of bird flu in RSU Banyumas from the Sigedang Village, the Kaliurip Village, the Madukara Subdistrict, Mistinem (32), on Friday (13/10).

More again startled when knew had a citizen of the Krinjing Village, the Lightning Village, of the Purwonegoro Subdistrict that currently also is treated in RSU Banyumas with the same sign.

The Krinjing village that beforehand had not canned be heard his name, currently suddenly became attention of the community.

A party of the official from the Health Service of the Regency (ET AL) also checked the condition for the Parimun house (17), the new patient RSU Banyumas.

The above translation describes the confirmed H5N1 fatality in Banyumas in Central Java, as indicated in today’s WHO update.  Local media describe a second hospitalized patient who also transferred to RSU Banyumas from RSUD Banjarnegara.  The second patient was from a neighboring village, Krinjing.

The two cases in Central Java as well as the confirmed cases from South Jakarta and Bandung died on consecutive days.  These three confirmed H5N1 deaths in  three regions on Java are cause for concern.

Although the vast majority of confirmed H5N1 cases in Indonesia are from Java, a source of infection has not been identified.  All human cases, except one from an infection in August, 2005 have been infected with H5N1 with a novel cleavage site.  These patients fall into two groups.  One, consisting of three patients infected in 2005 map to the upper branch of the bottom of the phylogenetic tree presented at a WHO meeting in Jakarta in June.  The vast majority of Java cases however, map to the lower portion of the tree.  All human sequences that have been made public since the meeting, also map to the lower portion.  This lower portion has no avian isolates.

The match failure was noted at the meeting, and 91 recent samples were sent to a WHO affiliated lab in Australia, Over 50 bird sequences have been made public from these recent samples and only one bird isolate from Java had the cleavage site.  However, it match the small group of three patients from 2005.  This duck isolate was from Indramayu, but the patients from Indramayu mapped with the majority of cases, which are on the lowest branch.

Two chicken isolates did map to the lower branch.  By these isolates were from 2005 in Central Sumatra, far from the human cases on Java, which have stretched from East Java to West Java and isolated during a time from from the index case in July, 2005 through the most recent deposits, from the summer of 2006.

The origin of these infections is unknown.  The only non-human Java match was from cat, also from Indramayu.  That sequence was closely related to the human sequences, including those from Indramayu.

The failure to identify the source of the H5N1 infections in Indonesia remains a cause for concern.

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