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H5N1 Positive Ragunan Zoo Vistor Raises Concerns

Recombinomics Commentary

October 17, 2005

Whereas the Ageng condition (2) that was treated in space of the roses isolation, results of his PCR inspection showed the negative, whereas his serology was positive. "He probabel birds flu." This from results of the first lab, we were again waiting for results of the second lab inspection that his sample was taken last October 8, he said.

The above case is a 2 year-old who visited Ragunan Zoo on September 11.  Transfer to RS Sulianti Saroso was on September 24.  Because the transfer was so long after exposure, the PCR test was negative.  However, the long delay in testing allowed antibody levels to rise to the level of detection.  If the October 8 collection is four fold higher than the earlier collection, the baby will be a confirmed case, based on the WHO definition requiring a four fold increase in titer.

There have been no confirmed cases in zoo visitors, although several have had H5N1 antibodies.  It is likely that many of the zoo visitors were PCR negative because they were tested late.  For mild cases that developed from casual contact, PCR positive results may require an early collection.

Indeed, two of the PCR positive cases were nephews of PCR positive patients.  Because they were relatives of PCR confirmed cases, they were tested within a few days of the onset of symptoms.  Both had fevers for a very short while and one has already been discharged.

The testing of patients after they are transferred may generate negative PCR data, because the virus has been cleared from the nose and throat. 

The PCR positive mild cases sampled early suggest the testing protocol in Indonesia will miss many mild cases.

Followup serum testing on discharged patients would be useful.

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