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Four Hospitalized Suspect H5N1 Cases In Lombok Indonesia
Recombinomics Commentary 13:30
October 17, 2011

Four residents of Central Lombok, West Nusa Tenggara, were treated in isolation rooms General Hospital (RSU) province of West Nusa Tenggara (NTB) as so suspect the H5N1 virus (bird flu). The four residents of Central Lombok each of initialed ADT (11 months), SHN (56), STK (10) from Peringgarata village, Central Lombok, and DSH (5 months) from Semayan, Central Lombok.

The above translation described four hospitalized suspect H5N1 in Central Lombok, which is just east of Bali, where a fatal H5N1 cluster of three has been reported.  Two of the three fatal cases have been lab confirmed locally, but the Indonesian Ministry of Health and WHO have not acknowledged any of these cases.
However, H5N1 confirmations are typically delayed.  The most recent confirmed H5N1 case in Indonesia died in Jakarta on August 25 after developing symptoms on August 8.  This case was not reported by WHO until October 10, although IHR requires reporting within 48 of lab confirmation.

Recently, media reports cited the spread of H5N1 in poultry in Bali, raising concern that the H5N1 has evolved to avoid prior immunological responses.  H5N1 has been endemic in Indonesia for many years and Indonesia no longer reports H5N1 poultry cases to OIE.

Monitoring H5N1 in humans is difficult because the most recent public sequences (at GISAID) are from patients infected in 2008, although all human and poultry H5N1 from Indonesia are clade 2.1.

Timely reporting of human cases and release of current H5N1 cases is long overdue.

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