H5N1 Bird Flu Cases In
Indonesia Grow To 89
By Dr. Henry L. Niman, PhD
They were spread in 9 provinces that is the Special Capital District of Jakarta (45 cases), Banten (13 cases), West Java (10 cases), Central Java (3 cases), East Java (3 cases), South Sulawesi (4 cases), North Sumatra (1 case), East Kalimantan (1 case) and Lampung (3 cases) and 2 cases were not yet known by his province origin.
From this case whole, 11 people among them died (3 people from 4 cases confirm, 2 people from 11 cases probable and 6 people from 69 cases suspek).
The number of suspected H5N1 bird flu cases has grown to 89 as of Thursday. The breakdown of the 84 cases from Wednesday are listed above. The cases are increasing daily and media coverage of the specifics has diminished. Cases are increasingly being reported as composite numbers.
The distribution shows that the cases are spread across the country (see Indonesia map), although most are in the Jakarta area (see Jakarta map). The number of cases reported a week ago was 42, so the increase in cases has been rapid.
The number of cases in the suspect category is high because many samples have not been confirmed by Hong Kong, but many mre test negative because of sample collection. Since samples are not collected at the primary hospital, the collections at the referral hospital test negative because they are collected too late after the onset of symptoms and the H5N1 has moved from the nose and throat to the lungs. Some of thes patients are positive for antibody, but others are negative because the serum is collected too early.
Thus, the total number of suspect cases is more accurate than the lab tests, because of sample collection.
The number of cases is rapidly increasing. Most of the more recent cases have links to dying poultry. However, many cases infected by people would not be transferred, so they would not be tested. Thus the number of suspect cases is a gross under-estimate of the true number of cases. Many are not detected because they do not go to hospitals because of costs.
The monitoring of H5N1 should be more aggressive. Multiple samples can give a clearer picture of the true extent of the H5N1 in Indonesia. The testing should include patients who have symptoms, even if there is not a link to dying poultry. The large number of zoo visitors who had symptoms or tested positive for H5N1. indicated transmission of H5N1 was caused by casual contact. More aggressive monitoring and tracing of these infections will determine how easily H5N1 is transmitting human to human.
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