- MT, a seven-year-old girl, currently being treated at
the Sulianti Saroso hospital in North Jakarta, tested positive on her blood
test, but negative on the Polymerase Chain Reaction (PCR) test, said Minister
of Health Siti Fadilah Supari as quoted by news portal detik.com.
- The minister nor other senior officials of the ministry
could be immediately reached for confirmation.
- The girl was previously treated at the Siloam Gleneagles
hospital in Tangerang and was referred to Saroso on Sept. 14. The ministry
was still waiting for the results of a second PCR test.
- It was also investigating another suspected case, identified
only as a family member of Rini Dina, the country's most recent confirmed
bird flu fatality. The relative tested positive on the blood test and is
currently suffering from flu-like symptoms, such as a fever and sore throat,
which are also symptoms consistent with early stages of avian influenza.
- "We are taking the patient to a hospital for observation
as soon as the family approves," she said.
- Siti added that there was a high possibility of other
suspected cases and that the public must be vigilant against the spread
of the disease. She declared that the country was already in the "third
stage of bird flu" and although there had not been any reports of
human-to-human transfer of the virus, she added that "it is just a
matter of time."
- The above comments suggest Indonesia is already at stage
4 or 5 and the pandemic is close to the final stage 6 which is defined
by sustained human-to-human transmission.
- Human-to-human transmission was clear in the initial
family cluster, which involved 3 members of a family of a government auditor
(38M). His eight year old daughter was the index case, showing symptom
on June 24. The time gap between her symptoms and her 1 year old sister
who developed symptoms on June 29 is a strong signal of human-to-human
transmission. Such a 5-10 day gap has been present in almost all familial
clusters in Vietnam, Thailand, and Cambodia. WHO however, has refused to
acknowledge the virtual certainty of human-to-human transmission in all
or most of those cases, which account for more than one third of confirmed
cases. Instead WHO maintains that the vast majority of cases come from
poultry, thereby contributing to more human-to-human transmission within
families, which is clearly happening in Tangerang.
- The WHO position is compounded by use of lack of lab
tests or false negatives to exclude patients. In the family of the auditor,
only he is an official case because his PCR test was positive. There were
only two serum samples from the index case and both were positive in tests
by two independent outside labs (in Hong Kong and Atlanta). There was no
doubt that the child died from H5N1 bird flu, but since the serum samples
were collected just three days apart, the rising titer (a sign of recent
infection) had not risen four fold in the three days, so only the father
was called a confirmed case. This exclusion justified the repeated claims
of "no evidence of human-to-human transmission", when in fact
there was little doubt that the gaps in onset dates of June 24, 29, and
July 2 indicated the index case infected her sister and father directly
- The comments above indicate there is another familial
cluster between the fatal case of the immigration officer and one of her
relatives, who is also laboratory confirmed. Both of these clusters are
in families of government workers who would have little direct contact
with poultry or pigs. Moreover there are two neighbors with symptoms and
the two familial clusters live in the same area of Tangerang, southwest
of the center of Jakarta.
- This concentration of fatal, lab confirmed H5N1 is the
highest ever reported and is likely to represent a fraction of the human
cases because there are no reports of infection in those most associated
with poultry and pigs.
- Sequencing data from the earlier familial cluster indicates
there is no reassortment with human genes and the sequence is similar to
sequences found in poultry in Java. Since H5N1 is endemic to Indonesia
and extremely limited testing in Tangerang found H5N1 in pigs, poultry,
and a pet birdcage, the opportunity of infections from animals and humans
is extremely high.
- WHO has yet to issue a warning to family members caring
for relatives with H5N1 infections, thereby contributing to the human-to-human
spread, which has been clear since the beginning of 2004 in Vietnam.
- Instead, words of assurance are issued to the press and
official counts bury the human-to-human transmissions and maintain a pandemic
stage 3 when clearly the level is at 4 or 5 and will soon be phase 6.
- WHO's failure to inform is hazardous to the world's health.
H5N1 does not read press releases. In evolves via recombination and acquisition
of mammal polymorphisms, which increases the likelihood of efficient human-to-
- From Patricia Doyle, PhD
- Hello Jeff - As I stated in previous email, the medical
care in Indonesia is not very efficient and there will be a problem with:
1. identifying H5N1 cases, and 2. securing an accurate case count.
- If H5N1 is not identified and reported - and should
the government decide to hide H5N1 stats - we certainly won't have an accurate
picture of the situation in Indonesia.
- Many people of means in Indonesia travel outside the
country to places like Thailand, Malaysia and Singapore for medical care.
- We may not find out about a pandemic until it arrives
on our shores.
- Thanks to Dr. Henry L. Niman, PhD for his website and
- Patricia A. Doyle, PhD
- Please visit my "Emerging Diseases" message
- Zhan le Devlesa tai sastimasa
- Go with God and in Good Health