Commentary
H5N1
Confirmed Case Concerns in Tangerang Indonesia
Recombinomics Commentary
01:55
February 23, 2009
information from Litbangkes, Kaila Nabila positive affected H5N1.
The above translation describes two cases with bird flu symptoms. One (2.9M) has died and has been lab confirmed, while the other is a hospitalized suspect case. The two cases are about 10 miles apart (see satellite map).
The number of confirmed cases and clusters in Tangerang has been high. The clusters included the first confirmed cases in Indonesia, in 2005. A recently released WHO phylogenetic tree has four isolates from human cases in 2008. These sequences have been placed on deposit at GISAID and continue to evolve away from the clade 2.1 pandemic target sequence, which was from the first confirmed case.
The continued reports of H5N1 confirmed cases or clusters in Tangerang remain a cause for concern.
Clusters in Indonesia last year led to a news blackout and a significant delay on reporting of confirmed human cases. Moreover, many milder cases in Indonesia are treated with Tamiflu and not tested. This protocol contributes to the high case fatality rate, which has been close to 80% since 2005 and suggests a high level of unreported milder cases.
The recent fixing of Tamiflu resistance, H274Y in H1N1 seasonal flu has increased concerns that co-infections involving season flu with H274Y and H5N1 in hosts being treated with Tamiflu will selected Tamiflu resistant H5N1.
The latest confirmed and suspect cases in Tangerang continue to increase those concerns.
Recombinomics
Presentations
Recombinomics
Publications
Recombinomics
Paper
at Nature Precedings