H5N1 Confirmed Cluster in West Java Indonesia
Recombinomics Commentary 22:54
March 30, 2008
Agus Yuhadi (15), the Patient suspect Avian Influenza (AI) from the Cimeta Village, Kecamatan Bulansari, Kabupaten Subang, was stated positive was attacked by the virus H5N1.
That was based on results of the sample inspection of blood as well as germs on Agus's throat, moments before the patient died, last Wednesday (26/3).
This action was also reinforced by the existence of information from the family that said that Dea Putra (6), the full brother Agus, died not at intervals of old before the older brother.
From the family's information also, Dea died resulting from dengue fever dengue fever (DBD).
The above commentary describes an H5N1 lab confirmed fatality (15M) in Kabupaten Subang, Indonesia, which is southeast of Jakarta in western Java. The patient’s brother (6M) also died recently and was also initially diagnosed with Dengue fever. The dengue fever misdiagnosis of H5N1 in Indonesia is not new. Neither are fatal H5N1 clusters. However, it is now almost three years since H5N1 was confirmed in humans in Indonesia and fatal H5N1 cases are still being misdiagnosed. These cases become obvious when they are part of clusters, but would be largely missed as individual cases.
Indonesia has the largest number of H5N1 confirmed cases as well as the largest number of deaths, but the surveillance and testing approaches, which include a lack of H5N1 testing until the patient is near death, or testing of contacts after the start of Tamiflu, raises concerns about the number of individual cases and clusters in Indonesia.
These concerns are compounded by the lack of sequence data on these cases. The last public sequences were released over a year ago, and although a small number of samples have been sent to the CDC for sequencing, none of these sequences have been released, and the analysis is generally limited to an absence of reassortment and changes in the receptor binding domain.
However, polymorphisms in new H5N1 sequences outside of Indonesia link back to earlier sequences, highlighting recombination events and linkage of the polymorphisms to widespread distribution via wild birds.
More detail on the above cluster and contacts, as well as the release of sequence data would be useful.
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