Commentary
Indonesian H5N1 Disinformation Campaign Raises Concerns
Recombinomics Commentary 11:44
June 17, 2008
Ali Usman's wife died of bird flu 10 days ago, but he still has not been officially notified by the government.
It took The Associated Press a week to track down and confirm the June 3 death of Usman's wife, Susi Lisnawati, which raised the country's toll to 110.
Though she was suffering from classic symptoms of the disease - breathing difficulties, coughing and high fever - she was not kept in isolation during her two days of hospitalization or otherwise treated as a suspected bird flu patient, her husband said.
She also was given a traditional Muslim burial, her body washed and shrouded by barehanded family members, before being placed in the ground without a casket, he said.
"Indonesia has agreed to continue notifications to WHO .... they have never said they would not do that," said David Heymann, the U.N. agency's top flu expert, adding that it does not matter if it takes several weeks to publicize the country's official toll "as long as the virus is known about and handled properly."
But when asked for an explanation, Health Ministry spokeswoman Lily Sulistyowati said test results had come back negative and would be delivered to the family within days. A senior ministry official, speaking on condition of anonymity because the issue has become so politically sensitive, later confirmed the tests were positive.
The above comments describe yet another example of Indonesia’s H5N1 disinformation campaign. Indonesia officials, like those in many countries, under-reports H5N1 cases. However, the latest series of cases and clusters have clear examples of disinformation. This campaign, as noted in the above quote, is being aided and abetted by WHO.
The series began with two clusters in March. In both cases, the index cases died with bird flu symptoms, followed by the death of a family member who tested positive for H5N1. Both of these cases were described in the WHO update, but the update failed to describe the fatal cases in the relatives.
The first cluster involved a relative who died of “lung inflammation". This cluster was described in multiple local media reports, but was not covered by wire services.
The second cluster however, was picked up by the wire services. The index case was said to have died of dengue fever. The dengue fever diagnosis was confirmed Nyoman Kandun, director-general of communicable disease, and the cluster was specifically denied, even though one family member has already been H5N1 confirmed. This mis-diagnosis was accepted at face value in a ProMED commentary, which also noted that there was no cluster since the two family members had different diagnosis.
However, the denial in the most recent cluster was difficult because the index case died with cyanosis in his fingers (and mis-diagnosed as typhus), which was also noted for his brother who was H5N1 lab confirmed. However, this lab confirmation was not reported to WHO, and the reporting delay was acknowledged by Health Minister Siti Fadillah Supari. This cluster was confirmed over a month ago, yet still has not appeared as a WHO official case.
Since that cluster, there have been multiple suspect cases and at least two, including the one above, have been lab confirmed. In the case above, the official report indicated that the patient was negative, but was an acknowledged positive based on statements from an anonymous source.
Thus, there have been four recent cases which have not been reported because of mis-diagnosis, which include respiratory disease, dengue fever, typhus, and H5N1 negative. These mis diagnosis have been associated with comments from high ranking health officials (Health Minister, Director General of Communicable Diseases, and Health Ministry spokeswoman).
This disinformation campaign goes well beyond the cases missed because of lack of testing or lack of sensitivity in the H5N1 tests and raises significant pandemic concerns.
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