Commentary
WHO H5N1 Situation Update On Indonesia Raises Concerns
Recombinomics Commentary 17:21
June 19, 2008
The Ministry of Health of Indonesia has announced two new cases of human H5N1 avian influenza infection. The cases are not linked epidemiologically. The first is a 16-year-old female from South Jakarta, DKI Jakarta Province developed symptoms on 7 May, was hospitalized on 12 May and died on 14 May. Investigations into the source of her infection indicate exposure to sick and dead poultry.
The above description from the latest WHO update of a confirmed case in South Jakarta cites exposure to sick and dead poultry, but fails to mention the exposure to the brother of the above case who died 10 days earlier with identical symptoms. Although the family had been told he died of typhus, his symptoms were described in multiple media reports, which included cyanosis in his extremities. The time gap between the two cases strongly suggests the above case was infected by her brother, whop died May 4. Moreover, another brother was hospitalized shortly thereafter with similar symptoms, but was discharged with a bird flu negative diagnosis.
The failure to mention or investigate the earlier death raises serious questions about WHO oversight of H5N1 in Indonesia. The above cluster follows two clusters in March, which also involved the death of the index case with bird flu symptoms, which was quickly followed an H5N1 confirmed death of a relative. One index case was said to have died from “lung inflammation”, while a second was said to have died from dengue fever.
The confirmation of H5N1 in each of these three clusters, and the failure of WHO to investigate or comment on the related fatalities are cause for concern.
The above cluster and the preceding cluster were well covered in the media, and the lack of any comment by WHO in its press releases or situation updates raise serious questions about their ability to manage or follow human H5N1 cases in Indonesia.
Media Links
Recombinomics Presentations
Recombinomics Publications
Recombinomics Paper at Nature Precedings