Commentary
Acknowledgement of H5N1 Fatality in Tangerang Indonesia Recombinomics Commentary 11:24
July 17, 2008
Relatives say a 38-year-old man has died of bird flu, raising the unofficial toll in the world's hardest hit nation to 111.
Abdul Kadir said Thursday his brother-in-law, Asnawi Sandri, died on July 10. He had symptoms of the disease, including high fever and coughing, when he was hospitalized.
Kadir says doctors told the family the father of two died of bird flu.
The above comments from an AP wire report confirm local media reports on a lab confirmed H5N1 case in Tangerang. The lab confirmation was announced on July 12 and carried in local media. Thus, the confirmation has been acknowledged in local media and one wire service, but has not yet been acknowledged in the WHO update.
Since this lab confirmed case has not been acknowledged as an official case, it is unclear if contacts were tested.
The last WHO update is on the death of the last official case, who died in May, but was not reported until June, in violation of International Health Regulations on H5N1 in humans, which is a reportable disease. The WHO update in June failed to acknowledge the death of the brother of the confirmed case, who was diagnosed with typhus, or the hospitalization of a second brother. Both brothers had bird flu symptoms, but the index case was diagnosed as typhus and the second brother tested negative. However, the two fatalities had the same cyanosis of the extremities, leaving little doubt that both were H5N1 infected.
The report of the one case was delayed for a month and associated with an announcement by Indonesia that they would no longer announcement lab confirmed cases at the time of confirmation. The above cluster was preceded by two additional clusters which were also reported as individual clusters, with index cases dying from lung inflamation or dengue fever.
The failure of Indonesia or WHO to acknowledge the clusters, which almost certainly involved human to human transmission, remains a cause for concern.
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