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Paradigm Shift Intervention Monitoring | Audio: Jan28 Apr21
Commentary Delayed H5N1 Confirmation In Indonesia Raises Concerns Recombinomics Commentary 21:43 July 31, 2008 The 4 suspected human cases of avian influenza reported in "Avian influenza, human (57): Thailand (Phichit), susp 20080730.2336" have not been confirmed. It remains true, therefore, that there have been no confirmed human cases of avian influenza in Thailand since 27 Sep 2006 (and none anywhere for several months). Date: Fri 18 Jul 2008 [Official confirmation, positive or negative, is awaited.... Mod.CP] The above comments are from today's ProMED commentary on suspect cases in Thailand, as well as a July 19 commentary on media reports on an H5N1 confirmed case in Indonesia. Recent reports that three of the five suspect cases in Thailand had tested positive for seasonal flu decreased the likelihood that the patients were H5N1 positive. However, the comment that there had been no confirmed H5N1 cases anywhere for several months is curious. The situation in Indonesia is far from clear, and the lack of transparency has been a cause for concern for some time. Indonesia declared H5N1 endemic in their last OIE report in the fall of 2006. Although the endemic declaration lowered required reporting frequencies of H5N1 in poultry to once every six months, Indonesia has not filed a report since 2006. In early 2007 they halted the shipment of clinical samples from suspect H5N1 patients and the number of samples sent for confirmation since early 2007 has been limited to a few patients. Moreover, there have been no public human H5N1 sequences from Indonesia since early 2007. This year there were a number of obvious clusters which were reported as individual sporadic cases. Index cases were said to have died from lung inflammation, typhus, or dengue fever. Media questions on these index cases have led to cluster denials and a new policy of delayed reporting. However, IHR regulations require reporting of human H5N1 cases to be made within 24-48 of confirmation, which was noted when Indonesia announced its new policy of delayed reporting. These concerns led to announcements that reporting would be done on a monthly bases. However, the last government report was made in mid June on two patients. On patient, who was part of a cluster, died in mid-May, while a second case died in early June. Thus, the reporting for both cases violated IHR regulations. WHO had indicated that they had a good relationship with Indonesia, even though sequences and samples were withheld. WHO maintained that it had no control over Indonesian notifications to its citizens, but WHO had not received any indication that Indonesia had changed policy on notifications to WHO. Thus, it remains unclear as to when Indonesia is notifying WHO. For other countries, WHO publishes a situation update shortly after they receive notice of a confirmed case. The long delays following lab confirmation of the past two cases raises concerns that either Indonesia is not notifying WHO in a timely manner, or WHO is delaying situation updates for Indonesia, or both. On July 10, another patient in Indonesia died, She was lab confirmed on July 12. However, Indonesia refused to deny or confirm the confirmation two weeks ago. It has now been three weeks since the patient died and six weeks since Indonesia issued its last update. The delays in reporting or acknowledging these lab confirmed cases by Indonesia, WHO, and ProMED remain causes for concern. Media Links Recombinomics Presentations Recombinomics Publications Recombinomics Paper at Nature Precedings |
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