Commentary
Delayed H5N1 Cluster Reports In Indonesia Raise Concerns
Recombinomics Commentary 23:52
August 4, 2008
An official from Indonesia's health ministry recently confirmed that a 19-year-old man died from an H5N1 avian influenza infection.
The man, a cargo worker, died in Tangerang, a suburb of Jakarta, Xinhua, China's state news agency, reported yesterday.
The confirmation of the man's death by an Indonesian health official appears to deviate from the country's recent policy of foregoing official announcement of H5N1 cases as they occur, opting instead for periodic updates. In early June, health minister Siti Fadilah Supari said the country would announce cases at longer intervals, perhaps as long as 6 months, according to previous reports.
Healthcare workers and family members alerted the media about Indonesia's last H5N1 case, that of a 38-year-old man who reportedly died on Jul 10. However, a health ministry spokeswoman declined to confirm the case and said officials would release the information in an H5N1 case update at the end of July. No updates appear to have been posted on the government's health ministry or avian influenza Web sites.
Also, it's not clear if Indonesia has notified the WHO about the two cases.
The above comments detail the reporting deficiencies associated with lab confirmed H5N1 cases in Indonesia. As noted above, it is unclear if the reporting delays are due to Indonesia’s failure to report the cases to WHO, in violation of International Health Regulations, which require notification of H5N1 human cases within 24-48 of confirmation, or if the delays are due to WHO failing to issue H5N1 updates in a timely manner.
Although the responsibility for the delays remains cloudy, the effect is to decrease transparency in Indonesia, which remains a cause for concern. It is unclear if the two cases from last month represent a geographical cluster or a contact cluster. Both cases were near the airport in Tangerang, just west of Jakarta. However, if the latest case was a cargo worker (some reports indicate he was a factory worker), then the two confirmed cases at the airport would be cause for concern.
Both patients were misdiagnosed. The early case was initially said to be a TB case, while the more recent case was initially diagnoses as dengue fever. These misdiagnosis are common in Indonesia and have been used to deny recent familial clusters. In those clusters, the index cases were misdiagnosed as lung inflammation, typhus, and dengue fever.
The majority of these recent cases were in Tangerang, raising concerns of more efficient transmission. However, a clearer picture of these clustered cases is hampered by misdiagnoses and increasing reporting delays by Indonesia, WHO, or both.
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