Commentary
WHO H5N1 Investigation In Sumatra Indonesia Raises Concerns
Recombinomics Commentary 22:42
August 10, 2008
The United States consulate general (the USA) in Medan also asked about the situation and the last condition for the Damuli Hut community, the IV Village, the Air Batu Village of 39,Kecamatan Air Batu, this Regency
Experts from the World Health Organisation (WHO) had arrived in the affected village in North Sumatra to help investigate the possible outbreak and the sudden death of three residents last week, a provincial health official said.
The above comments on the outbreak in Medan reflect the level of concern of non-Indonesian agencies with the situation in Medan. As noted, three patients died with bird flu symptoms, and additional patients were hospitalized. Although these patients are said to have tested negative, poultry in the region is H5N1 positive.
The presence of a WHO team, in the absence of confirmed H5N1 cases, is unusual, and raises concerns that there has been unreported lab evidence of H5N1 in patients in the region.
This region has had a history of confirmed or suspect clusters. The largest confirmed cluster was in Karo over two years ago, The cluster was linked to clear human to human to human transmission which led to increased surveillance of poultry in the region.
That cluster was followed by a cluster of similar size, but those patients tested negative. However, negative testing in Indonesia remains highly suspect. False negatives can be generated by widespread and aggressive Tamiflu use and the suspect sensitivity of the testing in Indonesia. In addition to the largest number of confirmed H5N1 cases and the largest number of confirmed H5N1 deaths, Indonesia also has the highest case fatality rate, over 80%, raising concerns that milder cases are either not tested or test negative.
Indonesia’s failure to test H5N1 infected patients in clusters is also cause for concern. Recent confirmed cases have been associated with relatives who die with bird flu symptoms, but these fatalities are said to be lung inflammation, typhus, or dengue fever.
These clusters, representing limited human to human transmissions have been followed by a new policy of delaying reports of cases. International Health Regulations require notification of WHO 24-48 hours after confirmed cases. Although WHO has stated that they have a good relationship with Indonesia, the WHO updates have been delayed and the two confirmed cases in Tangerang in July have not yet been reported in WHO updates, indicating Indonesia is not reporting these cases in violation of IHR requirements, or WHO is withholding reports of these confirmed cases in their situation updates, which report cases within a day or two of confirmation.
The WHO team on the ground, coupled with reporting failures by Indonesia and WHO, continue to raise concerns about the true situation in the Medan region of North Sumatra.
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