Fourth H5N1 Suspect Case in Garut Indonesia
Recombinomics Commentary
August 15, 2006
Was based on information of several citizens, several last days, several poultries around the patient's house died suddenly. Moreover, the distance of the patient's house only one hundred metre from the Siti Aminah house that died on last Tuesday with the sign similar to the bird flu patient.
The above comments describe the fourth suspect H5N1 bird flu patient in Garut in West Java, Indonesia. The index case, from a nearby village died with bird flu symptoms. However, his cousin, who also developed symptoms tested positive for bird flu and is an official WHO case because the positive result was confirmed by two independent labs in Indonesia. The patient is recovering at home.
The third victim, a neighbor of the most recent case, also died with bird flu symptoms and at least one media report indicated she was positive. As noted above, the fourth case lives on 100 meters from the third case.
Thus, the first two patients were related and were neighbors. The third and forth patients were neighbors on a nearby village. The clustering in time and space of four suspect or confirmed cases is cause for concern. Although all had links to dying poultry, the genetic link between H5N1 in people and those in poultry has not been established. Although over 40 poultry H5N1 are public, none have the novel HA cleavage site detected in all but one of the reported sequences from Java.
The lack of a match was discussed at the recent H5N1 meeting in Jakarta. Phylogenetic trees of the sequenced isolates indicated the samples with the novel cleavage site formed a separate branch that did not contain any avian isolates. All eight gene sequences of H5N1 from these patients were recently released and they have a large number of additional polymorphisms on all eight gene segments that are not found in Indonesian poultry. Although these sequences are more closely related at the protein level, there are also antigenic determinants that are only in the human samples. Moreover, analysis of polymorphisms in common between bird and human isolates identifies clustering that signal recombination. Thus, although there may be a relationship between H5N1 outbreaks in people and poultry, the direct linkage may be through another animal reservoir.
More details and test results on the suspect cases as well as animals and people in these villages in Garut would be useful.
Media Sources
Phylogenetic Trees