Commentary
ProMED Resumes Reports Of Suspect H5N1 Cases in Indonesia
Recombinomics Commentary 14:59
August 18, 2008
ProMED-mail has now decided to report all suspected human cases of H5N1 from Indonesia because the usual flow of information -- first suspect and then confirmation -- is disrupted there because of their public health policy.
Recombinomics applauds ProMED’s decision to reverse policy and report all suspect human H5N1 cases in Indonesia. As noted above, the flow of information from Indonesia has been disrupted by their announced change in public health policy. The length of the reporting delays is unclear, as is the reason for the failure of WHO to report lab confirmed H5N1 cases. Two July cases were widely reported in the media. The first case died on July 10 and was lab confirmed on July 13. The Ministry of Health refused to confirm or deny the lab confirmation. The second case died in early August. Although the Ministry of Health did confirm this case, the WHO had yet to report either case.
It remains unclear if this lag in WHO confirmations is due to IHR violations by Indonesia, or a change in WHO policy on reporting lab confirmed H5N1 cases, which are usually included in situation updates published a day or tow after confirmation.
Similarly, neither Indonesia nor WHO has commented on the three fatal cases in North Sumatra. Associated poultry has tested positive for H5N1, but recent deaths in the area have been attributed to dengue hemorrhagic fever, which has symptoms that approximate bird flu.
Clearly it is time for more transparency in Indonesia, official Indonesian reports notwithstanding.
WHO has the authority to investigate suspect H5N1 cases and they have an obligation to report the results of such investigations. It is time for WHO to follow the ProMED lead and increase transparency in Indonesia, by releases human H5N1 sequences generated since the Indonesian blackout from the beginning of 2007, and provide timely situation updates on lab confirmed cases, including those from July of this year and the three fatal suspect cases this month.
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