Commentary
Indonesia Acknowledges Confirmed July H5N1 Cases
Recombinomics Commentary 10:40
September 10, 2008
Bird flu killed 2 men on Indonesia's Java island in July [2008], the health ministry said, in its 1st reports of cases in almost 3 months. Both fatalities occurred in Tangerang city in Banten province, according to the Ministry of Health.
Laboratory tests conducted by the Indonesian health ministry's research center and the Eijkman Institute have found no evidence of human-to-human transmission in samples from 5 provinces, the ministry said in yesterday's statement.
"The number of bird flu cases tends to decrease because the patients infected by the virus have received appropriate and quick medical treatment," she was quoted as saying Monday.
The above comments are an update of the situation in Indonesia of sorts. The two cases were described in media reports in July or early August, shortly after confirmation. However, the Indonesian Ministry of Health refused to confirm or deny the earlier cases, and confirmed the later case by text message. However, the cases were officially confirmed this week, and WHO waited for the announcement to file a situation update.
Indonesia is required to report confirmed cases within 24-48 hours. It remains unclear if Indonesia continues to violate IHR requirements, or of they are reporting these cases to WHO, and WHO is failing to provide timely situation updates, which are usually published within 24-48 of confirmation. The lack of timely reports from Indonesia as well as WHO’s continuing failure to provide clarification remain causes of concern.
Similarly, the comments from Indonesia on the reduction in cases because of prompt treatment remain confusing. Patients that are H5N1 infected should be reported, regardless of time of treatment. Prompt treatment would only reduce if treatment leads to false negatives or there is frequent human to human transmission, which Indonesia continues to deny based on preconceived notions of the genetic markers that would signal human to human transmission. Such transmissions are common in Indonesia, although largely limited to close contact with family members. However, as seen above Indonesia continues to deny such transmissions.
These denials are supported by misdiagnosis, as seen in cases confirmed prior to the announcement that Indonesia would no longer report confirmed human cases on a timely basis. Three of the confirmed cases were members of three independent familial clusters, but the fatal infections of the index cases were attributed to lung inflammation, typhus, and dengue fever.
Thus, the updated information from Indonesia was just more of the same, and more cause for concern.
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