H5N1 Cluster in Tangerang Indonesia
Recombinomics Commentary
November 3, 2007
A 30-year-old Indonesian woman died of suspected bird flu on Saturday, the country's health ministry said here.
The woman from Tanggerang town on the outskirts of Jakarta died on Saturday in a designated bird flu hospital of Persahabatan in east Jakarta, said Harris Subiantro, an official of the anti-bird flu center of the ministry.
One of two laboratories' tests, which needed for confirmation, indicated that she was positive of avian influenza, said the official.
"She was dead today. One of laboratory tests has showed positive," he told Xinhua.
The above comments describe the fourth laboratory confirmed H5N1 in Tangerang in the past few weeks. Three of the four have been confirmed twice and are official WHO cases. Two of the earlier cases were neighbors. One (5F) died October 22, while the neighbor (3M) has returned home. Confirmed mild cases of H5N1 are rare, and the vast majority are contacts of confirmed cases, because patients with mild symptoms are not generally tested. Testing is done at infectious disease hospitals, and most suspect H5N1 are admitted after failing to respond to treatment at primary care facilities.
The geographical cluster in Tangerang, which is adjacent to Jakarta is cause for concern. The most recent public human H5N1 was made public in early January. Therefore the genetic evolution of H5N1 from patients in Indonesia is unclear. Although most of the patients have some linkage to poultry, the concentration of cases in space and time indicates the H5N1 is being transferred to humans more efficiently.
The other hot spot for human H5N1 in Indonesia is on the island of Sumatra in Riau. In addition to confirmed cases in September and October, there was a suspect family cluster. Although initial media reports indicated the niece (10F) was positive, subsequent reports indicated confirmatory test were negative. However, the death of her aunt (17F) 11 days earlier, keeps suspicions high since both had bird flu symptoms.
The increase in geographic clusters in Indonesia remains a cause for concern.
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