H5N1 Fatality in East Jakarta Raises Pandemic Concerns
Recombinomics Commentary 17:57
December 9, 2008

The second case, a 2-year-old female from East Jakarta, developed symptoms on 18 November, was hospitalized on 26 November and died on 29 November. Laboratory tests have confirmed infection with the H5N1 avian influenza virus. Initial investigations into the source of her infection suggest exposure at a live bird market.

The above comment from the most recent WHO situation update describes a second recently H5N1 confirmed case in Indonesia.  The above case was in East Jakarta, where there have been many previously confirmed cases.  This is also true of the case in Riau. However, recent reports have indicated 50% of the poultry sold in markets in Jakarta, Banten, and West Java is H5N1 positive, raising concerns of widespread human cases in the area.  The two most recent cases were reported relatively soon after confirmation.  However, earlier cases were reported weeks or months after confirmation, raising serious concerns.

In addition to the news blackout on confirmed cases, other lab confirmed cases and clusters have been denied and in other cases, index cases of H5N1 confirmed clusters have been said to be due to lung inflammation, dengue fever, and typhus.

The concerns surrounding these cases has been compounding by a withholding of samples from third party analysis, and a lack of sequences data.  The last human H5N1 sequences are from patients who died almost two years ago (January 2007).

Recently a large PCR confirmed cluster was reported in Makassar, and was reported to be lab confirmed was denied by the Ministry of Health.  The denial was followed by the placement of a WHO team into the region to monitor H5N1 in poultry.  The H5N1 situation in poultry has also been unclear since Indonesia has not filed an OIE report since 2006 and has halted shipment of poultry samples to the WHO regional lab in Australia.

These denials of lab confirmed cases and the withholding of samples and sequences have raised serious pandemic concerns.

Timely reports of confirmed cases and more interactions with third parties, including release of samples and sequences, would be useful.

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