H5N1 Cluster in Tangerang Indonesia Grows
Recombinomics Commentary
December 12, 2007
Joko Suyono, an official at the health ministry's bird flu centre, said the 47-year-old man from Tangerang kept ducks at his home and had recently traveled to the cities of Medan in Sumatra and Pandeglang in West Java.
On Monday, a 28-year-old woman, who also came from Tangerang, died of bird flu after being treated at the same hospital.
The two confirmed cases above extend the cluster of H5N1 cases in Tangerang. Four of the five most recent confirmed cases in Indonesia have been from Tangerang and all but one died. This clustering increases pandemic concerns. Sequences from most of the human cases this year have been withheld, so tracking of H5N1 evolution in humans in Indonesia is not currently possible. Bird sequences from Indonesia match earlier cases, but the most recent public human sequences from January had additional divergence not well represented in the public bird sequences.
H5N1 in poultry and wild birds in Indonesia has been widespread, but the recent confirmed human cases have been concentrated in Tangerang, adjacent to Jakarta, or Riau province in central Sumatra. These two geographic clusters suggest that H5N1 in these regions is more efficiently transmitted to humans and raise concerns about unreported cases. The vast majority of cases in Indonesia are confirmed when the patient is in critical condition and the case fatality rate in Indonesia is above 80%. This high rate raises concerns that milder cases are not being reported, raising additional concerns/
Release of sequences from the recent cases would be useful.
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