Tuesday, July 19, 2005

Indonesia: interim update

Antara, the Indonesian News Agency, says health authorities there are still investigating the three deaths last week, presumed due to bird flu. While urging calm, Health Minister Siti Fadilah Supari also urged caution and alertness:
"People should not be afraid but stay alert and pay greater attention to their surroundings, whether there are sick or dead poultry," Siti said after a meeting with President Susilo Bambang Yudhoyono.

The minister said people should also constantly watch out for people in their immediate neighborhoods who had a cold accompanied by high fever.
Significantly, Siti advised Indonesians not to eat chickens or eggs for the time being. Samples of blood and feces were sent to a reference laboratory in Hong Kong to confirm the infection was from influenza A/H5N1 (bird flu).

The Health Ministry is now trying to find the source of the infection and interest centers on an "animal husbandry" area in Tangerang, Banten, where the victims lived.
Agriculture Minister Anton Apriyanto on Monday inspected the animal husbandry area in Tangerang in question, during which he stated that the government was planning to stamp out all poultry and pigs within a radius of three kilometers from where the suspected bird flu outbreak was identified.

According to Apriyanto, the measure would be taken to prevent the possible bird flu virus from spreading further, especially to poultry in other places.

President Susilo Bambang Yudhoyono on Sunday asked the relevant agencies not to cover up the cause of death of the three people in Tangerang who were suspected to have died of bird flu.

"The causes of their death must be made clear and explained to the public. It should not be covered up," the President said. (Antara News Agency)
Thus, while there is no confirmation from Hong Kong as yet (test results expected 7/20 or 7/21), the government is assuming the answer will come back H5N1. But there is still much to be ascertained and made public, including any exposure histories and the timing of the onset of illness in the three cases. We need more than "not covering up." We also need information to be revealed.

Update, 7/20/05, 7:40 am EDST: The Indonesian Health Minister (Siti Supari) has confirmed that tests on blood samples from the father, one of three family members to die of acute pneumonia last week, have come back confirming bird flu (H5N1) as the cause of the infection. Results on the two deceased daughters were not yet available.
Asked if the three died from bird flu, Supari said: "Yes."

"It is not yet known how they got infected, but we continue to conduct an investigation on the ground," she said.

"The results show (the virus is) a conventional one, and not a new virus. Therefore, there is no need to worry about human-to-human transmission."

Authorities have taken samples of more than 300 people who had contact with the family on the outskirts of Jakarta.

They also plan to carry out extensive tests on animals within a 20-km (12-mile) radius of the family's house and slaughter those infected.

World Health Organization representative Georg Petersen told British Broadcasting Corporation that an in-depth investigation was needed, adding that in other countries the source of infection was often not known straight away. (Reuters, via Boston Globe)
If they don't known how this family was infected (there is no history of contact with poultry), it is hard to understand how they also know there is no worry about human-to-human transmission. This statement of the Health Minister can best be characterized as a lie. Indeed, a WHO representative confirmed that the question of human transmission was still under investigation:
The World Health Organization laboratory in Hong Kong confirmed the victims had contracted the H5N1 bird flu virus, she said. Authorities have kept 300 people who came in contact with the three victims under observation, Georg Petersen, the WHO's representative in Indonesia said in an interview. None have developed symptoms.

"More information is needed,'' to confirm if the virus spread from human contact, Peterson said. (Bloomberg)
It is worth noting that Indonesia has favored vaccinating poultry rather than culling them. The worry about this strategy is that it could produce infected but asymptomatic domestic poultry that were still infective.