Djibouti and Indonesia

East Africa has gotten its first human bird flu cases in tiny Djibouti on the Horn of Africa. The two year old girl's diagnosis was made by the US Naval Lab in Cairo (NAMRU3) and confirmed by WHO. Djibouti's Health Minister announced on state TV that three chickens were also shown to have H5N1 infection on April 27. The patient is still alive. Her siblings are reported to be showing symptoms and are being tested.

This is the first human case on the African continent detected outside of Egypt (13 cases), although there is suspicion others cases might have occurred. Introduction of the virus into Africa is a source of unease in the medical community because of the many new environmental and ecological niches the virus might exploit, including many species of animals and a large population of HIV positive people.

But for many, China and Indonesia remain the places of most concern. In Indonesia, where H5N1 is endemic in poultry and there have been 33 officially recorded cases with 25 deaths, comes word of a possible large cluster, with three deaths in one family and five other relatives being treated:

Another bird flu suspect has died in Tanah Karo Regency, North Sumatra making it the third possible bird-flu death in the regency within a week.

The latest victim has been identified as Ana Br Ginting, 29, a resident of Jl. Veteran in Tanah Karo’s capital Kabanjahe. The victim died on Wednesday at 5 AM after being treated at Adam Malik General Hospital in Medan, North Sumatra. “The family took her body back to Kabanjahe this morning,” said a hospital official.

Previously two other bird flu suspects, Roy Karo-Karo, 19, and his mother, Puji Br Ginting, died on May 9 and May 4 respectively. Five other of their close relatives are also being treated at Adam Malik for bird-flu symptoms, while another eight-year-old boy from the family has been moved to the Elisabeth Hospital, also in Medan, due to medical reasons.

The family are residents of Kubu Simbelang village, Tiga Panah District, Tanah Karo. All suffer from high fever and respiratory problems. Reports indicate that the family fell ill after consuming chopped chicken meat bought at a traditional market in Kabanjahe. The houses of the family are surrounded by chicken and pig farms. (detik.com)

And this from MetroTV:

A 19-year old bird flu suspect has died in North Sumatra while five members of his family have been hospitalized with symptoms of the deadly disease.

Roy Karokaro died at Adam Malik General Hospital in Medan, North Sumatra on Tuesday at 11 AM after he was transferred to the hospital from Kabanhaje General Hospital in Tanah Karo Regency, also in North Sumatra, after the victim showed symptoms of bird flu.

Five of the victim's close relatives, including an eight-year-old boy and a one-and-a-half-year-old infant are currently being treated in the hospital's intensive care unit with the same symptoms, high fever, coughing and liquid on their lungs, said the hospital public relations officer, Sinar Ginting. All victims lived in neighboring houses. The victim’s mother recently suddenly died due to similar symptoms, the official said. (MetroTV News)

(Sorry, no links at this time for either of these Indonesian reports; will supply if and when I get them).

Despite occasional news articles that the bird flu situation is calming down in Europe, things are not much changed elsewhere and human cases are appearing in new locations. The Indonesian cluster bears watching, but at this point we don't have confirmation of the diagnoses. There is no mention in these reports of international scientists involved in the investigations. We would hope the Indonesian authorities have enough sense to ask for help when they need it.

Because they need it.