Saturday, February 25, 2006

Indonesia and questions about its virus

A curious news story in The Sydney Morning Herald quotes a Dr. Andrew Jeremijenko, as saying the Indonesia H5N1 virus that is killing humans is different than the one that is killing birds. The only evidence cited in the article is this:
He said there had been no human deaths in Turkey, Vietnam or Thailand after effective control programs were implemented. But in Indonesia there was poor communication between the departments of Health and Agriculture and the deaths kept on coming, with two suspected H5N1 deaths in the past week. (Sydney [Australia] Morning Herald)
This can either be read that deaths have continued because of failure to control the disease as efficiently in Indonesia as in southeast asia or that there is something different about the virus. Apparently Dr. Jeremijenko believes it is the latter. We would be interested to know why.

Dr. Jeremijenko is identified as an Australian expert who has worked in Indonesia, most recently "leading influenza surveillance studies for a US naval medical research group." He was indeed listed as an Indonesia region expert in the South East Asian Nations Infectious Diseases Outbreak Surveillance Network website, with his affiliation as USNAMRU-2 (US Naval Medical Research Unit No. 2), whose uncertain fate we discussed in an earlier post. It was slated to close on December 31 of last year and it appears this has happened. If anyone has information on this please email us or leave them in the Comments to this post. The US NAMRU infectious disease laboratory in Jakarta was the most advanced in the region and important in training Indonesian scientists in diagnostic techniques like identification of infection with the bird flu virus. Demanding (and possibly getting) its shutdown is an act of colossal stupidity by the Indonesian government, one for which we may all pay in lost warning time.

Meanwhile we would like to know Dr. Jeremijenko's reasoning and evidence that the human virus in Indonesia is different in character than the one circulating in the poultry population there.

Update (3:14 pm EST, 2/25/06): Thanks to an alert and assiduous Commenter we have the link to the interview from which the newspaper article was taken. Unfortunately it doesn't shed a great deal of light on the evidence. Here is the relevant portion:
PETER CAVE: Are you seeing mutations in the virus in Indonesia?

ANDREW JEREMIJENKO: Yes, that's a good question. We are seeing mutations in the human virus. We are not seeing that same mutation in the bird virus. And that's of great concern.

Basically, when you do an investigation of a bird flu case, you should try to find the virus from the human and match it up with the virus from the bird and find the cause.

Now, in Indonesia, the investigations have been sub-optimal, and they have not been able to match the human virus to the poultry virus, so we really do not know where that virus is coming from in most of these human cases.

PETER CAVE: Does it suggest it's going through an intermediary before it's infecting humans?

ANDREW JEREMIJENKO: It's a possibility that we can't rule out. I think they really need to do a lot more investigations. So far the closest match we have to the human virus is from a cat virus. So the cat could be an intermediate. We really don't know what's happening yet. They need to do more studies, they need to get better investigators on the ground to work out what is happening in Indonesia, and it needs to be done urgently.

PETER CAVE: Can Indonesia do this on its own?

ANDREW JEREMIJENKO: I think they need international assistance. So far the investigations have been unable to match the viruses. It is poor communication between the Department of Health and the Department of Agriculture. There are many reasons, but they don't seem to be able to match the viruses from the human case to the animal case, and that is putting the world at threat.
Another reader has sent along the Doctor's email so I will query him directly and update further if and when I get an answer.