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F.ood & H.ealth : B.iological A.gents Last Updated: Nov 12th, 2006 - 20:38:00

Update: Another Bird Flu Case in Indonesia
By Kathy Jones
May 21, 2006, 11:41

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May 21, ( - Indonesian health officials said that an 18-year-old East Java shuttlecock maker had been diagnosed with bird flu after local tests seemed to confirm it. The Health Ministry's Director General for Disease Control, I Nyoman Kandun said Sunday that the teenager was being treated at a local hospital.

He added that the blood samples would be sent to a Hong Kong laboratory recognized by the World Health Organization (WHO) for confirmatory tests. "He was working as a shuttlecock maker. We are still tracing where (the factory) got the feathers," Kandun said.

Human cases of bird flu are directly linked to contact with infected poultry at the moment. Indonesia has borne the brunt of human bird flu cases this year. At least 32 have succumbed to the H5N1 virus with more than half of them dying in 2006. Indonesia's toll is second only to Vietnam, which has reported 42 deaths.

Last week, a "cluster" of infections and deaths in the same family had triggered concerns that the virus had mutated to a form that is easily transmissible between human. Although Indonesian officials have ruled out this scenario, the World Health Organization said that concerns still persist. No other members of the village where the family lived are known to have been infected with bird flu, the WHO added.

However, the Indonesian Health Minister Siti Fadilah Supari told reporters that there was no evidence of this mutation having occurred. "The virus is still the H5N1 strain based on the sequencing DNA examination but we need to confirm with the World Health Organization's lab in Hong Kong. But I think it will not be much different," she told reporters.

Indonesia has come in for severe criticism for doing too little to curb the spread of the bird flu virus, which has so far been found in poultry in two-thirds of the country's 33 provinces. Initially there was no mass culling and experts speculate that perhaps this was the reason the virus spread so rapidly through poultry.

As for the human cluster, there are still doubts on how seven members of an extended family became infected simultaneously. "It's good news that there is no further transmission," said Sari Setiogi, WHO's spokeswoman in Indonesia. But the source of the infection is also yet to be traced and this is worrying.

Epidemiologists have tested pigs, chickens, ducks and geese for the presence of the virus and had found bird flu antibodies were detected in pigs raised by the family. However nasal swabs taken from the pigs were returned negative. "We can't rule either way (human-to-human or animal-to-human) at this stage, we're still doing investigations," Setiogi said.

She added that the investigators were facing some logistical difficulties since the said family was still in mourning. "We are dealing with a family that has lost so many members and which has suffered such a loss ... they may not remember what happened, they may tell you something wrong," she added. "When you ask again, you get a different answer. So it's not easy for them to think easily and answer questions."

Clusters of human infections are a worrying trend since this means that people staying close together either got infected from a single source (which is highly unlikely) or got it from each other. This is a nightmare scenario for health workers. The Indonesian family cluster is the largest seen until now, but it must be stressed that such clusters occurred in Turkey and Azerbaijan as well.

Dr. Guenael Rodier, special adviser for communicable diseases to the regional director of the WHO's European office said that the occurrence of these clusters should serve as a warning, "Of course you can imagine that some human beings offer more binding opportunity for the virus than others," he said. "It's perfectly legitimate to think about it. But . . . we don't have enough cases today and pathology results to be able to document that. We can always explore a hypothesis. But my experience from the field is that often we have simple answers."

Scientists are also speculating whether genetic susceptibility is involved in such human clusters. Henry Niman, Ph.D., President of Recombinomics is calling on the WHO to release the human H5N1 bird flu sequences from the dead family members. He cited the index case who fell ill on April 27 and died on May 4 as being the key to this puzzle. The case was a 37-year-old woman who was buried without any tests being conducted.

Since her death six other members of her family have including two sons, a brother, a sister, a nephew and a niece have either fallen ill or succumbed to the bird flu virus. It is unlikely that the index case will be confirmed.

According to the WHO, 123 humans have so far fallen a victim to H5N1 virus. Although most deaths have occurred in Asia, the majority of them reported this year have occurred in Indonesia and Turkey.

The bird flu virus first surfaced in Asia in 1997 and then again resurfaced in 2003. Since then it has spread rapidly across Asia and Europe as well as Africa. Till now the virus has only been transmitted after close contact with infected birds and coming in contact with saliva, nasal secretions, and feces.

The fear is that if the virus mutates to an easily transmissible form between humans it would trigger a pandemic worldwide. The CDC says that some of the common symptoms of bird flu are fever, cough, sore throat, and muscle aches, eye infections, pneumonia, and severe respiratory diseases. As of now there is no evidence that eating cooked poultry will transfer the infection since the virus is heat labile.

For more information on bird flu, visit

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