Indonesian government mum as AP reports H5N1 case

Robert Roos  News Editor

Jun 13, 2008 (CIDRAP News) – An Indonesian woman died ofH5N1 avian influenza 10 days ago, but her case has not yet been publiclyconfirmed by the government, which is continuing to withhold information aboutavian flu cases, the Associated Press (AP) reported today.

The news came on the heels of the word from a World HealthOrganization (WHO) official that Indonesia has promised to keep the agencyinformed of human cases and deaths, as it is obligated to do under theInternational Health Regulations (IHR). The WHO official's comments appeared tocontradict statements last week from Indonesia's health minister.

On Jun 5, Health Minister Siti Fadilah Supari said thegovernment would no longer report human H5N1 cases and deaths promptly to theWHO. Different news accounts said she planned to report cases after they werereported in the news media or only at 6-month intervals. Supari said she wantedto focus attention on the country's successes in fighting avian flu.

Today's AP story says that a 34-year-old woman named SusiLisnawati died of avian flu Jun 3. Speaking anonymously, a senior healthministry official and four other health workers confirmed the case to the AP.But the government had not yet notified Lisnawati's husband, Ali Usman, that shehad the virus, according to the story, which came from Bitung, a city near thenortheastern tip of Sulawesi island.

The case has not been reported in the local news media, andit took the AP a week to track down and confirm it, the report said.

The case apparently raises Indonesia's H5N1 death toll to110, out of a total of 135 cases. The WHO's tally for Indonesia stands at 133cases with 108 deaths; the agency has not yet included Lisnawati and a15-year-old girl whose case was announced by Supari just last week, though shehad died May 14.

Dr. David Heymann, the WHO's assistant director general forhealth security and environment, said yesterday that Indonesia had assured theagency it would continue reporting avian flu cases, according to a CanadianPress (CP) report published yesterday.

"We've received official notice at our WHO office inJakarta that the minister will continue—as she has been—notifying WHO onconfirmed infections under the International Health Regulations," Heymanntold CP.

"She's been clear . . . that she has no intention ofnot conforming to the International Health Regulations," he said."She knows what they are. She's been told what those regulationsrequire."

Today's AP story carried similar comments from Heymann. Butaccording to the AP account, Heymann said it doesn't matter if it takes severalweeks for the government to report cases, "as long as the virus is knownabout and handled properly." He also said it did not appear that Indonesiawas flouting the IHR.

Under the IHR—agreed to by all WHO membercountries—governments are required to quickly report cases of diseases labeledas global health threats. Novel influenza strains are among the diseases thatcountries are specifically obligated to report.

Indonesia has been at odds with the WHO since early 2007,when Supari announced the government would no longer send H5N1 virus samples tothe agency. The country wants guarantees that it will receive a supply of anyvaccine derived from the isolates it supplies. The WHO has relied for decadeson free sharing of flu viruses in its effort to identify new strains, developvaccines, and monitor drug resistance.

See also:

Jun 5 CIDRAP News story "Indonesia quits offering prompt notice of H5N1 cases"

Jun 15, 2007, CIDRAP News story "Newglobal disease-control rules take effect

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