Avian flu hits Indonesia; human cases increase

Jan 26, 2004 (CIDRAP News) – Indonesia today joined the rapidly growing list of countries with poultry outbreaks of highly pathogenic avian influenza, while more human cases and deaths were confirmed in Vietnam and Thailand.

An Indonesian agricultural official said the disease was first spotted Aug 29, 2003, in Central Java, but no human cases have been reported, according to a story in today's Jakarta Post. An Indonesian veterinary researcher said the influenza A(H5N1) outbreak had been confirmed in November and accused the government of a cover-up, the newspaper reported.

The agricultural official, Sofjan Sudardjat, said the disease was widespread between September and November, according to the Post. The story said the government previously blamed the deaths of thousands of chickens in East Java and Bali in the past 3 months on Newcastle disease.

Indonesia joined Vietnam, Thailand, South Korea, Japan, and Cambodia on the list of countries with current or recent confirmed outbreaks of H5N1 avian flu. An avian flu outbreak also was reported today in Pakistan, but was said to involve a different viral strain.

The World Health Organization (WHO) today confirmed the third human case in Thailand and reported the death of a boy whose case was confirmed earlier. The newly confirmed case was in a 6-year-old boy, who was alive at the time of the report. Avian flu is suspected in another 10 cases in Thailand, including five fatal ones, according to a Bangkok Post report.

Another 6-year-old Thai boy, whose case was confirmed Jan 23, died yesterday, the WHO said. He had been hospitalized in Bangkok with severe pneumonia and acute respiratory distress syndrome. The third confirmed case in Thailand involves a 7-year-old boy.

The Thai boy who died was the seventh person known to have died of avian flu in the current outbreak. Six Vietnamese, including five children and a 30-year-old woman, have died of the illness since Dec 30, according to the WHO. The highest previous human death toll blamed on the H5N1 virus was the six deaths in Hong Kong in 1997.

On Jan 24 the WHO confirmed two human cases of H5N1 infection in Ho Chi Minh City, Vietnam. The patients were a 13-year-old boy, who died Jan 22, and an 8-year-old girl, who was listed in critical but stable condition. They were the first confirmed cases in the southern part of the country and brought the total number of confirmed cases in Vietnam to seven.

Thailand and Vietnam remained the only countries with confirmed human cases of the disease, according to reports. Vietnam had poultry outbreaks in 23 of its 61 provinces by Jan 24, the WHO said.

Disease experts fear that the H5N1 virus, if it infects a person already carrying another flu virus, could mutate into a form that could trigger a human flu pandemic. Today the WHO repeated past statements that most of the current human cases have been linked to direct contact with diseased birds and that there has been no evidence of person-to-person transmission.

As reports of human and poultry cases of the disease continued to grow, the WHO warned consumers to cook poultry products thoroughly and avoid buying live poultry in affected areas, but it did not recommend any travel restrictions.

"WHO recommends that travelers to areas experiencing outbreaks of this disease in poultry should avoid contact with live animal markets and poultry farms," the agency said. "Large amounts of the virus are known to be excreted in the droppings from infected birds."

In a Jan 24 statement, the WHO said duck products could be contaminated with the H5N1 virus, as was found in one recent study involving testing of imported frozen duck meat. But good food-handling hygiene and usual recommended practices for cooking poultry products should reduce any risk to "insignificant levels," the agency said. It also said consumers should take care in handling shell eggs or raw egg products, since eggs from infected poultry could be contaminated.

The WHO statement also noted there have been reports of pigs in Asia infected with the H5N1 virus. Experts believe that pigs played a role in past influenza pandemics by providing a "mixing vessel" for viruses.

In other developments, initial tests have indicated that the current H5N1 virus is resistant to one class of antiviral drugs, according to a Jan 25 report in the New York Times. Dr. Klaus Stohr of the WHO said tests showed that the virus was resistant to amantadine and rimantadine, which form the less expensive of two classes of antivirals used to treat the flu.

The Times story said the virus is believed to be susceptible to the more expensive class of anti-influenza drugs, the neuraminidase inhibitors, which include oseltamivir and zanamivir.

In Pakistan, researchers announced that avian flu has killed up to 4 million chickens in Karachi since November, according to an Agence France-Presse (AFP) report today. But the outbreak was said to involve H7 and H9 flu viruses, which are less dangerous than H5N1.

The AFP report also said a United Nations official in Laos reported an outbreak of suspected avian flu there. In addition, South Korea, which battled avian flu in December and early January, had a new suspected outbreak, according to the story.

See also:

Jan 26 WHO update
http://www.who.int/csr/don/2004_01_26/en/

Jan 24 Who update
http://www.who.int/csr/don/2004_01_24/en/

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