Indonesia blames two more deaths on avian flu

Sep 26, 2005 (CIDRAP News) – Indonesian officials have blamed two more deaths on H5N1 avian influenza, bringing the country's reported avian flu toll to six, although the cases have not yet been confirmed by an international reference laboratory.

A 27-year-old woman who died today and a 5-year-old girl who died last week had the virus, according to officials quoted by the Associated Press (AP) and Agence France-Presse.

In addition, Indonesian officials reported that several other people have tested positive for the virus, but they gave no details on those cases.

The 27-year-old woman was hospitalized Sep 22 and died early today at the Jakarta hospital designated for possible avian flu cases, hospital spokesman Dr. Sardikin Giriputro told the AP. He said blood and saliva tests confirmed her infection, but samples were sent to a Hong Kong laboratory for further confirmation. AFP listed her name as Karwati.

According to a Reuters report, Giriputro said it was unclear how the woman caught the virus, but 15 chickens in her household had died of unknown causes.

A blood sample from the 5-year-old girl, named Riska, tested positive for the virus, although a saliva test was negative, said I Nyoman Kandun, the health ministry's top infectious disease official, as quoted by AFP today. He said the ministry had classified her case as an avian flu death despite the mixed test results. Samples from the girl, who died Sep 21, have been sent to Hong Kong for further testing.

A Reuters report today said a polymerase chain reaction (PCR) test on the girl was negative, but the story didn't explain who conducted that test.

Previous deaths blamed on H5N1 avian flu in Indonesia include those of a 38-year-old man and his two young daughters in July and a 37-year-old woman who died Sep 10. In addition, the World Health Organization (WHO) said Sep 22 that an 8-year-old boy hospitalized in Jakarta had the virus. (The WHO has said the test results for the 38-year-old man's daughters did not meet the criteria for H5N1, but the Indonesian government regards their cases as confirmed.)

Yesterday AFP quoted Giriputro as saying that five hospital patients in Jakarta had tested positive for avian flu while five others had tested negative. But the story gave no details on the cases.

The AP said today that at least 34 people in Indonesia were hospitalized with possible avian flu symptoms. However, Health Minister Siti Fadila Separi said the situation remained under control and the virus did not appear to be spreading from person to person.

Indonesia to receive oseltamivir
The Indonesian government announced today that 400,000 tablets of the antiviral drug oseltamivir (Tamiflu), enough to treat 40,000 people, were being donated to the country this week, the AP reported. Supari, the health minister, said donor countries and agencies were providing the drug to help Indonesia fight avian flu, but gave no details.

The AP said the Australian government pledged today to give Indonesia enough antiviral medication to treat 40,000 people, but it was not immediately clear if the donation announced by Indonesia included the Australian contribution.

FAO says control strategy underfunded
In other news, the United Nations Food and Agriculture Organization (FAO) warned today, "The global strategy for the control of avian influenza in animals remains largely under-funded despite contributions pledged by some donors."

A strategy developed by the FAO and other agencies last May is expected to cost over $100 million over the next 3 years, the FAO said. So far, donor countries have pledged about $16.5 million. That includes $6 million each from Germany and the United States, $4 million from Switzerland, and $0.5 million from Japan.

"It makes sense to stockpile antiviral drugs to protect humans against a potential avian influenza pandemic, but at the same time we have to contain the virus at source, in animals, to reduce the risk to people," said Joseph Domenech, the FAO's chief veterinary officer.

The support pledged so far "is excellent, but it marks only a starting point and unless it translates into further financial funding to support affected countries, the cycle of bird flu infection that will occur in poultry this winter will not be stopped," Domenech said.

The statement said there is a "small window of opportunity" to vaccinate poultry before winter. Domenech said Vietnam, in particular, needs $10 million to complete its current nationwide poultry vaccination program, upgrade lab facilities, and conduct follow-up surveillance.

The FAO also said countries along bird migration routes should set up surveillance programs and will need money to do that.

"India and Bangladesh, Central Europe, the Middle East and parts of Africa should develop national prevention, early detection and rapid response plans," the agency said. Domenech said those efforts would cost about $50 million for the next 3 years.

FAO concerned about Indonesia
Last week, the FAO voiced concern about the spread of avian flu in Indonesia and called on the government to step up its efforts to control the virus.

"Avian influenza has become endemic in Indonesia and it is continuing to spread," Domenech said in the FAO's Sept 22 statement. "In view of the worrying situation, it is necessary for the government to improve its virus control policies and strategies."

The agency said veterinary and civil authorities should be provided with the full authority to enforce disease-control measures.

See also:

Sep 26 FAO statement
http://www.fao.org/newsroom/en/news/2005/107804/index.html

Sep 22 FAO statement
http://www.fao.org/newsroom/en/news/2005/107810/index.html

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