Another H5N1 case cited in Java; Sumatra quarantine grows

May 26, 2006 (CIDRAP News) – Indonesian health officials have reported that H5N1 avian influenza caused the recent death an 18-year-old West Java man, brother of a 10-year-old girl whose death was previously attributed to the virus, according to news agencies.

And in the North Sumatra family cluster, officials broadened home quarantine to include 54 people—up from the 33 reported yesterday—as a World Health Organization (WHO) official identified chickens as the likely source of the outbreak, according to Reuters stories today.

The 10-year-old and 18-year-old siblings died in a Bandung, West Java, hospital May 23, according to an Agence France-Presse (AFP) report today. Yesterday an Indonesian official said the girl had tested positive for H5N1 in a local lab but that results for her brother were still pending.

Today's AFP report quoted Ahmad Prihatna, an epidemiologist at the health ministry, as saying, "Tests carried out by the health ministry confirmed that they died of bird flu."

The two, according to an Associated Press article today, died within hours of each other less than a day after being admitted to Hasan Sidikin hospital in Bandung, capital of West Java. Samples have been sent to a WHO-accredited lab for confirmation, according to AFP.

If confirmed, the cases would raise Indonesia's avian flu death toll to 35, second only to Vietnam.

Voluntary quarantine expands
As the probe of the case cluster in North Sumatra continues, WHO officials have asked 54 people in the remote village of Kubu Sembelang to quarantine themselves at home, a Reuters story said today. None of these, the officials said, have exhibited avian flu symptoms.

Thirty-nine of the 54 are taking oseltamivir (Tamiflu) as a precaution, Reuters reported. "All who can take it are," WHO spokesperson Gregory Hartl told Reuters. "The others are not taking it because they are either pregnant, lactating mothers, or children."

The source of the Sumatran outbreak remains unknown, but WHO epidemiologist Steven Bjorge said poultry is the likeliest candidate, according to a separate Reuters story today.

"What we're finding out the longer our team stays up in that area is that there are many, many outbreaks in chickens that always go unreported," Bjorge told Reuters. "Just in the past couple of weeks, they have found a couple of outbreaks of chickens dying in various villages in that area.

"The first case [a 37-year-old woman considered by WHO to be the index case] has to get it from somewhere. It has to be something environmental." Asked if sick chickens were responsible, he was quoted as saying, "We think that it has to be that way."

Also today, the WHO reiterated that it will not raise its global pandemic alert level from phase 3 (human infection, but no or only rare human-to-human spread) to phase 4 (small clusters with limited human-to-human transmission, but spread is highly localized). The agency said this week that human-to-human-to-human (two-generation) transmission might have occurred in the North Sumatra cluster. But officials have observed no further spread beyond the family cluster and no ominous mutations in H5N1 viruses that have been analyzed.

Paul Gully, senior adviser to WHO's top avian flu official, Margaret Chan, said in a third Reuters report, "Our feeling now is there is nothing new that has happened which would make us want to consider moving to level 4."

H5N1 outbreaks in poultry
Avian flu outbreaks in chickens in Romania have now reached 70 in the past 2 weeks, Reuters reported today, and 35 additional outbreaks are suspected.

The Romanian Agriculture Ministry said in a statement cited by Reuters, "The bird flu virus has been confirmed in 75 localities from 13 counties. There are also 35 suspect locations. The national institute for animal health is further testing suspect deaths in fowl."

This outbreak originated 13 days ago at a poultry farm in the county of Brasov, about 100 miles north of Bucharest. Live chickens from the farm were sold to peasants across the country without health certificates, according to Reuters.

Elsewhere, Nigeria's agriculture ministry reported a new H5N1 outbreak in its northern state of Kano, according to a Voice of America story today.

The Nigerian Veterinary Research Institute said yesterday that samples of dead chickens from a farm near Kano tested positive for avian flu. Avian flu control teams destroyed more than 16,000 chickens on the farm to try to prevent spread of the virus, the report said.

And in Russia, new cases of avian flu in domestic birds have been reported in eight villages in three Siberian regions, Russia's agriculture ministry said today, as reported by RIA Novosti.

"Fowl infected with avian influenza have been registered in three villages in Novosibirsk Region, four villages in Omsk Region, and one village in Altai Territory," the ministry said in a statement. The article added that about 1.1 million birds have died of the disease in Russia, and 300,000 have been culled to control H5N1 since February, according to the Emergency Situations Ministry.

No human cases of avian flu have been reported in Romania, Nigeria, or Russia.

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