Indonesia reports another avian flu death

May 31, 2006 (CIDRAP News) – A 15-year-old boy in West Java has become Indonesia's latest avian flu fatality, according to news reports that cited local tests.

Meanwhile, the World Health Organization (WHO) reported today that in the remote North Sumatra village that witnessed a large family cluster of avian flu cases, no cases suggestive of H5N1 infection have been detected since May 22.

The 15-year-old boy, who was from Tasikmalaya, West Java, was admitted to a hospital May 29 and died yesterday, according to a Reuters story today. If his death is confirmed by a WHO laboratory in Hong Kong, his will be the 49th case and 37th death in Indonesia. About two thirds of those cases have occurred this year.

Government officials said that the teen had contact with infected poultry and that his own chickens died about 2 weeks ago, according to Reuters. In addition, the report said, the boy's grandfather was a chicken farmer who had 40 chickens that died recently.

The boy represents the third recent H5N1 fatality from West Java province. A 10-year-old girl and her 18-year-old brother died last week in Bandung, which is about 55 miles northwest of Tasikmalaya.

Today's WHO update on the case cluster in Kubu Simbelang village, Karo District, North Sumatra, states that 54 family members and other close contacts remain under home quarantine. In addition, investigators have been conducting house-to-house surveillance for flu-like symptoms throughout the 400 or so households in the village, and a surveillance command post was set up in the village last week.

With all this monitoring in place, no new cases resembling avian flu have been identified in Kubu Simbelang over the last 9 days, the WHO reports. This finding is important, the agency says, because it indicates that the H5N1 strain has not spread beyond members of the single extended family.

Today's WHO update also provides further details on the history of the case cluster.

As noted in previous reports, the original family member to fall ill was a 37-year-old woman who is considered the index case, though samples from her body were not collected before she was buried. According to today's report, she started showing symptoms consistent with avian flu April 24 and died May 4.

She sold fruit and chilies at a market stand about 50 feet (15 m) from a stand that sold live chickens, according to the WHO. She also kept a small flock of backyard chickens, which she allowed into the house at night. Three of these chickens reportedly died before she became ill. She also used chicken feces to fertilize her garden.

The woman had one sister and three brothers. The sister and two of the brothers contracted H5N1, and one of the brothers is the only infected family member to survive.

The family members who died of avian flu include the 37-year-old's two teenaged sons, her sister's 18-month-old girl, and a 10-year-old son of the brother who died.

On April 29, according to today's update, nine family members spent the night in the same small room as the index patient when she was severely ill and coughing heavily. Five to 6 days later, three family members experienced symptoms. These were her two teenaged sons and the surviving brother, who was from a village 6 miles away.

The sister of the initial patient developed symptoms at the same time, as did the sister's 18-month-old daughter. The sister, who lived in an adjacent house, cared for the index patient, accompanied by her young daughter.

The 10-year-old boy lived next door to the 37-year-old woman and was a frequent visitor in her house. His father, the woman's brother, was the final fatality (May 22) and had tended his son throughout his hospital stay from May 9 through May 13.

The WHO report also says that a parallel agricultural investigation still has not detected H5N1 virus in about 80 samples from area animals and chicken fertilizer, meaning that the initial source of the outbreak remains unknown.

See also:

WHO's Indonesia cluster update
http://www.who.int/csr/don/2006_05_31/en/index.html

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