WHO confirms 6 new H5N1 cases in Indonesia

May 30, 2006 (CIDRAP News) – The World Health Organization (WHO) confirmed yesterday six new cases of H5N1 avian flu in geographically widespread areas of the country, but none associated with the Karo, North Sumatra, family cluster that killed at least six people earlier this month.

Of the six new cases, three have been fatal, raising the number of cases in Indonesia to 48 and the number of deaths to 36, all in 2005 and 2006, according to WHO statistics.

In its report yesterday, the WHO identified a 10-year-old girl and her 18-year-old brother from Bandung, West Java, as among the fatalities. Both siblings, according to the WHO, had close contact with sick and dying chickens at their home the week before symptom onset. They showed symptoms May 16, were hospitalized May 22, and died the next day.

"The identical onset dates," the report says, "strongly suggest that [the patients] acquired their infection following a shared exposure to poultry, and not from each other."

A 39-year-old man from West Jakarta also died, according to the WHO. He developed symptoms May 9, was hospitalized May 16, and died May 19. He had cleaned pigeon droppings from roof gutters shortly before developing symptoms. Pigeons are among the bird species known to transmit H5N1.

Among the other cases was an 18-year-old East Java man whose symptoms developed May 6 and who was hospitalized May 17. He had been exposed to dead chickens in his home the week before symptom onset and is now recovering, according to the WHO report. In addition, according to Reuters, he sorted chicken feathers at his job in a factory that makes shuttlecocks.

The final two cases involve a 43-year-old man from South Jakarta and a 15-year-old girl from West Sumatra. The man developed symptoms May 6 and is now recovered and no longer hospitalized. The girl developed symptoms May 17 and is still hospitalized. The source of their infections remains under investigation, the WHO reported.

Indonesia, which has recorded 31 human cases of avian flu and 25 deaths in this year alone—far more than any other country in 2006—continues to worry scientists, according to the Reuters news story. "Of course I am worried," the story quotes Leo Poon, a University of Hong Kong microbiologist and H5N1 expert, as saying. "The problem has not improved at all in Indonesia. It's not a good situation."

Redefining pandemic alert phases
In other news, the WHO said today that it is refining its guidelines for its six-phase global pandemic alerts to make them clearer and plans to issue them in a few weeks, according to a separate Reuters report.

"It was highlighted last week that there is some confusion over these phases—what we mean when we go from phase 3 to phase 4," said WHO spokesperson Maria Cheng, as quoted by Reuters.

The pandemic alert is currently at phase 3 (human infection has occurred, but there is no or rare human-to-human spread). Phase 6 signals a full-blown pandemic.

"What we are trying to do is explain [it] in better terminology so that people understand [that] what we are looking for is not necessarily a numerical standard for the number of cases," said Cheng. "We're looking to detect any change in how the virus is transmitted."

Avian flu endemic in Africa?
Because of lack of funds to combat its spread in birds, avian flu may become endemic in Africa, a senior official with the UN Food and Agriculture Organization (FAO) told Reuters today.

"Africa is the continent where we are really worried to see endemicity becoming established," FAO's chief of animal health services, Joseph Domenech, told Reuters. "If this is the case, it will be a new plague for African farmers and will be a permanent reservoir for reinfection to other regions through trade and wild birds."

Domenech, according to Reuters, said that other countries should help Africa eradicate avian influenza.

See also:

WHO May 29 Indonesia report
http://www.who.int/csr/don/2006_05_29/en/index.html

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