WHO confirms Indonesian H5N1 case; nurses test negative

Jun 6, 2006 (CIDRAP News) – The World Health Organization (WHO) today confirmed that a 15-year-old Indonesian boy who died May 30 had H5N1 avian influenza, but the agency said four nurses who had suspicious symptoms after caring for avian flu patients were not infected.

The 15-year-old boy, from the Tasikmalaya district in West Java, experienced symptoms consistent with avian flu May 24 and was hospitalized May 26, according to the WHO. An investigation by provincial health authorities found that he had contact with his household’s sick and dying chickens the week before he became ill.

The WHO report concluded, "The H5N1 virus is considered firmly entrenched in poultry throughout much of Indonesia. Unless this situation is urgently and comprehensively addressed, sporadic human cases will continue to occur.

"The newly confirmed case is one of several where exposure occurred despite a clear signal of a high-risk situation arising from poultry deaths. Pending better control of the disease in animals, WHO and officials in the [Indonesian] Ministry of Health see an urgent need to improve public awareness of this disease, the risk factors for infection, and the behaviors that should be avoided."

Indonesia's toll of confirmed avian flu cases has reached 49, including 37 deaths. Vietnam has the highest count, with 93 cases and 42 deaths.

For the four Indonesian nurses, test results after 4 days of monitoring "have now convincingly ruled out H5N1 infection," a separate WHO report said today. Two of the nurses had cared for 10- and 18-year-old siblings in Bandung, West Java, who died May 23, and two had cared for patients in the North Sumatra cluster that involved at least seven members of one extended family in May.

Tests showed that one of the West Java nurses was infected with a seasonal influenza A(H1N1) virus. The other nurse had only transient, mild symptoms but was tested as a precaution.

In North Sumatra, a 34-year-old female nurse likewise had only mild, transient symptoms. The other nurse there, a 42-year-old woman, had experienced flu-like sickness June 1.

The WHO report concludes, "The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities.

"The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present."

WHO's investigation of the North Sumatra case cluster continues; the agency released no new information today on the source of the outbreak or further details on potential human-to-human transmission.

Worldwide, the number of avian flu cases has reached 225, with 128 deaths, according to the WHO.

Asia-Pacific test exercise
In other avian flu news, the 21-nation Asia-Pacific Economic Cooperation (APEC) group announced it will conduct an exercise Jun 7 to test the countries' response to an avian flu pandemic, according to an Agence France-Presse (AFP) story today.

The dry run, called "APEC Pandemic Response Exercise 2006," will test communication among the APEC countries, the article said. The exercise, to be coordinated by Australian officials, will involve a hypothetical scenario in which the H5N1 virus is spreading easily between people.

In addition to Australia, participating APEC countries include the United States and such avian-flu-affected countries as Indonesia, China, Thailand, and Vietnam, according to AFP. The simulation will begin about 7:00 a.m. Sydney time and conclude about 26 hours later when links with Washington, D.C., have been established.

APEC also includes Brunei, Canada, Chile, Hong Kong, Japan, South Korea, Malaysia, Mexico, New Zealand, Papua New Guinea, Peru, Philippines, Singapore, Russia, and Taiwan.

See also:

WHO confirmation of case in 15-year-old boy
http://www.who.int/csr/don/2006_06_06b/en/index.html

WHO statement on nurses
http://www.who.int/csr/don/2006_06_06/en/index.html

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