45th Indonesian avian flu death confirmed, team investigates possible cluster

Aug 17, 2006 (CIDRAP News) – A World Health Organization (WHO) reference laboratory confirmed today that a 9-year-old Indonesian girl from the remote Garut district in West Java province who died on Aug 15 had H5N1 avian influenza virus.

The girl's symptoms developed on Aug 1 and she was hospitalized the day before she died. Recent chicken deaths were reported in her household. She becomes Indonesia's 58th case and its 45th fatality. Indonesia has the world's highest number of avian flu fatalities, and the girl's case is the country's third case in 2 weeks.

Investigators are assessing recent bird-flu related events in three hamlets in the girl's village, which is about 93 miles southeast of Jakarta. The 17-year-old boy who was Indonesia's 57th case (confirmed by the WHO on Aug 14) is from the same village but lives in a different hamlet. The WHO said the boy is recovering.

When the boy became ill, his 20-year-old cousin developed severe respiratory symptoms but died on Aug 5 before he could be hospitalized or tested for the H5N1 avian influenza virus. "Based on epidemiological and clinical findings, however, infection with the H5N1 virus is strongly suspected," the WHO said in its report.

The boy and his cousin developed symptoms on Jul 26, and investigators assume they acquired their infection from the same environmental source. The WHO pointed out that the currently recognized incubation period for H5N1 infection of 2 to 8 days makes human-to-human transmission between the two highly improbable.

Teams that include authorities from the local health department, the Indonesia Ministry of Health, and the WHO are in the three hamlets investigating these cases. Animal health experts are also on the scene. Recent unexplained poultry deaths have occurred in the village, and exposure to sick chickens was documented in all three cases.

Local publicity surrounding the recent avian influenza events, along with the presence of the investigative teams, have prompted additional patients to be screened for presence of the H5N1 virus. The WHO said rumors of additional late July and early August deaths from respiratory disease in the hamlets are being investigated.

Initial media reports noted that the hamlets were difficult to reach by road or phone, but the WHO said good field communications have been established with the Ministry of Health.

An Associated Press (AP) report today said that a total of seven confirmed or suspected bird flu deaths have occurred in the village. Health officials told the AP they were awaiting lab results for a girl who was hospitalized yesterday in West Java's capital, Bandung, where she received the antiviral drug oseltamivir. Besides the 20-year-old man mentioned in the WHO report, the AP said three others from the same area died before testing for the H5N1 virus could be performed.

See also:

Aug 17 update on Indonesia situation
http://www.who.int/csr/don/2006_08_17/en/index.html

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