WHO confirms 3 H5N1 cases in Indonesia

Oct 16, 2006 (CIDRAP News) – The World Health Organization (WHO) today confirmed three fatal cases of H5N1 avian influenza in Indonesia, involving two women from Java and a boy from South Jakarta, bringing Indonesia's toll to 72 cases with 55 deaths.

The first case involved a 67-year-old woman whose infection was reported by the Indonesian health ministry on Oct 11. The WHO said she became ill on Oct 3, was hospitalized Oct 7, and died Oct 15. Her illness was complicated by a chronic condition, the agency said.

The second case involved an 11-year-old boy from South Jakarta who got sick on Oct 2, was hospitalized Oct 7, and died a week later. The WHO said the boy had been exposed to dead chickens in his neighborhood.

The third case was in a 27-year-old woman from Central Java province who became ill on Oct 8, was hospitalized Oct 12, and died the next day. The WHO said the source of her exposure is under investigation.

The Jakarta Post reported on Oct 12 that doctors who treated the 67-year-old woman suspected she also had encephalitis. Hadi Jusuf, a doctor at Hasan Sadikin hospital in Bandung, where the woman had been hospitalized, said hospital neurologists who examined the woman concluded that she had a brain inflammation caused by a virus.

Hadi told the Post that the woman was unconscious when admitted to the hospital but that doctors could find no evidence that her loss of consciousness was related to acute respiratory distress or pneumonia, as was true of some other avian flu patients treated at the hospital.

The woman’s cerebrospinal fluid was tested repeatedly after an initial result was negative, Hadi said.  He said he had not received results from the health ministry’s lab. If the tests are positive, the woman would be Indonesia’s first avian flu patient to have brain inflammation caused by the infection, Hadi told the Post.

Neurologic complications of H5N1 infection have been reported before, though rarely. A Vietnamese boy who died of encephalitis in 2004 was later found to have had H5N1 infection, according to a research report published last year. Encephalitis is also known to be a rare complication of ordinary influenza.

The sole survivor of the avian flu case cluster in North Sumatra last May, Jones Ginting, had brain abscesses after he was hospitalized. An Associated Press article, published after he was released from the hospital, said that after he experienced a stiff neck and headaches, tests showed multiple brain abscesses caused by parasites.

With the three newest avian flu cases, Indonesia’s case-fatality rate is 76%, second only to that of Cambodia, where all six H5N1 patients died.

The latest cases bring the WHO's global avian flu count to 256 cases with 151 deaths, for a case-fatality rate of 59%.

See also:

Oct 16 WHO statement

Feb 16, 2005, CIDRAP News article "Avian flu caused encephalitis in Vietnamese boy"

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