Woman's death marks Bali's first H5N1 case

Aug 13, 2007 (CIDRAP News) – Indonesia's health ministry today announced that a 29-year-old woman from Bali died yesterday of H5N1 avian influenza, signaling the first human case on the popular tourist island, and that her 5-year-old daughter had died earlier of a similar illness.

Lily Sulistyowati, head of Indonesia's national avian influenza control committee, said in a health ministry press release that the woman became ill Aug 3 with a fever and respiratory symptoms and was diagnosed about a week later with serious pneumonia. On Aug 10 she was hospitalized at Sanglah Hospital in the Bali capital of Denpasar with a high fever and breathing difficulties, and she died there 2 days later.

Tests at the health ministry's lab and the Eijkman Institute in Jakarta confirmed that she had an H5N1 infection, the press release said. If the World Health Organization (WHO) confirms the woman's case, she will be listed as Indonesia's 103rd case-patient and its 82nd fatality.

The woman is from Jembrana district, where avian flu is endemic in poultry, the health ministry reported. The district is in the northwestern part of the island, far from the major tourist areas, Agence France-Presse (AFP) reported today.

Ian Barr, deputy director of the WHO's Collaborating Centre for Reference and Research on Influenza, said travelers shouldn't panic about a human H5N1 case being confirmed on Bali, Australia's Sydney Morning Herald reported today.

"Most of these cases occur in villages, not in downtown Kuta or Denpasar, so I'm not sure that travelers should be too concerned," he told the Herald.

The woman's 5-year-old daughter died of pneumonia on Aug 3, and investigators found that several chickens raised by the woman and her neighbor had died in early to mid July, according to the press release. The girl had played with chickens before she died. Tests by livestock officials confirmed that the birds died of H5N1 infection.

Health officials haven't determined if the girl had an H5N1 infection. Bayu Krisnamurti, head of Indonesia's national bird flu commission, told reporters that the child's body had been buried and that authorities could not confirm the cause of her death, the Chinese news agency Xinhua reported today.

A 2-year-old girl from a neighboring home is being treated for a suspected H5N1 infection at Sanglah Hospital, the Indonesian health ministry reported. She came down with a fever and cold 3 days ago and is receiving oseltamivir (Tamiflu).

Although avian flu is endemic in birds in Jambrana district and other parts of Indonesia, the country's last official outbreak report was filed in October 2006, according to the United Nations Food and Agriculture Organization (FAO).

Joko Suyono, a spokesman for the ministry's bird flu center, said villagers in the woman's town didn't burn the dead chickens but buried them or fed them to pigs, according to a Reuters report today.

Indonesia is one of two countries, along with China, where pigs have been found infected with the H5N1 virus. Last October, Indonesian researchers reported that two pigs on Bali were infected with the virus, though they did not document if the pigs were sick or died.

Flu experts worry about H5N1 infections in pigs because the animals can carry human and avian influenza viruses, potentially serving as a "mixing vessel" that could produce a strain that could launch a human flu pandemic.

In other avian flu developments, national television in Togo reported three new H5N1 outbreaks on farms in the Lacs, Golfe, and Zio regions east of the capital, Lome, according to an Aug 11 AFP report. The west African country reported its first H5N1 outbreak in June, bringing the number of African nations reporting the disease to 10.

See also:

May 31 FAO avian flu bulletin with chart of H5N1 outbreaks by country
http://www.fao.org/docs/eims/upload//228650/AIDENews_may07_no46.pdf

Oct 10, 2006, CIDRAP News story "Pigs, cats in Indonesia infected with H5N1"

Jun 22 CIDRAP News story "Togo conforms first H5N1 outbreak"

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