Indonesia quits offering prompt notice of H5N1 cases

Jun 5, 2008 (CIDRAP News) – Indonesia's health minister said today the government has stopped the practice of promptly notifying global health officials each time it confirms a human H5N1 avian influenza case or death, a move some say will likely hamper efforts to monitor the world's pandemic risk level.

Health Minister Siti Fadilah Supari today confirmed that a 15-year-old girl from Jakarta tested positive for H5N1 avian influenza on May 13 and died the next day, according to a report from the Associated Press (AP). Indonesia's National Committee for Avian Influenza Control and Pandemic Influenza had previously listed the case as confirmed on its Web site, but the information is apparently no longer listed.

The WHO, which typically confirms cases when it receives notifications from health ministries or test results from its collaborating laboratories, has not yet confirmed Indonesia's most recent case and has not commented on Supari's decision to stop sending out H5N1 case notifications. The WHO's last confirmed an Indonesian H5N1 case, in a 3-year old boy who died on Apr 23, on Apr 30.

Supari told the AP that the health ministry would not send out H5N1 case confirmations until after they have been reported in the media. However, Reuters reported today that the ministry will announce the death toll from the H5N1 virus only every 6 months.

"How does it help us to announce these deaths?" Supari told the AP. "We want to focus now on positive steps and achievements made by the government in fighting bird flu."

She told Reuters that announcements of H5N1 deaths are sometimes misunderstood. "It's OK not to announce it. Sometimes they only give hurtful comments instead of helping," she said without further explanation.

Indonesia has been hit hardest of any country by the H5N1 virus. According to the WHO's most recent count, the country has had 133 cases and 108 deaths.

The country's refusal to share timely reports of human H5N1 cases is the latest in a series of controversies that began when Indonesia stopped sharing its H5N1 isolates in early 2007 to protest what it views as a lack of access to affordable H5N1 therapies and vaccines. The WHO has held several meetings to resolve the virus sharing issues, but so far no agreements have been reached.

Sharon Sanders, editor-in-chief of FluTrackers, a well-known Web message board that focuses on avian flu developments, told CIDRAP News that Indonesia's decision to delay H5N1 notifications will obscure what is happening there, which negatively affects the world's ability to prepare for a pandemic.

She said Indonesia's news blackout would likely have the opposite effect from what the government apparently intends. "Now, there will be intense speculation and generation of rumors surrounding suspicious deaths that have similar symptoms to H5N1 infections," Sanders said. "False rumors of an H5N1 outbreak have the potential to be even more economically devastating than a government-confirmed outbreak."

Established in early 2006, FluTrackers monitors avian flu developments in several languages from several sources and hosts international discussion forums and resource lists.

Sanders said media reports coming out of Indonesia are generally reliable, but have some drawbacks. "In many instances, reported suspicious human cases have little or no follow up, so we are left with gaps in our total picture," she said.

Indonesia's avian flu news blackout might increase traffic to online avian flu communities, such as FluTrackers and FluWiki, because they translate and analyze Indonesian newspaper reports, blogs, newscasts, and other sources, Sanders said.

"FluTrackers will continue to publish what we can; however, we rely on the local sources in Indonesia," she said. "Since the national government is imposing restrictions on when they confirm human deaths, we are watching for other restrictions such as suppression of the local news media to develop."

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