Indonesia reports 20 H5N1 cases -- 19 fatal -- since January

Dec 30, 2009 (CIDRAP News) – Indonesia's Ministry of Health, updating information on H5N1 avian influenza for the first time since January, quietly reported this week that the country has had 20 human cases so far this year, with 19 of them fatal—a 95% case-fatality rate (CFR).

A terse notice from the Ministry of Health on Dec 28 listed the figures and said the latest reported case was identified in South Jakarta on Sep 23. Indonesia's cumulative H5N1 toll since 2005 is now 161 cases with 134 deaths, for a CFR of 83%.

The World Health Organization (WHO) updated its chart of H5N1 cases and deaths today to include the new numbers from Indonesia, but it posted no report on the cases. The global H5N1 total is 467 cases with 282 deaths, a CFR of 60%. Indonesia is the hardest-hit country overall, though Egypt has had more cases this year—39, with just 4 deaths.

Indonesia's then–health minister, Siti Supari, announced in June 2008 that the government would stop issuing prompt reports of new H5N1 cases and instead offer only periodic updates. The announcement raised concern about the world's ability to track the virus's evolution and impact.

Supari also stirred controversy in 2007 by clamping down on sending samples from H5N1 patients to the WHO, saying viruses from the samples are used to make vaccines that enrich pharmaceutical companies but are too expensive for Indonesia and other developing countries.

Since the June 2008 announcement, Indonesia has issued few official reports of H5N1 cases. The WHO posts H5N1 situation updates based on reports from governments; the last time the agency gave an update on Indonesia was Jan 22, reporting two cases. A press report quoting an Indonesian official in early March noted four more cases, all fatal, but they were not registered by the WHO at the time.

The health ministry's notice this week gave no details on any of the recent cases.

The WHO's H5N1 tally for this year to date includes 72 cases with 32 deaths, compared with 44 cases with 33 deaths in 2008. Besides Egypt and Indonesia, countries that have reported cases and deaths this year are China (7 and 4), Vietnam (5 and 5), and Cambodia (1 and 0).

The often deadly H5N1 virus has not yet gained the ability to spread easily from person to person, though it has circulated widely in birds for the past 6 years. Disease experts still fear that it could gain transmissibility through mutation or by reassorting with another flu virus.

See also:

Jun 5, 2008, CIDRAP News story "Indonesia quits offering prompt notice of H5N1 cases"

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