Avian, human flu coinfection reported in Indonesian teen

Mar 17, 2008 – ATLANTA (CIDRAP News) – An Indonesian teenager has been brought forward as a case of simultaneous infection with seasonal and avian strains of influenza—a possibility that health planners have long warned could give rise to a pandemic flu strain.

In a paper presented today at the International Conference on Emerging Infectious Diseases, Vivi Setiawaty of Indonesia's Center for Biomedical and Pharmaceutical Research and Development described the case of a 16-year-old girl who was tested for flu in Jakarta in April 2007 under a flu-surveillance system established in 2005 by the Indonesian Ministry of Health.

The girl, who had been experiencing flu symptoms for several days, was only mildly ill, with a 100.5ºF fever, sore throat, cough, headache, and body aches, but no difficulty breathing and no signs of pneumonia. (Case reports of H5N1 patients in countries such as Thailand have described more dramatic clinical presentations.)

Throat and nasal-swab samples that were taken on the 6th day of her symptoms tested positive by reverse-transcriptase polymerase chain reaction (RT-PCR) for both avian influenza H5N1 and the seasonal flu strain H3N2 at the Indonesian National Institute of Health Research and Development. Serology test results were less clear. Antibody titers from serum samples taken the 6th day provided a weak indication of H5N1 infection (titer of 1:10) but were negative for H3N2; convalescent sera, on the other hand, gave a strong indication of H3N2 infection (titer of 1:640) but were negative for H5N1.

The test results were confirmed by the Eijkman Institute for Molecular Biology in Jakarta, an arm of the Indonesian Ministry of Research and Technology, according to the paper. The girl's case fell within the period when the Indonesian government was not sharing flu isolates with the international laboratory system maintained by the World Health Organization, and there was no indication whether her isolates were evaluated outside the country.

"This is the first case-report of a human with both influenza A/H5N1 and H3N2 co-infection," the paper states. "Such infections are of great concern due to the possibility of genetic reassortment leading to the emergence of a H5N1 strain that is more easily transmitted human to human, and emphasizes the importance of advanced laboratory-based surveillance in geographic regions where both human and avian influenza viruses are co-circulating."

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