Indonesia deadly strain

So far the mortality rate for Indonesia is:

Indonesia confirms new human case of avian flu Published: Sunday, 13 August, 2006, 11:47 AM Doha Time

JAKARTA: A teenager was confirmed yesterday as the latest bird flu case in Indonesia, the country worst hit by avian influenza with 44 human deaths recorded, health officials said. The 17-year-old youth, who lives in an isolated area of West Java’s Garut district, has refused treatment at a hospital designated for bird flu cases, said Runizar Rusin, an official with the health ministry’s bird flu centre. The teenager is Indonesia’s 59th confirmed case based on local tests, which are usually accurate, and his refusal typifies a lack of knowledge of the danger of the virus among Indonesians in rural areas, Rusin said. “His test results, which I obtained today, show that he is positive with H5N1 (the deadly strain of the virus) but he is not hospitalised, as, being a villager living in an isolated area, he thought that he’s just suffering from ordinary flu after visiting a local health clinic,” Rusin said. “But fortunately, the clinic took samples of his blood and saliva and sent them for testing and they came out positive. “Now our team in the field are trying to take him to a hospital” in West Java’s main town of Bandung, he said. The teenager had been in contact with dead chickens near his house before he became ill, he said. Rusin said samples from the teenager were confirmed by the health ministry’s research and development laboratory and the US Naval Medical Research Unit laboratory in Jakarta. Samples from his relatives and neighbours had also been taken for testing and a culling of poultry within a 1km radius of his house would be carried out soon, Rusin said. His case comes after officials earlier this week confirmed the deaths of two teenagers from the virus, taking the number of human fatalities to 44 in Indonesia. Meanwhile, Cambodia has suffered its second outbreak of bird flu this year in the same province where the H5N1 virus killed a boy in April, officials said yesterday. The virus was confirmed in more than 1,300 ducks that died in Prey Veng province, 70km southeast of Phnom Penh, but there were no immediate reports of human infections, they said. “Yes, bird flu is back,” senior Agriculture Ministry official Nou Muth said. “We have announced this outbreak to alert villagers not to handle dead poultry.” Most of the more than 130 people killed by the virus, including six in Cambodia, have contracted the disease through close proximity to infected birds. “Bird flu is still the hot issue for us. We are still worrying that villagers in the affected are might have been selling their chickens or ducks to others secretly,” Nou Muth said. Several hundred domestic ducks, which can carry the H5N1 virus without necessarily showing symptoms, had been culled in within 3km radius of the outbreak, agriculture official Yim Vanthan said. The world’s first first lab-confirmed human-to-human transmission of bird flu occurred in Indonesia three months ago in a cluster of seven deaths, sparking serious concern among scientists. It raised the spectre of a dangerous viral mutation that may have permitted efficient transmission among people, bringing nearer a global human flu pandemic with the potential to killmns. But the slight mutation that took place was determined to be insignificant. – Agencies

http://www.gulf-times.com/site/topics/article.asp?cu_no=2&item_no=102246&version=1&template_id=45&parent_id=25

well my guess would be that they are a 3rd world country

well going from a country that its people sleep with there chickens

ops144 wrote: well my guess would be that they are a 3rd world country   and handel everything there poorly......   the virus isnt even active in this country yet....   and even if it dose we are a much more sanitary country...

having been on a couple of missionary trips to 3rd world courntries, no question that usa is "more sanitary", but is it really enough?  i am also faculty at a dental school, and I see colleagues come into the rest room and NOT wash their hands when they are done with whatever! scary!!

so i wouldn't bank on employees in restaurants washing their hands the way that hands should be washed.  the signs are great for a CYA....and because by law there must be a posting.  check out your city's local paper in the section where restaurant citations are buried....it'll freak you out and you'll bag your own lunch or skip that going out to the restaurant stuff.  not that we have to live in a bubble....just saying, though, that just because we live in the usa, we should not be complacent.

MedClinician,

Glad to see you back on the boards. I enjoy reading yours posts. Argyll.

    Originally posted by medclinician

What mystifies me is we continually get these cases in Indonesia with no cases in U.S. We live in a global communinty. Is it so unlikely that one person with this whatever it may be, would get on a plane and come here? Is there current testing being done for H5N1 in humans in the U.S. anywhere who exhibit symptoms and have the results of those tests ever been released?


Medclinician:

Its no mystyery. It's that efficient, sustained H2H2H does not yet exist with H5N1. There are more than 200 million peple in indonesia, and still only 39 cases this year. Even if the real number is 10 times that many, the incidence is still less than 0.0002%. H5N1 is still relatively hard to get. I agree that we may be closer than WHO admits, but even so, we are a mutation or 2 or 3 away from a real pandemic.

just trying to put things into perspective

gardener

    

medclinician,

I think you are being alarmist. this post is going to sound a little harsh, because when you write with a tag of "medclinician" and your post sounds like the world is falling apart from the standpoint of infectious diseases in general, I feel that I must respond. 'cause it's not. yet.

First of all, and most importanty, we do test for flu. All the time. Basically everyone with respiratory failure without a clear etiology and anyone hospitalized with symptoms of flu gets a rapid test for flu. This includes children. If it's flu and the person has exposure to a group of animals known to becarrying the disease or has recently arrived from an area with endemic bird flu, we will subtype to determine H5N1.

Yes, once Avian flu is seen in birds in this country, we will see sporadic cases contracted from birds, probably associated with marginal and unsafe living conditions. Maybe we will see them this fall with the southern migration. However, this will be avian flu in humans, NOT pandemic flu. It will pose a minimally greater risk to the population than other zoonoses like hantavirus and plague.

This is a far cry from coming here to "find a warm comfy spot and spread." The conversion to pandemic virus could happen here, but given the sheer numbers of people who live close to poultry in the rest of the world, it is unlikely. If a pandemic comes, it will most likely arrive with a human travelling from an area where the virus has already started to spread. In that case, we will have warning.

Yes, sanitation is a general problem in the spread of disease, but it ever has been. Since the advent of soap and running weater, it is only getting better. The of illness in daycares is un fortunate, but a fact of life. After you work with children for several years, you become immune to most of it.

Gastroenteritis circulates twice a year in the early spring (rotavirus) and late summer (enterovirus). We are smack in the middle of enterovirus season (roughly July 15 to September 15th.) Your antibodies to these only last a few years, so the fact that your whole family got sick is unfortunate, but hardly concerning from a public health perspective.
Disease that need to be reported generally are. Lice and strep don't need to be reported.

hope your family are feeling better.

gardener

gardener wrote: medclinician, First of all, and most importanty, we do test for flu. All the time. Basically everyone with respiratory failure without a clear etiology and anyone hospitalized with symptoms of flu gets a rapid test for flu. This includes children. If it's flu and the person has exposure to a group of animals known to becarrying the disease or has recently arrived from an area with endemic bird flu, we will subtype to determine H5N1. Yes, once Avian flu is seen in birds in this country, we will see sporadic cases contracted from birds, probably associated with marginal and unsafe living conditions. Maybe we will see them this fall with the southern migration. However, this will be avian flu in humans, NOT pandemic flu. It will pose a minimally greater risk to the population than other zoonoses like hantavirus and plague. hope your family are feeling better. gardener

I agree with you, no doubt there are many good hospitals that do follow up on respiratory infections without a clear etiology, swab test, and if there is further reason to believe the patient has been exposed to Avian will continue to run to subtype to check for H5N1.

Having worked at such hospitals such as Stanford, which are leaders in disease research and very thorough, I would need to do more research to verify how many hospitals, if such data is available, are as vigilant in screening for H5N1.

In speaking to Dr. Kumar in the Cayman Islands, one perspective is that bird flu in humans is a misnomer. In Dr. Kumars words "at this point it becomes human flu." Whether there needs to be a mixer vessel (pigs) who are now a species that can carry H5N1 or can be directly transferred to humans a a submutate form (such as the hunter incident in Ohio) is a question which some research has already been done on.

Since there have been statements by government officials, the executive office, preparation for mobilization of the military and national guard, extemely precise preparation plans drafted in preparation of a coming Pandemic, it is likely there are reasonable amounts of data to support such action.

It should be understood that there is evidence that in types of human H5N1 rectal swabs are testing positive, strains have developed which can live at much lower temperatures in the upper respiratory tract, and the barrier of acid in the stomach has failed to keep infections from the lower intestinal tract. Also, it has been found in the blood of human patients.

No less than 30 research companies are actively working presently on developing vaccines and potential vaccines as well as antibody research and several vaccines which have already been tested and have proved effective in some cases.

In suggesting a stockpile of 400,000,000 doses of Tamiflu, and increased Relenza research, this indicates that  there is  a definite informed group of scientists who feel Avian will pose a significant health threat to America.

No doubt, there are multiple other strains of disease which many suggest should receive more attention and more funding. It has been pointed out that West Nile Virus is an active and present disease in the U.S. and needs to be addressed.

One must consider a separation from what might be considered alarmist, in the face of the growing infections of human H5N1  in Indonesia and Vietnam.

It is good to have such a dialogue and I hope it is interesting and informative to those who read these posts.

In closing I would restate there is a tremendous political and economical undercurrent in discussing the feasibility of a Pandemic.  I respect the opinion and experience of all who post.

There is certainly an indication of at least two camps, or prospectives here. I most honestly hope the model you have described of a very weak infection with minimum deaths and a much over hyped danger is the more accurate extrapolation of the future. No one, more than I, would be very grateful to be mistaken or worried about something which will never happen.

Perhaps in the media the spin is turning from the "not if, but when" to "probably never, but if so, of little account."

Defintely, one always would strive to be the voice of reason, the calming view which represents a reality which is less threatening, less ominous, less likely to cost a lot of money, and hope a Pandemic never occurs.

More research is called for here. I respect your right and view that Avian is not a serious threat to America and will not result in a world wide Pandemic. But in all sincerity and based on my research so far, I believe it will.

I appreciate your concern for our family. We are on the same team, all of us who are health professionals, and it is not my intent to unduly alarm people. Let's monitor the situation and continue to exchange data.

When the government is worried enough to spend a lot of money, resources, and personnel, then I worry as well. We probably have the most informed agencies and database in the world. So my thoughts still based on all I have read and researchered are still.. not if, but when.

Some good things mentioned yet we need to take into account the many people that are not coming in to be tested with mild cases. But that can be bad, the way I see it is there is twice the amount they are reporting.

medclin