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Ciptapangan Visitor
Indonesia struggles to track H5N1 source, 2 more die
posted by admin on 24/05/06

By Fitri Wulandari and Tan Ee Lyn

JAKARTA, May 22 (Reuters) - Health officials in Indonesia are still struggling to track down the source of a worrying family cluster of H5N1 bird flu infections as tests showed that two more people have died of the same disease.

One of the latest victims belonged to a Sumatran family, which lost several members earlier this month to bird flu, sparking fears of human-to-human transmission.
While H5N1 is still regarded as a bird disease, experts have warned for more than a year that it might mutate and pass efficiently between humans and cause a global pandemic.

"One man from the same Sumatra cluster died this morning. He is the father of the child who died on May 13. He ran away after he received Tamiflu," said I Nyoman Kandun, director-general of communicable disease control at the health ministry.
"He was found in the village later but refused treatment," Kandun told reporters at a news conference.

Five of his relatives have been confirmed as bird flu deaths by the World Health Organisation (WHO) which also says another family member has survived being infected with H5N1. 
Another death could not be confirmed because no samples were obtained but she is considered the initial case of the cluster in Kubu Simbelang village in north Sumatra.
The woman died on May 4 but, nearly three weeks on, Indonesian experts have come no closer to finding the source of the virus.

Blood samples taken from chickens, ducks and pigs in the neighbouring district of Kabanjahe -- where there was an outbreak of H5N1 in chickens in January -- have tested positive for antibodies for the H5 component for the virus. 
But local scientists have yet to test the samples specifically for N1 antibodies. 
Nasal swab samples of the animals tested negative for H5N1, meaning they were no longer infected.

Abdul Adjid of Indonesia's Veterinary Research Institute, which is handling the animal samples, said his laboratory would try to test the samples for N1 antibodies. 
"We are trying to do the N1 tests. Maybe we will ask the WHO or the FAO (Food and Agriculture Organisation) to provide (assistance) so that we can improve our ability to do that," Adjid told Reuters. 

If these samples come back positive for N1 antibodies, it could mean that the animals, which are healthy and free of the disease now, were infected with H5N1 some time in the past. 
It takes between one and two weeks to test definitively for H5N1 antibodies in more sophisticated laboratories.

Adjid suggested that the movement of diseased poultry might have played a role in the Sumatran family's tragedy. Kabanjahe is about eight kilometres (five miles) from Kubu Simbelang. 
"There was an H5N1 outbreak in chickens in Kabanjahe in January, so maybe that's why the pigs, ducks and chickens are positive for H5," he said. 
"People buy chickens and pigs from Kabanjahe ... the family bought chickens and pigs from Kabanjahe," he said. 
The cluster has alarmed the medical community, which has called repeatedly for stronger measures to stem the disease in poultry. 

"The fact that so many people are infected means that a lot of its poultry is infected ... if a place is infected, it usually starts with the chickens first, then pigs, then man," said Lo Wing-lok, a Hong Kong based infectious disease expert.

"There is no evidence yet of human-to-human transmission, but the problem is in poultry and mutation can happen in chickens." 
Kandun, however, said there was no evidence the H5N1 virus had mutated or reassorted in the family members. 

Based on previous genetic sequencing, the H5N1 virus in Indonesia is believed to have originated from Yunnan province in southern China. The first H5N1 poultry outbreak in Indonesia was identified in late 2003. 
Kandun said a 38-year-old man from Jakarta who died last week had also been declared positive for bird flu by local tests.

The WHO has confirmed 32 fatalities from avian influenza in the world's fourth most populous nation, the second highest number of human deaths after Vietnam. 
Commenting on the family cluster, Kandun said: "We cannot conclusively confirm nor rule out human-to-human transmission ... maybe they have genetics susceptibility, exposed to a common source ... a lot of things we don't know." 

AlertNet news is provided by Reuters

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