All eyes upon Riau, Indonesia
Scott McPherson
in influenza and infectious diseases
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11 Comments
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18 References
As we have learned over the weekend, the suspected bird flu death of 44-year old Linda Tismery of Pekanbaru, Riau Province, Indonesia, has been confirmed as H5N1. This is the second H5N1 death in a week for the nation of Indonesia; the first was a male 21-year old West Jakarta shopkeeper who apparently was exposed to chickens. The fact that, according to the Jakarta Post, some 26 deaths of the 87 now-confirmed H5N1 deaths in Indonesia come from the Greater Jakarta area (its capital) has apparently passed unnoticed.
Interesting. If you read that 26 deaths in, say, Atlanta, Georgia since 2005 were from bird flu, would you take the news passively? But I digress.
From the Jakarta Post:
Riau woman dies of suspected bird flu
- October 06, 2007
Rizal Harahap, The Jakarta Post, Pekanbaru
A woman believed to be suffering from bird flu died Friday morning in Pekanbaru, Riau province, after having received treatment in Arifin Achmad Hospital's isolation ward since Thursday.
The 44-year-old housewife, identified only as L, lived in a housing complex in Rumbai, Pekanbaru.
"The patient died at dawn. Our diagnosis indicated she was suffering from bird flu," the head of the hospital's bird flu mitigation team, Azizman Saad, told journalists Friday.
Before being transferred to Arifin Achmad Hospital, she had received treatment at several other hospitals in Pekanbaru.
"She was even treated at a hospital in Jakarta," Azizman said.
She was moved to Arifin Achmad Hospital after doctors at Awal Bros hospital noticed her symptoms were similar to those of bird flu victims.
"There is an indication her condition was detected late. As a consequence, she was already in bad shape when she was moved to this hospital," Azizman said.
Members of the woman's family declined to comment on whether she had come into contact with poultry recently.
L's death brings the number of bird flu fatalities in Riau this year to three. The other two victims lived in the Kampar and Indragiri Hulu regencies.
The Health Ministry confirmed Tuesday that a West Jakarta shop attendant died from bird flu last Friday, increasing the country's human death toll from the virus to 86.
Originally a disease carried by poultry, the H5N1 virus was first detected in humans in 1995 in Hong Kong.
Indonesia first reported human bird flu cases in 2005, but since has recorded the most human bird flu cases in the world at 107.
Now the Indonesian press is reporting that two of the nurses who attended to Ms. Tismery have also begun exhibiting bird flu symptoms. This translation is courtesy of Dutchy and Theresa42 of FluTrackers.com:
Pekanbaru -- the media: (the media): two nurses from hospital early bross Pekanbaru, on Monday (8/10), suffered fever after have handled the victim who died from positive bird flu b Linda Tismery, 44, that died on Friday (5/10) last in RSUD Arifin Ahmad, Pekanbaru.
The identity of the two, to now still was kept secret . Together 63 other immediate contact. the amalgam of the team body perusal and expansion the health (balitbangkes) the Department of Health RI and the health service (dinkes) Riau still did check and appropriation blood the serum all the contacts.
Two nurses victim bird flu putative infected
Written by: Rudi Kurniawansyah
PEKANBARU -- MEDIA: (Media): Two nurses Hospital Awal Bross Pekanbaru, Monday (8/10), experience fever after ever handle victim died positive bird flu Linda Tismery, 44, who died Friday (5/10) previously in RSUD Arifin Ahmad Pekanbaru.
Identities both, until now still kept in secret with 63 contacts nearest rest. Team combination Body Research & Pengembangan Health (Balitbangkes) Depkes RI and Department of Health (Dinkes) Riau still perform checkup/surveillance and take serum blood everyone contact aforementioned.
The nurses had duties over some 63 patients. All 63 are appearing to be OK, but the two nurses are quite ill. This is always a cause for concern, because human-to-human transmission is becoming less and less rare in Indonesia, and any preliminary report of health care staff becoming ill causes ashen faces and worried looks both in Jakarta and in Geneva.
According to "boots on the ground" health care workers, taken from from a previous blog, http://www.scottmcpherson.net/journal/2007/9/24/indonesian-cases-continue-to-pile-up.html :
"Bird flu in Riau is a horrible disease at the moment. Right now there were 23 bird flu cases (grand total, starting from 2005) 3 of them died. In the rainy season we have at the moment, the bird flu virus will circulate for three more months. The health service asked the whole society to watch out and be very carefull, especially the bird breeders.
"Then the "sub head" of the health service and a someone from the Riau Food Authority say this: ' There were extremely many bird flu cases in Riau, not only the 23. We will not know how much, because the cases were in the interior, dying from high fever is regarded as normal by the public'.
" We reported 23 cases, our take is there could be as many identical cases in the districts that were not reported". "Because of this we ask the whole community to watch out for this virus.
"People should go to a clinic or to the Health Service if they display symptoms especially sudden high fever, and get medication. The dedicated bird flu hospitals are: RSUD Arafin Ahmad, RSUD Dumai and RSUD Tembilahan."
So something is going on in Riau, where my count shows five confirmed cases of H5N1 have occurred this year, with four deaths, and five times that many suspected cases have been reported and treated as the Real Thing. Not a good sign at all. Now we have ill nurses and a deepening mystery.
The close physical proximity of Riau to Singapore, Malaysia, should also be a cause for concern. Singapore's luck won't hold out forever. Neither will the Philippines'.
Scott McPherson
Good news. The two nurses in question have tested negative for H5N1. That may lessen the anxiety over their patient's trip to Jakarta before her death.
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Reader Comments (11)
Are we only seeing the tip of the iceberg? Aren't there any WHO investigators in the field getting some kind of estimate on how many cases are missing?
Do we have an clinical cases, complete with exact treatment of the hospital deaths? What are the physicians in all these countries doing...or not doing? Is there something they are doing that makes this flu more deadly? Like aspirin? What IS working? What are the folks in the countryside doing that might be working to save lives? (I'm sure their remedies are going to be ignored...they shouldn't be.)
Sorry. Full of questions. But, believe me, I've been trying to read as much as possible from the many flu blogs out there. Not seeing answers to these questions.
The WHO has very limited resources in the field, and the heroic NGOs such as Doctors Without Borders are preoccupied with African Ebola and other very, very legitimate health care concerns.
The Indonesian government is trying to cope with the enormity of the situation, but I can best describe it as holding on for dear life. This is one huge reason Indonesia withheld its H5N1 samples until it could get an agreement on some sort of vaccine equity. Also, since Indonesia has teamed with US company Baxter Pharmaceuticals to develop its own human vaccine based on its Clade 2.1 strain of bird flu, it has rushed through testing and is rushing head-first into production and vaccination. Indonesia has decided to mimic the warcry of the Ford Administration in 1976: Store vaccine in people, not in warehouses.
Phytosleuth,
What is compounding the diagnosis problem is that, for the most part, these villages are so remote that it takes days to get someone to a hospital. Of course, the person tries to avoid hospitalization (who doesn't?). But eventually, the fever gets so high snad the body degrades so quickly that hospitalization is the only solution. From there, it takes more time to get them to the proper hospital. Of course, Tamiflu effectiveness is in the margins at best by then.
And then there are the Eight suspected bird flu patients, who were admitted on October 7, to the Adam Malik hospital in the North Sumatran city of Medan!
Re: WHO's limited resources in the field
So every country in the world is relying on WHO? That is not a very resilient strategy. Even plants have designed redundant survival systems.
Birdflunewsflash,
Yes, big story in Medan if any of them tests positive. I am preparing a blog on that for today. Still trying to weed through some medical journals on "Tipping Point" blog.
Many thanks for the comment! Greatly appreciated. Great Website you run!
Scott
Medan suspected patients are Negative. I thought the word "Cluster" was very interesting, because I've been trying to find out if these 7 people were related or neighbors, and I can't seem to narrow it down. All I've got for facts are these:
So the chickens died days before entering hospital.
The chickens belonged to society. (?)
They were told by the Health authorities to go to the Hospital.
They arrived at midnight.
hat-tip Dutchy:
Excerpt:
The Assumption Cluster Bird Flu from Medan Negative
Jakarta -- the MEDIA: was based on the inspection of RT-PCR the Body laboratory of Litbangkes Department of Health, 8 patients who it was suspected were infected by the bird flu virus that was treated in RSUP Adam Malik, Medan, it was confirmed the negative.
http://www.mediaindonesia.com/berita.asp?id=145570
Comment: It looks like WHO is in Medan now though:
hat-tip Dutchy:
Excerpt:
Striven for by us before lebaran, results have been known, said Kasubdin the Eradication of infectious diseases and North Sumatran Sanitation of the Environment of the Health Service Dr Surya Dharma to the reporter in his office, on Monday (8/10).
Concerning the condition for seven casualties, Surya said they were still undergoing the maintenance in RSUP H Adam Malik Medan since Friday night (5/10).
Surya added, the Service of Kesehatan North Sumatra dropped the team of the fast movement to 10 regencies off/the city that was stated had become the place of the spreading of bird flu.
This was done after seven residents of the Village 6, the Lake Village of 7,Kecamatan Labuhan Deli the Deliserdang Regency and an inhabitant Street Al Rido Pasar VIII, the Cudgel, the Deliserdang Regency, was stated suffered suspect bird flu.
This team has been trained by the professional power for the handling of bird flu especially to his humankind that became casualties. Further this team will work in 10 regencies/Kota, said Surya
According to Surya, 10 regencies/the city that became the team's target of the fast movement was, Langkat, Deliserdang, Medan, Karo, Simalungun, Tapanuli Utara, Tapanuli Selatan, Asahan, Serdang Bedagai and Tapanuli Tengah.
"10 regencies/this city also received help from WHO. Sementara the other area still under the co-ordination in order to the spreading" of "bird flu not happen," tambahnya.
Comment: Regarding WHO, they can not operate in Indonesia, unless the Indonesian Government invites them.
Commonground,
Great points all, especially on the WHO/Indonesia issue (and don't we all know about THAT continuing soap opera)?
Let's look at the "fast movement" team(s) and the apparent involvement of the WHO. Karo, Medan, others. Most now well-known to us in fluland. Do we suspect that there is increasing volatility of the virus in these ten towns? In my presentations, I use an adaptation of the old law enforcement line "Follow the money." I say "Fpollow the Tamiflu." Maybe we should now say "Follow the fast response teams."
Thanks Mr. McPherson. I personally don't feel the virus is any more volatile in the ten towns. It's just a matter of getting the Tamiflu in them within the first 24 hrs of symptoms. Not so easy. And with the rainy season coming on.....yes, I think you're right. Follow the fast response teams. :-) And now that I think about it, the nurses did not get their Tamiflu until 72 hours after their fever began.
It looks a great!
The fact that, according to the Jakarta Post, some 26 deaths of the 87 now-confirmed H5N1 deaths in Indonesia come from the Greater Jakarta area (its capital) has apparently passed unnoticed.
The question is: Does the US care enough to get involved and attempt to send new treatments for the bird flu in this country. Are we going to send help or is it up to missionaries?