All eyes on suspected Medan, Indonesia bird flu outbreak
Scott McPherson
in influenza and infectious diseases
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The wires and blogs are atwitter this morning with news of a suspected human outbreak of H5N1 in North Sumatra, Indonesia. The hospital in Medan, according to first reports (and let me stress first reports), includes three dead and thirteen hospitalized.
The deaths and hospitalizations were preceded by a mass die-off of poultry and pigeons. That pigeons would die of H5N1 is not new but also not common.
But the sheer volume of people suspected of infection -- at least sixteen -- simply cannot be simple bird-to-human infection. If any of these cases turns out to be H5N1, the inference is that we have some serious H2H going on here.
A cluster of sixteen sick and dead/dying in one village reminds one of the largest suspected H2H H5N1 cluster of all time, back in early 2006 in Turkey. As many as two dozen were suspected of having contracted the H5N1 virus. However, that cluster's scope was not totally determined, nor was H5N1 proven to be the culprit in all the cases. Insufficient testing, coupled with considerable government anxiety, hampered the overall search for truth.
Now, in 2008, we have to contend with a bipolar Indonesian government, on top of sketchy media reports. We may never know the truth about this suspected cluster unless we get some Boots on the Ground, and quickly. Here is the AFP wire story:
| MEDAN (Indonesia) - THREE people have died and 13 have been admitted to hospital with symptoms of bird flu in Indonesia, a nurse treating the patients said on Wednesday.
Officials and residents in Asahan district of North Sumatra province said villagers began showing symptoms of avian flu after a large number of chickens died suddenly last week. The nurse at Asahan district's Kisaran hospital said three people had died after suffering bird flu-like symptoms in Air Batu village. 'According to residents there, a number of chickens died suddenly last week followed by several pigeons. Days later, three people died with the same ailments,' the nurse, Mariana, said. Another 13 people had been admitted to the hospital with 'high temperatures and respiratory problems,' she said. Two of these - a baby boy and a seven-year-old girl - were transferred early Wednesday to a bird flu isolation unit at Adam Malik hospital in the provincial capital of Medan, officials said. Adam Malik hospital spokesman Sinar Ginting confirmed that blood samples from the two children were sent Wednesday to a health ministry laboratory in Jakarta for analysis. 'We are now waiting for the result,' he said. The father of the baby boy, Slamet Riadi, said a lot of poultry had died in the village a week ago. His baby developed a high fever and respiratory problems shortly afterward. A spokesman for the health ministry could not be reached for comment. The ministry, which has stopped giving regular bird flu updates, announced earlier this week that the human toll from avian influenza in Indonesia had risen to 112 with the recent death of a 19-year-old man. The man was from a town adjoining the capital Jakarta on Java island. Indonesia is the country worst-hit by the deadly H5N1 strain of bird flu, which can be passed from bird to human. Experts fear it could mutate into a form easily transmissible between humans and kill millions in a global pandemic. -- AFP
Apparently, all 13 hospitalizations are of persons under age 40. Specifically, ages 8 months to 39 years. While the ages of the dead are not conclusively known ,one translation from Flutrackers.com would lead one to believe the dead are also under 40. This fits the profile of bird flu sufferers. Also, according to local news stories, the hospitalized are responding well to Tamiflu.
Stay tuned. |
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