Published Date: 2007-12-12 23:00:48
Subject: PRO/AH/EDR> Avian influenza, human (161): Indonesia, China
Archive Number: 20071212.3995
AVIAN INFLUENZA, HUMAN (161): INDONESIA, CHINA
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
In this post:
 Indonesia (Banten)
 Indonesia (Banten)
 China (Jiangsu)
 Indonesia (Baten)
Date: Wed 12 Dec 2007
Source: Reuters News [edited]
Indonesian man tests positive for bird flu
An Indonesian man from an area west of the capital has tested
positive for bird flu and is being treated at a hospital in Jakarta,
a health ministry official said on Wednesday [12 Dec 2007]. Joko
Suyono, an official at the health ministry's bird flu centre, said
the 47-year-old man from Tangerang kept ducks at his home and had
recently travelled to the cities of Medan in Sumatra and Pandeglang
in West Java.
"Two tests have confirmed that he suffered from H5N1 and the
agriculture ministry has taken samples from the ducks and is still
investigating where he may have contracted the virus," Suyono said.
Contact with sick fowl is the most common way of contracting bird
flu, which is endemic in bird populations in most parts of Indonesia.
Mukhtar Ikhsan, an official at Jakarta's Persahabatan hospital, said
the man was being treated in an emergency unit and was on a
respirator. On Monday [10 Dec 2007], a 28-year-old woman, who also
came from Tangerang, died of bird flu after being treated at the same
Indonesia has had 115 confirmed human cases of bird flu and suffered
92 human deaths, the highest number globally.
[Byline: Mita Valina Liem; editing by Ed Davies and Alex Richardson]
 Indonesia (Banten)
Date: Wed 12 Dec 2007
Source: KOMNAS FBPI, Indonesia [edited]
More Bird Flu Cases From Tangerang
A 47-year old man known as "M," from Cipondoh sub-District, Tangerang
Municipality in Banten Province, is infected with the H5N1 influenza
virus, according to tests conducted by the Health Research and
Development Center of the Ministry of Health and the Eijkman Institute
Overall, Indonesia has now recorded 115 confirmed human H5N1 cases
and 92 fatalities. The case fatality rate now stands at 80 percent.
Up to today [12 Dec 2007], Banten Province has recorded 20 bird flu
positive cases with 16 fatalities.
M, a businessman had onset on 2 Dec 2007. He had shown symptoms of
fever, coughing, and breathing difficulties. He was treated at Usada
Insani Hospital in Tangerang on 8 Dec 2007, then was referred to
Persahabatan Hospital in Jakarta on 10 Dec 2007. At the moment, M is
still under treatment at Persahabatan Hospital Jakarta
Exposure to sick birds remains the primary source of human infection
with bird flu. It is advised for people not to keep poultry or for
people who keep poultry to keep their birds well away from home.
Health workers are expected to be more observant on influenza
symptoms, such as fever, very high fever and coughing, especially if
they find a patient who has had contact with poultry or lives in an
area where bird flu was endemic. In previous cases, the symptoms
include stomach ache and diarrhea. If the person has these symptoms,
immediately go to the local clinic to get first aid, that is to
People are urged to learn more about bird flu and to reduce their
risk of contracting the virus by adopting clean and healthy behavior:
1. Do not touch sick or dead chickens. If you have had contact with
sick or dead chickens, promptly wash your hands with soap and report
the incident to your village head;
2. Wash your hands and cooking appliances with soap before cooking.
Cook chicken and eggs well;
3. Separate poultry from humans. And also separate new poultry from
existing poultry flocks for 2 weeks;
4. Go to a Public Health Center or Hospital immediately if you have
flu and fever symptoms after having contact with poultry/chickens. Do
not wait more than 2 days, especially if there are many poultry
around your house or you had contact with poultry.
(This information is published by The Center for Public
Communication, Secretariat General MOHRI. For further information,
please send e-mail to:
Lily. S. Sulistyowati, Head of Public Communication Center)
ProMED-mail Rapporteur Mary Marshall
[The 28-year-old woman who died on Mon 10 Dec 2007, and became the
92nd fatality in Indonesia, was also a resident of the the satellite
city of Tangerang, just west of Jakarta, where 3 other bird flu
deaths have been reported since October 2007. No link between these
cases has been reported.
The HealthMap/ProMED-mail interactive map of the island of Java,
showing the location of the city of Jakarta, spelled Djakarta on it,
in the extreme left, can be accessed at
<http://healthmap.org/promed?v=-2.6,120.9,5>. - Mod.CP]
 China (Jiangsu)
Date: Tue 11 Dec 2007
From: Amin Soebandrio
A comment on the Jiangsu cases
1. It has been clearly proven that the [H5N1] avian influenza virus
infects human through the respiratory pathway, not the oral pathway.
Therefore, the [Chinese] authorities should try to find other
possible sources of infection (other than in the "mud"). [For the
relevance of this allusion, see "Avian influenza, human (157): China
2. Our past experience with the very first human cases (and family
cluster) in Indonesia, as well as the famous Karo/Kabanjahe cluster
[is that] genetic susceptibility seems to play a very important role.
In the first cluster, the father and his 2 daughters died, but his
wife and son have shown no clinical symptom at all. In the Karo
cluster, only blood-related family members were affected, while the
other people attending the same party in the same house were not. It
is possible that in this Jiangsu case, the man shared genetic
susceptibility with his father, and not with his mother and certainly
[not] with his girl friend.
Amin Soebandrio, MD, PhD.
Professor in Clinical Microbiology
Chairman, Expert Panel of the Indonesian National Committee for Afian
Influenza and Pandemic Preparedness.
Senior Advisor for Food and Health Technologies to the Minister of
Research and Technology
23rd Floor, BPPT Bldg, 2, Jl. MH Thamrin No. 8 Jakarta 10340 Indonesia
<firstname.lastname@example.org> and <email@example.com>
[There is general agreement that the risk of transmission of H5N1 avian
influenza virus from poultry to humans by an oral route is unlikely.
I agree that genetic susceptibility is a determining factor, possibly
the most important factor. The following is a description of the Karo
'cluster' referred to in Dr. Soebandrio's comment, taken from the WHO
Timeline at 18 May 2006
"Indonesia reports the largest family cluster in any country to date,
with 7 confirmed cases (the 34th through 39th and the 42nd) from 4
households in the Karo district of North Sumatra. The index case
(unconfirmed) develops symptoms on 24 Apr, the last case dies on 22
May. Cases include the index case's 2 sons, (aged 15 and 17 years),
her 10-year-old nephew, her 2 brothers (aged 25 and 32 years), her
28-year-old sister, and this sister's 18-month-old daughter. Disease
does not spread beyond the extended family. Limited human to human
transmission can not be ruled out. Viruses do not show any
significant genetic mutations or reassortment." - Mod.CP]
[Nevertheless, WHO -- perhaps to be on the safe side -- recommends
cooking potentially infected poultry and eggs, see:
"Is it safe to eat poultry and poultry products?
?In areas experiencing outbreaks, poultry and poultry products can
also be safely consumed provided these items are properly cooked and
properly handled during food preparation. The H5N1 virus is sensitive
to heat. Normal temperatures used for cooking (70 C in all parts of
the food) will kill the virus. Consumers need to be sure that all
parts of the poultry are fully cooked (no ?pink? parts) and that eggs,
too, are properly cooked (no ?runny? yolks)? In areas experiencing
outbreaks in poultry, raw eggs should not be used in foods that will
not be further heat-treated as, for example by cooking or baking."
The Indonesian recommendations in  above are strictly in line with
these. ? Mod.JW]