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Published Date: 2012-01-11 16:10:33
Subject: PRO/AH/EDR> Avian influenza, human (05): Indonesia (JA) conf.
Archive Number: 20120111.1007152

AVIAN INFLUENZA, HUMAN (05): INDONESIA, (JAKARTA), CONFIRMED
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[1]
Date: Tue 10 Jan 2011
Source: Jakarta Globe [edited]
http://www.thejakartaglobe.com/home/5-year-old-brother-of-bird-flu-victim-cleared-by-doctors/490207

Health authorities in Jakarta on Monday [9 Jan 2012] gave the 5-year-old brother of a young man who recently died of bird flu a clean bill of health. The toddler was hospitalized with a fever and cough on Saturday [7 Jan 2012], the same day his 23-year-old brother died of the disease.

"The laboratory results for the brother of the victim came back negative," Dien Emmawati, the head of Jakarta's health office, said on Monday [9 Jan 2012]. Officials have confirmed that the 23-year-old man had bird flu. He died at a bird flu referral hospital in Tangerang after the main hospital in the capital was unable to accommodate him because of a lack of space.

Dien said her office, along with the Ministry of Health's research and development agency, had taken blood samples from about 10 people who had been in close contact with the 23-year-old before his death for testing. "Officials stepped up their monitoring of residents in the surrounding area on Saturday [7 Jan 2012], and the intense monitoring will remain in place for 2 weeks, so we will know immediately if anyone else has been infected," she said. The health office has also distributed Tamiflu to area residents to protect them from infection.

"Bird flu patients can be saved if they are brought to the hospital as early as possible to get the appropriate treatment," Dien said. "If they come in too late, it is difficult to treat them." She added that she would issue a directive to the city's 3 referral hospitals to prioritize bird flu patients so that no more patients were turned away and referred to another hospital. "We will ask that 2-3 beds be left empty at the referral hospitals," she said.

Data from Jakarta's health office show 3 people in the capital were infected with bird flu last year [2011], with 2 deaths. There were 3 bird flu patients and 3 deaths in 2010 and 10 infections resulting in 8 deaths the previous year.

Meanwhile, Jakarta's fisheries and agriculture office has said that it is opening 6 locations across the city to field reports about sudden bird or poultry deaths, which could indicate a bird flu outbreak. People will be able to call in the reports and speak to officials. The telephone numbers are: 0816954326, 08128543354, 081284211191, 08158834371, 08151827656 and 08129940881.

[Byline: Dofa Fasila]

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Communicated by:
ProMED-mail Rapporteur Mary Marshall

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[2]
Date: Wed 11 Jan 2012
Source: Jakarat Globe [edited]
http://www.thejakartaglobe.com/home/latest-bird-flu-death-puts-jakarta-back-on-high-alert/490456

The recent death of a man from Sunter, North Jakarta from bird flu has put the country on alert and highlighted that after years of struggling with the virus, Indonesia is still not free from its dangers. A 23-year-old man died after being treated for 6 days at Satya Negara Hospital. His blood test came back positive for the H5N1 virus, making him the 1st fatality of bird flu [avian influenza A/(H5N1) virus infection] in 2012 [i.e. in Indonesia]. Health officials suspect he was infected by a pigeon that he kept. His 5-year-old brother was rushed to Persahabatan Hospital in North Jakarta after developing a cough and a fever but was cleared of bird flu.

In October [2011], 2 young siblings died in Bali from bird flu after having had contact with dead fowl in their neighborhood in Bangli district. Prior to that, Indonesia's last official human death from [avian] influenza was a woman in Tangerang, who died in July 2010.

Health Minister Endang Rahayu Sedyaningsih acknowledged on Tuesday [10 Jan 2012] that despite all its efforts, Indonesia had been unable to completely wipe out bird flu in the country. "Bird flu is indeed an unfinished problem in Indonesia. We need to stay alert," she said. She said as long as the infection remained endemic among poultry, there would always be the risk that the virus would infect humans.

Muhammad Azhar, the agriculture ministry's avian influenza control coordinator, has said it is particularly difficult to control the spread of bird flu because backyard farming is such an ingrained part of the culture. He said large companies that dealt with huge amounts of poultry posed less of a threat than backyard poultry farms, because the big companies implemented tough bio-security measures.

The Ministry of Health has found that in some traditional markets in Jakarta, traces of the H5N1 virus are found not only on sick poultry but also on knives and cutting boards as well as the chicken sellers themselves, although they were not infected. Most of the sellers, however, did not realize the danger that they were facing, according to the ministry.

But Dr. Marius Widjajarta, chairman of the Indonesian Consumer Protection Foundation for Health (YPKKI), said bird flu continued to pose a threat because the government had abandoned its campaign to improve hygiene standards in the country. "In 2006 and 2007, when bird flu 1st emerged in Indonesia, the awareness campaign was massive, but now it has been quiet. Almost nothing has been done," he said. "How do you expect to change public behavior if you don't tell them constantly?"

Emil Agustiono, secretary of the National Committee on Zoonosis (Komnas Zoonosis) and an epidemiologist said climate change had also changed the character of the H5N1 virus. "Climate change has caused humidity levels to increase, and, unfortunately, the survival abilities of various viruses have increased because of that," he said. But he quickly gave assurances that so far, the feared genetic mutation that could cause human-to-human transmission of bird flu had not happened. "A genetic mutation that would allow for the transmission of the virus from human to human is our main concern, but we have been lucky," he said. "Studies have shown that it has not happened yet."

In 2007, the health minister at the time, Siti Fadillah Supari, expressed her concern that some countries were trying to manipulate the virus by genetically engineering it to allow for human-to-human transmission and possibly turn it into a bioweapon. Emil said such experiments had been done, and that Siti's concern was proven correct: the virus had been altered, becoming capable of transmitting it from human to human. "Luckily, the experiment has been shut down because it was extremely dangerous," he said.

Meanwhile, he said Indonesia had sufficient regulations to prevent H5N1 infections; however, the problem was in the implementation of the regulations. For example, most people who keep backyard poultry ignore the regulation on the minimum distance between their house and poultry cages. It is also nearly impossible to completely prohibit backyard farming. Emil said another problem was that bird flu symptoms resembled those of the common flu, meaning most people will seek help too late.

Ari Fahrial Syam, an internist at Cipto Mangunkusumo Hospital in Jakarta, said health workers needed to be more familiar with bird flu symptoms and had to be aware if patients had been in recent contact with poultry. Most of the symptoms, he said, are similar to those of the common flu: coughing, runny nose, fever, nausea and diarrhea. If the symptoms are more severe than usual, he suggests that people immediately seek medical help.

Marius, from the YPKKI, also criticized the lack of bird flu referral hospitals. He said Jakarta had no regional hospital specifically for bird flu patients. Most referral hospitals such as the Sulianti Saroso and Persahabatan are general hospitals. "Tangerang has one [hospital that can handle bird flu patients], but Jakarta has none." The 23-year-old Jakarta resident had been referred to Sulianto Saroso, but the infectious diseases hospital did not have a free isolation room to treat him.

Ali Gufron Mukti, the deputy health minister, said the ministry had formed bird flu handling teams in anticipation of the disease spreading in Jakarta. Agriculture Minister Suswono said his ministry was monitoring the disease across the archipelago and called on people to immediately report any sudden deaths of birds and poultry.

In Jakarta, the city's maritime and agriculture office is conducting sweeps to check on possible bird infections. "The sweeps are meant to ascertain that poultry and pet birds are free from the avian influenza virus. If any birds are found to be infected, then they must be destroyed," said the office's chief, Ipih Ruyani.

Indonesia has seen the most official bird flu fatalities. In 2011, 9 of the 11 global bird flu infection cases were fatal. Since it 1st emerged in 2003, bird flu has infected more than 500 people, most of them in Indonesia.

[Byline: Dessy Sagita, Arientha Primanita, Dofa Fasila]

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Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Laboratory testing has confirmed the preliminary diagnosis that the 23-year-old man in North Jakarta died as a result of avian influenza A/(H5N1) virus infection. His younger brother, hospitalised about the same time with similar symptoms, is not now thought to have contracted avian influenza. There is no other indication of spread of infection, and it is believed that the deceased patient contracted infection from a pet bird. This case, when confirmed by WHO, will be the 183rd, and 151st fatality, in Indonesia since the 1st case was recorded in 2005. It is the 1st confirmed case and fatality in Indonesia in 2012.

Overall, these 2 articles from the Jakarta Globe provide a commendably balanced assessment of the avian influenza situation in Indonesia compared with reports in the local Indonesian press and is less hysterical than some international sources.

Jakarta is the capital and largest city of Indonesia. Officially known as the Special Capital Territory of Jakarta, it is located on the northwest coast of Java. The HealthMap interactive map of Java can be accessed at: http://healthmap.org/r/1CO1. - Mod.CP]

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