Indonesia Fourth Country to Record Human Death From Bird Flu

JAKARTA, Indonesia, July 25, 2005 (ENS) - A 38 year old government employee who died on July 12 is Indonesia’s first confirmed human case of H5N1 avian influenza, the Ministry of Health in Indonesia reported Thursday.

In the past two weeks, his two young daughters also died of severe pneumonia illness compatible with H5N1 infection, but laboratory confirmation is not yet available. The family is from Tangerang, a district near the Indonesian capital.

An investigation is currently underway with team members from Indonesia's Ministry of Health, Ministry of Agriculture, United States Naval Medical Research Unit 2, and the World Health Organization (WHO) to identify potential sources of the infection.

The remaining four residents of the house - two members of the family and two household workers - remain healthy and show no symptoms to date. The Ministry of Health is closely following over 300 contacts, including health care workers, family members, school and office colleagues and neighbors. None of these contacts has shown any symptoms as yet.


The government employee died of avian influenza this month at the Siloam Gleneagles Hospital, Tangerang. His two daughters also died there. (Photo courtesy Siloam Healthcare Group)
Serum samples have been collected from contacts of the cases, starting from the family and neighbors, health care workers, while any possible poultry contact is being investigated - market sellers, retail food outlets, and pet birds. Environmental and veterinary sampling is being carried out by the Ministry of Agriculture.

Indonesian and world officials fear that the disease could mutate into a strain that could easily be passed between humans, touching off a global pandemic that could result in millions of deaths, but there is no sign that has happened as yet.

To date, there have been 109 human cases of the highly virulent H5N1 strain of avian influenza in Vietnam (87), Thailand (17), Cambodia (4) and Indonesia (1), resulting in 55 deaths.

On Sunday, the Tangerang poultry service in Legok, southwest of Jakarta, burned 18 pigs and several dozen ducks that were infected by avian influenza. Health officials say the country's first victims may have been infected from the farm, which was 15 kilometers (nine miles) from where they lived.

Agriculture Minister Anton Apriyantono, who oversaw the killings, said officials had at first planned to kill 200 pigs, but decided to kill only those animals that actually tested positive for the virus.

Health officials say that pigs can carry both bird flu and human flu viruses simultaneously, and worry that the two might combine into a virus that can spread from human to human.

"The danger is heightened they will exchange genetic material and produce a completely new virus, based on H5N1 but with human elements - and that virus - and here's a very big 'if' - if that virus spreads to humans and became capable of transmitting easily between humans, then we would be approaching a pre-pandemic situation," said Peter Cordingley, the WHO spokesman for the Western Pacific.


Indonesian poultry farm (Photo by Ian Douglas courtesy FAO)
In Indonesia, the virus has spread to 21 provinces out of 33 over the past two years. It was found to have jumped species from birds to pigs in May, when infected pigs were discovered on the densely populated island of Java.

There are few pig farms in Indonesia, a largely Muslim country where pigs are considered to be unclean.

The virus, which is taking an ever-tightening hold at least eight Asian countries, has so far led to the slaughter of over 140 million chickens in an attempt to halt its spread.

In May, global influenza experts gathered in the the WHO Western Pacific Regional Office concluded that strains of the H5N1 virus circulating in northern Vietnam are possibly becoming more infectious for people. Still,, the experts stressed there was no conclusive evidence yet from Vietnam or any other affected country of the virus passing between humans.

A further concern is that genetic sequencing of H5N1 virus samples from human cases in Vietnam and Thailand shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza.

Health officials say this would leave two remaining antiviral medications - oseltamivir and zanamivir - that should still be effective against currently circulating strains of H5N1 virus.

Efforts to produce a vaccine that would be effective against the H5N1 strain are underway.

If these H5N1 viruses gain the ability for efficient and sustained transmission between humans, there is little preexisting natural immunity to H5N1 infection in the human population, and an influenza pandemic could result, with high rates of illness and death.

With special attention to 44 key hospitals, the Indonesian Ministry of Health, working with WHO, has carried out seminars and workshops to strengthen surveillance of influenza-like illness, outbreak investigation, and appropriate isolation and barrier nursing.

Stockpiling of personal protective equipment to protect health and veterinary workers, and procurement of antivirals for treatment and prophylaxis is continuing. Information has been provided to assist the community with general health precautions, including frequent hand-washing, avoiding contact with sick animals, and safe and hygienic handling and cooking of poultry.

Indonesia and China have decided to cooperate in the eradication of bird flu. Tri Satya Putri Naipospos, director of animal health at the Agriculture Ministry's directorate general of animal husbandry, said in Jakarta Friday that the cooperation between the two countries will take the form of exchange of experts and vaccine production.