Avian influenza, human (147): Indonesia, WHO

International Society for Infectious Diseases
<http://www.isid.org>

Source: World Health Organisation (WHO), CSR, Diseases Outbreak News,
Thu 14 Sep 2006 [edited]
<http://www.who.int/csr/don/2006_09_14/en/index.html>


Indonesia: Avian influenza situation - WHO Update 31
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As of 14 Sep 2006, the Ministry of Health in Indonesia has confirmed
2 additional cases of human infection with the H5N1 avian influenza
virus. These cases occurred in March and May 2006.

The 1st case occurred in a 5-year-old male from East Bekasi, West
Java Province. He developed symptoms on 4 March 2006, was admitted to
hospital on 6 Mar, and died on 19 Mar. Test results, using 2
different assays, showed high antibody titer for H5N1 on consecutive
serum samples taken on days 11 and 15 of his illness. These test
results are consistent with new WHO criteria for laboratory
confirmation. A field investigation at the time found that the case
was exposed to diseased poultry in the vicinity of his home, where
some birds tested positive for the H5 virus subtype.

The 2nd case is a 27-year-old male from Solok, West Sumatra Province.
This case was identified during the tracing of contacts of the man's
sister, a 15-year-old female who developed symptoms on 17 May 2006
and was subsequently confirmed to be H5N1 infected. Her brother spent
6 days caring for her during her hospital stay. The brother developed
mild symptoms of cough and abdominal discomfort, with no fever, on 28
May 2006; his symptoms remained mild and he recovered within a few days.

Despite his mild and atypical symptoms, the brother was tested as
part of the Ministry of Health's protocol for contact tracing and the
management of any contacts with symptoms. He was given a 5-day course
of oseltamivir beginning on 1 June and was placed in voluntary
isolation pending recovery.

Initial tests of samples collected from the 27-year-old male were
negative for H5N1 infection. In August, follow-up testing of
paired-serum samples found a 4-fold rise in neutralization antibody
titer for H5N1, a test result which meets the WHO criteria for
laboratory confirmation.

The 27-year-old male reported no contact with diseased or dead
poultry in the days prior to symptom onset as he spent most of his
time at the hospital. The investigation determined that he had
exposure to his sister during her hospital stay, and that
human-to-human transmission could not be ruled out as the source of
his infection.

The retrospectively confirmed cases bring the total in Indonesia to
65. Of these cases, 49 have been fatal.