INDONESIA REPORTS LARGE AVIAN INFLUENZA (AI)

UNCLAS SECTION 01 OF 04 JAKARTA 006150 SIPDIS SIPDIS SENSITIVE DEPT FOR EAP/IET, A/MED AND S/ES-O DEPT FOR OES/FO, OES/EID, OES/PCI, OES/STC AND OES/IHA DEPT PASS TO USDA/FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG DEPT ALSO PASS TO USDA/FAS/FAA/DYOUNG AND USDA/APHIS DEPT ALSO PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL DEPT ALSO PASS TO HHS/BILL STEIGER AND AMAR BHAT PARIS FOR FAS/AG MINISTER COUNSELOR CANBERRA FOR APHIS/DHANNAPEL ROME FOR FAO NSC FOR JMELINE BANGKOK FOR RMO, CDC, USAID/RDM/A USPACOM ALSO PASS TO J07 E.O. 12958: N/A TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU SUBJECT: INDONESIA REPORTS LARGE AVIAN INFLUENZA (AI) CLUSTER IN MEDAN REF: A) Jakarta 6148; B) Jakarta 6024 and previous JAKARTA 00006150 001.2 OF 004 ¶1. (SBU) Summary: Six members of a Medan family have tested positive for the H5N1 virus by NAMRU-2, and five have died as of May 15. Four of these have been confirmed by both the University of Hong Kong (UHK) and CDC Atlanta. Two members from this cluster remain hospitalized, with one intubated and progressing poorly. A final hospitalized relative has tested negative for H5N1. A nurse who treated the infected patients has also tested negative for H5N1. There have been no new cases since the initial emergence of this large family cluster. WHO and NAMRU-2 officials are helping the Ministry of Health (MOH) investigate the cluster. NAMRU-2 also confirmed that a 38-year female from Surabaya who died May 11 tested positive for H5N1, as did a 12-year old male from West Jakarta. The WHO is sending extra epidemiologists to assist in the investigations. End Summary. Large AI Cluster in Medan -------------- ¶2. (SBU) Since May 4, six members of a North Sumatra family have died, with five shown to have been infected with avian influenza (Ref A). No samples were taken from the 40 year old female index case prior to her burial. Two other family members remain hospitalized with the prognosis quite poor for one. Indonesian and U.S. scientists have expressed concern about this extended family cluster and the rapidity of cases/deaths. However, they believe the fact that secondary cases have not arisen is a positive sign. ¶3. (SBU) Center for Disease Control and Prevention (CDC) influenza specialist Dr. Tim Uyeki, currently on TDY in Jakarta, has noted there is a need for additional information about the Medan cluster before human-to-human transmission can be ruled out. However, not surprisingly, distraught relatives are not cooperating with health officials. Dr. Uyeki believes that GOI officials still need to sort out both animal and human exposures. (Note: There have been clusters in Indonesia before, but because of lack of epidemiological evidence, there has been exists little information on the causes of the clusters). ¶4. (SBU) The MOH said that on May 12, the Directorate General of Disease Control and Environmental Health (P2M) shipped specimens to Hong Kong University. NAMRU-2 also shipped samples on May 12 to the CDC. As of 15 May, both UHK and the CDC have confirmed infection in four of the patients. Case Profiles -------------- ¶5. (SBU) NAMRU-2 provided the following profiles of the Medan patients: -- The index case is a 40-year female named Puji. She JAKARTA 00006150 002.2 OF 004 became ill April 27, was hospitalized May 2 at a local clinic, and died May 4. Authorities did not take samples from her so they cannot determine whether she died of an H5N1 infection. She also suffered from tuberculosis. The patient attended a community cookout April 29 at a soccer field behind her residence at which both chicken and pork were served. Each of the victims confirmed to be infected with H5N1 attended the cook out. -- Puji's 19-year old son Roy Karo Karo suffered the onset of AI symptoms on May 4, was admitted to the Adam Malik hospital May 8, and expired May 9. NAMRU-2 found samples drawn from him AI positive May 11 and the CDC confirmed on May 15. -- Another of Puji's son, 18-year old Boni Karo Karo, displayed AI-like symptoms May 6, was hospitalized at Adam Malik May 8, and died May 12. NAMRU-2 found samples drawn from him AI positive May 12 and the CDC confirmed on May 15. -- Puji's sister, 29-year old Anta Ginting, became ill May 4, was hospitalized at Adam Malik May 8, and died May 10. NAMRU-2 found samples drawn from her AI positive May 11 and the CDC confirmed on May 15. -- Anta Ginting's daughter, 18-month old Rena, experienced AI symptoms May 3, was taken to a local clinic May 6, admitted to Adam Malik hospital May 9, was removed from the hospital May 12, returned to the same hospital May 13, and subsequently died May 14. NAMRU-2 confirmed her as AI positive May 11. Neither CDC nor UHK have confirmed. -- The brother of the index case, 25-year old Jonas Ginting, became ill May 4, was admitted to Adam Malik hospital May 8, ran away May 12 and returned to the same hospital May 13. He is now on a ventilator. NAMRU-2 confirmed him as AI positive May 11 and the CDC confirmed May 15. -- Puji's nephew, 10-year old Rafael, suffered an onset of AI symptoms May 3, was sent to Adam Malik hospital May 9, and declared dead May 14. NAMRU-2 confirmed him as AI positive May 11; CDC results are pending. -- Puji's other sister, 35-year old Terang, fell ill May 8 with vague symptoms not suggestive of H5N1, and was hospitalized May 9 (presumably at Adam Malik). She has tested negative for H5N1 at NAMRU-2. The village where the Ginting family resides is reportedly in a mountainous region 2 1/2 hours from Medan, the capital of North Sumatra. It is reportedly a non-Moslem area, where there are very few ducks but many swine and chicken. Local veterinary officials also reported no recent cases of AI in poultry. They said initial sampling of manure behind the family's home and testing of poultry in the area came up negative. One AI Death in Surabaya -------------- JAKARTA 00006150 003.2 OF 004 ¶6. (SBU) NAMRU-2 has also confirmed that a 38-year female in Surabaya who died May 11 tested positive for avian influenza. The University of Hong Kong has confirmed this result. Dr. Palilingan, Head of Research on human-to-human AI transmission at Dr. Sutomo Hospital told Congen Surabaya the patient was admitted to RKZ (Catholic) Hospital on May 8th. She subsequently died on May 12th. Palilingan said authorities tested her for AI, sent the samples to the MOH lab in Yogyakarta, but that the results had not yet been released. Paliling also noted that two hospital employees that tended to the AI patient, a nurse and another staff, are now suffering with high fevers. They have also been tested locally for AI and dengue fever, which is now prevalent in Surabaya, but the results have not been made public. MOH Hosts Emergency Meetings -------------- ¶7. (SBU) The Executive Director of Indonesia's National AI Committee, Bayu Krisnamukti, chaired emergency meetings at the MOH on the Medan cluster on May 14. Many officials attended, including from the WHO and the MOH, CDC and NAMRU- ¶2. Bayu stated that the GOI would focus its AI efforts on 13 provinces and districts. He said the priorities would be animal and human investigations; surveillance and early detection; alerting of hospitals and clinics; controlling the source of the virus. Bayu also announced that there would be an emergency cabinet meeting on May 16 to discuss the cases. ¶8. (SBU) Immediately after the Bayu meeting, Uyeki met at the MOH's Command Post (Posko) with Dr. Nyoman Kandun, Director General of Disease Control and Environmental Health (P2M),Dr. Haryadi Wibisono, Director of Infectious Diseases at P2M, and other MOH and WHO officials to discuss the large Medan cluster, the potential for limited human-to-human transmission and possible next steps. Key points that emerged included the importance of sending investigative teams to the field and ensuring coordination. A WHO official said that an epidemiologist from its South East Asia Regional Office (SEARO) in New Delhi should arrive in Indonesia and proceed to Medan on May 15. In addition, a veterinarian epidemiologist from WHO Bangkok could travel to Indonesia as early as May 16, with another epidemiologist from Geneva perhaps following. The WHO epidemiologist in Medan thinks that the situation is under control at this time. NAMRU-2 and Dr. Uyeki of the CDC are also working closely with the MOH. Human AI Case Profile -------------- ¶9. (U) With the five new confirmed H5N1 case in humans in the past week, the number of confirmed H5N1 cases in humans has jumped to 41, with 31 deaths. An additional seven cases are probable. All told, 47 cases are confirmed or probable with 35 resulting in fatalities (74 percent). JAKARTA 00006150 004.2 OF 004 ¶10. (SBU) NAMRU-2 data indicates the following AI-related case profile as of May 15: -- Number of laboratory confirmed (positive PCR and/or serology) human AI cases: 41, of which 31 have been fatal (fatality rate of 76 percent). -- Number of probable AI cases:6, with 4 deaths (fatality rate of 67 percent). -- Number of cases awaiting verification by the US CDC: 3 -- Number of possible AI cases under investigation: approximately 22. -- Number of excluded AI cases: 286. PASCOE