INDONESIA: AVIAN INFLUENZA UPDATE

UNCLAS SECTION 01 OF 03 JAKARTA 007166

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E.O. 12958: N/A
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU
SUBJECT: INDONESIA: AVIAN INFLUENZA UPDATE

REF: A) Jakarta 6812 and previous

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1. (SBU) Summary: Over the last four weeks, Indonesian
authorities have investigated four potential avian influenza
(AI) clusters with assistance from the World Health
Organization (WHO) and NAMRU-2. These include the well-
documented North Sumatra family cluster that resulted in
seven confirmed H5N1 cases; a brother and sister in Bandung,
West Java; a family in Solok, West Sumatra; and two children
in the Jakarta suburb of Tangerang. Health care workers in
Medan and Bandung who reported some association in the
treatment of confirmed H5N1-infected patients have been
hospitalized, but H5N1 infection has been ruled out. NAMRU-
2 and the Ministry of Health (MOH) have determined that a 15-
year-old male from Tasikmalaya, West Java who was admitted
to a Bandung hospital on May 28 was infected with H5N1.
NAMRU-2 and the MOH laboratory continue to collaborate on
testing of H5N1 suspects. Despite the increase in human
cases, the U.S. Centers for Disease Control and Prevention
(CDC) has found no evidence to conclude that the H5N1 virus
in Indonesia has changed to become more transmissible.
Indonesia currently ranks second in the world in both H5N1
cases (51 confirmed) and deaths (39). End Summary.

Update on Recent AI Clusters
--------------

2.(SBU) As of June 7, one patient from the North Sumatra
cluster remains hospitalized and will likely recover. Other
recent AI cluster activity includes the following:

--The WHO-H5 Reference Center at Hong Kong University has
confirmed that an 18-year-old male and 10-year-old female
from Bandung, West Java were infected with the H5N1 virus.
Both patients died after hospital admission on May 22. The
CDC confirmed the 10-year-old female as H5N1 positive. Two
nurses who had treated the two siblings at Hasan Sidikin
Hospital in Bandung, West Java (reftel) subsequently
complained of influenza-like symptoms. However, NAMRU-2 and
the MOH laboratory have diagnosed both as H5N1 negative.

--On 22 May, a previously healthy 14-year-old female from
Solok, West Sumatra reported to a local health clinic in
Bukit Sileh with a fever (six days) and cough. Two of the
patient's sisters had died on 14 and 21 May after exhibiting
several days of fever, coughing and dyspnea. The clinic
referred the patient to M. Djamil Hospital in Padang, were
she is currently undergoing treatment for an acute
respiratory disease. A MOH team, including a NAMRU-2
clinician, investigated and found that the victims had
processed and cooked an ill chicken prior to the development
of symptoms. Also, reports of dead and dying birds were
evident within the community. NAMRU-2, the MOH and the WHO-
H5 Reference Center in Hong Kong have confirmed H5N1
infection in the 14-female, who is recovering. While only a
single case was confirmed, this remains a suspected family
cluster.

--A 15-year-old male from Tasikmalaya, West Java reported to

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Hasan Sadikin Hospital in Bandung on May 28 with an illness
consistent with H5N1 infection. The patient died shortly
after admission. Samples analyzed at NAMRU-2, the MOH and
Hong Kong University have determined that he was infected
with an H5N1 virus.

Conflicting Test Results for Probable AI Cluster
-------------- ---


3. (SBU) In addition to the confirmed clusters described
above, there have been conflicting test results in the case
of probable H5N1 infection in two children from the Jakarta
suburb of Tangerang. A five-year-old male and seven-year-old
female were afflicted with influenza-like symptoms and
respiratory distress after contact with dying poultry in a
nearby slaughterhouse. Both were treated at Fatmawati
Hospital in Jakarta on May 28. The five-year-old male has
died but the seven-year-old female remains alive. However,
despite epidemilogic evidence of exposure to dying chickens,
after extensive testing, neither NAMRU-2, the CDC, nor the
University of Hong Kong have confirmed H5N1 infection from
multiple specimens taken from the children. At the same
time, tests for H5N1 at the MOH laboratory were positive.
NAMRU-2 has cause to believe that the MOH laboratory has
experienced a recent problem with specimen contamination.

Nurses H5N1 Negative
--------------


4. (SBU) Investigators associated with the WHO have
identified two nurses in Medan who had some contact with
earlier confirmed H5N1 cases and who complained of mild
recent illness. A 42-female nurse reported cough and fever
on June 1, and was treated with Tamiflu (oseltamivir) at
Adam Malik Hospital in Medan. As of June 7, the nurse has
left the hospital and her whereabouts are unknown. A second
nurse had showed less specific symptoms on May 28th (sore
throat, cough, myalgia, no fever),but had normal x-ray
readings and received no Tamiflu treatment. She remains
well. NAMRU-2 and the MOH laboratory have determined that
samples from each nurse were negative for H5N1-infection.
However, an H1N1, or normal influenza A virus, was found in
samples taken from the 42-year old nurse.


5. (SBU) Human influenza A (H1N1) and A (H3N2) and influenza
B viruses circulate throughout the year across Indonesia.
In the last six months, NAMRU-2 has diagnosed at least five
health care professionals who have interacted with H5N1
cases with non-avian, normal human influenza viruses. NAMRU-
2 maintains surveillance in 30 sites across Indonesia and
provides isolates and information to the WHO Influenza
Reference Centers for the purpose of vaccine preparation.

Human AI Case Profile
--------------


6. (SBU) In the past week, the number of confirmed H5N1
cases in humans in Indonesia rose from 47 to 51, with 39
deaths. NAMRU-2 data indicates the following AI-related

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case profile as of June 06:

-- Number of laboratory confirmed (positive PCR and/or
serology) human AI cases: 51, of which 39 have been fatal
(case fatality rate of 76 percent).

-- Number of probable AI cases: 5, with 3 deaths (fatality
rate of 60 percent).

-- Number of cases awaiting verification by the US CDC three

-- Number of possible AI cases under investigation:
approximately 13.

-- Number of excluded AI cases: 310.

PASCOE