H5N1 makes a New Mile Stone - Human to Human transfer

[The Flying Dutchman]

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Ladies and Gentlemen;

Although I have not been posting news regularly to TB2000. I still do follow the news closely. And at times, like this one. I post a series of news articles - which link together to make a mozaic of a *given* situation.

And H5N1 (avian flu) has apparently made a MAJOR change in it's genetic composition. It can now transfer between humans; perhaps not easily yet - but still transfers are being observed in Indonesia.

I am posting some of the last 4 days of my interesting news takes on H5N1, beginning with the takes from the 24th, then working foreward.

Shakey

<B><center><font siae+=1 color=red>H5N1 Admissions Include Eight Ragunan Zoo Visitors</font>
<A href="http://www.recombinomics.com/News/09240501/H5N1_Jakarta_Zoo_8.html">Recombinomics Commentary</A>
September 24, 2005
Mr Sardikin said two people who visited a Jakarta zoo whose birds were infected with the virus were admitted to the hospital on Friday night and Saturday morning.</B></center>
Another two patients, including a one-year-old girl, were admitted to the same hospital later Saturday, the Detikcom news website said.

The above comments indicate the number of patients admitted with bird flu symptoms continues to rise. The two additional zoo visitors brings that total to eight children in addition to two Ragunan Zoo workers who have been admitted to Suliant Saroso. Although the hospital is a referral hospital, it has limited admissions because of shortage of rooms and ventilators. Earlier in the week 115 zoo visitors with symptoms were denied admissions because the symptoms were not severe enough. Recently a class of 30 who visited the zoo had several members develop high fevers, and they also have not been admitted.

The zoo was closed on Monday, so many of the visitors from the weekend are just now developing symptoms or going to local hospitals, so the 8 admitted to Suliant Saroso reprsent only a small fraction of those visitors with symptoms.

The class of thirty was standing by the birds, where are heavily infected with H5N1, although the birds are asymptomatic. The large number of zoo visitors with symptoms repreaents a dramatic change in transmission, since media reports suggest the visitors were at the zoo on several different days and there have been no indication that those with symptoms had direct contact with the birds.

More data is required to understand the full extent of these transmissions, but the efficiency for human infections appears to have increased significantly.

 

[The Flying Dutchman]

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<B><center><font size=+1 color=brown>Saturday, September 24, 2005. 10:24pm (AEST)
Jakarta registers four more bird flu patients</font>
<A href="http://www.abc.net.au/news/newsitems/200509/s1467776.htm">www.abc.net</A>
Patients with bird flu symptoms in the Indonesian capital Jakarta were improving while four more people were hospitalised after displaying symptoms of the virus, doctors said. </B></center>
"Generally their conditions are improving, except for one person. Unless further tests show otherwise, at least four of them can be discharged today," hospital deputy director Sardikin Giri Putro said.

Twenty-one people, including the four new patients admitted on Friday and Saturday, were being treated at the Sulianti Saroso infectious diseases hospital in Jakarta.

Sulianti Saroso is one of 44 hospitals nationwide that have been designated to treat bird flu patients as Indonesia steps up the fight against the virus following the death of a man and his two young daughters in July.

So far four people have been confirmed to have died from avian influenza in Indonesia.

Mr Sardikin said two people who visited a Jakarta zoo whose birds were infected with the virus were admitted to the hospital on Friday night and Saturday morning.

Another two patients, including a one-year-old girl, were admitted to the same hospital later Saturday, the Detikcom news website said.

The H5N1 bird flu strain has killed 63 people in South East Asia since 2003, the majority of them in Vietnam. Indonesia's health ministry confirmed that the country's four victims died from H5N1.

On Wednesday a five-year-old girl died in Sulianti Saroso hospital showing symptoms of bird flu but authorities have yet to confirm bird flu as the cause of death pending the completion of lab tests in Hong Kong.

The World Health Organisation's (WHO) biggest fear is that H5N1 may mutate, acquiring genes from the human influenza virus that would make it highly infectious and lethal to millions in a global pandemic.

But the WHO in Geneva has urged calm, saying investigations in Indonesia had produced no evidence that H5N1 was spreading easily from person to person.

President Susilo Bambang Yudhoyono on Friday urged the culling of birds in infected areas but warned against overstating the threat.

Foreign donors on Friday promised to help Indonesia in its battle against bird flu after the UN warned of a worrying situation and urged the country to improve its virus control policies.

In addition to the four Indonesian deaths, a boy named Firdaus had also tested positive for bird flu, health officials said.

About 100 people who visited the Jakarta zoo have come to the Sulianti Saroso hospital for health checks over the past few days, the Jakarta Post said.

Authorities closed the zoo for 21 days starting Monday after tests showed that most exotic birds there were infected with bird flu.

The bird flu outbreak is expected to hit tourism worse than terrorism does, said Yanti Sukamdani, chairwoman of the Indonesian Hotel and Restaurant Association.

"Tourists are likely more afraid of ... the outbreak of a disease than a terror attack," she was quoted as saying by the Jakarta Post.

The government is seeking to attract six million foreign tourists this year, but the number of foreign arrivals has so far only reached 2.45 million.

-AFP

 

[The Flying Dutchman]

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<B><center><font size=+1 color=blue>Panicked residents crowd Jakarta hospital</font>
September 24 2005
<A href="http://www.thejakartapost.com/detailheadlines.asp?fileid=20050924.@02&irec=1">The Jakarta Post</A>
Despite an earlier call from the World Health Organization (WHO) to remain calm, Jakarta residents who had visited Ragunan Zoo or had direct contact with chickens or other birds crowded the Sulianti Saroso Infectious Diseases Hospital in Sunter, North Jakarta, on Friday.</B></center>
The hospital has seen more than 100 people coming of their own volition for checks over the past few days. "Most of them said they had been to Ragunan zoo," said the hospital's deputy director, Sardikin Girisaputro.

Around 30 frightened students from the Ksatria High School in Percetakan Negara, Central Jakarta, for instance, rushed to the hospital after several of their friends had fallen sick after a school tour to the zoo.

Sardikin explained that the hospital's two observation rooms could only accommodate 22 patients at the most, while its ICU facilities could only accommodate three patients.

"So, we can't just receive any patients who feel that they have a fever or respiratory problem as we have limited capacity."

The hospital, which receives patients referred by doctors as well as Jakarta Health Agency, has set a number of stages for dealing with suspected bird flu patients.

Those who get a fever or respiratory problem should go to the nearest hospital or public health center for initial treatment. If there is no improvement in three days, they may be referred to the infectious diseases hospital.

"First of all we check their history of contact with high risk areas and dead poultry. If they show clinical symptoms, we will conduct laboratory tests and x-ray their chest," Sardikin explained.

On Friday, of 18 patients suspected of having been infected with the bird flu virus and being treated in the infectious diseases unit of the hospital, 17 were improving, Sardikin said.

"One of the patients tested positive for typhoid, but we still have to wait for the laboratory tests on bird flu ... only one patient is still in a worrying condition," he said.

Two patients have been tested positive for the H5N1 strain of the bird flu virus.

The hospital's director, Santoso Suroso, said that they suggested that a number of the patients, including one of the patients who had tested positive for bird flu, go home as they had recovered completely.

"Several of them no longer have fevers while one of them even asked us to let him go home as he felt completely better," he said.

A seven-year-old patient, who tested positive for bird flu, was also getting better and had been taken of a respirator. (003)

 

[The Flying Dutchman]

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<B><center><font size=+1 color=green>Twelve H5N1 Bird Flu Patients Linked To Ragunan Zoo </font>
<A href="http://www.recombinomics.com/News/09240502/H5N1_Jakarta_Zoo_12.html">Recombinomics Commentary</A>
September 24, 2005
Until at this time the number of patients was suspected of by birds flu that was the visitor Ragunan reaching 12 people.</B></center>
The number of patients currently reaches 21 people and three additional patients who came on Saturday (24/9), that is Dony (15 years) the Tangerang citizen, Bilsqi Widyawati (1.5 years) the citizen Cempaka White Jakarta and Ageng the Murti Day (2 years) the citizen of the Big Bekasi Hut.
All of them had visited Ragunan.

He said the Karwati condition (27), the citizen Cikarang, the employee Ragunan, not better and still was in maintenance space of Integrated Circuit the Unit (ICU).

The above machine translation indicates the number of patients at the Sulianti Saroso hospital with ties to the Rangunan Zoo is now up to 12. Three are zoo workers, including one, Karwati, who is in critical condition. She and tour guide, Aniek Setyonni, have both tested positive for H5N1 antibody.

The hospital also is treating food vendor, Abdul Muntalib. Test result announced indicated only 4 of 27 zoo birds tested were negative. The positive samples were collected September 5 and 6, so workers and visitors had been exposed to infected birds for some time before the zoo closed on September 19.

Although many of the patients had visited the zoo that weekend, Bilqis Widiawati had visited the zoo on September 11 and had been hospitalized at RS Medika Griya Sunter. Thus, like most of the suspected bird flu case, hospitalization was not reveal until transfer to Sulianti Saroso, which for Bilqis was September 24.

Thus, the number of zoo visitors with symptoms may be significantly higher than the 12 patients admitted. Indeed 115 visitors were turned away earlier this week and a high school class of 30 had visited the zoo on September 18, and students soon developed high fevers. These patients have also not been admitted.

The visit over an extended time period indicates that the infections were not due to an unusual event. It seems that multiple visitors where infected on several days and there had been little evidence of close contact.

The transmission of H5N1 to zoo visitors over an extended time period indicates that H5N1 is now transmitting via casual contact, a strong signal that the pandemic has moved to phase 5.

 

[The Flying Dutchman]

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<B><center><font size=+1 color=purple>Bali scrambles to fight bird flu</font>
September 25, 2005 - 11:22AM
<A href="http://www.smh.com.au/news/world/bali-scrambles-to-fight-bird-flu/2005/09/25/1127586735075.html">FairFaxDidigital</A>
After weathering terrorism and drug busts, the tourist-dependent island of Bali is bracing for a new scourge: bird flu.</B></center>
The disease has broken out in neighbouring Java, just a short flight or ferry ride away.

"If this becomes a pandemic then all bets are off, not only in Bali but throughout the world," said Jack Daniels, owner of Bali Discovery Tours.

"I think the Indonesians know that and they are taking all steps to stop that from happening."

While some environmentalists say the Indonesian Government must do more, Robert Kelsall, chairman of Bali Hotels Association is optimistic.

He said as long as the outbreak remained contained to Java it should not hit visitor numbers to Bali, where tourism drives 80 per cent of the economy.

"The situation is escalating every day in Java, but we're in close contact with the health authorities in Bali who actually seem to be very proactive," he said.

Bali - one of Australia's favourite holiday destinations - has for some time banned imports of live chickens, while conducting tests on poultry stocks around the island, he said.

Following the outbreak in Jakarta, where four people are confirmed dead from the potentially lethal H5N1 virus, the island's Government has closed major bird markets in the capital Denpasar as a precautionary measure.

Kelsall said the hotel association had also issued guidelines to members about cooking and handling chicken and eggs.

It was also checking what precautionary measures local chicken suppliers were taking.

But others are more worried.

Activist Michael Chesney of Canada, who lives in Candi Dasa in Bali's east and has been lobbying the local Government since the first Asian avian flu outbreak three years ago.

Today he said authorities were not taking the threat seriously enough.

"Until somebody dies, nobody is going to respond," he told AAP in Tauman, a poultry farming village in Candi Dasa.

In Tauman, densely populated chicken farms sit alongside schools and residential dwellings, raising concerns that if the virus enters Bali it would quickly spread.

"Nobody wants to know, not the Government and not WHO [World Health Organisation]," Chesney said.

"All I get is shoulder shrugs when I try to tell them about the lack of hygiene at these cages."

WHO spokesperson Sari Setiogi said the organisation was not overly concerned about the problem.

"As long as residents don't seek close contact with the chickens and they manage their hygiene habits, they should be okay," she said.

"Bali has a very good surveillance system in place."

However, Chesney called for new legislation requiring permits for farmers with more than 1,000 chickens and enforcing basic hygiene standards such as installing septic tanks and making sure farms were at least one kilometre from residential areas.

Under the current law dating back almost two decades, only farmers with 10,000 chickens or more must have a permit.

"This has the potential to become an ecological disaster, it could be the nail in the coffin for Bali as far as tourism is concerned," Chesney said.

However, tourists so far seemed unconcerned.

"News of bird flu in Bali wouldn't necessarily stop me from coming back here," said Sydney woman Michelle Merser while eating chicken curry in a Candi Dasa cafe.

"It would make me change my eating habits though," said Dutch tourist Patricia Driessen.

"I wouldn't stop coming here unless there was a major outbreak.

"One or two deaths wouldn't scare me off."

 

[The Flying Dutchman]

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<B><center><font size=+1 color=red>The biological tsunami</font>
Brisbane
24sep05
<A href="http://www.theadvertiser.news.com.a...255E912,00.html">www.theadvertister.com</A>
SOME Australian scientists are so concerned about the possibility of an imminent killer-flu pandemic from Asia they have family stockpiles of antiviral drugs, just in case.</B></center>
A particularly virulent strain of avian flu, known as H5N1, has already killed more than 60 people in four Asian countries since 2003.

Five deaths, including that of a five-year-old girl, have recently been linked to bird flu in Indonesia.

So concerned are Australia and the United States, they will raise urgent concerns about the pandemic at the upcoming APEC meeting in South Korea.

The Australian Government has 3.95 million courses of the antiviral drugs Tamiflu and Relenza ready to protect essential workers for six weeks if a pandemic hits.

The worry is that if avian flu mixes with a type of human flu, it may develop into a new, highly infectious strain that's easily transmitted between people and invisible to human immune systems.

Such a virus is suspected to have caused the 1918-1919 influenza outbreak which killed about 40 million people - 1.5 per cent of the world's population at the time.

"If that happens with H5N1, I think calling it a biological tsunami might not be very far off," said infectious diseases expert John Mackenzie, of Curtin University in Perth. "If it happens in Beijing today, it'll be in New York tomorrow."

Existing drugs are capable of preventing infection or treating the disease in those showing early symptoms.

Blood products and vaccines developer CSL Ltd hopes to have a vaccine for bird flu ready by August 2006 or earlier in the event of an emergency.

Professor Mackenzie hasn't got his own supply of antiviral drugs in case of a pandemic but he knows people who have.

"A colleague of mine has bought some in Australia with a prescription from her doctor," he said.

The World Health Organisation says pandemics can be expected three to four times each century, with historical documents tracing them back to the 1400s.

Three were experienced last century - the post-World War I outbreak and much milder flu pandemics in 1957 and 1968. All emanated from South-East Asia. "We know historically that we have these pandemics at regular intervals and we've been ready for one," Professor Mackenzie said.

Of most concern to scientists and politicians is the possibility of a pandemic as severe as the 1918 outbreak, which killed about 12,000 Australians in a population of four million.

Already, pharmaceutical company Sanofi Pasteur has begun human trials of a H5N1 vaccine.

That data and results from other manufacturers will be shared at a WHO meeting in Geneva in November to be chaired by Australian medical virologist, Ian Gust, of the University of Melbourne. But there's no guarantee a H5N1 vaccine would work against a mutant strain.

"It may have mutated to the point where you really need to make a vaccine specifically for that," Sanofi Pasteur's Australian medical director, Victor Carey said.

Professor Gust, director of WHO's Collaborating Centre on Influenza in Melbourne, said the size of bird flu outbreaks in Asian countries, with a more recent spread towards Europe, were unprecedented. Since December 2003, the H5N1 virus has been detected in 11 countries.

Human deaths have been recorded in Vietnam, Thailand, Cambodia and Indonesia and tens of millions of birds have died or been culled to control

 

[The Flying Dutchman]

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<B><center><font size=+1 color=brown>Six Indonesians dead from bird flu
Government orders medicine stockpile; Australia pledges support</font>
<A href="http://www.cnn.com/2005/WORLD/asiapcf/09/26/indonesia.birdflu.ap/">CNN.com</A>
Monday, September 26, 2005
Six people have died and 10 others have been confirmed with the virus -- though some of them have not shown any of its usual flu-like symptoms, said I Nyoman Kandun, director general of Communicable Disease Control at the Health Ministry.</B></center>
He said that 34 people have been hospitalized with symptoms of bird flu, or H5N1 virus, across the country.

Health Minister Siti Fadila Supari said 200,000 tablets of anti-viral drug oseltamivir, known commercially as Tamiflu, would be available Tuesday and another 200,000 tablets by Friday.

Supari said that the medicine -- enough to treat 40,000 people at 10 tablets per person -- showed that the government had things "under control." Tamiflu is the only treatment so far proven effective against bird flu in humans.

It was unclear if the six dead included a women who was suspected to have died of the disease on Monday. The 27-year-old woman had been treated for symptoms of the virus since last Thursday at the government-designated hospital for suspected bird flu cases, said Dr. Sardikin Giriputro.

Giriputro, the hospital's deputy head, said initial tests at the hospital showed the patient had contracted bird flu, but that further tests would be needed to confirm the diagnosis.

The H5N1 strain of bird flu has swept through poultry populations in large swaths of Asia since 2003, killing at least 65 people and resulting in the deaths of tens of millions of birds.

Most human cases have been linked to contact with sick birds. But the World Health Organization has warned that the virus could mutate into a form that spreads easily among humans -- possibly triggering a global pandemic that could kill millions.

The Australian government pledged Monday to help Indonesia speed up its response to bird flu, saying it will donate enough anti-viral medicine to treat 40,000 people to its northern neighbor to help it cope with the illness.

Canberra had previously pledged 10,000 courses of the medicine to Indonesia.

"They have been caught a bit short to tell you the truth, and they're finding it difficult to handle," Foreign Minister Alexander Downer told reporters in Adelaide.

Medication distribution was moving "a little more slowly than we would have liked, but I think they're getting better organized now," he said.

It was not immediately clear if the 600,000 doses announced by Indonesia included any of those pledged by Australia.

 

[The Flying Dutchman]

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<B><center><font size=+1 color=green>CNN reports the number 34 </font>
<A href="http://www.cnn.com/2005/WORLD/asiap...sia.birdflu.ap/CNN.com">CNN.com</A>
Monday, September 26, 2005
JAKARTA, Indonesia (AP) -- Indonesia's death toll from bird flu has risen to six and the government has ordered more than a half-million tablets of anti-viral medicine to fight the disease, the Health Ministry announced Monday.</B></center>
Six people have died and 10 others have been confirmed with the virus -- though some of them have not shown any of its usual flu-like symptoms, said I Nyoman Kandun, director general of Communicable Disease Control at the Health Ministry.

He said that 34 people have been hospitalized with symptoms of bird flu, or H5N1 virus, across the country.

Health Minister Siti Fadila Supari said 200,000 tablets of anti-viral drug oseltamivir, known commercially as Tamiflu, would be available Tuesday and another 200,000 tablets by Friday.

Supari said that the medicine -- enough to treat 40,000 people at 10 tablets per person -- showed that the government had things "under control." Tamiflu is the only treatment so far proven effective against bird flu in humans.

It was unclear if the six dead included a women who was suspected to have died of the disease on Monday. The 27-year-old woman had been treated for symptoms of the virus since last Thursday at the government-designated hospital for suspected bird flu cases, said Dr. Sardikin Giriputro.

Giriputro, the hospital's deputy head, said initial tests at the hospital showed the patient had contracted bird flu, but that further tests would be needed to confirm the diagnosis.

The H5N1 strain of bird flu has swept through poultry populations in large swaths of Asia since 2003, killing at least 65 people and resulting in the deaths of tens of millions of birds.

Most human cases have been linked to contact with sick birds. But the World Health Organization has warned that the virus could mutate into a form that spreads easily among humans -- possibly triggering a global pandemic that could kill millions.

The Australian government pledged Monday to help Indonesia speed up its response to bird flu, saying it will donate enough anti-viral medicine to treat 40,000 people to its northern neighbor to help it cope with the illness.

Canberra had previously pledged 10,000 courses of the medicine to Indonesia.

"They have been caught a bit short to tell you the truth, and they're finding it difficult to handle," Foreign Minister Alexander Downer told reporters in Adelaide.

Medication distribution was moving "a little more slowly than we would have liked, but I think they're getting better organized now," he said.

It was not immediately clear if the 600,000 doses announced by Indonesia included any of those pledged by Australia.

 

[The Flying Dutchman]

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<B><center><font size=+1 color=blue>Bird flu kills two more Indonesians
From correspondents in Jakarta</font>
26sep05
<A href="http://www.theadvertiser.news.com.au/common/story_page/0,5936,16725091%255E1702,00.html">The Advertister</A>
INDONESIAN health officials have confirmed two more deaths from bird flu, bringing the total number of fatalities in the country from the H5N1 virus to six.</B></center>
From correspondents in Jakarta I Nyoman Kandun, the health ministry's director-general of infectious diseases, said a test confirmed that a five-year-old girl named Riska had become the latest victim of the virus.

http://www.theadvertiser.news.com.a...55E1702,00.html

"Her blood test was positive," he said.

Although a saliva sample tested negative, the ministry has classified her case as a bird flu death based on the blood analysis, he said.

Samples have been sent to Hong Kong for further analysis.

A 27-year-old woman, who was one of five patients who had tested positive for bird flu at the Sulianto Saroso hospital for infectious diseases, also died on Monday, the hospital said

 

[The Flying Dutchman]

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<B><center><font size=+1 color=purple>Five Jakarta hospital patients have bird flu. 3 more deaths? </font>
<A href="http://www.manilatimes.net/national/2005/sept/26/yehey/top_stories/20050926top6.html">The Manila Time
September 26 2005</A>
JAKARTA: Five hospital patients in the Indonesian capital have tested positive for bird flu while five others were found not to have contracted the disease and will be discharged, a doctor said Sunday. </B></center>
“Five have tested positive,” said Sardikin Giriputro, the deputy head of the Sulianto Saroso hospital for infectious diseases in Jakarta. The hospital has admitted a total of 22 people suffering symptoms similar to those caused by the bird flu, he said, but so far tests showed only five had been infected.

“Five other patients did not contract bird flu and since their test results were negative and their clinical conditions have improved, we will allow them to leave the hospital tomorrow,” Giriputro said.

The 12 others were still awaiting the results of tests, he said, adding that most were showing signs of improvement.

A two-year-old girl was admitted to the hospital on Sunday. She visited Jakarta’s Ragunan zoo last weekend and subsequently had a high fever.

Dozens of fowls and birds at the zoo had tested positive for bird flu. Authorities on Monday closed the zoo for 21 days.

So far four people have been confirmed to have died from avian influenza in Indonesia.

The H5N1 bird-flu strain has killed 63 people in Southeast Asia since 2003, the majority of them in Vietnam. Indonesia’s health ministry has confirmed that the country’s four victims died from H5N1.
--AFP

 

[The Flying Dutchman]

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Oct. Issue of the National Geographic Magazine

(snip)
<B><center><font size=+1 color=red>Tracking the Next Killer Flu</font>
<A href="http://www7.nationalgeographic.com/ngm/0510/feature1/index.html">National Geographic October</A>
In Southeast Asia a virus that kills chickens is now also killing people. The race is on to keep the bird flu from ravaging the world.</B></center>
<i>Get a taste of what awaits you in print from this compelling excerpt.</i>

To most of us, flu is a nuisance disease, an annual hassle endured along with taxes and dentists. Some people think a flu shot isn't worth the bother. But flu is easy to underestimate. The virus spreads so easily via tiny droplets that 30 million to 60 million Americans catch it each year. Some 36,000 die, mostly the elderly. It mutates so fast that no one ever becomes fully immune, and a new vaccine has to be made each year.

That's ordinary flu. But the disease that is taking lives in Southeast Asia is no ordinary flu. Its primary victims have been chickens, more than a hundred million of them, killed either by the virus or in often futile control efforts. It's not unusual for chickens to get flu; in fact, avian-flu viruses far outnumber human ones. But Robert Webster of St. Jude Children's Research Hospital in Memphis has studied flu viruses for 40 years and has never seen the likes of [this] one.

"This virus right from scratch is probably the worst influenza virus, in terms of being highly pathogenic, that I've ever seen or worked with," Webster says. Not only is it frighteningly lethal to chickens, which can die within hours of exposure, swollen and hemorrhaging, but it kills mammals from lab mice to tigers with similar efficiency. Here and there people have come down with it too, catching it from infected poultry. Half the known cases have died.

In those deaths many public health experts hear the distant rumblings of a catastrophe. So far this virus—classified as H5N1 for two proteins that stud its surface like spikes on a mace—isn't good at passing from birds to people, let alone from one person to the next. "It can make that first step across, but then it doesn't spread easily from human to human," says Webster. "Thank God. Or else we'd be in big trouble."

Maybe H5N1 will never learn the trick of racing from person to person like the milder flus that empty offices and classrooms each year. Maybe it simply can't. Or maybe efforts to eradicate the virus—largely fitful and underfunded so far—will succeed. But experts are urging the world to prepare for the worst.


Get the whole story in the pages of National Geographic magazine.

 

[The Flying Dutchman]

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<B><center><font size=+1 color=brown><center>Confirmed H5N1 Bird Flu Deaths In Jakarta Increase to Six </font>
<A href="http://www.recombinomics.com/News/09260501/H5N1_Jakarta_Confirmed_6.html">Recombinomics Commentary</A>
September 26, 2005
From 10 positive cases of birds flu, six people including dying namely Iwan Siswara, his two daughters Sabrina and Thalita, Rini Ignoble, Riska and Karwati.</B></center>
Whereas four positive patients birds flu that still was living namely Paradise, Gayatri pearls and two patients from South Sulawesi. The "complete name that from South Sulawesi, I forgot," said Kandun.

The machine translation above includes two recent H5N1 bird flu deaths in the Jakarta area. The most recent is Karwati a mother of two who has been described in media repots as being 27 or 30. One report indicates she has a connection with the Ragunan Zoo, but most reports link her exposure to 15 birds that died near her home, including one or more that was eaten. Another was given to neighbors and they are undergoing testing. Her death is the first strongly linked to birds who had suddenly died.

The other case, Riska, died last week and was just confirmed to be H5N1 positive. She also had contact with dead birds, but also had a pet bird, which again focuses attention on pet birds. The first three H5N1 reported fatalities were in a family from Tangerang. The birdcage across the street from their residence was H5N1 positive.

The above report also indicates H5N1 patients have been identified in South Sulawesi. These data indicate that the H5N1 in humans in Indonesia is widespread, In addition to the 10 deaths, there are 32 cases being investigated.

There is considerable concern over false negatives or misdiagnosis. Rini Ignoble's (Rini Dina's) nephew, Paradise initially was H5N1 positive by PCR, but is now being discharged and is H5N1 negative, He will be the first discharged positive patient. Thus, collections from patients after the H5N1 has been cleared from serum will fail to detect the infection. Similarly, misdiagnosis is common. Karwati was initially diagnosed as having typhus, which was changed to Dengue Fever when she vomited blood and was bleeding from her nose. This presentation sounds similar to the index case in Thailand, who subsequently infected her mother and aunt.

The above negatives and mis-diagnosis of Dengue Fever raise serious questions about the monitoring of H5N1 in Indonesia and throughout the region.

 

[The Flying Dutchman]

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<B><center><font size=+1 color=green>Zero stockpiles of bird-flu
medicine—health secretary</font>
September 28 2005
<A href="http://www.manilatimes.net/national...050928top6.html">www.manilatimes.com</A>
HEALTH Secretary Francisco Duque said Tuesday that the Department of Health lacks sufficient medicines to meet the deadly effects of an avian influenza if a pandemic breaks out. </B></center>
Duque told reporters that the DOH does not have a stock of oseltamivire, a drug usually used in treating avian influenza induced by the avian influenza-causing H5N1 virus.

He disclosed that developing-world countries like the Philippines have difficulty acquiring the medicine.

“There is only one drug company producing oseltavimire which is Roche of Switzerland. Developed countries usually have a stock of this medicine. We have a zero stockpile,” Duque said.

He noted that during the 56th session of the World Health Organization regional committee for Western Pacific in New Caledonia, health officials had requested Roche to make at least 30 million oseltamivire capsules in the event a pandemic breaks out.

“The WHO has been telling us to ‘prepare, prepare’ but we can’t get the medicine. I hope that, on humanitarian grounds, we should be able to access [to the medicine],” Duque said.

The drug is administered to an infected individual twice a day for five days. Ten doses of the medication cost about P1,000.

The DOH had placed an order for P10 million oseltamivire last year, but none have been delivered.

Duque said that it was high time developing countries were given priority in the production of the drug.

“Why should the more vulnerable nations be deprived the ability to stockpile? And why do those [countries] that are less at risk have thousands [of stocks]?” Duque asked.

The health secretary assured the public that the government has been preparing for avian influenza. It has established the Avian Influenza Protection Program, in partnership with the Department of Agriculture.

The DOH’s main task is to ensure that there will be no human-to-human transmission.

 

[The Flying Dutchman]

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<B><center><font size=+1 color=blue>Hospitalization of Brothers of H5N1 Positive Zoo Visitor </font>
<A href="http://www.recombinomics.com/News/09270501/H5N1_Jakarta_Brothers.html">Recombinomics Commentary</A>
September 27, 2005
Jemima's assurance flattest birds flu was received from results of the inspection Litbangkes the Department of the RI Health that was accepted by RSPI Sulianti, on Tuesday (27/9/2005). </B></center>
"Litbangkes results showed his serology was positive, but PCR him was negative."

While two older brothers were siblings, M. Arir Nurwiyono (10) and M. Fauzan Toriq (8), that it was suspected is affected by birds flu currently his condition began to improve. Both of them were treated in RSPI Sulianti since Monday, yesterday. As in the case of Jemima, both of them could also visit to Ragunan FAMILY PLANNING.

The above machine translation indicates that 9 year old Jimima Napitutupulu has tested positive for H5N1 bird flu. She is the first visitor to Ragunan zoo to test positive for H5N1. She transferred to Suliani Saros on September 21 from the Bekasi region.

Her two brothers, M Ari Nurwiyano and M Fauzan Toriq were admitted to Suliant Sarosos yesterday wth bird flu symptoms. The three family members demonstrate that the transmission of H5N1 to humans is becoming increasingly efficient. It is not clear if all three were infected at the zoo, or if the two brothers were infected after the zoo visit by their sister or other patients at the hospital. However, it is clear that infection of three family members indicates transmission of H5N1 is becoming more efficient.

The H5N1 positive patient is not on a ventilator and appears to be a relatively mild case. This raises the possibility than many of the 115 zoo visitors or members of the high school class may inb fact be H5N1 infected, but may have milder cases. Some of these cases may eventually sero convert. Most of the lab confirmed H5N1 cases have been for H5N1 antibody. The number of PCR positive cases has been limited to the father of the two daughters who formed the first familial cluster. The second familial cluster, Rini Dina and her nephew where the other two cases that were H5N1 positive by PCR test. The other positive cases had H5N1 antibodies, including Riska Ardian who died last week and Karwati who died this week. Zoo tour guide, Ari Setyorini has also tested positive for H5N1 antibodies.

The growing number of H5N1 positive cases suggests that H5N1has moved to stage 5 in Indoinesia. The clusters of cases is growing, both within families as well as those who visited the zoo. However, clear linkage between the clusters has not been established, indicating widespread infections from multiple sources.

Since some of these cases have been mild, while others have been misdiagnosed as dengue fever, a widespread screening of serum samples collected 30 days after exposure is required to determine the true extent of H5N1 infections.

It seems likely that the number infected at the zoo is large, and only the most severe cases are being admitted. The possibility of widespread silent transmission of H5N1 has not been adequately addressed. Zoo visitors with symptoms appear to be increasingly likely to be H5N1 positive.

Monitoring of H5N1 in humans in southeast Asia remains scandalously poor.

 

[The Flying Dutchman]

-


<B><center>Tuesday, 27th September 2005
<font size=+1 color=purple>Doctor issues bird flu warning</font>
<A href="http://www.manchesteronline.co.uk/men/news/health/s/175/175581_doctor_issues_bird_flu_warning.html">Manchester Evening News</A>
A LEADING Manchester doctor has criticised the government for being badly prepared for bird flu.</B></center>
As reported infections continue to spread across the globe - most recently in Indonesia - Dr Kailash Chand has accused the government of having too few drugs and too little planning.

So far the disease can only be passed from birds to humans in close contact and has not mutated into a form which can pass from human to human. But doctors fear that such a mutation could kill up to 50,000 in Britain without drugs.

Dr Chand, a GP and local representative of the British Medical Association, said: "What the government's response seems to me is some kind of denial. The Department of Health is not accepting that an avian flu epidemic could be a reality.

"A lot more needs to be done. GPs on the front line have had no planning advice from the government on how to deal with a large scale outbreak, but your local GP would be a first point of call.

"I'm not trying to be alarmist, but we need to have a better policy so that nobody suffers. The government cannot close its eyes any more."

Overdue
His warning comes after reported outbreaks of bird to human infection in Kazakhstan and central Asian parts of Russia at the end of August, though there have been no reported cases in Europe.

North west health chiefs are adamant that there is no immediate threat from bird flu, though they do admit that the we are overdue some form of flu epidemic.

Hugh Lamont, of the north west Health Protection Agency, said: "We have done a lot of work to prepare for a flu pandemic. It won't necessarily be bird flu, as there is no evidence yet of the virus transferring from human to human, and it is still very difficult to catch.

"But there is a flu pandemic every 30 to 40 years, and the last one we had was in 1968, so we are overdue one."

A spokesman for the Department of Health said: "If an outbreak did occur we would first ask GPs to identify any new strain, then isolate any sufferers while we pinpointed and vaccinated against the virus. If infection carried on there are whole raft of social measures, including banning football matches and pop concerts, that we could take."

 

[The Flying Dutchman]

-


<B><center><font size=+1 color=red>Avian flu in Indonesia:
WHO medicine flown from India </font>
Tuesday, September 27, 2005
<A href="http://www.indianexpress.com/full_story.php?content_id=78957">NEW DELHI,</A> SEPTEMBER 26: Indonesia, battling avian flu, has found an answer to shortage of medicines. The first consignment of Tamilflu, the only medicine that has been found effective in treating the disease, was flown from WHO-South East Asia Regional Office in New Delhi on Saturday. Roche is the only firm which produces the medicine. </B></center>
‘‘The WHO headquarters is stocking the medicines and will be providing it to people if need be. We had our stocks and have send them already,’’ said WHO SEARO spokesperson Harshan Beer Kaur Pandey.



India, however, has no stock of the medicine in case of an outbreak. ‘‘There is only one global producer. In India, we, however, have a medicine called Amantidine, which can be used for initial symptoms of avian flu, but Tamiflu is not available,’’ said an official.

‘‘We are keeping our fingers crossed as the conditions under which the poultry rearing happens in the country are suitable for it to spread,’’ the official added.

The approaching winter becomes crucial in India’s fight to keep the disease at bay. The government is likely to finalise the national surveillance and preparedness plan soon.

 

[The Flying Dutchman]

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<B><center><font size=+1 color=brown>Bird flu alert in Assam </font>
<A href="http://www.telegraphindia.com/10509...ory_5287184.asp">www.telegraphofindia.com</A>
Guwahati, Sept. 26: The Union ministry of environment and forests has directed Assam to draw up a contingency plan to combat bird flu before migratory birds start arriving in the state. The wake-up call follows reports that some of the feathered visitors from China could be carrying strains of the deadly disease. </B></center>
Alarmed by Delhi’s warning, the state forest department has convened a meeting of veterinarians, wildlife officials and other experts on September 30 at the state zoo here.

Quoting the ministry missive, sources here said the first flocks of three species — the bar-headed geese, the great black-headed gull and the great cormorant — migrating between Qianhai Hu in China and South Asia, mostly India and Bangladesh, have been sighted in the region.

This year, avian flu was first detected on May 4 among wild birds in China’s Qinghai province over which lie two migratory paths — the central Asian flyway and the east Asian flyway. Birds migrating to the region mostly take the Central Asian flyway to Assam.

Delhi’s warning comes amidst reports that the deadly H5N1 avian influenza virus has struck migratory geese at a nature reserve in western China and led to a large number of deaths. Tens of thousands of birds that could be carrying the virus are reported to have left the reserve in September and are headed for warmer climes across the Himalayas. These birds reach India mostly in early October.

According to experts, the birds can pass on the virus to domestic poultry or avian pets, which can, in turn, transmit the virus to humans as well.

“There is cause for concern and Dispur should take urgent steps to make sure that the disease does not strike in the state,” said P.C. Bhattacharjee of the zoology department of Gauhati University.

Sources in the state government said places where heightened vigil was required were Kaziranga, Dibru-Saikhowa and the wetlands to which the birds mostly flock. “We are not taking any chances. Friday’s meeting will decide the steps needed to combat the disease,” a senior state wildlife official said.

The ministry has also asked the state government to monitor and report any incidence of suspected cases related to birds dying of avian disease. Suitable samples should be collected for virus testing.

 

[The Flying Dutchman]

-


<B><center><font size=+1 color=blue>Dengue Fever Misdiagnosis of Fatal H5N1Case Causes Concern </font>
<A href="http://www.recombinomics.com/News/09260502/H5N1_Jakarta_Dengue.html">Recombinomics Commentary</a>
September 26, 2005
Not old at intervals of, Karwati again cut off one chicken and only was eaten by his family. Further was reported Karwati on Monday September 19 experienced the fever.</b></center>
Because never recovered, Karwati was brought to RS Medika Cikarang that was located around 1 km from his house.

"He entered RS Medika on Tuesday morning." Initially Karwati was diagnosed suffered typhus. Afterwards vomited blood and the nosebleed, afterwards were diagnosed by dengue fever. However when tell about chronological before Karwati was sick, the RS side at once reconciled RSPI Sulianti Saroso, he said.

The above machine translation indicates that the latest confirmed H5N1 fatality was initially misdiagnosed as having dengue fever. She was transferred to Sulianti Saraos because she had eaten a bird that had died suddenly. Thus, had that history not been revealed, or if the bird appeared healthy because of an asymptomatic H5N1 infection, it is likely that the H5N1 would have been recorded as another dengue fever death in Indonesia. Thus far this year Indonesia has recorded 538 fatalities from dengue fever.

The entire area is reporting unusually high number of cases of dengue fever. The Philippines has recorded 259 dengue fever deaths.

Last year the index case of human-to-human transmission in Thailand was diagnosed as dengue fever because she vomited blood and had a nose bleed. She fatally infected her mother, who was H5N1 positive. Her aunt was also H5N1 positive.

The confusion of pandemic influenza with dengue fever was also seen in the 1918 flu pandemic. Many patients had internal bleeding and bleeding under this skin. This led to mis-diagnosis of dengue fever, typhoid, and cholera.

The spread of H5N1 in Indonesia suggests monitoring efforts in the region are far from adequate. Indonesia now has 10 acknowledged H5N1 cases. Six have died and one has been discharged. Two are in South Sulaweto, indicating H5N1 in humans has spread far and wide.

The number of H5N1 cases in Indonesia and the area in general is unknown because of the lack of H5N1 testing combined with false negatives. Indeed, only one of the three family members in Tangerang is an official H5N1 cases, although all three clearly died from H5N1 infections.

An increased screening of patients is long overdue, and the latest fatality should make it clear that the number of H5N1 case misdiagnosed as dengue fever may be very large.

 

[The Flying Dutchman]

-


<B><center><font size=+1 color=purple>Avian flu could be substantial threat this fall </font>
By Alexandra Bogdanovic
09/27/2005
<A href="http://www.timescommunity.com/site/...id=506066&rfi=6">www.timescommunity.com</A>
Regional health officials are caught between the proverbial rock and a hard place.</B></center>
They don't want to create panic about the potential for pandemic influenza. But they don't want to create a false sense of security, either.

At a meeting of area health and emergency officials held in Culpeper last week, Dr. Lillian Peake said it is vital to let the public know that a large-scale epidemic could occur and that health officials are beginning to plan accordingly.


"We have no idea whether (this subtype) will cause a pandemic," said Dr. Lillian Peake of the Rappahannock-Rapidan Health District. "But one will occur at some point."

According to Peake, a pandemic is an outbreak of cases throughout the world.

"It is a viral equivalent of the perfect storm," she said.

In order to cause a pandemic, a flu virus must meet three criteria, Peake explained. It must be a new subtype that has not infected people in the past; it must cause severe illness in people; and it must have sustained transmission from person to person.

The new variety of avian (bird) flu, which is now considered a pandemic threat, meets two of those criteria. People have not been infected by it in the past, and it does cause severe illness. In fact, 51 percent of the people who have been infected have died, according to Peake.

"That is an extraordinarily high mortality rate," Peake said. "Person-to-person has occurred, but sustained transmission has not been established."

Worst-case scenarios

According to information provided by the Center for Disease Control, an avian flu pandemic affecting 25 percent of Americans could result in 786,032 to 4.7 million hospitalizations. It could also result in 187,478 to 1.1 million deaths.

If the virus affected 35 percent of people in Virginia, projections indicate that as many as 1.3 million could get sick. There could be more than 28,000 hospitalizations and more than 6,200 deaths.

Currently, the state only has 14,706 staffed hospital beds and 892 isolation rooms, Peake said. With surge capacity, the total number of staffed hospital beds would be 18,079 and the number of isolation rooms would be 1,362, she said.

Just in case

Consequently, Peake said public health officials must now figure out how they will cope with several challenges. Specifically, she said they must decide how to prioritize patients. They must also figure out how to deal with staffing shortages at hospitals, how to protect health care workers and how to manage mass fatalities, she added.

In addition to the challenges posed by limited surge capacity, public health care officials face complications due to limited supplies and production of flu vaccines, Peake explained.

Only 300 million doses of flu vaccine are produced worldwide each year, she said. In the 1980s, 25 drug companies made flu vaccines here. Now there are only five that do so and of those, just two produce the majority of the flu vaccine for this country, according to Peake.

The supply and production of anti-viral medications are also limited, Peake said. The current supply is just enough to treat 2.3 million people for 10 days. However, there are plans to build the stockpile to serve 20 million people, Peake noted.

Health officials say the shots generally given to the public to combat the flu aren't effective against this particular variety of avian flu. But people at risk for getting the flu should still get their injections to prevent them from catching other types of the virus.

"We certainly don't want to discourage anyone from getting a flu shot," said Lucy Caldwell, a public information officer with the Virginia Department of Health.

Physicians urge the elderly, children, pregnant women and those with other risk factors such as underlying, chronic illness, to get their flu shots within the next couple of weeks. The rest of the general public will be able to get flu shots after Oct. 24.

Currently, there is nothing to indicate that there will be a vaccine shortage in Virginia, Caldwell said.

Advance warning

Health experts first identified avian flu as a mild disease in poultry in Asia in the early to mid-1990s. By 1997, it was classified as a severe disease in poultry -- causing death in 48 hours. The disease was reportedly transmitted to 18 people and there were five deaths.

In the last couple of years, there have been "lethal outbreaks among poultry," Peake said. One hundred and twelve people have gotten the disease and there have been 57 deaths, she added.

Two documented outbreaks of different varieties of bird flu have occurred outside of Asia in the last three years. One happened in the Netherlands in 2003. Eighty-three people got sick and one died, according to data provided by Peake.

During that outbreak, family members of poultry workers also became ill, indicating that the virus could be transmitted among humans.

The other outbreak happened in Virginia in 2002. Nearly 200 farms were affected and 4.7 million birds were "depopulated," Peake said. One poultry worker got sick.

There were three influenza pandemics during the 20th century, according to the Centers for Disease Control. They occurred in 1918, 1957 and 1968.

Of those, the "Spanish flu" pandemic of 1918 was by far the most lethal. Roughly 25-35 percent of the world's population was affected. There were 40 million deaths worldwide, and most of those who died were healthy people between the ages of 15-35.

"In many areas, the life expectancy dropped by 10 years or more," Peake said.

 

[The Flying Dutchman]

-


<B><center><font size=+1 color=red>At least 57 people suspected of contracting bird flu in Indonesia</font>
September 28 2005
<A href="http://news.yahoo.com/news?tmpl=story&u=/afp/20050928/wl_asia_afp/healthfluindonesia_050928081417">YahooNews.com</A>
JAKARTA (AFP) - At least 57 people were being treated for suspected bird flu in Indonesia, where the disease has already claimed six lives, officials said.</B></center>
OF the total, 20 patients were under observation at Jakarta's Sulianti Saroso hospital for infectious diseases, a doctor there, Ilham Patu, said.

The latest suspected case, a 23-year-old man from the capital, was admitted late Tuesday.

Blood and muccus samples from the patients were being tested locally with any positive results indicating bird flu being sent to World Health Organization laboratories in Hong Kong for confirmation.

Since Monday the hospital has released five people who were suspected of contracting bird flu but tested negative.

Health ministry spokesman Sumardi said Wednesday that a shipment of some 20,000 doses of Tamiflu, anti-viral medication that can stop flue if given quickly when symptoms develop, will arrive in the country on Friday.

"This medicine will be sold commercially at pharmacies," he said. So far, it has only been available in hospitals.

Six Indonesians have died of bird flu, bringing to 65 the number of people in Southeast Asia known to have died from the H5N1 strain of the virus since 2003. Vietnam has recorded 43 deaths, Thailand 12 and Cambodia four.

The WHO fears H5N1 will mutate, acquiring genes from the human influenza virus that would make it highly infectious and lethal to millions in a global pandemic.

<b>But it has also urged calm, saying investigations in Indonesia had produced no evidence <u>that H5N1 was spreading easily from person to person</u>.</b>


welp! Now it's being admitted that H5N1 may be going human to human!

 

[The Flying Dutchman]

-


<B><center><font size=+1 color=brown>New suspected bird flu cases emerge in regions </font>
<A href="http://www.thejakartapost.com/detailheadlines.asp?fileid=20050928.@03&irec=2">Jakarta Post</A>
September 28 2005
Four people in Bandung, Semarang and Bandar Lampung have been hospitalized with suspected avian influenza after showing symptoms of the disease.</B></center>
Chicken vendor Suprat, 58, was admitted to Dr. Kariadi Hospital in Semarang, Central Java, on Tuesday with a high fever, cough and respiratory problems.

The resident of Kendal regency had been treated at Roemani Hospital for a week, before being transferred to the government-designated hospital for bird flu patients.

Roemani Hospital head Sofa Chasani said tests have yet to confirm Suprat has bird flu.

A chicken seller, Suprat supplied 800 kilograms of chicken daily to markets in Semarang and Kendal.

Of the total 42 cases of human infection nationwide since July, there has been one case of human infection in Central Java. However, the virus killed around 8.17 million poultry in 2003 and 2004.

In Bandung, a 16-month-old baby named Kayla has been treated since Saturday in the isolation room of government-designated Hasan Sadikin General Hospital.

Her mother Titik Tri Herawati said Kayla had been taken to Santo Yusuf Hospital with a high fever, but was the hospital had referred her to Hasan Sadikin instead as she was showing bird flu symptoms.

Hasan Sadikin Hospital head Cissy B. Kartasasmita said an initial diagnosis of Kayla's condition indicated severe pneumonia, but her blood sample had been sent to the Ministry of Health in Jakarta for tests.

The Bandar Lampung man who is believed to have bird flu is a 20-year-old resident of Tanggamus regency named Hendriansyah. Three days after his admittance to Abdul Moeloek General Hospital in Bandar Lampung on Saturday, Hendriansyah's condition had regressed from a high fever to severe pneumonia.

Principally an avian disease, the H5N1 bird flu virus was first seen in humans in Hong Kong in 1997. Since then it has killed at least 65 people, with six fatalities in Indonesia.

The virus has spread to 22 provinces in the country, killing more than 9.5 million poultry.

The bird flu outbreak has sparked fears among residents in Bandarlampung, who saw dozens of chickens die sudden deaths over the weekend.

"Their deaths were unusual. The chickens had a high fever, and then, when they were slaughtered, there was almost no blood spilled," said Julfrizal, a resident of Pesawahan regency.

Lampung Health Office head Wirman said avian flu vaccine had been distributed to every district, while campaign activities to prevent further outbreaks had been stepped up.

However, Herdimansyah, chairman of non-governmental organization Lampung Sehat, was critical of the local administration's efforts to stop the virus from spreading.

"Until now, it's only Way Kanan regency that has financed an anti-bird flu operation, with a Rp 100 million (US$10,000) budget. The vaccine situation is not clear either," he said.

 

[The Flying Dutchman]

-


<B><center>Sep 28 15:37
<font size=+1 color=green>Another Suspected Bird Flu Case Occurs In E Java</font>
<A href="http://www.antara.co.id/en/seenws/?id=6564">link</A>
Surabaya, E Java (ANTARA News) - SP, a woman from Ponggok village, Kota sub district, Pacitan district is currently under intensive treatment at the Dr Soetomo Hospital here for suspected avian influenza.</B></center>
"Judging by her current condition, we strongly believe she has avian influenza. For confirmation, we are still waiting for the results of laboratory tests being done in Jakarta," JP Palilingan, a member of the Dr Soetomo Hospital`s team of physicians handling bird flu cases.

He said the woman was still in critical condition as she was having a respiratory problem, suffering from coughs and high fever.

She was brought to the hospital last Friday for a respiratory problem and a complaint about her lungs. She was moved to an isolation room on Monday as her condition was deteriorating , he added.

Dr Soetomo Hospital director Slamet Riyadi Yuwono separately said the woman`s condition was categorized as being one level above "suspected" bird flu.

"We have sent samples of her blood and saliva to Jakarta for further conveyance to the WHO laboratory in Hong Kong. Hopefully, we will know the results soon. But her condition is, indeed, one level above suspected," he said.

Anis Kusnaedi, one of the woman`s relatives said Sp had been keeping many poultry.

"Before she fell ill, one of her poultry died and after that she got breathing porblems," Anis added.

Indonesia announced its first human avian influenza case last July when Iwan Siswara Rafei and his two daughters died. So far, five people have been killed by the deadly virus, following the death of Rini Dina of South Jakarta on September 10 and Karwati of Cikarang, West Java on September 26.(*)

[editied to add]:

Please feel free to make comments etc on this thread (It brings the thread back to the top - and I won't ride herd on it; if there is no interest in H5N1 - then the thread should fall away - Shakey

 

[juco]

-


Please feel free to make comments etc on this thread (It brings the thread back to the top - and I won't ride herd on it; if there is no interest in H5N1 - then the thread should fall away - Shakey

The only comment I can think of right this minute is... Lord, have mercy on us.

Thanks, Shakey.

 

[garnetgirl]

Thanks, Shakey.

Please keep posting as you are able. We really need to keep on top of this.

garnetgirl

 

[eens]

I have been pretty much ignoring this topic............ until now. It has my full attention!

 

[Claudia]

I'll comment yet again how astonished I am that the people who post here seem to have very little interest in something that really could be a danger, while wasting time and type on conspiracy theories and nonsense. This is a serious issue, which I follow on a daily basis. As Shakey says, if no one is interested, this thread will fall by the wayside, which is exactly what I fear will happen.
Everytime I have tried to comment on this issue, it seems to be dead in the water before I can finish posting.

Because I follow it so closely, I can say with some confidence that the title of the thread - that H2H transfer is occurring - has not been proved and may be a false statement. Nothing in the cut and pasted articles documents H2H, although the patient in Java may eventually fall in that category. All information coming out of the area is very suspect as to accuracy For anyone who might have been interested in obtaining Tamiflu or other anti-viral drugs, it may already be too late to do so. We were fortunate in that when the situation was explained to our physician (two months ago), he wrote us prescriptions for Tamiflu and amantadine and antibiotics for post-flu complications. I believe that soon physicians in this country will be told not to prescribe in order to conserve the amount of anti-virals available.

I would suggest that anyone with an interest in staying alive should read Dr. Niman's Recombinomics site daily -
and I say daily because this is a rapidly evolving situation. This is one of the sites that the above information was from. Everyone here claims to be so interested in prepping - well, prepping for a possible pandemic should come at the head of the list, and it's not exactly the same as prepping in case the boogie men crawl out from beneath the bed and cause trouble.

I would also suggest that anyone who remains ignorant of the specifics do a simple Google search on "H5N1" or "avian influenza". Although it is difficult at times to tell what is propaganda and what is truth, it would be far better than being as uninformed as I think most people are. Better yet, first get a good book about the 1918 pandemic so you'll have some background - this is a possible scenario for future events if H5N1 has its way.

Even now, it is but one plane ride away. One infected person flying from Jakarta to any number of international airports could spread this around the world. That person could have taken his trip . . . yesterday.

 

[Ironhand]

I've also been following this issue around the web and am very appreciative of the indepth information here. Please keep posting.

 

[Doomer Doug]

THIS IS IT!

This is what I have feared ever since I wrote The End of Antibiotics. Human to Human transmission is the final straw. You will recall one of my "predictions" for this year of Toto was a global bird flu pandemic by Christmas. we are on track for that. The planet will pay dearly for the corruption and incompetence of Red China. I have also been following bird flu closely and have seen a pattern emerging.

We are indeed, just a plane away from direct introduction into the continental USA. Add in all the disease ridden illegal immigrants, plus the collapse of the health system in the wake of Katrina and Rita, well you get the idea.

It is certainly ironic that TEOTWAWKI begins with hurricanes and a good old fashioned global pandemic or plague. I once read a book on the Black Death in Europe and its effects.

People who think this current order will continue to exist for a while longer are ignoring reality.

Once the plague, our own version of the Black Death, hits hysteria won't even begin to describe the reaction.

And it is here at TB2K where we have been following it. God I love this forum.

Bird flu coming to a town near you soon enough.

 

[The Flying Dutchman]

-There seems to be more *events* concerning H5N1. So if no one minds, I'll add what I am running into this afternoon (I usually hit the news late at night). But H5N1 isn't waiting for no one -

Shakey



<B><font size=+1 color=red><center>Reports of Widespread H5N1 Cases in Indonesia</font>
<A href="http://www.recombinomics.com/News/09280501/H5N1_Indonesia_Widespread.html">Recombinomics Commentary</A>
September 28, 2005
Till Wednesday struck 14.00 WIB, four new patients who it was suspected were infected by birds flu underwent the maintenance in RSPI Sulianti Saroso.</B></center>
The number of patients admitted to hospitals throughout Indonesia continue to rise. Media accounts described 12 recent admissions. At Sulianti Saroso there were four admissions yesterday and three more today.

However, there has also been reports of recent admissions in East Java (35F), central Java (58M), Bandu (1.5 F), and Bandar Lumpung (20 M and brother)

The four admissions at Sulianti Saroso yesterday included two brothers, Arir Nurwitano and Fuazan Tonq, (10M and 8M) who had been to Rangunan Zoo, a 3 year old child, Ni Made Superior, who lived near a chicken slaughterhouse, and Ahmad Zaenudin (23M), whose doves had died.

Today, Syifa, a 10 month old girl, 25 year old Salmet Wibodo, and 27 year old Adam Budi were admitted. They also had ties to poultry.

The large number of cases, spread across Indonesia is cause for concern. Most of these patients initially check into primary care facilities where no clinical samples are collected. By the time they are referred to a facility specializing in infectious diseases, the virus has moved from the upper respiratory tract to the lower respiratory tract, so PCR tests are negative. Similarly, serum samples are then collected too early for significant antibody titers to have developed, so those HI tests are also negative.

Thus, sample collection is far from ideal, and most tests are negative even though it is likely that many of the patients are H5N1 positive. If the patient recovers, there is no autopsy material, and in many cases autopsies are not preformed on fatal cases because of religious prohibitions.

Thus, many of the H5N1 infections are not detected by initial lab tests, so the true extent of H5N1 infections in Indonesians is largely unknown.

 

[MaureenO]

Whoa.

Maureen

 

[The Flying Dutchman]

-


<B><center>Jakarta, Wednesday, July 27, 2005 12:00:00 AM
<font size=+1 color=brown>Sick Jakartans Urged to Test Blood for Bird Flu</font>

Uploaded by : Umar Firdaus, MD, M.Kes.
<A href="http://www.asean-disease-surveillance.net/ASNNews_Detail.asp?ID=3234">ASEAN DISEASE SURVEY</A>
Jakartans are now much more aware of the deadly bird flu, with more of them going directly to one of the two referral hospitals in the capital to thoroughly check their colds and flus. </B></center>
However, it is not all that easy to get a blood sample checked for the disease.

The Indonesian Ministry of Health's director for animal-related diseases control, Hariadi Wibisono, explained that people who had clinical symptoms similar to avian flu and had a history of direct contact with infected animals should have themselves examined at the hospitals.

"The hospitals will determine whether their reports match the criteria and then take blood samples to examine the possibility of other diseases that have similar symptoms to avian flu."

However, if there were no declared diseases other than bird flu, the patient's blood serum would be taken to the ministry's laboratory for serology and virology tests.

The serum would also be taken to the World Health Organization's referral laboratory in Hong Kong to undergo international procedures for high-fatality diseases, "not because we doubt our own tests," said the ministry's virology laboratory supervisor Bambang Heriyanto.

The government has officially appointed Persahabatan Hospital in Rawamangun, East Jakarta, and Sulianti Saroso Hospital in Sunter, North Jakarta, as referral hospitals in response to the recent deaths of three Tangerang residents from bird flu.

Last Friday, AS, 26, was taken to Sulianti Saroso Hospital with a high fever, severe coughing and diarrhea.

On Sunday, AB, 31, a photojournalist, signed himself into the hospital to be treated in the isolation room as he was often exposed to infected poultry while covering news stories on bird flu.

But the doctors confirmed on Monday that the two residents of Tangerang were not infected with the virus.

Sardikin Giriputro, head of the hospital's special team, said that AS only had a diarrheal disease.

Team member Ida Bagus Sila Wiweka said that AB was diagnosed as having typhoid and bronchitis.

Sardikin said that both patients, AS and AB, would require further observation for the next several days while waiting for the results of blood tests from the health ministry's laboratory.

"Should the lab results show normal conditions and should the patients continuously have no coughing and high fever, we can send them home," he added.

Separately, an officer from the health ministry's research and development agency reported that it had received a letter from the Cipto Mangunkusumo General Hospital (RSCM) concerning a patient showing clinical symptoms similar to avian flu. "We received a letter last Friday reporting that a 50-year old man from East Jakarta died of symptoms similar to avian flu," said the officer, who asked for anonymity.

The man, who died on his fourth day in RSCM, had come in with an acute pneumonia and had a progressive pulmonary infection on his second day treatment. Investigations showed that he sold poultry for a living.

The handling of the case was apparently not well-coordinated with the ministry's laboratory claiming not to have taken and tested any samples from the man.

However, it had received a report from the Jakarta office of the U.S. Naval Medical Unit Research 2 that the man had tested negative on both serology and virology.

However, the ministry's director general of disease control and environmental health, I Nyoman Kandun, said that any other laboratory conducting the tests should be under the ministry's supervision.

 

[The Flying Dutchman]

-


<B><font size=+1 color=green><center>China announces emergency measures to combat possible birdflu outbreak</font>

Last Updated 29/09/2005, 02:26:24
<A href="http://www.abc.net.au/ra/news/stories/s1470617.htm">ABC Radio Australia</A>

China has announced colour-coded emergency measures to avert and handle an influenza pandemic amid fears that a deadly strain of bird flu could mutate and infect millions of people around the world. </B></center>
The avian influenza that has killed 65 people in Asia, is believed endemic among the country's bird population.

The Health Ministry will set up a national anti-influenza leadership group and stockpile vaccines.

Four levels of alert -- blue, yellow, orange and red -- will indicate the seriousness of the outbreak.

The most serious level, red, will be announced in case of a consistent and rapid spread of new sub-type flu virus among the people, or if the World Health Organisation announces the outbreak of a flu pandemic.

 

[The Flying Dutchman]

-


<B><font size=+1 color=blue><center>Number of human cases of bird flu reaches 42 in Indonesia </font>
<A href="http://english.people.com.cn/200509/27/eng20050927_211105.html ">Xinhua</A>
September 27 2005
There are 42 reported human cases of bird flu across Indonesia but only 10 patients have been tested positive of bird flu, Minister of Health Siti Fadillah Supari said Monday in Jakarta.</B></center>
Six of the ten people infected with bird flu have died recently, the minister said.

Supari said bird flu cases have been reported from at least eight provinces in the country, with Jakarta having the highest case number of 28.

She made the remarks hours after the death of a 30-year-old housemother during intensive hospital treatment for developing bird flu symptoms, the six death of the Avain influenza ever reported in the country.

Source: Xinhua

vhttp://english.people.com.cn/200509/27/eng20050927_211105.html
__________________

 

[Cabal]

Where did the articles mention human to human transfer?

 

[The Flying Dutchman]

-
Cabal - back up and looked towards the bottom of the articles; you'll see a <b>Boldened</B> sentence-paragraph about H5N1 not easily transfering from one human to another.

 

[ittybit]

The pot boileth over...

Check this out - http://www.timebomb2000.com/vb/showthread.php?t=169732

Its already here in one form or another.

Considering the Philipines strikingly large # of 'dengue' diagnosis >250 cases, and considering the migratory paths birds are flying over in that area of the world, I believe we are seeing the first breaker of this pathological tsunami.

Its already here in the USA. The questions are, 'will it spread' and 'how'?

Nothing will be allowed to hinder international travel or commerce UNTIL people are dropping over dead all over the place.

A bit too late at that point.

The USA has extensive commercial ties with Asia.

The USA has extensive cultural interaction via tourist and immigrant populations that live here. The West Coast is an open portal for entry.

 

[ethan hunt]

shakey,

good job

i have tried to follow this as best as i can. things seem to be accelerating. this is what the experts said would happen, it now has a specific geographical pattern.

thanks

 

[CeeBee]

Thanks Shakey for the comprehensive updates. Keep up the good work.

I found it particularly alarming to read that large numbers of people were infected merely by being in proximity to H5N1-infected birds at the zoo. No direct contact. Formerly it was not considered easy to "catch" the bug from birds. It is now. And since it's in so many human hosts, with flu season coming on, it's all but inevitable that it will combine with human influenza and trigger a pandemic. It can only get worse from here on out.

 

[UnusualSuspect]

Well, I'm glad I have my big 7.8 ounce bottle of Sambucol. It seemed like a reasonable enough purchase, especially for a poor college student who can't afford 10 doses of Tamiflu.

 

[Gayla]

Bumping back to the front page, and thanks, Shakey!