bali

Recombinomics Commentary 16:45
November 7, 2011
 189, which corresponds to antigenic site B of H3N2, may represent an immunodominant epitope,

The above comments, regarding the receptor binding domain change R193M (H3 numbering), found in an escape mutant  from A/Indonesia/05/2005, from the second confirmed H5N1 case (37F, fatal) in Indonesia,  are from a paper entitled “Broad Cross-Protection against H5N1 Avian Influenza Virus Infection by Means of Monoclonal Antibodies that Map to Conserved Viral Epitopes”.  A position 193 change (S193F) was associated with the fixing of adamantine resistance (S31N in M2) in seasonal H3N2, as well as the fixing of oseltamivir resistance (H274Y in NA) in seasonal H1N1, as detailed in “Emergence and Fixing of Antiviral Resistance in Influenza A Via Recombination and Hitchhiking”.  Thus, the finding of R193M in all of the 2008 and 2011 human H5N1 sequences from Indonesia (see list here) signals the importance of position 193 in seasonal H3N2, seasonal H1N1, and pandemic H5N1.

The similarities between seasonal H1N1 and pandemic H5N1 are striking. In late 2007 / early  2008 oseltamivir resistance began appearing in multiple countries in the northern hemisphere in patients who had not been treated with oseltamivir (Tamiflu). All sequences were from clade 2B (Brisbane/59) and the frequencies varied (highest in northern Europe, including Norway where initial cases were reported).  A subset of those cases had A193T.  In the 2008 southern hemisphere flu season, the frequency of H274Y rose to 100% in South Africa and A193T was in the dominant sub-clade.  Similar sequences were found in Australia, and in late 2008 the 100% frequency for H274Y spread throughout the northern hemisphere.  Virtually all sequences had A193T as well as changes at two or more flanking positions (187, 189, 196).  These combinations likely facilitated immunological escape, from responses to prior infections or vaccinations.

The sequences from the three Bali fatal H5N1 cases have a series of changes, D187N, A188G, R193M) that are remarkable similar to the locations and combinations of changes seen in seasonal H1N1, and likely represent similar immunological escape from human immunological response, facilitating spread and cluster formation.

Once again the Indonesian Ministry of Health is acknowledged for its rapid release of these important sequences, which highly the importance of transparency and increased surveillance.

By reason of the image of tourism, the provincial government of Bali has chosen not to announce the status of Extraordinary Events (KLB) bird flu in humans in Bali.Though based on a ministerial decree kesehatah (Health Minister) in 1371 In 2009, the status of bird flu in Bali has been entered in the status of an outbreak, after the death of two sisters from Bangli District Sanglah Hospital in Denpasar. 
Nyoman Sutedja Simakrama when met after the ceremony the Governor of Bali in Renon (29/10) image reveals a reason other than tourism, the status of bird flu outbreaks have also not announced because of bird flu in general has been endemic in Bali since 2007. Status of bird flu outbreaks have also not announced to avoid unrest in the community. 
"Not for political reasons, because otherwise disturbing the public does not want to eat chicken's multiple effects, which the farm could go bankrupt, the public be not eating, nutrition into malnutrition," said dr. Nyoman Sutedja. Nyoman Sutedja. 
Sutedja confirmed although not announced the status of the bird flu outbreak, but the standard of care and prevention of bird flu in Bali in accordance with the standards and protocols outbreaks. (mlt) (MLT)

Mother and Child''Suspect''Bird Flu Denpasar (Bali Post) -

Suspected of having bird flu, mother and child from Banjar Pande, Abiansemal, Badung, each Ni Nyoman S. (42) and Ni Kadek S. (10), Saturday (29/10) yesterday, was treated at Sanglah Hospital. Both were treated intensively in the living bird flu Sanglah Hospital. Both patients were referred from the Hospital Ship, Friday (28/10) and then, at 15:32 pm by ambulance.

According to the Head of Public Relations Sanglah Hospital, dr. Kadek Nariyantha, patients present with complaints of fever, fever, and cough. Although referred to the status of suspect bird flu, but the history of contact with poultry remains unclear. Meanwhile, the lab results for the two patients are still not yet out, so to treatment while the patient is treated in accordance with SOPs handling of bird flu.

It is said, while the second condition of the patient is still stable. That is, the patient had no heat or cough again.

With the receipt of two patients suspect bird flu origin Abiansemal, Badung, at Sanglah Hospital, then throughout the year 2011 the total number of suspect bird flu patients who received approximately 20 people, two of whom tested positive for bird flu and eventually died.

108CSR.com - The bird flu virus has claimed three victims in Bali, Wayan brothers Ari Aldiawan and Nengah Rica, along with their mother, Ni Wayan Purnami. All three are citizens of the Village Jehem, Bangli regency, Bali.


But the Governor of Bali, Made Mangku Pastika, not too worried about the bird flu virus will develop into a plague. According to him, Bali has been experienced to handle the bird flu virus. "We are very experienced. All appropriate SOPs already set standards. Living community participation needs to be improved to prevent the spread of the deadly virus," said Pastika in Bali Parliament House on Friday (21/10).

Pastika said the Provincial Government of Bali has been attempts to localize the birds and make the vaccine. "I appealed to the district government is also doing the same thing," he said. During this time, continued Pastika, has never been any protest from the central government and relevant international world of bird flu in Bali, because of all SOPs handling of bird flu has been conducted properly.

Meanwhile, the rapid test (rapid test) has shown, that the 62 villages in Bali have been infected. Rapid test were retested several times in a number of laboratories, and the result is the same, namely 62 birds in the area of bird flu positive.

http://www.108csr.com/home/news.php?id=2651

Recombinomics Commentary 13:30
October 17, 2011

Four residents of Central Lombok, West Nusa Tenggara, were treated in isolation rooms General Hospital (RSU) province of West Nusa Tenggara (NTB) as so suspect the H5N1 virus (bird flu). The four residents of Central Lombok each of initialed ADT (11 months), SHN (56), STK (10) from Peringgarata village, Central Lombok, and DSH (5 months) from Semayan, Central Lombok.

The above translation described four hospitalized suspect H5N1 in Central Lombok, which is just east of Bali, where a fatal H5N1 cluster of three has been reported.  Two of the three fatal cases have been lab confirmed locally, but the Indonesian Ministry of Health and WHO have not acknowledged any of these cases.
 
However, H5N1 confirmations are typically delayed.  The most recent confirmed H5N1 case in Indonesia died in Jakarta on August 25 after developing symptoms on August 8.  This case was not reported by WHO until October 10, although IHR requires reporting within 48 of lab confirmation.

Recently, media reports cited the spread of H5N1 in poultry in Bali, raising concern that the H5N1 has evolved to avoid prior immunological responses.  H5N1 has been endemic in Indonesia for many years and Indonesia no longer reports H5N1 poultry cases to OIE.

Monitoring H5N1 in humans is difficult because the most recent public sequences (at GISAID) are from patients infected in 2008, although all human and poultry H5N1 from Indonesia are clade 2.1.

Timely reporting of human cases and release of current H5N1 cases is long overdue.

machinetranslation

"Increase Bird Flu death toll '

The [number of] victims died from bird flu in Bali, is increased.

Biological mother of two children who died from bird flu in Bali, died at her home. Before burial, the officers took a blood sample suspected suspect bird flu in the village Jehem Tembuku Bangli district of Bali.The victim is the biological mother of two children who a few days ago died in hospital Sanglah Bali positive result contracted bird flu. She experienced symptoms of fever and heat, although the results of her blood tests last week declared negative bird flu . She died two days after leaving the hospital treatment room Bangli.

Relatives and families of victims, including her husband, wept as the bodies were taken to be treated like a corpse ambulans.Jenazahnya suspect bird flu. The whole etugas wear sterile clothing and cover the bodies obliged to use a mask.

Anticipating the spread of the H5N1 virus, Department of Health and Husbandry Bangli, spraying disinfectant around the victim's home. The remaining birds were still alive immediately burned en masse.


http://news.mnctv.com/index.php?option=com_content&task=view&id=18616&Itemid=14

Recombinomics Commentary 12:20
October 17, 2011
Biological mother of two children who died from bird flu in Bali, died at his home. Before burial, the officers took a blood sample suspected suspect bird flu in the village Jehem Tembuku Bangli district of Bali. The victim is the mother of two children who a few days ago died in hospital Sanglah Bali positive result contracted bird flu. He experienced symptoms of fever and heat, although the results of his blood tests last week declared negative burung.Ia flu died two days after leaving the hospital treatment room Bangli.

The above translation indicates the mother of the two fatal cases in the Bagli district in Bali, Indonesia has also died.  Although the earlier test on the mother was negative, she had H5N1 symptoms, including a drop in platelet count.  Moreover, the delay in the date of death strongly suggests human to human transmisson.

Negative H5N1 results for Indonesian patients who recover are common, but confirmation of fatal is more frequent, leading to a case fatality rate of over 80%, which has been the situation in Indonesia since the first confirmed H5N1 cases in 2005.  The Ministry of Health and WHO have not reported H5N1 confirmation of any of the three fatal cases, which is also not unusual for Indonesia.  IHR requires notification with 48 hours of lab confirmation of novel influenza cases, including H5N1, but several years ago Indonesia announced reporting changes for H5N1 cases.  The timing of notication of WHO remains unclear, but WHO announcements of confirmed cases follows announcements by the Indonesian Ministry of Health.

In addition to the three fatal cases in Bali, four additional suspect H5N1 cases have been hospitalized in central Lombok.. which is east of Bali