indonesia

Red Dot: Positive Human Case. Red Only: Suspected Human Case

West Java

2/21/12

Name: 19 yo (F)

From: Tangerang

Adm: 2/12

Onset: 2/8 - fever

Notes: Health Team surveyed home & neighborhood, can't determine source.

Confirmed: Positive

DOD: 2/13

Bali

2/21/12

Name: WM (12) (M)

From: Badung

Adm: 2/21 Denpasar Sanglah Hospital

Recon: 2/16 Surya Husada

Notes: Family took him home after death.

DOD: 2/21

Confirmed: Positive based on PCR

Central Kalimantan

Name: M (49)

From: Desa Muroi, Kapuas Tengah, Palangkaraya, Kabupeten Kapuas

Onset: 2/17; day after eating dead poultry

Adm: 2/18 Rumah Sakit Umum Daerah (RSUD) Doris Sylvanus Palangkaraya

Recon: 2/18 Muhammadiyah hospital

Notes: Had 12 chickens, 3 died. Then they cut more chickens to make family dishes. 2/21: chickens tested positive for New Castle. Negative for H5N1. Patient improving health.

South Sulawesi

Gowa

5 Members of Single Family

2 Adults, 3 children

From: Gowa Reg., Pallangga Dist., panaikang Village

Adm: 2/21 Dr. Wahidin Sudirohusodo Hosp. Makassar

Recon: 2/16 Hospital Sheikh Yusuf

Name: Surti (32)

Name: Suci Maharani (3 months)

Name: M. Agung (6)

Name: Nephew of Surti, Suci Ramadani(7 months)

2/19: 5th person was treated at Sheikh Yusuf, w/sym's high fever & flu.

Notes: Friend: Daeng Kenang (40) said hundreds of chickens died suddenly in his home.

I also have another 5 Suspected in East Java from February 17th:

East Java

2/17/12

5 Suspected People

Name: Ponimah (50) Husband

Name: Karju (52) Wife

From: Petamanan Village, District of South Bugul, Makati City

[Jalan Wahidin Selatan, RT 2, RT3 / RW III Kelurahan Petamanan, Dist.: Bugul Kidul, City Pasuruan.]

Onset: 2/12 (according to quote from brother below)

Adm: Ponimah Saiful Anwar Hospital (RSSA) Malang 2/18

Reconciled: Ponimah to Soedarsono Hospital on 2/18.

Name: Jacob, brother Ponimah ""My brother suffered from fever, coughs and colds. This, since 5 days ago. Moreover, before he was suffering from a sore throat,"

Notes: "There were five people suspected of being infected and we took blood samples to be tested," said Kartika, officers Flu Pasuruan Bird Animal Husbandry Department, Friday (02/17/2012).

"4 other suspects monitored from their homes" (2/18).

Thanks to Commonground's: http://pandemicinformationnews.blogspot.com/2012/02/commongrounds-indonesia-case-list-map.html

Recombinomics Commentary 16:00
February 21, 2012

Denpasar Bird flu virus still a threat, a boy with the initials WM (12) died of the H5N1 virus is. WM is the origin of Badung, Bali
"Based on the PCR, he's positive, "he said. case of death of this child is the fifth death from bird flu virus that occurred in Bali.

The above translation describes lab confirmation of another fatal H5N1 case (12M) in Bali.  Earlier, sequences from a Bali cluster of three were released.  The sequence from the mother was a recombined sequence derived from the sequences from her children.  The sequences had multiple receptor binding domain changes, which may have been present in the Indonesian clade 2.1 H5N1 used in the Ron Fouchier transmission experiments, which began with three changes and acquired two additional changes.  The five changes in two genes represented previously reported polymorphisms, which were used in ferret transmission experiments.  The death of all 40 exposed ferrets has raised concerns that a lethal transmitting H5N1 could emerge in the near term.

The recent clusters in Indonesia and Egypt have raised concerns that the withholding of the details in the Fouchier and Kawaoka experiments continues to be hazardous to the world’s health.

Absence of Poultry Contact for H5N1 Bali Indonesia Fatality
Recombinomics Commentary 18:00
February 21, 2012

Of the interrogation Sanglah party, according to Ken, could not be ascertained whether the WM had contact with poultry. "The family is still denying that the victims had contact with poultry. We are therefore of bird flu team is digging deeper than where the victim of a virus," explains Ken. But from the VCR in Sanglah examination showed that the victim was positive for influenza WM birds. Due to the bad condition when taken to the hospital Sanglah, WM can only last for five hours and finally died at 03.00 pm, Tuesday (21/2) yesterday.

The above translation, describing the recent fatal case near Bali, Indonesia notes the lack of a reported bird contact.  This case follows a cluster of three with disease onset dates which supported human to human transmission, which was also supported by the recombinant H5N1 sequence from the mother (39M) of the first two cases (5F, 10M).
These lab confirmed cases increase concerns that the H5N1 in Indonesia is evolving toward efficient transmission.  Clade 2.1 was the source for the H5N1 used by Ron Fouchier.  After 10 passages in ferrets the virus had 5 chnages in 2 genes and 4 of the 5 changes have been found in published sequences.

This alarming development has been overshadowed by concerns of bioterrorism and an NSABB recommendation to withhold details.  This recommendation has been rejected by scientisis meeting in Geneva last week, who were given the details on the tranmssion studies.

The relative ease in the creation of a transmitting H5N1 or an H5 reassortant highlights the lack of preparation for a transmitting H5N1.
The current vaccine program has largely stockpiled older isolates, and although newer targets have been selected. Pandemic preparedness lags, and the only clade 2.1 vaccine target is the 2005 isolate from the initial Tangerang cluster.

Suspect H5N1 Cluster In East Java Indonesia
Recombinomics Commentary 14:30
February 17, 2012

Outbreaks of bird flu again attacked chickens in residential Wahidin Road South, RT 2, RT3 / RW III Petamanan Village, District of South Bugul, Makati City.

At least 80 chickens died suddenly from a week ago. In addition to attacking the chicken, the bird flu outbreak is believed to have infected a number of residents in these settlements. A total of five people are known to suffer from the disease with symptoms of fever, bone pain, and shortness of breath.

As experienced Ponimah (52). Since three days ago, he felt the symptoms of shortness of breath, cough, runny nose, watery eyes, and bone pain.

The above translation describes a suspect H5N1 cluster near Pasuruan, south of Surabaya in East Java, Indonesia.  Addition reports indicate the poultry associated with the suspect cases has tested positive for H5N1.
Symptoms in 5 residents in area raise concerns of increased transmission. 

The report being delayed at Science from the Ron Fouchier lab in the Netherlands used a clade 2.1 sequence from Indonesia to generate a transmissible H5N1 in a ferret model, which maintained its lethality.  After ten passes in ferrets, the transmitting H5N1 had 5 changes in two genes.

Release of five changes in this manuscript is long overdue. 

H5NI virus or commonly known as bird flu has mutated over the nature of change or development time, this is further strengthened by reports of a number of areas.  Even so, not yet ascertained the impact of the change.
  It is feared the virus could be more dangerous than ever before.  Further research is needed to ensure the fatality rate of the new virus.
  Head of Animal Husbandry and Health of Central Java Province, Semarang District Whitono reveals, some poultry that died of bird flu now has features that are not as usual, ie no black or bluish spots on the comb or body part that is not hairy.
 Meanwhile, Head of Animal Health Animal Husbandry and Animal Health in Central Java, Eko Sutarti revealed, though not sure about the new virus, characteristics of birds that died of bird flu part shifted.
  Usually the birds that died of bird flu are marked with blue or black spots on the comb or body parts that are not covered in fur.  Now the poultry that died suddenly without these spots were found positive for bird flu.
  Of Brebes, Central Java, reportedly, the body's defense system against virus attacks poultry in the region changed when compared with previous years. This is evident from the clinical symptoms found in cases of chicken deaths in the region last week.
 Head of Animal Health and Veterinary Public Health Veterinary Services Bradford, Jhoni Murahman say, around 2003, when he first outbreak of bird flu virus in Bradford, clinical symptoms of bird deaths at that time happened very quickly and in large quantities.  Physical signs in birds that died of bird flu is also very clear, that the body was black, very much saliva, swollen heads and blue crest on the head.

  However, at present, clinical symptoms are not very visible. Poultry deaths tend to be in unison, but one by one.  Body of dead birds as well just turn blue with not a lot of saliva and the head is not swollen.

25 Tail Poultry Sudden Death 
  London continues to increase alertness, following the discovery of 25 birds that died suddenly in some districts during 2012. . However, after checking through the rapid test, avian bird flu was declared negative.
   Bandung, Maria Dewi in Soreang, Sunday (12/02/2012) says, from the beginning of January 2012 to Sunday, it received reports of about 25 birds died suddenly.
  "There have been reports from some districts, namely Cimaung, Rancaekek, Nagreg and Soreang who reported any poultry that died suddenly. But after we checked, it turns out negative bird flu," he explained.
  It is said, if there are reports of dead birds suddenly, direct action by the parties Disnakan spraying disinfectant around the discovery of the dead birds.
 "In particular for this disinfectant we have not been scheduled. But there are reports of each case, we immediately move and do a rapid test. With the rapid test, in 20 minutes can be found out whether the results are positive or negative. In addition, we also do spraying disinfectant," he said .
  Although not yet found a positive poultry bird flu this year, but continue to increase vigilance Disnakan. Moreover, the previous year was found positive poultry bird flu in eight villages. Only when compared to the year 2010, that number has decreased.
  Maria further said, to prevent bird flu cases in the District does not happen again.  Bandung, it will continue to take preventive vaccination of pets, especially birds and the provision of disinfectants.
http://translate.google.com/translate?hl=en&ie=UTF8&prev=_t&rurl=translate.google.com&sl=id&tl=en&twu=1&u=http://esq-news.com/2012/berita/02/14/waspada-virus-flu-burung-mutasi.html

Recombinomics Commentary 14:15
January 25, 2012

 Now, allegations of similar cases are also found in West Jakarta, where a boy aged three years initials RV, a resident of RT 15/07 Cengkarengtimur Village, District Cengkareng , died on Monday (23 / 1) around 06.00 after previous intensive care at Friendship Hospital, East Jakarta.

Regarding the victim's body is covered a coffin and not allowed to open, say Parwathi, it was according to the procedure as a form of anticipation of the hospital for suspected cases of bird flu. Despite the negative results of bird flu, disclosed Parwathi,

The above translation describes the death of a suspect H5N1 case (3M) in Cengkareng, Indonesia, which is adjacent to Tangerang, where another suspect H5N1 case (18M) also died after testing negative for H5N1.  These two cases had bird flu symptoms and were buried in a sealed coffin, which is customary for H5N1 cases.

The failure to detect H5N1 in these two fatal cases in adjacent areas on the west side of Jakarta is in addition to the suspect case in Bekasi, on the east side of Jakarta, as well as the confirmed cluster in North Jakarta, where the second case initially tested negative for H5N1.

These five cases in the Jakarta area raise concerns that H5N1 is being more efficiently transmitted as it evolves away from the sequences being used in the H5N1 PCR test.

Recombinomics Commentary 12:45
January 25, 2012

Patient suspect bird flu, Rohmat (18), resident of RT 09/03, Ciodeng Village, Village Blooms Jaya, District Panongan, Tangerang regency, died after being treated for five days in critical condition in RSU Tangerang District, on Wednesday.

Previously the patient's condition was critical since it first entered isolation space bird flu," said Public Relations RSU Tangerang Regency Ahmad Muchlis when confirmed on her cell phone. According Muchlis, until now is still not clear whether Rohmat died from bird flu or not. "There is no certainty. But the results of observations in the home environment Rohmat by the Health Department yesterday was negative bird flu," he said. He added that the next will Rohmat shrouded corpse in the mortuary. Chances are, he said, Rohmat not take home to his family home. "The possibility is not taken home, but immediately buried," explained Muchlis.

The above translation describes the death of a suspect H5N1 case (18M) in Tangerang, Indonesia, which is on the northwest side of Jakarta.  The death follows a confirmed H5N1 cluster in North Jakarta, as well as suspect fatal cases in Cengkareng, which is adjacent to Tangerang, as well as Bekasi, which is on the east sided of Jakarta. 

Although the three most recent cases have not been H5N1 confirmed, the second case (5F)  in the North Jakarta cluster tested negative multiple times before H5N1 confirmation at autopsy, raising concerns about the sensitivity of the H5N1 for the bird flu currently circulating in Indonesia.
False negatives in Indonesia are common because patients are tested after the start of Tamiflu treatment, which lowers the RNA level.  Patient who recover continue to test negative and are not reported as confirmed cases, while those who die have increasing H5N1 RNA levels, which eventually test positive.  This testing procedure accounts in part for the high case fatality rate, which ha been near 80% in Indonesia since the first confirmed cases were reported in 2005.

However, at least two the three cases adjacent to Jakarta have tested negative, even though the patients have died with H5N1 symptoms, and have been quickly buried, per protocol for confirmed H5N1 cases.
These recent fatalities and the failure to link the cases to infected poultry, has raised concerns that the H5N1 in Indonesia is being transmitted more efficiently, as seen in the confirmed cluster in North Jakarta as well as the Bali cluster.

Sequences from the Bali cluster included receptor binding domain changes (D187N, A188G, R193M), as well a clear examples of recombination.  Moreover, these chnages are likely to lead to immunological escape.

Release of sequences from the North Jakarta cluster would be useful.

Blue dot postmark is confirmed poultry. Blue postmark is suspected poultry. Red is human:

Back in October, 2011, the Chickens started to die in the Bone Regency. We reported it on Nov. 25th. Article found here:

16/10/2011 10:04

Liputan6.com , Bone: Hundreds of chickens died suddenly in the Village Ponceng, Bone regency, South Sulawesi. Allegedly the chickens died of bird flu that is circulating in the area. Dead chickens salivate.

On January 11, we previous reported a family of 6 in S. Sulawesi. 3 Family members were dead, and the other 3 were put in ICU, along with 15 others. Article(s) can be found here, here, here, here, and here.
Our details are below.

Date of article 1/10/12 

3 Family Members Died in house with Same Complaints 

Below: Father, Mother, 11 yo 

Name: Risnawati or Nismawati (16) 

Name: Nurbaya 

Name: Arsil

Name: Wahid

From: Relemba, Tombolopao Dist., Gowa

Sym’s: high fever, sore throad

Adm: RSU Wahidin (a referral hospital for bird flu)

Notes: All live in same home. All had same complaints. Health Department went in to village, 1/7. Family & neighbors taken blood samples. 15 people were brought to Wahidin Hosp. Suffering from severe clinical symptom’s.

 

Adm: 14 civilians in Intensive Care, RSU Wahidin

 

Deaths:
3 Brothers

Name: Zul Asril (6)

Adm: 12/20 - Pustu Health Ctr.

Sym’s: high fever sore throad/bleed when spitting

Diagnosis: tonsillitis pharyngitis/acute inf. Resp. tract.

DOD: 12/26/11

 

Name: Amiruddin (17)

Adm: None. Brought to Traditional Healer.

Sym’s: same as brother Zul

Onset: 12/25

DOD: 12/30/11

 

Name: Nurmiati (14)

Adm: none

Sym’s: sore throat

Onset: (?) Drastic decline on 12/31.

DOD: 1/3/12 Died on way to health center

 

On 1/20, Residents were brought to the hospital in N. Sulawesi located here.
Excerpt:

Shocking, bird flu virus (H5N1) that is very deadly if contracted in humans, was endemic in the region Kanonang Kingdom, Western District Kawangkoan, Minahasa regency. A number of residents who allegedly exposed to the virus was rushed to hospital and 2740 chickens and ducks dimusnahan, Friday (01/20/2012).
"The incidence of chickens died suddenly had occurred from late December 2011. Until now there are chickens that died suddenly," he said
Head Distanak North Sulawesi Province, Johanis Palenewen said, according to procedures for handling bird flu, if there is one area of ​​bird flu infected poultry, all poultry population in the area must be destroyed.
"Culling of poultry has been within the rules. We found no positive poultry infected with bird flu, poultry populations so that all must be destroyed. This is done to break the spread of bird flu virus," he said.

In an article, 1/20, 2 boys are hospitalized, suspected of bird flu, posted here and here:

Unexpected Observations Diskes Minahasa boy Bird Flu, Friday, January 20, 2012 16:59 pm "But we will continue to observe its development. We are concerned lest the later symptoms appear several days after the sudden death of poultry at the scene," he said. Manado (North Sulawesi Reuters) - North Sulawesi Provincial Health Office observe the two boys suspected bird flu in the village of Kanonang, District Kawangkoan, Minahasa regency, North Sulawesi Province.

"There are two three-year-old boy and 12 years, but both had to go home to his village. We are still observing to see the development of a sequel," said Head of Controlling Health Problems (FMD) Diskes North Sulawesi Province, dr Lampus Jemmy, in Manado, on Friday.

He said the two boys was observed after feathered friends around him died suddenly and unexpectedly have a fever.

Article dated January 21, that tells of the poultry dying with absolutely NO symptoms.
Excerpt:

Hundreds of chickens owned by residents of Environmental Makammu 2, Village Bulukunyi, District of South Polongbangkeng, in an instant died suddenly, Friday, January 20.

The incident shocked the owner of the chicken. Worried about bird flu, chickens that died immediately annihilated by dumped and buried. Residents later reported the incident to the related department.

"There is no previous symptoms. But before dying chickens bowed his head bowed. After five minutes later, the chicken is dead," said one resident, Dg Nuntung. Until yesterday afternoon, his ten chickens died.
Neighbors Nuntung Dg, also experienced the same event. Fourteen of his chickens, died suddenly.
"One chicken bangkok kasian I die, too. Now live chicks remaining," said Dg Nanring.

Do not want to take risks, a number of teams from the field of Animal Husbandry Takalar immediately took to the field. They took samples of dead chickens and chickens live who are ill to be examined the scene.

"The chickens are infected with virus positive ND (newcastle disease), not the bird flu. ND virus is not contagious to humans, but its spread to other chicken fast enough," explains Head of Livestock Department of Agriculture and Forestry Takalar Ghani Muhammad Ridwan.

He also suggested to conduct spraying disinfectant on the chickens are still alive. Ridwan also said, live chickens infected with ND virus can still be consumed as long as it is cooked to perfection.

"To destroy this virus is rather difficult. Control can only be done by way of vaccination. It is common place, as it related to weather factors. So that affect the health of chickens that are easily infected with ND virus of this disease," he explained.

To obtain more complete results, it also brought some samples to be tested in depth in the laboratory.
http://tinyurl.com/7847moc

source: http://pandemicinformationnews.blogspot.com/2012/01/indonesia-commentary-on-sulawesi-h5n1.html

Recombinomics Commentary 16:30
January 19, 2012

" Because of his condition continued to decline, eventually the patient died on January 16, 2012 at around 2:00 pm.

Bird flu actually detected on her 5-year-old woman with the initials U.S. in Tanjung Priok, North Jakarta, Jakarta Province. This is confirmed by the Ministry of Health Directorate General of Disease Control and Environmental Health. New cases of H5N1 have also been confirmed by the Center for Basic Biomedical and Health Technology, Health Research Agency".

The above translation describes another fatal case (5F) in Tanjung Priok in North Jakarta who was the sister of a WHO confirmed case (23M who died January 7) who raised pigeons.  The 9 day gap in dates of death raises concerns that the cluster was due to human to human transmission. 

This Indonesian cluster follows a cluster in Bali, which involved a mother and her son and daughter.  Those sequences which had multiple receptor binding domain changes (D187N, A188G, R193M) were released almost immediately, and release of sequences from this cluster would be useful.

These receptor binding domain chnages continues to increase concerns that the multiple chnages in circulation will recombine to produce combinations similar to those censored at Nature and Science which produced efficient transmission in a ferret model.

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.

Recombinomics Commentary 14:30
November 7, 2011
The Indonesian Ministry of Health, (NIHRD-MOH) has released HA sequences (A/Indonesia/NIHRD11766/2011, A/Indonesia/NIHRD11771/2011,  A/Indonesia/NIHRD11815/2011) at GISAID from the H5N1 cluster (5F, 10M, 25F) in Bali (collected on October 7 and 16).  The Indonesian MoH is commended for the rapid release of these important sequences.

The sequences had a series of receptor binding domain changes flanking position 190 (D187N, A188G, R193M).  This series is remarkable similar to changes associated with the fixing of oseltamivir resistance in seasonal H1N1 (all HA sequences changed position 193 (A193T) with a variety of combinations at positions 187, 189, and 196).

R193M was also present (see list here) in the 2011 West Java sequence (A/Indonesia/NIHRD11073/2011) recently released, as well as the prior human 2008 sequence from Indonesia (A/Indonesia/7261/2008, A/Indonesia/7272/2008, A/Indonesia/8228/2008), and escape mutant from the second confirmed human case (37M) in Indonesia, A/Indonesia/05/2005, which was also a cluster.

The finding of an R193M escape mutant, as well as the presence of this receptor binding domain change in recent human cases, including the Bali cluster raises pandemic concerns.

Recombinomics Commentary 12:20
November 3, 2011
The National Institute of Health Research in Jakarta, Indonesia has released the HA sequence (at GISAID), A/Indonesia/NIHRD11073/2011, from a fatal H5N1 case (2M) from West Java, Indonesia collected on January 28, 2011. 

This is the first public human H5N1 sequence from Indonesia since 2008 and the release is to be commended.

The closest demographic match from WHO reported cases is a fatal case (2M) in Depok City, West Java who developed symptoms on February 3, 2011 and died February 6 (an unusually short time frame).

The HA has two significant receptor binding domain (RBD) changes, Q226K and R193M. 

Position 226 is one of the two positions (the other is 228), which change binding preferences from avian gal 2,3 to mammal gal 2,6 which is dominant  in the upper respiratory tract of humans, facilitating transmission.

Position 193 changes (H3 numbering) have been noted in the establishment of adamantine resistance in seasonal H3N2 (S193F) or oseltamivir resistance is seasonal H1 (A193T).

Thus, these two important RBD changes may facilitate H5N1 transmission and emergence in humans.  Release of H5N1 from more recent fatal human cases in Indonesia, such as the Bali cluster would be useful.

Jakarta Residents should be wary consume chicken. Therefore, 80 percent of shelters where poultry infected with avian influenza virus show.

Until now undertaken efforts to address Jakarta Governor Fauzi Bowo related to this issue is still very minimal.

Head of Operational Office Indonesia-Dutch Partnership on Highly Pathogenic Avian Influenza (HPAI-IDP), Ivo Claassen, said, based on surveillance in some poultry shelter facilities in Jakarta and the results of research conducted in 2007 and repeated again in 2009, showed 80 percent of the houses shelter these birds infected with avian influenza virus.

"The results of this study we have given to the government of DKI Jakarta. This became the basis for restructuring. But for some reason, the improvement was not so done. So, the situation has not changed," said Ivo told the press at the close of the IDP-HPAI project on Wednesday ( 11/02/2011).

According to him, in fact the source of the virus exists outside of Jakarta. However, the virus was brought to Jakarta for the distribution system that is not true that birds spread the Jakarta area.

"It's a matter of marketing chains that should receive immediate treatment," he explained.
Chairman of the Control Unit and the Control of Avian Influenza Ministry of Agriculture, M Azhar said the results of research that the government of Jakarta has been given a recommendation.

One was to make regulations regarding the prohibition of live birds enter into Jakarta. In the field realization is to make integrated slaughterhouse.
"Capital regulation restrukurisasi make poultry market chain, although not yet optimal path. The strategy places relocated poultry pieces making it easier to control and reduce risk, is currently being pursued," he said.

http://www.tribunnews.com/2011/11/02/80-penampungan-unggas-di-jakarta-terinfeksi-flu-burung

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.