Indonesia registered its 51st official case and 39th death this week, a 13 year Jakarta boy who had helped his grandfather slaughter sick chickens, took sick a week later and was dead less than a week after that. There’s more discouraging news from this benighted bird flu hotspot.
The Indonesian Ministry of Health says the people in the village where the large family cluster with human to human transmission have refused to be tested or have their chickens tested. WHO has been saying repeatedly that there is no evidence of infection beyond blood relations in this cluster (Jakarta Post). If many villagers refused to be tested, how informative is this statement? Does it mean that all plausible contacts have been tested and found negative or does it just mean that they don’t have evidence? We also learn that the virus from the family cluster did in fact show some mutation, despite earlier denial by WHO this was so. WHO statements were reported in various ways, including “no significant mutations,” but they have done little to clarify what they mean. Now the line is that the virus isolated from one of the cases has changed but not in any “major” way. Presumably this means it is not a reassortant. What else it means is unclear, since we are still in the dark about the changes that would signal enhanced transmission probability between people.
Keiji Fukuda, WHO’s coordinator for the Global Influenza Program in Geneva, said the Indonesian case appears to resemble other family clusters where limited human-to-human transmission occurred following close contact. He said scientists must find out whether anything is different about the way the virus is behaving.
“The really critical factor is why did that cluster develop?” he said. “What’s the reason why people in a cluster got infected?” (AP)
How do they know the changes seen in this virus are not related to critical factors that allowed the cluster to develop? What are the changes that were seen and why aren’t the sequences being deposited in GenBank? If it is the Indon government preventing this, let’s hear it. If it is scientists or WHO or some laboratory dragging their feet, let’s hear it. We”ve tied to be understanding here and I think we’ve cut WHO quite a lot of slack. But our patience is at an end.
Meanwhile the bad poultry infection we thought we knew about turns out to be worse than we thought.
“We thought there was dramatic underreporting, but we never imagined that it would be so pervasive,” said Tufts University’s Jeff Mariner, who is working with the U.N. Food and Agriculture Organization in Jakarta.
He spoke on the sidelines of a three-day meeting that wraps up Friday in the nation’s capital attended by some of the world’s top bird flu experts.
Mariner is coordinating an FAO program that trains local surveillance teams to conduct field interviews with farmers to track backyard poultry that have suddenly died. The teams then use bird flu test kits to identify whether bird flu is to blame.
In the 12 pilot districts on Java Island, the teams detected 78 poultry outbreaks from January to May — roughly one in every 10 interviews resulted in bird flu, Mariner said. He added those numbers cover only about a third of each district due to a lack of manpower needed to conduct the interviews.
“Leaders are now realizing, ‘Boy, this is just the tip of the iceberg,”‘ he said Thursday. “Whereas before, district leaders were saying, ‘Well, we don’t really think we have it.”‘
There are plans to expand the project to Bali and Sumatra islands, but Mariner said the virus will continue to spread unless Indonesia can devise a coordinated approach for local governments to work together to control the disease.
Slaughtering and vaccination are now currently sporadic at best and often outbreaks in poultry are not reported until a human case is discovered.
“It’s gonna be a long struggle,” Mariner said. “It’s 300 million poultry … and it’s a rapid turnover in the population. Essentially, you get an entirely new population after six months.” (AP)
So the Indonesian news comes in three flavors: bad, worse and uninformative. WHO (or whoever has control) needs to release the sequences to GenBank. No one believes WHO’s characterizations any more. Their credibility is going down the toilet.