Another Indon cluster?

What is totally ignored is the desire of corporate executives and government officials in Indonesia and Thailand to conceal any evidence of human to human transmission; because if that information was publicized; the negative impact on the Indonesian economy could be profound.
Corporate profits in Asian countries are the first priority. If poor peasants and middle class people die of bird flu, who cares? Will corporations in Asia loose money if these non-consumers or consumers without much buying power, die? The answer is hell no.
What is being ignored is the destructive capitalist system which controls us all. The problem is not just in Indonesia. The problem is also here in the US.
There may be tremendous pressure on WHO employees in Indonesia, for them the conceal the truth. WHO employees do not want to offend the Indonesian elite. If they do, they may be thrown out of the country.
If you were an Indonesian corporate executive, would you want to announce to the world that a deadly disease, highly contagious to humans, was circulating in your country; and that it was out of control? If you were an American tourist, would you want to fly to Indonesia on vacation if you knew there was bird flu in the country, and that it had gone human to human? If that information was released regarding H5N1, it would cause corporate profits to crash.
Please remember that in the capitalist system, human lives are worthless. The only time a human life is considered valuable in the Market, is if a profit can be made. The reason it will be impossible to stop the spread of bird flu, is because the elite in the capitlist system will use their power to conceal its presence in humans, until it is too late.

william, it is pity you weren't commenting here when Juan was a frequent commentator. You two see things the same way.

IMHO, we're seeing the world pot coming to slow boil, cluster by cluster by cluster....

There actually are quite a few relationships, but the wire reports are slow and confused. There are multiple local media reports which include names of patients and hospital transfer details. One indicates the 35F mentioned above has tested positive. The two negatives will likely turn positive (both had pneumonia hnd contact with the H5N1 positive 9F and one is her cousin). In addition, the 9 year old daughter (there are 2 nine year old females) of the 35F also died, but had been diagnosed as typhus (no sample collected for H5N1 testing). The Cikelet subdistict is only 20 km in width, and most of the cases live within a few blocks or houses of each other (the hamlets have less than 100 people).

This is a major cluster with efficient transmission to humans and has several clusters within the cluster

http://www.recombinomics.com/News/08190601/H5N1_Garut_C2C.html

More details have come out today. Two of the earlier "rumored" fatalities (late July / early August) that WHO said were being investigated were siblings, and another 5 year old sibling was admitted today. There are also two siblings of another fatality with symptoms who had been given Tamiflu but not admitted (I still need to check to see if the two sets of relationships above are the same).

In any event, there are 1-2 more family links distinct from the 3 sets linked to the 3 confirmed positives (and the size of teh cluster is at least 14).

The efficiency of transmission to humans is clearly up (and one media report indocated the sequence in Garut was novel (did not match Karo or Bekasi).

The multiple transmisson at multiple foci are why the pandemic projections (and Tamiflu blanket) are utter nonsense (the assumptions for the projections are fataly flawed).

William: i agree with you 100%. The really stupid part of this is that in their failure to stop the pandemic at its source, or at least mitigate its spread by informing the public so they can take precautions like isolating themselves and avoiding travel, they doom the economy they are trying to protect to a far worse and longer failure, possibly irrecoverable. Governments seem to be short sighted in the extreme, they follow the policy of the ostrich, they follow the policy of the emperor's new clothes. They have no real plan other than "business as usual" in hopes the danger will pass and it will all go away. They've done it with global environmental change for decades, and they're doing it again. The best we can do is try to keep ourselves informed and know when to duck and cover. My own personal issue with this is that my own family members are of the ostrich ilk, ready only to believe the worst when it becomes the worst - which is when the government and WHO finally have to admit there is a global pandemic sweeping the world - and that is probably too late. So I don't know if they will survive this or not, and it's hard to let go of them.

The data out of Garut paints a pretty clear picture, How long it will take for wire services or testing to present the real deal is anyone's guess. However, the cases under "investigation" by WHO include two siblings (4M and 13F) who died on July 31 and August 1 with a "typhus" diagnosis. A 5 year old sibling was admitted today, strongly suggesting H2H (and I think another sibling is at home with symptoms). Another child (9F) was also diagnosed as "typhus", Her date of death isn't clear (probably late July / early August), but the 35F who died on Thursday is her mother. A cousin and playmate of another 9F who has died and tested positiev for H5N1 initially tested negative, although they were hospitalized with pneumonia. The cousin of another confirmed case died on Augst 5. Thus, there are four dead who were never tested for H5N1, and two more with pneumonia who tested negative.

Indonesia and the rest of the world have no clue about how many people have been or are currently infected with H5N1 in Indonesia because they are not tetsed or return false negatives. The above cases in Garut are in a small village with dead poultry everywhere (which are fed to the dogs or people).

Thankyou Harry for your efforts and informative posts on your website and this site. You are giving many of us the ability to prepare for any pandemic when it occurs. Thank you for this.

Harry

Thought you may be interested in this article below just out of Bloomberg re Resistance issues with Tamiflu.

Also what are your opinions on Long Acting neuraminidase inhibitors which are currently being worked on. Especially the Zanamivir based one and intravenous zanamivir (Relenza )

''Relenza isn't made in pill form because the drug can't enter human cells and tissues properly by that route, Jennifer Armstrong, a Glaxo spokeswoman said last month. Glaxo is in the early stages of studying the possibility of a version that could be administered directly into the bloodstream, she said.

``If an intravenous or oral preparation of zanamivir is finally available, it will replace oseltamivir whose only superiority is good systemic blood level,'' said Yuen.

http://www.bloomberg.com/apps/news?pid=20601102&sid=apT0bMPgell0&refer=…

I would also like to take this opportunity to thank you, Dr. Niman, for your tireless posting. I wish I could get a "day pass" to stop in and hear you speak Monday.

Apologies Henry

My sons name is harry.

Revere: this reminds me very much of the cluster of cases in Turkey, a situation that worried flublogia greatly, but obviously didn't turn out to be the start of a pandemic. I was wondering how you'd compare the new Indonesian cluster(s) to that, or to the Karo cluster, and whether you thought the danger was greater, less, or similar.

Thanks.

caia: I don't have enough information to make a comparison or even make a judgment about this set of cases and suspect cases in isolatation. So I'll just wait to see what develops. I'm not more alarmed at this point, just (appropriately) watchful to see what develops. We will be seeing more of this kind of thing as surveillance is ramped up and authorities become more accustomed to revealing what is going on.

I could kiss you, Revere, with all of your reason and measured logic.

Just a quick update. The 35F has now become an offial case. Her 9 year old saughter died earlier this month (typhus diagnosis, but biord flu symptoms). Several more cases have been admitted, ranging in age from 4 to 60. Some appear to be from new villages. One admission, may actually be a sibling of the 20M cousin of the first confirmed case, as well as another case, (13F) who died of "typhus" (both had bird flu symptoms). If true, one family would have two dead (20M, 13F), one hpositalized (5M?), one at home with symptoms, and a cousin that is confirmed (17M who is first confirmed and recovering).

Thus, there are now 3 officially confirmed cases, but all have dead or hospitalized relatives (and 2 have tested negative and are recovering from pneumonia - the negative data of relatives with serious symptoms remains VERY questionable.

The MR in Indonesia (all strains) is higher that was the case in Turkey. However, this assumes we know of all cases in which deaths didn't occur, which is probably not the case.

It's becoming increasingly clear that these strains are extremely virulent. After 48 hours it is doubtful whether any drug, Tamiflu, Relenza, etc. is going to make much of a difference in severe cases. The key is early treatment.

These cases have been traced to children feeding dogs sick or dead birds. The latest human sequences that have been anaylzed were not related to bird sequences. How long after feeding the dogs did the children get sick? Is it possible that the dogs get the flu from the birds and the virus further adapts to humans via the mammalian vector(dog)?
Have samples been taken from the dogs in question and sequenced? This would seem logical and prudent to me since they may be asymptomatic carriers. Why has this question not been addressed? Further, most of the human cases have been in children - who interact very closely with dogs, as any parent knows, and without washing after.
I am not an epidemiologist, but I would expect one of them to pursue this and report on it if only to dispel fears of viral adaptation and dogs(or cats) as carriers.
I read in one of the books on the Spanish flu that passage of a virus from person to person increases the virus' ability to adapt to the human species many fold, I think it was 40 times increases infectivity as much as a million times. Therefore every new cluster, especially the undiagnosed cases, has the potential to develop an ever more adapted virus. AND THIS PROCESS DOES NOT NEED ANOTHER, OLDER, ALREADY INFECTIVE HUMAN FLU VIRUS TO DO IT!
Comments Mr. Niman?

One report has it that a 35 year old woman has died in Cikelet, a village where a 9 year old girl and and a 17 year old male are confirmed cases. The male's 20 year old cousin died of presumed bird flu but was buried without being tested.

The 17 yr-old who was confirmed is named Umar. His male cousin aged 20, who presumably died of bf on Aug 5, was named Misbah.

Misbah's sister, Rubiyah (13), ALSO died presumably of bf -- BEFORE Misbah on Aug 1.

Another of Misbah and Rubiyah's siblings, Risman (5), is currently in hospital and is suspected of having bf. In addition, it's likely that at least one more sibling from this family has presented with symptoms and is being tested.

Thus, Rubiyah, who died three weeks ago, is most likely the index case for this fairly large family cluster which involves at least 4 or 5 (or more) cases.

For a (lengthy) discussion, see here >> http://www.flutrackers.com/forum/showpost.php?p=26438&postcount=65

Also >>

Text from original Indonesian news story:

"Sebelumnya, tiga korban lainnya, Misbah dan Rubiyah, keduanya kakak kandung Risman, dan Dea Amalia, 9, anak kandung Euis Lina, meninggal dunia. Saat itu, ketiga korban didiagnosa terkena radang typhus, namun menjelang kematiannya mengalami shock dan sesak nafas berat."
http://www.mediaindo.co.id/berita.asp?id=109206

Machine translation (toggletext.com):

"Beforehand, three other casualties, Misbah and Rubiyah, both of them the full sibling Risman, and Dea Amalia, 9, the uterus child Euis Lina, died.At that time, the three casualties were diagnosed was affected by the inflammation typhus, but gazed at his death experienced shock and breathless difficult."
http://www.flutrackers.com/forum/showpost.php?p=26434&postcount=62

"Umar" sounds like a Muslim name; the dog farming situation may not be the case here.