Bali bird flu cases: signal or noise?

Bird flu in Indonesia and elsewhere keeps simmering away. Little stuff, here and there. Constant noise, so much so you wonder if you will hear the signal, if and when it sounds. Will it suddenly become so loud it is unmistakable? Or will it be there, growing louder and louder until everyone can hear it and in retrospect, see that it was there before we recognized it? I don't know the answer. Lots of worrisome sounding things I ignore and wait for a couple of days more information to sort them out. That's my inclination for the latest Indon case on the resort island of Bali:

Bali has recorded its first human death from bird flu and authorities have begun culling all birds in the area in a bid to contain a possible outbreak.

It is also suspected that the dead woman's daughter died from the H5N1 avian flu virus earlier this month - but she was buried before the possibility was realised.

Yesterday agriculture authorities destroyed 400 birds in a 1km radius of the village of Tukadaya in Jembrana regency, in northwestern Bali, where the victims lived.

The National Bird Flu Control Committee confirmed that Ni Luh Putu Sri Windani, 29, who died in Bali's Sanglah hospital in Denpasar late on Sunday, had tested positive to bird flu.

She was taken to the hospital three days earlier with pneumonia-like symptoms.

Her daughter Dian, 5, had died on August 3 at a local hospital with similar symptoms.

Chickens belonging to a neighbour of the dead woman had previously died, and have tested positive to the virus as well.

A two-year-old child from the same village is currently under observation in Sanglah Hospital with similar symptoms, but doctors said late yesterday that her condition was improving.

Her grandmother Wayan Norni said chickens belonging to her family had previously died, and the dead woman lived about 200m away in the same village. (Cindy WocknerCourier Mail, Australia)

So the facts still need to be sorted out. The age of the dead daughter is given as 3 in other stories, the sick chickens are variously described as in the dead woman's household, or as here, next door, in some stories tests from the daughter are described as positive while in other stories it's said she was cremated before any tests could be made. As of this writing, we still don't know if there is a third, related case in a neighbor child.

It's clear, however, the Indon authorities are deadly afraid that the Bali tourist industry will also become a victim. The deaths occurred in a village about 3 hours from the main tourist area, but the island is densely populated and poultry are infected. Indonesian authorities are taking blood specimens from contacts of the cases to rule out human to human transmission, although as usual, this case is being blamed on infected birds. We don't know how plausible this is with the scant information we have in these somewhat contradictory news reports.

If none of this is very reassuring, maybe this will calm your fears:

Most of Indonesia's bird flu cases have been in West Java and South Sumatra, but Kandun said he was not surprised to see one surface on Bali, after previously seeing it pop up on Sulawesi, another heavily-populated central Indonesian island.

"It's dense population meets with dense animal population," he said. "We expected Bali would (eventually) have it."

Kandun said he hoped the initial death on Bali would not affect tourism, as he said Bali's health department was fully prepared to handle bird flu cases and also restricts the import of animals.

Bali's tourism industry is trying to recover from terrorist attacks by Islamic militants in 2002 and 2005, and arrivals during the current high season have exceeded expectations.

"Why be afraid to go to Bali?" Kandun said. "Bali has had bombs and people still go there." (Earth Times)

Then, maybe it won't. That depends on whether you think it is signal or noise. The odds favor noise. But I wouldn't bet my life on it.

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The relationship and onset dates are somewhat worrisome, but it's just too hard to tell what's going on. If the child passed it on to the parent it would not be the first suspected case of such transmission (primary care giver, close contact).

Is there something else that is causing you to be a bit more "uneasy" Revere? Or just not sure we can keep dodging bullets?

There are two points that came out in Peter Caves reporting on this incident that bear thinking about when we think about the risk factors of a pandemic getting started. (Peter Cave is the on-the-scene Australian ABC journalist who broke the story)
Firstly he reports that dying chickens have been fed to the village pigs for some time instead of being burned. I think we all realise what THAT means. Secondly, that despite village chickens having died prior to the daughters death, she was not tested for H5N1, and so no samples were taken. Just another bird flu death that won't show up on the "official" tally. Clearly the Indon authorities are out of control in both case surveillance and preventative strategy. Reminds me of when the infected Jones Ginting was allowed to waltz out of the hospital, get on a bus and return to his village. Unbelievable!
I believe it was also Peter Cave who commented that the genetic sequencing of samples from the victim will be compared to the dead chickens to see if they were the source. Let's see what that reveals, or indeed if it is reported at all.

Revere, I am still a bit confused about this genetic matching issue. It is often stated that the sequences from victims do not match dead poultry and that there must be a mammalian reservoir since the sequences contain mammalian polymorphisms.(Recombinomics commentaries , and others). What is your take on this please? It can wait till you get back from holidays obviously. But if this is a possibility, surely there must be a concerted effort going on to trace the source of the infection? Wouldn't there be folks running around catching cats and dogs and mice and rats and bats etc? Is the WHO really that slack?

I know this may be hard to digest, given that we are ten years into this and it hasn't happened yet...but it is now, only a matter of time.

Awe Hell Rob, you know the WHO is such an efficiently run organization. They allow themselves to be extorted once, then a second time and now they have new cases popping up.

I dont think they give one big rats butt about their people only that they gain access to the world stage and our money. Its pretty evident that H2H2H? might be underway. Tom DVM is also very much right in that we have been riding the pony for about truly twelve years with H5N1 and it seems to be gaining a foothold. It may have been running around over there for quite some time and undetected before that as H1N1 was apparently.

Then with one reassortment/recombination the human race or a good part of it ceases to exist because they dont want to give up samples, isolates and other data and at least in part because the politics and the BS are as long as the Pacific is deep. Nice work WHO. You let them goat rope you, now what?

It gives me no pleasure but I think you'll be able to smell this BS along with the bodies all the way to the States if it goes amok and starts killing in a highly efficient way.

By M. Randolph Kruger (not verified) on 13 Aug 2007 #permalink

Tom & MRK,

Lets take a deep breath fellas. No argument from me that H5N1 seems to be evolving, and in a dangerous direction, but I think the question of whether the victims are becoming infected from "close association with infected poultry" (as we are continually being told),whether that is valid or not, is a critical question. How do we know the victims are infected by poultry, what is the science? Do the genetic sequences match, or don't they?

BTW Tom, the Australian quarantine service is sending a bunch of pigeons back to Canada, cuz it seems they have been exposed to H5N1. See
http://www.abc.net.au/news/stories/2005/10/21/1487872.htm

Thats my rub with it Robbie. The goddamn Indons no longer have the right to say no IMO. This has become a deal about a non existent vaccine that we cant make for right now at least without their samples and etc. To me thats horseshit for the rest of the planet and they have been working to this end for some time. They tried it in the aircraft business by trying to demand that the airlines that flew into their country be made in whole or part by them. This is no different. The WHO made a terrible mistake in letting them into the board because doctors that become politicians and thieves in the same breath, are just that.

I tossed it out there for grins once about the possible chemical or nuking of Indon if it became a threat to the world. It is covered by the UN Charter under every countries national security clause. They dont even have to declare war. This is rapidly IMO moving towards a showdown in the UN Security Council and they wont blink a bit if they tell them to pony it up, or else.

We arent there yet. This little theater is still being run with all the slick the Machiavellians in Indon can pull. Time is running out and its going to be too late when it happens so that leaves the rest of the world not much choice. They wont be sending aid, they could send ICBM's. Would they? I honestly dont know. The ChiComs seem to have theirs under control but not many other places. Wouldnt stop it as Revere says but it buys time and that is something we have precious little of right now. We have to have something that WORKS! Tamiflu might help some, statins are interesting but none of them are in such of a supply that they could be used for anything other than a fire blanket.

Foul on Indonesia.

By M. Randolph Kruger (not verified) on 13 Aug 2007 #permalink

Rob, I thought they'd finally matched the human sequences to duck sequences. I think there's something about it on recombinomics.

Steph

"2007 H5N1 HA and NA Sequences in Thailand Exactly Match 2004
Recombinomics Commentary
August 14, 2007

Today 2007 HA and NA sequences from a duck Thailand were released at Genbank (A/duck/Phitsanulok/NIAH6-5-0001/2007). The new H5N1 sequences from Thailand create another problem for explanations of influenza evolution via random mutations. In the swine sequences (described at Nature Precedings), the most dramatic examples of sequence conservation were in two internal genes, PB2 and PA. These genes encode proteins that are part of the polymerase complex, and would therefore have considerable selection pressure for high fidelity replication, although the sequence identities were at the nucleotide level, so even silent changes were absent."

By M. Randolph Kruger (not verified) on 14 Aug 2007 #permalink

Revere, I think you forgot two other important points:
1. It seems that It was only when the mother died from confirmed H5N1 that the authorities decided to re-examine the cause of death for the daughter. Obviously, this raises suspicions that there could be similar unreported deaths from the Bird-flu virus in Indonesia.
2. Health official Joko Suyono said there had been sick chickens around the woman's house and many had died suddenly in recent weeks.
"The villagers didn't burn the carcasses". "Instead they buried them or fed them to pigs, he said". (Source: http://birdflunewsflash.wordpress.com/)

The first point give as an epidemiological problem,
The second one give as a more threatening problem about mixing vessels, reassortement, etc...