Indonesia bird flu: still critical

The chief veterinary officer of the UN's Food and Agriculture Organization (FAO) reaffirmed what everyone paying attention already knows: the bird flu situation in Indonesia is critical. The archipelago nation is the fourth most populous country in the world fragmented geographically on 17,000 islands and politically by a disastrously decentralized government. Of its 31 provinces, FAO says 31 have reported infected poultry, and on some of the largest -- Java, Sumatra, Bali and southern Sulawesi -- it is endemic and solidly entrenched. There are an estimated 30 million poultry smallholdings in backyards everywhere. There is little control over the commercial poultry operations. As a result of a particularly egregious powerplay by the Indonesian Minister of Health, we are missing a great deal of information about the genetic changes in the virus over the last year.

Along with bird flu in poultry has come bird flu in people, more cases and more deaths in Indonesia than anywhere else in the world:

"The human mortality rate from bird flu in Indonesia is the highest in the world and there will be more human cases if we do not focus more on containing the disease at source in animals," said FAO Chief Veterinary Officer Joseph Domenech.

"Furthermore, I am deeply concerned that the high level of virus circulation in birds in the country could create conditions for the virus to mutate and to finally cause a human influenza pandemic," Domenech warned.

"The avian influenza situation in Indonesia is grave - all international partners and national authorities need to step up their efforts for halting the spread of the disease in animals and making the fight against the virus a top priority." (FAO)

As if to underscore this concern comes word via reporting by Maryn McKenna at CIDRAP News, of a case of co-infection of an Indonesian teen by H5N1 (bird flu) and H3N2 (human seasonal flu), one scenario that worries flu experts because of the potential to add bird flu virulence factors to a highly transmissible human virus via reassortment or possibly other mechanisms. Here's McKenna's excellent reporting:

In a paper presented today at the International Conference on Emerging Infectious Diseases, Vivi Setiawaty of Indonesia's Center for Biomedical and Pharmaceutical Research and Development described the case of a 16-year-old girl who was tested for flu in Jakarta in April 2007 under a flu-surveillance system established in 2005 by the Indonesian Ministry of Health.

The girl, who had been experiencing flu symptoms for several days, was only mildly ill, with a 100.5ºF fever, sore throat, cough, headache, and body aches, but no difficulty breathing and no signs of pneumonia. (Case reports of H5N1 patients in countries such as Thailand have described more dramatic clinical presentations.)

Throat and nasal-swab samples that were taken on the 6th day of her symptoms tested positive by reverse-transcriptase polymerase chain reaction (RT-PCR) for both avian influenza H5N1 and the seasonal flu strain H3N2 at the Indonesian National Institute of Health Research and Development. Serology test results were less clear. Antibody titers from serum samples taken the 6th day provided a weak indication of H5N1 infection (titer of 1:10) but were negative for H3N2; convalescent sera, on the other hand, gave a strong indication of H3N2 infection (titer of 1:640) but were negative for H5N1. (CIDRAP News)

We don't have any more details, so much remains unclear about this. Most importantly, how reliable is the reported diagnosis of H5N1 infection? If this young woman was truly infected with H5N1 she didn't show serologic evidence of it, which calls into question either the diagnosis or the validity of the seroprevalence surveys that have failed to show evidence of mild,

or asymptomatic infection with H5N1. In the latter case this might be seen as good news because it means there is more herd immunity and a lower case fatality ratio than previously thought, but it also leaves open many questions about immune response and how to measure it properly for this virus. In addition, it is premised on the validity of the report. As McKenna notes, the case fell into the black hole period when Indonesia was not sharing virus, so it is not at all clear whether we will know more or whether more can even be known.

So far this bird flu season is looking a lot like previous ones. That's bad because previous seasons all were freighted with the potential for disaster. So is this one.


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It is a right step that FAO actively gets more involved with BF control and starts from Indonesia.

It is a long way for FAO to be effectively in contributing to the solution though. At least it is a good sign.

FO: I never look at the ads but the Sb bloggers have complained to the publishers about one or another of them before and I am emailing them now to get this crap off the site. Thanks for bringing it to my attention.