This is a continuation of Possible Cluster in Cikelet Indonesia 5 Possible Cluster in Cikelet Indonesia 5
If anyone objects we can change it to Possible Cluster in Cikelet Indonesia 6. I think as more outbreaks pop up in other areas of the country it would be better to have one thread than many.
We can also start similar threads for Thailand etc.
anonymous – at 13:50
It’s the key above the enter key, on my keyboard.
anonymous at 13:10-
I just copy the whole text from the blue box and replace the ‘link_url’ text with the actual link and then overtype the description.
If you want to type it in, the Vertical Line is Shift-Backslash.
ANON-YYZ – at 13:32
“Well, the new bottom line queston: Are there mutations facilitating H2H?”
No, H2H is generally determined from epidemiology and only secondarily from virology. ie, if you see a chain of cases with disease onset, contact history, etc that suggests h2h, that information is far more important than finding some mutations in the virus alone.
If you read the WHO containment protocol document, for example, you will find that figuring out whether efficient h2h has occurred is primarily a epidemiologist’s territory, with or without support from virology data, and that presence of virological signals without actual cases of h2h is not considered grounds for containment.
Okay I will try it. This is the link showing the CFR in Indonesia is a whopping 77%.
whoo hoo anonymous at 14:15
blue perfect
anon_22 – at 14:00
I think I know that, but I would like a straight answer to a straight question. If you don’t have an answer, that’s fine. We’ll leave the question open.
We are going in circles. Neither questions have been answered.
Are you suggesting it’s irrelevant. WHO already closed the book, there’s nothing to see here, let’s look elsewhere?
1. The bottomline question: did it mutate or not?
OR
2. Are there mutations facilitating H2H?
Is the answer: since the WHO said there is no evidence that H2H occurred, then we don’t need to find out whether mutations facilitating H2H occurred.
OR
Is the answer: Don’t ask. We may never know.
HISTORY BELOW coz it’s a new thread.
ANON-YYZ – at 11:08
The bottomline question: did it mutate or not?
anon_22 – at 13:20
Flu viruses mutate all the time. It is a matter of tracking whether the mutations are facilitating h2h.
ANON-YYZ – at 13:32
Well, the new bottom line queston:
Are there mutations facilitating H2H?
We have already seen the WHO answer (“preliminary” so they hatch their bets in case some one finds something). No evidence of H2H, therefore draw your own conclusions.
anon_22 – at 13:55
No, H2H is generally determined from epidemiology and only secondarily from virology. ie, if you see a chain of cases with disease onset, contact history, etc that suggests h2h, that information is far more important than finding some mutations in the virus alone.
If you read the WHO containment protocol document, for example, you will find that figuring out whether efficient h2h has occurred is primarily a epidemiologist’s territory, with or without support from virology data, and that presence of virological signals without actual cases of h2h is not considered grounds for containment.
Thanks anonymous at 14:15…
The total number of H5N1 human cases and CFR for each year and country can also be viewed here. I try to keep it updated based on the official WHO figures.
Heather- thanks, I did not know about that. Those percentages are scary. What gets me is that those figures don’t include all those recent deaths in Indonesia where the victims died before samples were taken. So it very well may be more than 77%.
ANON-YYZ – at 14:40
Is the FAO involved in collecting animal samples? Is it only NAMRU, CDC or the WHO?
Here’s recent news about Malik Peiris take (using Thailand as example, but apply to Indonesia as well):
ANON-YYZ
Unfortunately, the posts gave a rather fragmented view of what I am talking about. If your question was ‘did it mutate?’ and I take it at face value, then the answer would be flu viruses mutate all the time. I don’t know the sequence information to know whether it did or not, but I wouldn’t be surprised if it did.
Put it in another way, if you look at any phylogenetic tree, any sequence that is not in exactly the same spot as another sample has mutated from the other one.
So the question is not really ‘did it mutate’. I suspect what you are really interested in is “did it mutate to something that makes us more worried about the onset of a pandemic?”
My response to that one is this. If you want to track the onset of a pandemic, epidemiological information of an outbreak will give you a better headstart everytime. The virus may show mutations that suggest it is more likely to go h2h, but the presence of certain mutations does not necessarily give us an accurate indication of that.
This is because currently we do not yet know the full set of mutations necessary for a pandemic strain to emerge from H5N1. Past information based on other viruses eg H1N1 might give us some indication, but as the papers on receptor binding, for example, reviewed on this thread show, the same set of mutations in different subtypes do not necessarily result in the same binding preferences.
So knowing what mutations are present is useful information, but for the purpose of knowing whether it is likely to go h2h2h2h2h2h2h then fast up-to-date outbreak information like what our forum participants have been diligently compiling recently with Karo, Cikelet etc, is the most valuable immediate information.
OK Anon__22, I understand how the epidemiological data may be more important right now than the later sequencing date. So, the big question now is: surely you have been following all the names, family realtionships, dates of onsets, etc. So, in your opinion, from an epidemiological point of view, has H5N1 so far exhibited greater transmissability, ie, indicating H2H2H2H transmission??? Just, what exactly, does the limited epidemiological information leaking out say to you??
pugmom,
“Just, what exactly, does the limited epidemiological information leaking out say to you??”
I have to be very cautious as this time (as opposed to Karo) I have not had time to follow everything as closely as I would like. But I am getting a general impression from the clusters around Cikelet that somehow the virus there may be finding it easier to go b2h. Now, it could be lifestyle differences, genetic predisposition, better reporting, etc. But there is a chance that this local strain is different and finds it easier to jump the species barrier.
If they perform very efficient culling, it may solve the problem, at least temporarily. If not, we should continue to see frequent outbreaks in that area especially but maybe in other areas, depending on whether there is poultry movement etc. (I am for the moment setting aside the possibility of a mammalian host such as pig.)
Up to now, there doesn’t seem to be clearcut information like the kind that we got for Karo of h2h transmission, even though the onset dates of a few of the cases lead us to think there could be some. And the outbreak is still ongoing, so the next couple of weeks will tell us whether there are more secondary or tertiary cases.
Up to now, it does not appear that the virus at Cikelet is more efficient in H2H than previous outbreaks in Indonesia even excepting Karo. But if it is indeed more efficient in b2h, then the medium term (not short term) stakes are raised another notch, cos we know that Indonesia has the worse track record of containing outbreaks and the worse CFR of all countries. The virus is endemic everywhere. Up to now, we’ve had one consolation that at least it seemed rather hard for humans to catch it from the birds given the extent of the endemicity. Now that consolation may be disappearing…
As a non scientist I would like to throw this out there. In 1997 BF infected chickens and subsequently chickens infected people, then a good percentage of those people died. Today BF infected chickens and subsequently infected people then a good percentage of those people died. In 1997 there was little proof of any sustained H2H, today there is little proof of any sustained H2H. Sometimes the big picture gives more perspective.
anon_22 – at 16:48,
If they perform very efficient culling, it may solve the problem, at least temporarily.
A report yesterday stated that a full cull had not been done in Cikelet because villagers were hiding their flocks. Think it was in the Jarkarta Post.
banshee,
Thanks. Unfortunately, this is exactly what I expect.
anon_22
Thank you.
All I can say is that it’s difficult to believe the extent of the outbreak near Cikelet can be explained completey by ‘inept villagers’. Indonesia and the WHO have said as much: no evidence of easier B2H nor any H2H. WHO has better come clean. The answer may be in the sequences, but if samples are not collected, releasing sequences may not tell us much.
The history of Indonesia is one of ‘too little too late’. I just hope they wake up, or some one make them wake up.
If they are not completely transparent, Indonesia can forget about confidence in the tourist industry, WHO or no WHO. Tourist should go to Thailand instead, or some other safer place.
Given the stakes, I don’t think people on the blogsphere will rest until all truth is out.
banshee – at 17:04
That information was leaked by the government. If they are really serious, I would see people hauled away to prison or another culling operation, but we haven’t heard that. It’s setting expectations. If more people end up in hospitals, its because not all chicken has been culled.
It’s just like they said its going to be rainy season, so if there are more outbreaks, it’s not because of increasing virulence etc.
anon_22 at various time ;-)
Thanks for taking the time to provide more explanations. Sometimes, all of this information is so very difficult to decipher. And, to everyone else who are also making this deluge of information more digestable.
BP – at 17:04
“As a non scientist I would like to throw this out there. In 1997 BF infected chickens and subsequently chickens infected people, then a good percentage of those people died. Today BF infected chickens and subsequently infected people then a good percentage of those people died. In 1997 there was little proof of any sustained H2H, today there is little proof of any sustained H2H. Sometimes the big picture gives more perspective.”
What you say is true to a certain extent. That’s why I’m not in panic mode.
However, since 1997, the virus has now spread to 50+ countries. It has shown that its ability to infect humans in 1997 was not an aberration but something it has the ability to do repeatedly. It has also demonstrated the ability to infect multiple species, including some that do not usually get sick from flu viruses at all such as cats and tigers, and to transmit efficiently between those hosts immediately after jumping species barrier.
We also know that the original source of the 1997 virus in Guangdong is still actively producing new reassortants, which are exhibiting increasing virulence towards mammals, as discussed here The evolution of H5N1 influenza viruses in ducks in southern China.
Also check out this series Final Adaptation of H 5 N 1 to Humans Role of Mammalian Reservoirs on the possibility of a mammalian reservoir, which would significantly increase the possibility of H5N1 becoming the next pandemic virus.
Finally, let me refer you to the recent interview on CNN of Malik Peiris who used the phrase ‘extremely likely’ to describe our current risk.
ANON-YYZ – at 17:09, I don’t expect the Indonesian gov’t or their policies to change in the near future. Unless something really significant changes, it will be business as usual. They have failed to control H5N1 in their country and I think the horse is already out of the barn on this one. If a panflu does start in Indonesia, I suspect that in the long run they will not be able to contain it. Additionally, I think you are giving the Indonesian gov’t too much credit to think that they are manipulating the news in such a way. Truly, their government is so fragmented I don’t think they could pull it off. I really do think that they did not complete a total cull in Cikelet and probably for the reasons stated. I think what is going on here is a mixture of corruption and inepitude and not necessarily a grand scheme to withold the truth from us. Just my opinion of course.
Are the WHO people wearing N95s when handing out the Tamiflu “blanket” to people?
If so we should should assume they think it is capable of going H2H2H….somewhat efficiently.
http://tinyurl.com/gvtm9 More bits and pieces out of Sulawesi---dated 8–25–06
Liputan6.com, Kendari: three people were related that remained a house in Street Ponggoloka, Kendari, South-East Sulawesi, just recently was stated it was suspected terjangkit bird flu.
The three of them suffered hot high and breathless. This sign was suffered simultaneously after being found dozens of poultries died suddenly around their residence.
Responded to these findings, the local Health Service at once stuck to the family’s house with the label was inscribed with AI or avian influenza. This step was carried out to guard against the spreading of the bird flu virus.
However, Ambu Sao, casualties’s family complained because the action it was considered was abundant…….
Lots of flu activity over the past couple weeks after the summer lull. Not lot’s of mainstream coverage, unlike in the early months of ‘06.
Feel’s like a blindside punch might be on it’s way.
banshee – at 17:20
Thank you.
Your projected outcome is darker than mine. I thought they had a good chance of containing it. They seem to be trying so much harder.
banshee – at 17:20
“I think what is going on here is a mixture of corruption and inepitude and not necessarily a grand scheme to withold the truth from us.”
I think so too.
ANON-YYZ – at 17:23, I also think they are trying harder. But even under the best circumstances, a virulent panflu would be very hard to contain. I just don’t think they are currently CAPABLE of containing a pandemic flu - nothing to do with malice on their part.
pugmom – at 17:23
Heightened social distancing.
(Does any one know what happened to the Karo family who tried to sue to government for calling them bird flu infected when it was seasonal flu?)
It’s at least unpleasant, but I give credit to Indonesia for trying to warn their residents.
Better safe than sorry.
I just made this post on the news thread, but thought it belongs here as well…
There was a report on NPR this afternoon that I caught the last few minutes of. What I heard sounded well-balanced and informative. I don’t have time to listen to the full report at this point, but thought I’d post the link for those who want to listen to it. The report talks about how Indonesia announced it is cutting it’s bird flu budget and contrasts that decision against the rampant bird and human flu cases.
You need to scroll down and select the fourth story title “Bird Flu report.” The story runs 7:30 in full.
Edna Mode – at 17:29, This could be a calculated announcement to try and get more funding.
banshee – at 17:26
Sorry, I didn’t mean they can contain a pandemic flu. I meant they had a good chance of containing the Cikelet outbreak, for what is left in Cikelet, not for the those who have left (human or chickens).
And more from Sumatra—enacting an alert level I http://www.analisadaily.com/0-3.htm dated 8–25–06
The Simalungun health: the Simalungun Regency Alert I after the Existence ‘Suspect’ Bird Flu Medan, (the Analysis) The Simalungun regency was stated alert I for 24 hours after the discovery a villager One Thousand Dolok the Silimakuta Subdistrict was expected (suspect) bird flu.
The confirmation was sent by the Section Head the Simalungun Health and Kesos Dr Waldi Saragih to the reporter in the office of Kasubdin P2P the North Sumatran Health Service Dr the Service Sun, on Thursday (24/8) responded to the development of bird flu in the Simalungun area.
According to him, when having someone was found it was suspected bird flu then in the area was stated alert I. for that he ordered the head of the local Community Health Centre and the auxiliary Community Health Centre (Pustu) as well as the midwife to alert in the case of bird flu.
He said, the Simalungun side of the Health Service also gave counselling to the citizen that still had or maintained the poultry (the chicken) kept him, when finding the livestock peliharan him and the sudden neighbour died immediately reported him to the local Livestock Breeding Service to be had action taken against him lanjuti.
Even so when having the local citizen was found suddenly the high fever immediately brought him to the local community health centre during immediately received the maintenance when needing the patient was reconciled to the central Public Hospital of H Adam the Medan Owner the only special reconciliation hospital for the bird flu patient, he said.
Moreover also his side appealed to his citizen when being directly in contact with his kept livestock must make use of the mask (the cover implement of the mouth) so that the virus is indirectly inhaled, uses the patron of the spectacles and washes the hands to prevent the poultry virus and must bathe to avoid the virus.
It was most again important that the waste of the chicken must be burnt then was planted guarded the virus, he stressed. That most again important was appealed to to the community when eating the egg must that really was cooked so as his germs died. Even so when eating chicken must be cooked completely to avoid the bird flu virus, said Waldi. KONDISI
In the meantime Kasubdin P2P the North Sumatran Health Service Dr the Service Sun also explained the development of the health of the condition for the patient ‘suspect’ RL bird flu (35), in the situation was pregnant 3 day months to 4 still experienced the fever 36.5 Celcius levels, when compared to beforehand demanm him achieved 39.5 Celcius levels. This means that hot him continued to descend, said the Sun.
However like that the patient until this must be still undergoing the maintenance in the special room of the handling of the bird flu patient in RS Adam the Owner at the same time still was waiting for results of the blood inspection of the health laboratory Department of Health Jakarta to know positive not him the patient suffered bird flu, he stressed. (Ms)
I posted parts of this story on the news thread earlier today but thought these extracts may be useful to understand the amount of poultry movement that goes on in Indonesia on a daily basis … how can it ever be contained while this continues? Here is the whole news story http://tinyurl.com/nttx2
<snip> Experts say human infection will only be brought under control when poultry outbreaks are reduced. Head of Simalungun husbandry office S. Hutauruk said the spread of the virus in the regency was growing due to its location near Karo despite the implementation of preventative measures.
“We’ve culled over 24,000 chickens in 13 villages. This will continue in other areas,” he said.
Besides Simalungun, Dairi and Deli Serdang regencies in North Sumatra are also widening their poultry culls after discovering infected fowl. There have been no reports of human deaths from the virus in the two regencies.
In Cirebon regency, West Java, <snip> … The regency is also tightening controls on the traffic of poultry into and out of West Java through the establishment of a monitoring post in Losari, located on the border of West Java with Central Java. Samples from the poultry will be tested, with birds suspected of having the disease quarantined or exterminated.
The post checks up to 40 trucks of poultry each day. Each truck usually transports around 1,000 birds from Central Java areas, such as Purbalingga, Purworejo, Semarang and Solo.
The administration also is disinfecting sites known to host H5N1, such as poultry markets and neighborhoods with large backyard chicken populations.
In Garut, inspectors continued to make their rounds of three villages in Cikelet district where two people died of bird flu late last week. More makeshift health posts were built in Cikelet, Kampung Tipar, Cibalong, Pemeungpeuk and Cimari.
<snip> Agriculture Minister Anton Apriyantono urged households to keep chicken coops clean to prevent the spread of infection.
“We have some 30 million households keeping poultry. We’ve tried our best, but people must be aware of the issue of cleanliness.”
Anton said he believed that public participation would help Indonesia be free of bird flu by 2008. (emphasis mine)
(Bayongbong, over 100 km from Cikelet, now has a suspect BF victim, a 14 y.o.) (note again the reference to the chicken in the cellar.) http://tinyurl.com/l69mh dated 8–25–06)
Suspect AI emerged in Bayongbong Garut the bird flu VIRUS from the Subdistrict Cikelet the Garut Regency, it was estimated has spread to the Bayongbong Subdistrict. An inhabitant Kp. Seroja RT 02/03 the Village Mulyasari the Subdistrict Bayongbong Garut, AT (14), on Wednesday night (23/8) approximately pkl. 22. 45 WIB was brought to RSU Dr. Slamet Garut. He was reconciled by the doctor the Bayongbong Community Health Centre to RSU, because of suffering the illness with signs similar to bird flu. If AT positive contracted the Avian illness influenza (AI), meant health apparatus and livestock breeding in Garut must work again harder. The representative of the Garut Regent H. the Hermawan Memo then claimed startled. “Cikelet with Bayongbong, his distance was very far, almost 100 kilometre.” But why could nyampai also, ok? He asked, immediately after visiting AT in RSU isolation space Dr. Slamet, on last Thursday. Concerning the AT condition, according to results of the team’s inspection of RSU isolation space Dr. Slamet Garut, was not too serious. He was indeed breathless, but was not too heavy. His respiration then only 30 times per the minute with the temperature of the body 38 Celsius levels. “Was not as serious as the other patient.” That was the reason, we did not yet reconcile him to RSHS, said the doctor guarded IGD RSU Garut Dr. Harry Galuh.
According to information of Agus Sugiat (38), the father AT, some time before had the poultry died suddenly around his house. However, was not yet known by the cause of the death of this poultry. He has then reported him to village apparatus. However in his territory, did not yet have the poultry vaccination or spraying of the chicken coop by the official. “Even the socialisation or the existence notification of the threat of the bird flu virus then had been never available.” To the end my child suddenly was counted suspect and was reconciled to this isolation space, said Agus to wabup, on Thursday (24/8). According to the Memo, if the poultry in Bayongbong positive was attacked H5N1, depopulation will also be carried out in Bayongbong.
A person suspect bird flu was named Gilang (12), the citizen of the Village Gunungsulah the Cigadog Kec Village. Cikelet has come home from RSU Dr. Slamet, on Thursday (24/8). He has been stated healthy by the team of the doctor. Beforehand, Gilang was reconciled the Cikelet Community Health Centre to RSU Dr. Slamet and was treated in isolation space since Monday (21/8). Whereas 4 citizens Cikelet Garut that was treated as suspect bird flu in Handsome Sadikin space of the Hospital Poinciana Tree (RSHS) Bandung, on Thursday early afternoon (24/8) was permitted to come home. The four of them were stated by the negative. “Four patients were returned to RSU Garut.” For the control, depended the development of their health. If one week more the control already no worries, meant to not have the problem, said the Chairman Tim the Control of Bird Flu of RSHS Bandung, Dr. Hadi Jusuf, Sp. P. D-KPTI. Ismawati returning (5), Santi (8), Kuraesin (32) and Osin, the husband Kuraesin, was released by Director Pelayanan Medis Dr. Moch. Rizal Chaidir, Sp. B. O. and Director Umum and Operational Dr. Noormartan, y Sp. P. K. the Patient as well as his family was despatched by three RSHS ambulances. The two parents Santi, Sarila (24) and Iwan (26), admitted to being happy because of the daughter the three of them that has been permitted to come home. They claimed not want to still maintained the chicken in their cellar. The similar acknowledgment was raised by the couple Osin and Kuraesin. Both of them admitted to losing their 30 kept nonpedigreed chickens because of being sick. Through to his returning, Kuraesin pregnancy that was 14 weeks, also old was stated healthy. Whereas two patients suspect from Cikelet other that still was treated, T (61) and Her (21), yesterday gradually improved. Both of them were still being waiting for results of the sample inspection in Balitbangkes Jakarta. Hadi said hot the Her body that originally 40 Celsius levels descended to 38 Celsius levels. But, he still the cough and breathless.
Does anyone know if there has been any type of humanitarian effort to raise money to compensate these chicken farmers, so that they would be more willing to cull their birds, rather than hide them? Isn’t it true, many only have a handfull of chickens, but that is also ALL they have? Money is raised all the time, for other things, far less serious. There are all kinds of minisitries, maybe one of those would be willling to go in and see that these farmers culled their chickens and were more than compensated. Just a thought?
It’s not even September yet, and human H5N1 patients seem to cropping up left and right in Indonesia.
I’d love to know what this winter holds for us.
I have an odd question for the doctors and scientisits:
IF we see increasing numbers of human H5N1 victims,esp in Indonesia, but the CFR changes in a downward direction, would this be any indicator of it mutating toward a h2h2h2/panflu form?
I realize that earlier detection and treatment alone can cause that, but…if the CFR drops as the numbers rise, COULD it be an indicator that we are but inches from true panflu????
This seems to be the first time in history that we are able to watch a potential pandemic unfold. This includes, checking samples for mutations, diagnosis of patients,getting info from around the world on line, etc. I wonder… how does anyone really know if viruses behave like this all the time before a pandemic. We really don’t have info on that do we? I think the closest thing to look at is the SARS and learn from that. I would suspect that a virus could smolder for years and years and never go H2H2H or then go H2h2H. We really have not had this opportunity to study this before now.
Ruth – at 19:21
Right!! How do we know where we are on the timeline? One minute-one hour-one day-one decade from the start of panflu?
Is it even possible to know that?
Is this story new? I have not seen anything about this. Read here
“Seven people from the same village have been hospitalised in Indonesia with suspected bird flu.
The group is from Karo district in the northern Sumatra province, where seven members of one family died of the deadly H5N1 virus in May.
Their deaths fuelled fears that the virus was mutating into a form which could pass easily from human to human, but experts later ruled this out.
Indonesia recorded its 42nd human bird flu death at the end of July, the same total as in Vietnam.”
anonymous – at 19:30
It’s from August 3 2006.
mom11 – at 18:46 --- Could you email me at wturner3 at gmail dot com? I have a message to relay…thanks
banshee – at 17:31
My posting this in no way indicates I think Indonesia needs more funding. I haven’t had a chance to listen to the whole story (we have company). I just find the MSM reporting interesting when taken in light of wiki info.
From what I understand, the Indonesian government is so corrupt, there’s no guarantee that any international funds for bird flu fighting even get where they’re supposed to.
I can’t help but think that in a way humans are breeding the pandemic flu. We have the virus on a careful selection program and are giving it optimum conditions and opportunities for reaching an easily H2H form.
I DO feel like we are being held for ransom to end it.
If this question has been addressed, then I apologize in advance! —donning nomex suit—
Is it possible that the CFR has been skewed somewhat? It appears that the highest mortality has been among those individuals who ended up at the hospital, but I believe that there had been commentary of people with flu like symptoms in the villages who “recovered”.
Without real numbers of all infected people, it is difficult to develop real CFRs.
Just a thought . . . and this thing is looking like a real beeeeotch.
Doesn’t it seem as if more people are recovering? Thank goodness. Could it be because of a greater awareness, they are getting medical attention earlier?
As to the “cellar” for the chickens, isn’t that the underpart of the house, built on stilts. I was in Southeast Asia for awhile, years ago, and the houses were often built open, so air could circulate, and up off the ground. It is hot, it is humid, you feel damp all the time, there are bugs every where, but it is knock out beautiful and the people are amazing and lovely.
dated 8–24–06 http://www.mediaindo.co.id/ (I think we knew that there were 3 people ill, but we did not know their names or that they were all children in one family. Maybe someone who has kept up with the spread sheets can help out here.)
Kendari — MIOL: three children Ambo Sao, 45, the Citizen RT 03/RW 05, the Punggalaka District, the Mandonga Subdistrict, the Kendari City, the South-East Sulawesi Province was it was suspected infected by the bird flu virus. Unfortunately, because of the lack of the cost, up until Thursday (24/8), the three of them were not brought to the hospital. Three Ambo Sao families, Istiwati, 17, Nurhadayani, 5, and Ahmad Djafar, 1 year 6 months, already three days were sick. They suffered was sick like the characteristics of the bird flu sufferer, that is hot high, coughs, breathless and had a headache. According to Ambo Sao, before his three children were sick, dozens of tails of the chicken belonging to their neighbour, died suddenly. “I did not want to bring children to the hospital, because of his cost was definitely very expensive,” he said
Ambo Sao that was professional as this taxi driver submitted if his three children were infected by the bird flu virus. The matter is, he already did not know must where looked for the medical treatment cost. Abdul Wahid, the Chairman RT 03/RW 05, the Punggalaka District, the Mandonga Subdistrict said just the first time having his citizen who was sick with the characteristics of bird flu. He acknowledged, several days ago already dozens of tails of the chicken belonging to his citizen died suddenly. As far as this is concerned, did not yet have the official of livestock breeding that carried out spraying or the vaccination against the poultry belonging to the citizen of the Punggalaka District, the Mandonga Subdistrict. (HM/OL-02).
After reading these posts, I started wondering about the dogs the boys feed sick chickens. Is this being watched or has it been reported on. I hope it hasn’t been swept under a rug. gina
pugmom – at 23:05
Ambo Sao that was professional as this taxi driver submitted if his three children were infected by the bird flu virus.
If the taxi driver got sick from his children, then he could have infected a lot of people if it were H2H.
pugmom – at 18:43
Suspect AI emerged in Bayongbong Garut the bird flu VIRUS from the Subdistrict Cikelet the Garut Regency, it was estimated has spread to the Bayongbong Subdistrict.
If this is ‘spread from Cikelet’, then the official line of ‘inept villagers’ in Cikelet is not believable, because Bayongbong is 100KM north and closer to North Garut with some of the richest rice fields in Indonesia.
Map:
Cikelet is on the southern most end of the road shown on the map.
ANON YYZ. This strain has not achieved efficient H-H but it is, in my opinion, phenotypically an evolutionary and adaptive improvement over Karo last spring.
Therefore, the ‘drums of war’ are beating and getting closer…I think all the conditions are in place for H5N1 to make its final ascent of the mountain (really unfortunate).
For some reason, I believe that it will astound the experts one last time and put all the last mutations together at once and pop up…it could happen anytime but I could make a sound scientific argument of the trend-line that it could occur this winter (unfortunately).
As I said last night, I believe it is going to happen within the borders of China or very close to the borders of China because there has been more adaption there than anywhere else.
I wish I had better news but to be honest…there has been no good news since last summer with respect to this virus and I fail to see how we are going to have good news in the next twelve months…
…and if the virus advances in the next twelve months as much as it did in the last twelve months then we will be in the middle of a pandemic next year at this time.
I would still like to know what is going on in pigs in China and Indonesia.
Thanks Tom, your insights are always welcomed even if the bearer of bad news, which I agree with by the way. You have been accurate thus far, unfortunately:) The flocking or schooling theory is valid— a turn in the virus to a pandemic strain all at one. It is also the most unnerving.
I just gleaned this 2 articles from flutrackers which is slightly interesting:
Pikiran Rakyat 8/24 says Dua suspect flu burung yang dirawat di Ruang Flamboyan RSHS Bandung, Ismawati (5) dan Santi (8), diperbolehkan pulang karena kondisinya sudah stabil. “Hasilnya udah ketahuan bahwa ini bukan Avian influenza,” ujar dr. Hadi Jusuf, Rabu (23/8). Perawatan selanjutnya atas kedua pasien itu diserahkan ke Puskesmas Cikelet. Akan tetapi, orang tua kedua anak tersebut, yakni Kuraesin dan Osin, yang juga dirawat di Ruang Flamboyan, belum boleh pulang.
means
Ismawati(5) & Santi(8) are in stable condition, can be discharged, tested negative for birdflu, further treatment will be referred to Cikelet local health centre. However, their parents, ie. Kuraesin & Osin, in Flamboyan Ward, cannot be discharged yet. Hence, Ismawati & Santi are children of Kuraesin & Osin.
http://www.mediaindo.co.id/berita.asp?id=109141
Yati mengungkapkan, dua korban suspect flu burung Santi dan Ismawati adalah tetangga dekat korban Ai Siti Aminah. Keduanya juga diketahui menghadiri pemakaman Ai, yang merupakan teman bermainnya
means
Santi & Ismawati are close neighbours of deceased Ai Siti Aminah. Santi & Ismawati attended Ai Siti’s funeral & are her playmates.
So sorry, pls ignore above post.
says Santi’s parents are Iwan & Surilah.
I don’t know which to believe. Leave u guys to track further.
This is my own personal tally of the situation - not to be taken too seriously. I gathered the info from Recombinomics so take that into consideration also. This does not include the poultry die offs everywhere. Just trying to get a simple handle on the situation. This is not a current list, this is just a crude tally.
South Sulawesi: 3 siblings (cluster?); 2 additional patients hospitalized
Bekasi - 1
Cikilet - total of 20
Another suspect in Bayongbong sub-district Garut
Mamypoko, thank you so much for your assistance.
I think we are losing track of where all the outbreaks are. I have heard Java (Cikelet and Jakarta), North Sumatra and Sulawesi within the past week through this site - there may be more. Is anyone willing to do a summary of places and cases? I am afraid I am too out of touch with it at present but I will volunteer to maintain it if someone else gets it together.
I have spent about 3/4 of my waking time pondering this puzzle of H5N1 and how it entered the human population. I have had a mantra in my head now for over a month that I can’t shake out. It is there all the time and it is this: the bird flu sequences, esp in Indonesia, do NOT match the human flu sequences. It has been like a broken record, playing over and over. What does that mean? To me, it means that the humans in Indo are now carrying around their own unique brand of H5N1. I think all the poutry die-offs are a red herring at this point and lead us down the wrong path. Where did the humans get it? They may well have gotten it from each other. Where did case 0 get it? Who the heck knows. We may find out really late in the game. I think this calls for a new paradigm shift in our thinking, away from the birds. If we only knew the human sequencing of the patients right now and could compare it to the bird sequencing. Say this supposition is correct. Then the next big question is how did 5 separate clusters pop up all at once? (Garut, Bekasi, North Sumatr, South Sumatra, and Sulawesi.) That is, are all those human cases sporting the same unique H5N1? Where is the common vector? Remember Karo—only one of the sequences came close to matching the bird sequences. Are we looking at different mutations in the 5 clusters, or did H5N1 finally learn how to pick the lock with the same mutation simultaneously in all 5 locations all at once? These questions are driving me nuts. I know the epidemiological data is critical here, but I wish they would hurry up and do the sequencing too. Because I can’t get that mantra out of my brain, the bird flu sequences don’t match the human flu sequences.
“I think all the poutry die-offs are a red herring at this point and lead us down the wrong path.”
Amen Pugmom, amen.
It is concerning me that they are letting these “negative cases” back in the community while they are still taking tamiflu. What if the cases are false negatives because of taking the tamiflu? When the tamiflu runs out, will these cases flare up again and be shedding virus? -probably better adapted virus at that that also has a higher resistance to the tamiflu. We saw that late last year and early this year in a few cases that did better while initially on tamiflu, but then went downhill fast when the medication stopped. That is what prompted them to start dosing higher (doubling) in the first place and giving it for a longer time. If cases are deemed negative, do they cut the tamiflu ration down to the preventative 1 per day level for 10 days or maintain the higher dose given to BF positive patients?
Pugmom. Your comments are highly astute and I agree with them.
It won’t be that there is a unique strain ciruculating only in people. Monotreme has been correct all along. He parsed from the data that there had to be some adaption going on in mammals that was later showing up in humans and the evidence appears to prove his point.
So here is a couple of things to consider.
There are now probably ten strains of H5N1 in these countries, maybe one combination in one country and other combinations in other countries…some we know about…many we don’t.
These ten strains are on ten pathways one beside another…some effect only birds as you have pointed out, some affecting only mammals and some affecting both.
This is natures way to accelerate adaptions exponentially in a pathogen because each of these pathways will interect recominations reassortments etc. will occur between each of these strains…
…Here’s the big question…at some point these pathways will start to converge (although H5N1 continues to break every rule in the virus rulebook)…so the question becomes are we on the converged pathway and recent events seem to indicate that we were the ‘endgame’ all along.
I think we should consider Asia for out purposes as one country…the now endemic nature of H5N1 there would indicate that would be appropriate.
Secondly, wild birds from Indonesia are going to fly to other places. Does anyone know where they fly to?
Tom DVM: Added to your above statement is the fact that Vietnam is reporting/expecting up to five times the amount of regular, seasonal flu expected this year. This will eventually mix with one or all of the above strains making it catch like a wildfire in that we all know that the regular, seasonal flu is highly contagious.
Janet. Excellent point to keep in mind. Thanks!!
At some point some of those seasonal flu’s might be H5N1 but I don’t think just yet.
For further information, please refer to FluTrakers as this is where I composed this. It is events that have happened today.
Dunggalaka/Mandonga/Kendari/South East Sulawsi:
Sibblings:
17 yr - not yet brought to hospital - suspected bf
5 yr - not yet brought to hospital - suspected bf
1 1/2 yr. - in hospital critical condition.
Kamonji - Central Sulawesi:
Admitted:
2 yr.
1 1/2 yr.
21 yr.
Hundreds of students at TK Alsyiyah Bustanul Atfal in Kamonji District given a Holiday due to concerns with BF.
I forgot to add: at least 5 resident in Palu have been hospitalized. [Don’t know where Palu is? Also, I don’t even know if this is already been report before].
Commonground Thanks. Important information. I think I get your point!!
Tom DVM – at 10:13 …wild birds from Indonesia are going to fly to other places. Does anyone know where they fly to?
Migratory map available here but it will take someone with a subscription to Nature Magazine to access it.
Tom DVM - at 10:53, I’m sorry,I didn’t mean to insult anyone. I’ve come upon some changes for myself these last few weeks. I have never followed a “cluster” closely before, and I took the Garut cluster on. After about 5 days, I was so confused with more incoming, that I grew dizzy. I had to stop. Couldn’t keep tabs anymore. Now, with the other areas popping up, I feel i can’t really post anything, for fear it will be a repost. A duplicate. It’s all jus too much to keep track of. But my fear remains the same, and I post these things, so everyone here is aware of how fluid this situation is. It seems to all be happening very quickly.
Commonground – at 10:52
At least 2 outbreaks in Sulawesi.
Map:
Kendari in the South East and Palu in the North West, about 250 Miles apart.
It’s popping up every where, and the time between human getting sick and chicken’s dying is much shorter. When I first reported Kendari chicken outbreak, I was saying watch the news for the next 3–5 days. Well, the next day, they reported people admitted to hospital.
Since the time is so short, some people will get sick before the public start taking extra precautions.
ANON-YYZ - at 11:14, Thank you. I don’t even recall you saying that. Maybe I need a vacation.
Commonground. You didn’t insult anyone…I appreciate the information…thanks again.
Commonground – at 11:10 I have never followed a “cluster” closely before, and I took the Garut cluster on. After about 5 days, I was so confused with more incoming, that I grew dizzy. I had to stop. Couldn’t keep tabs anymore. . . . It’s all jus too much to keep track of.
I know just how you feel. For a while I felt I was on top of what was going on, then I took a day or two off, and suddenly it seems it’s everywhere. New names in Cikelet. New regions. More and yet more toggletext. Maddening. This morning I thought I read a couple people had tested positive, but it might have been something I dreamed last night. Just can’t keep things straight anymore.
ANON-YYZ – at 11:14
Correction
Palu is considered by the Indonesian press to be Central Sulawesi.
Milo - at 11:35, well, at least we gave it a shot. It may just come to a point, where none of us can keep track anymore. That is what scares me the most……
Commonground, Milo, or someone else…I have been away from the computer all day and will be away most of the rest of the day. Can someone please (without the minute detail of names, ages, locations, etc.) just tell me how many confirmed or suspected clusters in total we are monitoring at this point in time (12:19 EST)? Thank you so much!
Commonground - If we can’t keep score, is the game over??? Yet another win for H5N1?
OKbirdwatcher - at 12:29 - I can’t give Edna Mode at 12:23 an answer. I’m still hoping it will all subside. Until the next time.
Here’s what I could gather from the Northern Sumatra thread at FT.
RL (35) - 8/22
Closing off of roads - 8/22
Ramita - 8/23
The Simalungun regency was stated alert I for 24 hours after the discovery a villager Seribu Dolok, the Silimakuta Subdistrict, was expected (suspect) bird flu. [This is today - and I believe it’s saying a village “Seribu Dolok” was suspected of BF - JMO? ]
Correction: I believe it’s saying a VILLAGER “Seribu Dolok”
Consider the “bug out” factor. If 4 infected people bug out from a cluster area and 1 of them starts a new cluster somewhere else then there could be multiple limited H2H clusters.
Edna Mode – at 12:23
I can only give you a rough picture.
Very roughly, 2 places in North Sumatra, 1 in South Sumatra (so far chicken only), 2 places in Sulawesi, Cikelet appears to have spread North by 100KM i.e. 2/3 of the way to Jakarta indicating possible failure of containment, vaguely some in East and Central Java.
The main issues are:
1. it’s popping up in many places
2. chicken outbreaks followed very shortly by human infections - little or no time to respond
3. Tamiflu sometimes administered too late i.e. late detection and reporting
4. health care systems severely strained. Expect exhaustion in the near future.
5. watch for more drastic measures e.g. cull and ban all backyard poultry
6. watch for quiet international backlash e.g. tourism, cancelled or postponed investments
Commonground – at 12:55 ,12:34
They are using a tamiflu blanket over the region, closing roads, culling birds and still it seem ever day there are a few more cases. The only thing “positive” is that it does not seem very good at H2H but I am afraid it is just a matter of time now (this flu season??)
Found this (FT) for South Sumatra:
“Palembang - Tim [team] technical the control of South Sumatra Province bird flu today (21/8) will send 22 samples of the citizen’s blood of two locations was different in the Lubuk Linggau city. Respectively, 15 citizens Kaba Ceremeh and five people from the Megang area. Whereas, two again blood two citizens that was expected (susfpct) bird flu, the daughter Wira Maharani (8) and the son Wira Aditya (3.5 months).”
What a bright ray of sunshine toay :)~
I’m with you commonground & Milo, I just can’t keep up. I try and update my notes and find I have the same person two or three times, them I see two or three people posted that I have no clue about. I think once we got to 20 or 21 people in Garut I got confused, and just can’t catch back up!
OKBirdwatcher “If we can’t keep score, is the game over??? “ i don’t know, but I’m starting to feel that way.
I think that someday soon H5N1 is going to go through Indonesia and then the rest of the world like s**t through a goose. We will probably look back on these postings and wonder why we didn’t see it coming.
DennisC - at 13:09, I’ve heard they really don’t have a “flu season” there? But they do have rainy seasons. I am getting to the point where I’m a little skeptical about reading the “news” here every morning……. Also the closing of the school for a week:
TK Aisyiyah diliburkanHundreds of students TK Aisyiyah Bustanul Atfal were forced to be given a holiday until a week came because of the location of their school only be at a distance around five metre the discovery of the chicken that terjangkit bird flu.Moreover has had the child that complain about was attacked by the fever.The medical staff from the Health Service of the Palu City also carried out the inspection to these TK children.The parents of the pupil also received the briefing from the Muspika element local so that mewaspai the plague of bird flu that began to attack the Palu City and to monitor always the health of his child for this week.If having signs that aroused suspicion immediately reported to the preceptive post the emergency that was formed around the location of bird flu of the danger in the Palu Subdistrict West.(HF/OL-02).
“I think that someday soon H5N1 is going to go through Indonesia and then the rest of the world like s**t through a goose.” My first laugh of the day! Thanks Hillbilly…LOL
After reading all this, it seems to me that B2H is becoming easier. It used to be that one needed a long term exposure to sick chickens, now maybe just some exposure is causing the illness. I suspect their are several cases of H2H also. Hillbilly Bill, I think that many of us do see it coming. But sitting here in the midwest, I can’t do anything about it.
Commonground – at 13:14
There hasn’t been any more news from Lubuklinggau after this was reported first by Influentia2 and pugmom, as the South Sumatra provincial government at Palembang may be waiting for test results or equipment.
In view of the increasing number of outbreaks and the strain on health care resources, we can expect the epidemeological information from the local authorities to be less accurate, as well as newspaper fatigue (just like us here).
However, the geographic pattern of the outbreaks, which doesn’t take too much time to track, will give us a fairly good understanding of the state of H5N1 progression. One can easily fall into the trap of the deer staring at the head lights. This was discussed in “To Catch a Falling Knife” thread.
I posted several maps during the last several days as Influentia2 first reported the North/South Sumatra outbreaks. You may wish to take a look at those maps.
Is the WHO still in Indonesia? Are they still claiming no H2H?
OKbirdwatcher – at 12:29
Commonground - If we can’t keep score, is the game over??? Yet another win for H5N1?
In a way, you are drawing a parallel of the game of Wack-A-Mole which I suggested, at the beginning of the Cikelet outbreak, was the shape of things to come.
We are only trying to keep score from a remote distance with no clear and present danger to ourselves. Indonesian public health resources are stretched and strained. At this time, I don’t thing the game is over yet. I do expect some new measures from the Indonesian government is response to this situation.
I think it may take a few more ‘waves’ of shifting dynamics before it actually turns pandemic. The last ‘shift’ was in May in Karo. I think we still have time, but it is becoming more and more inevitable.
If b2h is becoming much more efficient, and the migratory wildfowl can spread it, well, then, this is the accelerator/afterburner that we all have feared. It will be the factor that will exponentially expand the “petri dish” for the evolution of a slam-bang, highly efficient h2h.
You may of heard of the phenomenon of “inflation” right after the Big Bang at the beginning of our Universe. In a virological sense that MAYBE is happening now.
anonymous – at 13:36
Yes WHO is still in Indonesia. The preliminary update on Cikelet was ‘no evidence of H2H’, ‘no evidence of easier B2H’. The book is closing, but not completely, as I think even the WHO realizes that they need ‘plausible deniability’ in case containment fails.
The latest news is Cikelet may have spread North 100Km. Cikelet is in South Garut and is a poor, hilly area. North Garut is on plains with rich rice fields - a very different economy - with likely better hygiene.
MSM seems to be having trouble keeping it all straight too. MSM is having trouble reporting on this because the cases are difficult/impossible to track and confirm, so they rely on the WHO. However, while the WHO is giving out reassuring statements, there is no way they [the WHO] knows what is going on either. Scary.
Ignorance hampers Indonesia’s bird flu fight
JAKARTA (Reuters) …”New fears that the virus had mutated into a form that can easily pass between humans arose this month after a series of confirmed or suspected cases in West Java’s remote Cikelet village, where bird flu is rife in poultry.
The World Health Organization (WHO) said there is no evidence that human-to-human transmission has occurred in the area, but experts say what is most worrying is how human cases are often shrouded in mystery with officials unable to say whether the virus is in the environment or how widely it has spread — which means H5N1 outbreaks in poultry essentially go uncontrolled.”
Hillbilly Bill – at 13:21
I think that someday soon H5N1 is going to go through Indonesia and then the rest of the world like s**t through a goose. We will probably look back on these postings and wonder why we didn’t see it coming.
I hope you are not talking about Canada Goose. :-)
I happen to think that even if the H5N1 strains don’t turn pandemic in Asia, it is still possible (though less likely) that the ‘highly adapted’ strains once land in America, may find the last key that unlocks the Pandora’s box with the help of a species not found in Asia.
Complacency on ours shores could be deadly.
Anon yyz- has the WHO or any officials made any comments on all these new cases that keep popping up? Like the 3 reported on News Now this morning (with the 2 very young toddlers?) I don’t mean to appear lazy, I just am not as good at seeking out info as some of you here. I basically just read News Now and Cidrap. That’s all I know about. Anyone know what the officials are saying about all the new cases (not in Garut) but in Indonesia?
The unluckiest guy (gal) in the world-a “three year” prepper living next door to Panflu Pete, (and you didn’t even like the guy).
ANON-YYZ at 13:55-I worry more about bad luck than complacency. : )
anonymous – at 14:04
Not on individual cases, but on ‘state of Indonesian resources in the battle against bird flu’, there is a story on the news tread today:
ANON-YYZ – at 12:17
Indonesian officials commemts ususally quoted in News stories.
Read JV – at 14:12 on the News Reports for Aug 25 thread.
Despite all of the confusion of suspected cases, new cases, etc. What is the actual count of COMFIRMED cases since this all began, beginning from the first confirmed case in Cikelet? What is the actual number of positive tests which have been returned? I realize that there are probably some of the early deaths in Cikelet, which may have been positive but never tested, but then again they could have died from Dengue fever or a host of other horrible diseases that are prevalent in the area….the point is, we will never know. I have been aware for some months that they have been testing thousands for “possible” bird flu cases, but in fact few have actually been positive. I guess my point is, that I am not going to be too concerned about the increase in “suspect” cases as there have been many, since the beginning of this year. I’m waiting for the positive results to start showing up or for deaths due to “suspected bird flu” to increase drastically before I am going to really get concerned. As Medical Maven pointed out the other day, Bird Flu is so thick in Indonesia you could cut it with a knife. There will continue to be human cases of B2H or poassibly another mammalian source there as long as it is endemic. I’m not so interested in bird flu, and that passing to man, but am trying to gauge when panflu begins to occur.
I think they making a school holiday in that on area becasue they think or know it is going H2H.
I doubt the kids would be getting AI from birds at school?
Thread is getting long, so closing and continuing here
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