# 1057
Disturbing reports are coming out of Bali this morning, where a 29 year old woman and her 5 year old daughter have both died from the H5N1 virus, according to authorities. Additionally, a 2 year-old neighbor child is also ill with similar symptoms.
This from The Daily Telegraph.
Bird flu confirmed in Bali
August 13, 2007 12:00am
HEALTH officials in Bali have confirmed that a woman and her daughter died there from the deadly H5N1 strain of influenza.
The deaths of the 29-year-old woman and her five-year-old daughter were the first from bird flu in Bali and took the nation's toll to 83, a health official said.
The woman, Ni Luh Putu Sri Windani, lived in the northwest of the island, far from the major tourist centres.
She died yesterday, while her daughter died on August 3, said Bayu Krisnamurti, head of Indonesia's national bird flu commission.
"Both people are positive, from (tests at) the Eikman Institute and the health ministry's lab," he said.
In Indonesia two tests must be returned positive before a human infection is confirmed.
Chickens in Ms Windani's neighbourhood were positively infected, said Joko Suyono of the Bird Flu Information Centre in Jakarta.
Ms Windani, from a village in the district of Jembrana, was suffering from a high fever before dying of multiple organ failure, said Ken Wirasandi, a doctor at Sanglah Hospital in Denpasar.
Mr 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.
Contact with sick fowl is the most common way for humans to contract the H5N1 virus.
The woman had started showing symptoms more than a week ago, but was only admitted to hospital six days later.
She was transferred to Denpasar on Friday, where she was treated in the isolation unit, Mr Suyono said.
A two-year-old neighbour of Ms Windani has also been admitted to hospital in Denpasar.
A spokeswoman for the Australian Department of Health and Ageing said the situation was being closely monitored.
There is still some confusion about this story, with some news outlets reporting both the mother and child have tested positive for the H5N1 virus, while others are reporting that the child wasn't tested, and was cremated 10 days ago.
This story has so many worrisome elements, it is hard to keep count.
First, this has the earmarks of a cluster. Ten days ago a 5 year-old child dies, now yesterday her mother has died, and today we learn a neighboring child is sick with similar symptoms.
The exact onset dates are missing from the reportage thus far, but it appears that the mother became ill several days after the death of her child. The onset of illness of the neighbor child is unstated. This staggering of onset dates suggests either a persistent environmental vector, or possibly even human-to-human transmission.
Bali is a popular tourist destination with a large number of international travelers. Should an extended outbreak occur there, the ability to contain it diminishes over what a more remote, less traveled area might experience.
And more than 2 years after Indonesia began experiencing bird flu deaths, villagers are still feeding sick and dead poultry to their pigs. Pigs are, of course, an excellent `mixing vessel' for flu viruses, and have been known to acquire the H5N1 virus.
Obviously officials will be watching this area closely for the next week or two to see if more cases pop up.
