# 1110
Practically from the time it happened, most scientists and lay observers believed the Karo cluster in Indonesia to have involved limited human-to-human transmission.
Indonesia's Health Minister, however, continues to deny any H2H transmission in that country, and apparently gives little credence to the Hutchinson Study from last week.
This from Xinhua, then a bit of discussion.
Indonesia dismisses human transmission on bird flu
www.chinaview.cn
2007-09-03 19:37:16
JAKARTA, Sept. 3 (Xinhua) -- Indonesia confirmed that there has been no human-to-human transmission of avian influenza virus in the country, Health Minister Siti Fadilah Syupari said here Monday.
The minister told a press conference that thousands people had been killed should the transmission occurred already in Indonesia.
" There is no human-to-human transmission in Indonesia," she said.
"There has been no virologist report, and it is still zero epidemiologist," said Fadilah at a office here.
She said that the conclusion of the experts from the Fred Hutchinson Cancer Research Center in Seattle, Washington last week could not be used to say that human-to-human transmission had already happened in Indonesia, as the expert only make their calculation mathematically.
The expert found a statistical confirmation that H5N1 virus spread from human-to-human between a small number of people within a family in North Sumatra, Indonesia, where eight people died in April last year.
"That is only a statistical test," said the minister.
In North Sumatra, the cluster contained a chain of infection that involved a ten-year-old boy who probably caught the virus from his 37-year-old aunt, who had been exposed to dead poultry and chicken feces.
The minister said that Indonesian authorities already declared the cluster in North Sumatra as limited human-to-human.
"For example, the father, who has two children, he died. Why was the mother not infected by her child, why only the father was infected?. This still become a big question until now," said Fadilah.
The Karo cluster, described above, took place in April and May of 2006. It so shook the scientific community that stockpiles of Tamiflu were shipped to Indonesia and other parts of S.E. Asia.
- The index case was a 37 y.o. woman presumably infected from poultry. She fell ill on April 27th, and died on May 4th, 2006.
- On April 29th, 2 days after she became ill, there was a family gathering, and 6 other family members became infected. Five of the six died, all between May 6th and May 14th.
- On May 15th, the brother of the index case fell ill, and died on the 22nd of May.
Now, can we prove this was definitely H-2-H?
No, but it is very suspicious. The six family members falling ill a week after contact at a family gathering with the index case is pretty compelling, even without the statistical analysis of the Hutchinson study.
The last member of the cluster fell ill 2 days after the deaths of his family members. Once again, this would fit with the incubation period, and suggests H-2-H.
Now . . . could all 8 family members have contracted the virus from a common vector? Also possible, although it would have to have been a persistent one to infect 8 people over 3 weeks of time.
Proving human-to-human transmission, outside of a controlled laboratory experiment, is almost impossible. We don't even know, with certainty, all of the modes of transmission of influenza. The debate over droplet verses airborne transmission continues.
It appears that Supari is playing word games, for she admits that the government had recognized the Karo Cluster as `limited Human to Human transmission'. Which is basically what many scientists outside of Indonesia have been saying.
So I'm confused.
If Indonesia admits to `limited H2H' in Karo, why all the bluster? Does this somehow play favorably to her domestic audience? Is this some form of face-saving move for her government? Or do they really believe there was no H-2-H transmission in karo?
Whatever their rationale, Indonesian officials seem determined to counter any suggestion of H2H transmission vigorously.
Which may not advance our knowledge of the virus, but does give me something to blog about on an exceptionally slow labor day weekend.
