Tuesday, March 29, 2016

Watching Indonesia Again For H5N1

# 11,206

Although it certainly wasn't the only hot spot for avian flu - between 2005 and 2012 Indonesia reported roughly 190 human H5N1 infections -  well ahead of both Egypt and Vietnam. Poultry outbreaks were so numerous, they were no longer regularly eported to the FAO.

Worse, reporting and surveillance out of Indonesia was often cloaked in secrecy, with the conspiracy-minded (now-ex) Health Minister Siti Fadillah Supari blocking the export of H5N1 virus samples to the WHO and shutting down America's NAMRU-2 (Naval Medical Research Unit) stationed in Jakarta.

The battle over Indonesia's official silence on avian flu cases became public in 2008 (see WHO: Indonesia Agrees To Resume Bird Flu Notifications), and while an agreement to report was announced, notifications remained patchy at best.

Gradually the number of human H5N1 cases reported by the MOH dwindled down; from a high of 55 in 2006, to only 3 in 2013. Exactly why cases have dropped dramatically in Indonesia, but have gone up in places like Egypt and Cambodia, isn't clear.

While we've seen scattered reports of poultry die offs, and a handful of human H5N1 cases over the past couple of years (n=4), avian flu reporting out of Indonesia has become pretty uncommon.

But over the past couple of weeks H5N1 was detected in poultry in Cilandak, South Jakarta, the Jarkarta Post reports the City on alert for bird flu after fowl deaths and Flu Burung is suddenly front page news again in Indonesia. 

Two reports:  First, from Kabar24.com, a report obviously designed to reassure the public, stating that the MOH is bringing in a large quantity of antivirals to protect the population. 

BIRD FLU: Health Ministry Set 1 Million Doses Antivirus
Bisnis.com, JAKARTA - The Ministry of Health set up one million doses of the drug oseltamifir or influenza antiviral drugs commonly used to handle the spread of bird flu from birds to humans. "The drug is already prepared, there will be another one million doses were prepared. There are currently about 5,000 doses enough because there is no transmission to humans.

However, we remain vigilant, "said Director of Disease Prevention and Control Tular vector and zoonotic Ministry of Health Vensya Sitohang after opening a seminar in Jakarta, Monday (03/28/2016). Vensya said that vigilance is the major in dealing with the outbreak of the H5N1 virus after a number of birds found dead suddenly in a relatively large amount. the Ministry of Health and Ministry of Agriculture to coordinate to map some of the province were found affected by bird flu, the Ministry of Health noted the spread of H5N1 cases up to March 2016 there were over 17 districts / cities in seven provinces, seven provinces covering Lampung, West Java, East Java, Yogyakarta, West Sulawesi, South Sulawesi, and Jakarta.

However, the trend is sourced disease outbreaks are rated diminishing until March 2016. "the case continues to drop from the year 2012 to 2015 case of two sick, two deaths. We focus this year should not be sick, let alone dying, "said Vensya.
(Continue . . . )

A second report, with a bit more substance, comes from the Jakarta Post, and it concerns well known Virologist and H5N1 expert Dr. Chairul Anwar Nidom from Airlangga University.

Dr Nidom - who has been a frequent critic of over-reliance on poultry vaccines to control H5N1 in Indonesia (see Indonesia: Debate Over Poultry Vaccination) -  will test recent virus samples looking for any signs of increased health threats to the public.

Team to examine effect of avian flu virus on humans
Indra Harsaputra, The Jakarta Post, Surabaya | Headlines | Tue, March 29 2016, 9:53 AM

A research team from Surabaya-based Airlangga University will examine Avian flu virus samples to investigate the possibility of the disease spreading to humans.

 Head of the university’s Avian Influenza Research Center Chairul Anwar Nidom said the team consisting of 14 researchers had acquired samples of the H5N1 virus from two locations, Lamongan and Banyuwangi regencies, where the virus has killed thousands of poultry.

“We will analyze how far the virus has changed or mutated as well as the risk that the virus could be transmitted to people,” Chairul told The Jakarta Post on Monday.

(Continue . . . )

While on the surface, the reports of poultry outbreaks coming out of Indonesia in recent weeks don't seem particularly noteworthy, the press and the MOH appear to be taking them seriously.

And given Indonesia's past history with H5N1, we'll be keeping an eye on it as well.  

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