# 2722
When someone presents with a high fever, respiratory symptoms, or pneumonia in Indonesia, or China, or anywhere else in the world where the H5N1 virus exists, one of the first questions most doctors ask is about recent exposure to poultry.
Since H5N1 is primarily a disease of birds, that makes sense.
And early on, almost all of the known human bird flu infections could be traced directly to some sort of contact with fowl.
Increasingly, however, we are seeing occasional cases where there are no known contacts with poultry, leaving us with an unanswered question.
Where did the victim contract the virus?
Another animal vector, like a dog or a cat, or even possibly an asymptomatic human? Or perhaps the virus was in the environment; bird droppings brought in on someone's shoes, or in house plant fertilizer, in store-bought produce, or . . .
Well, you get the picture. There are a lot of possibilities.
The latest case out of Indonesia, that of a 21 year-old housemaid, is another example of an unknown vector for the virus.
This from the Jakarta Post.
Thursday, January 29, 2009 7:34 PM
Dead housemaid tests positive for bird flu
Indra Harsaputra , THE JAKARTA POST , SURABAYA | Thu, 01/29/2009 1:46 PM | The Archipelago
A housemaid who died from a lung infection at Dr. Soetomo General Hospital in Surabaya over the weekend was infected with Avian flu, the hospital revealed Wednesday.
Chairman of the Press Forum at state-run hospital Urip Murtedjo said Sunday that a blood sample taken before the victim's death and sent to the Health Ministry had tested positive for Avian Flu.
The victim, identified only as S, and who is believed to have worked as a housemaid for a family in the city, was transferred from to the hosptical from a private hospital last Friday after suspicions were raised that she was suffering from the fatal disease.
"Initially, we did not know but remained suspicious of the patient's symptoms. After her death, the hospital's medical team sent a sample of her blood to the Health Ministry and the laboratory test result *confirmed* she was infected with the H5N1 virus," he told The Jakarta Post.
Urip said the hospital's medical team had doubted she was infected with the disease after learning the patient was not exposed to poultry at her work place or in her home village in Lumajang.
"This case has received a serious level of attention from the medical team because it is a new phenomenon," Urip said.
Chairul Anwar Nidom, a bird flu specialist at Airlangga University in Surabaya, said it would be foolish to rule out the possibility of an endemic in the city, citing recent outbreaks in Jakarta, West Java, North Sumatra and Banten.
He said his team would continue to research the path the virus was taking across the archipelago to determine which areas were vulnerable.
