(UPDATED)
# 2764
On February 1st of this year, the good folks at The Bird Flu Information Corner - a joint endeavor between Kobe University, Japan and Institute of Tropical Disease, Airlangga University, Indonesia - translated and posted an article about `two sisters' from Bogor that died in mid-January `strongly suspected' of bird flu.
We now know they were not sisters, but were brother and sister.
We also learned that the Health Department was taking blood samples and handing out Tamiflu in their neighborhood.
Health service collects blood samples
31-01-2009 15:08 WIB
Meanwhile, Health service of Bogor took blood sample of people around the bird flu victims neighborhood who died last week (1/16), Nurul Hikmah and her sister Ruslani (30), the residents of Cilendek barat RT 3/8, Cimanggu Barata Bogor.
Bogor is a small town, about 40 km south of Jakarta. In recent weeks we've seen numerous reports of dead or dying poultry from the area, and in the past, Bogor has been a hotspot of bird flu activity.
In January of 2007, there were media reports of multiple `bird flu suspect cases', mostly children, from this area. If any of these cases actually tested positive for the virus, it was never announced. Most likely, they were suffering from some other viral illness.
Bogor is also the home of the Bogor Agriculture Institute (IPB), which conducts research into avian influenza. So the town's name may sound familiar to some of my readers.
As a reminder, Indonesia currently refuses to release information in real-time on suspected, or confirmed, human cases. So, while the Health Ministry probably knows if the first two victims died of the H5N1 virus, they are not releasing that information to the world.
For now, all we have are suspect, or suspicious cases.
Last night, the Bird Flu Information Corner posted an update to the Bogor story, one that suggests that - whatever is going on there - it isn't over yet.
First their translation (by a real human being, not a machine translator!), and then a recap.
Bogor, West Java::: Victim’s family refuses to be observed
Radar Bogor, 07 February 2009.
Victim’s family refuses to be observed
Ruslan’s brother, Ridwan (35) who’s now under observation due to high fever refuses to do chest x-ray. The victim’s family even refused to welcome public health authorities when visited their house.
“W suspected this family may have possibility to get same infection since they share same gene and Ridwan is working as trash collector as his broher Ruslan”, said the head of public health Gang Kelor dr Sri Utami.
Sri aso mentioned that nine people around this area are developing high fever. Ruslan’s wife is known has left to Cirebon before her blood sample is collected.
Before Ruslan and his sister Nurul stated as bird flu suspect victims, suddenly death chickens were found around their neighborhood. Meanwhile the nine victims from RW 04 (3), RW 11(2) and RW 16 (4) which developed high fever are now still under observation and received Tamiflu treatment.
Source: Indonesia local newspaper, Radar Bogor
Note: There appears to be some discrepancies in gender between the various translations. We see this a lot, when translating Bahasan to English. He becomes She, Brother becomes Sister, male becomes female.
We live with it, but It makes it very difficult to tell who's on first.
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UPDATED 10:00 EST: Ida at the Bird Flu Information Corner has sent in an update for us, that straightens out the genders of those involved.
My thanks go to everyone at BFIC for the work they are doing.
I would like to confirm that Ruslani (30) previously reported as 'sister' is actually brother of Nurul, the first victim who died. In the other hand, Nurul is a female. Nurul and Ruslani had died due to infection, meanwhile now their brother Ridwan (35) is developing same symptoms as his siblings. I can't confirm anything about this, but just say they are strongly suspected to contract bird flu virus until the next update.
So Ruslani is a male. Nurul is a female. And Ridwan is a male. Two brothers and a sister. The two fatalities in mid-January were therefore, brother and sister.
To avoid confusion, I've edited my blog to reflect this new data. Thanks Ida!
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As near as I can piece all of this together, in mid-January two siblings Nurul Hikmah and her brother Ruslani (30) died in Jakarta hospitals of what was `strongly suspected' to be H5N1.
At the same time, many birds died in their neighborhood, and tested positive for the bird flu virus.
The health Department took blood samples, put close contacts under surveillance, and handed out Tamiflu.
Now a brother, Ridwan (35), is `under observation', apparently at home, with a high fever but refuses a chest x-ray. His family refuses to allow public health officials access to him.
There is much distrust of `modern medicine' in Indonesia, understandable I suppose, given the 80% fatality rate when bird flu patients enter the hospital. Many people still prefer herbal remedies, or to seek traditional medical help.
The quote from the local health official is particularly interesting. After all, he must know by now the results of the sister's test.
W suspected this family may have possibility to get same infection since they share same gene and Ridwan is working as trash collector as his broher Ruslan
He worries that, because these are blood relatives (`shares the same gene'), the fevered brother may be suffering from the same infection as his (brother?/sister?).
There is a belief, at least among some researchers, that there might exist a genetic propensity to catching the H5N1 virus - based on the observation that the few human-to-human transmissions we've seen appear to happen among blood relatives.
Meanwhile, 9 other people in the area are under observation with `high fevers', at home, and receiving Tamiflu. Their condition doesn't appear to be overly serious at this time.
Confusing? Indeed.
And I'm not 100% sure I've got all of the details straight. Alas, we live in a world of incomplete information.
While obviously a concerning report, even if all of these dozen or so `suspect' cases should turn out to have the bird flu virus (which is unlikely), we are still a long way from sounding alarm bells.
We've seen larger outbreaks in the past that have burned out, either through the use of Tamiflu, or of their own accord. Turkey and the Karo cluster in Indonesia both come to mind.
Based on what we know right now, Bogor is worthy of our attention, but not our alarm.
We've little choice but to wait for the next report. Hopefully it will contain more solid information.
In the mean time, a big hat tip to The Bird Flu Information Corner for finding, and translating these reports. The work they are doing is both welcome, and invaluable, to the rest of the world.
