# 5907
Trying to piece together what is going on with bird flu in Indonesia has always been a challenge.
Local media reports are sometimes incomplete or inconsistent, machine translations can introduce additional ambiguities to these stories, and the Ministry of Health (Depkes) has a history of being less than forthcoming with details on H5N1 cases.
To make matters worse, laboratory testing for the H5N1 virus in Indonesia has always been problematic. The virus can be difficult to detect, and in some cases, has only finally been found in biopsied lung tissue taken after the patient died.
Additionally, the administration of Tamiflu can reduce viral replication enough to make detection of the virus even more difficult.
As a result of these combined vagaries, I tend to take all reporting on bird flu out of Indonesia with a large grain of salt.
By way of example, there are conflicting reports this morning as to whether the mother of two recent bird flu fatalities who died at home after fleeing the hospital (see Indonesia: Bali Bird Flu Suspect Dies, Suspect Cases Increase in Mataram) will be tested again for the H5N1 virus.
She reportedly tested negative for the virus several days before her death (it is also likely she was receiving prophylactic antivirals at the time).
The woman was buried on Monday (see video), and as is common when bird flu is suspected, those handling the body (and many of the mourners) wore protective gear.
The Bali Post reported (h/t History Lover on The Flu Wiki) that:
Many people suspected the victim's death was due to having been infected with bird flu. But officials did not conduct swab tests at Diskes Bangli or get the victim's blood, so the swab test (fluid) from the victim's mouth and nose are still referring to old data when the victim stayed with her son in Sanglah Hospital with a negative result of bird flu.
While admitting that H5N1 was a possible cause of her death, the article also stated:
She was depressed because her two children were left behind. The victim's body was in a weak condition after days of not eating. This was exacerbated by an unstable mental state, so that in such conditions a variety of diseases can attack it.
We’ll have to wait to see if any additional samples were taken from this victim before she was buried, but there is the possibility that we’ll never know with absolute certainty whether she had the virus.
This morning, we’ve also a report from Ida at BFIC that indicates that two of the (now) five suspected cases of bird flu on the neighboring island of Lombok have tested negative for the H5N1 virus, but that additional laboratory testing to confirm that is still needed.
Lombok Tengah, West Nusa Tenggara ::: Two bird flu suspect patients diagnosed negative
Posted by Ida on October 18, 2011
Lombok Tengah – Two bird flu H5N1 suspect patients treated at West Nusa Tenggara provincial hospital in Mataram, MA (11-month-old boy) and IS (53-year-old woman) diagnosed negative by the hospital. Hoewever, hospital is still waiting for the confirmation from the Ministry of Health laboratory in Jakarta.
Two other patients, DS (5-month-old girl) from Semayam, Praya and SK (10-year-old girl) from Pringgarata are still under intensive treatment at isolation unit. DS was reported of developing fever after several chickens raised by her family died–off. SK was admitted to hospital because of fever and weakness. Both patients are treated as bird flu suspects because they live in bird flu endemic areas and possibly had contact with birds. Patients have been treated with Tamiflu for bird flu anticipation.
Given the chequered history of reporting and testing out of Indonesia it is tempting to `fill in the blanks’ with guesses as to what is really going on, but that can often serve to further distort the story.
Rather than speculate on specific cases, I prefer to acknowledge that our view of what is going on in Indonesia (and many other regions of the world) is limited by language, distance, and a lack of surveillance and reporting.
Cases will go undiagnosed, lab tests may or may not be definitive, and at best, we are probably only getting an overall sense of what is going on.
And in truth, that happens with every disease in every country. Even in the United States the CDC can’t tell you exactly how many people died from the flu last year, or how many people contracted Lyme Disease, or the West Nile Virus.
While only seeing the tip of the pyramid can be frustrating, it is a pretty much a universal limitation of disease surveillance and reporting.
Despite the built in `fog of flu’ in Indonesia (and around the world) the hope is by tracking and comparing individual cases we will be able to quickly pick up on any major changes in the way bird flu virus behaves.
In the meantime, when it comes to media (or even official) reports on details of individual cases out of Indonesia (or anywhere else), I’m afraid the old rule applies:
Caveat Lector.
