Although this story began to filter out through the Indonesian media yesterday (see Crof’s reports here, and here), this morning English language reports are beginning to emerge that provide greater detail.
While not necessarily alarming, there are a few aspects to this story that stand out, including the location (close in to the capital), the supposed vector (pigeons instead of poultry), and the initial presentation of symptoms apparently suggestive of a gastric infection.
Although pigeons have been linked to H5N1 a few times in the past, they are generally considered less susceptible to the virus than many other bird species (see Spain: H5 Avian Flu In Doves).
In humans, H5N1 infections typically present as respiratory illnesses, but there have been reports of gastrointestinal symptoms before. One of the earliest came from this study involving the deaths of a brother and sister in Vietnam in 2004.
de Jong MD, Bach VC, Phan TQ, Vo MH, Tran TT, Nguyen BH, Beld M, Le TP, Truong HK, Nguyen VV, Tran TH, Do QH, Farrar J.
In June of 2007, we got a report (see Atypical Presentations of H5N1) out of Indonesia, of a child infected with H5N1 but that presented without respiratory symptoms.
A year later, in a large review of Chinese bird flu patients (see Clinical Case Review Of 26 Chinese H5N1 Patients), we find several mentions of gastrointestinal involvement as well.
With all that serving as prelude, a roundup of reports on this suspected case. First this bare bones report from the Xinhua News Service.
Updated: 2012-01-09 16:34
JAKARTA - An Indonesian man aged 23 years old who was suspected of having infected by avian flu virus died at 22:50 pm local time on January 7, an official said here on Monday.
Dr. Dien Emawati, M Kes., head of Health Department at the Province of Jakarta, said that the patient was suspected of being infected by the virus as he was sick following the death of one of his pigeon a week before.
"On January 3, he was treated in Satya Negara Hospital with sicknesses of high fever, queasy and faint with body temperature of 39.2 Celsius degree. He was suspected of having avian flu virus as his condition worsened with suffocation, and we found a contact factor with his dead pigeon," said Emawati.
She said that the authorities of Jakarta province scrutinized fowls around the scene and destroyed chicken runs.
"We also gave tamiflu (to prevent the spread of the flu) to the members of the victim's family," said Emawati.
She added that the scrutiny will be intensified throughout Jakarta.
The Jakarta Post weighed in overnight with a bit more detail. Their report indicates the patient – who fell ill around the first of the year – was first seen at a local hospital and diagnosed with a gastric infection, then sent home.
His condition worsened and he returned to the hospital several days later and was tentatively diagnosed with dengue, and was finally admitted.
When his condition deteriorated they tried to transfer him to bird flu equipped hospital, but he died on Saturday during transport to a different facility.
The Jakarta Post, Jakarta | Mon, 01/09/2012 5:38 PM
A person suspected of being infected with bird flu, identified as PDY, 23, a resident of Tanjung Priok, North Jakarta, died on Sunday.
PDY’s body was stored in a coffin by the Tangerang public hospital and was buried in Jakarta.
North Jakarta health agency’s public health management unit head Ati Sukmaningsih said that based on the examination of PDY’s blood and mucus, he had died of bird flu.
Several news reports have indicated that this victim’s sibling (age 5) was also suffering from similar symptoms, and has been hospitalized.
He had symptoms of fever, cough and colds, since two days ago.
MONDAY, JANUARY 9, 2012
VIVAnews - Head of Jakarta Health Agency Dien Emawati, stating the results of laboratory examinations of the ASR, 5, the negative of the bird flu virus.
ASR is the younger brother of PDY, 23, a resident of New Road South Ancol RT 10 / 6 No 30 Sunter Agung, Tanjungpriok, North Jakarta, who died from bird flu virus. ASR is in direct contact with the PDY, experiencing symptoms of fever, cough and colds since Saturday, January 7, 2012 yesterday. He was admitted to the ICU special bird flu Friendship Hospital, East Jakarta.
"The results of examination of the victim's sister according to the laboratory negative, hopefully a speedy recovery," said Dien Emawati at City Hall held a press conference in Jakarta, Monday, January 9, 2012. After the incident , Dien explained, the institute along with the Research Ministry of Health has conducted blood sampling in close contact with as many as 10 people. The result will be out in about a week.
Finally, a report (h/t again to Gert on FT) indicates that the governor of Jakarta has instructed that measures be taken to prevent the entry of the virus into the capital.
The Jakarta Post, Jakarta | Mon, 01/09/2012 4:43 PM
Jakarta Governor Fauzi Bowo says that he has instructed the city’s Health Agency and the Maritime and Agriculture Agency to conduct a thorough investigation into a suspected bird flu case in Tanjung Priok, North Jakarta, which killed one person.
Although these stories seem to be pretty certain that this patient died from the H5N1 virus, until this is officially confirmed, this remains a suspected case.
Testing for the H5N1 virus is not always easy, or successful (particularly after Tamiflu has been started), and so we’ll be watching with interest the health of the victim’s sibling and recent contacts over the next 10 days or so.
For now, bird flu remains primarily a threat to poultry. The virus remains poorly adapted to human physiology, and despite ample opportunities to cause illness in humans, the virus only causes rare, sporadic infections.
The concern, of course, is that over time that may change. That the virus will mutate into a form that is easily acquired and passed on by humans.
And so we watch developments in places where the virus is endemic with particular interest.