Showing posts with label Indonesia. Show all posts
Showing posts with label Indonesia. Show all posts

Tuesday, March 31, 2015

Indonesian MOH Statement On 2 Recent H5N1 Cases

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# 9886

 

 

Four days ago, in Watching Indonesia: Media Reports Two H5N1 Cases In Tangerang, we saw unconfirmed media reports of two recent (fatal) H5N1 cases in Tangerang, very near the capital Jakarta.   Although these reports continued over the weekend, today the Indonesian MOH has finally posted a statement on their Sehat Negeriku (Healthy Mine Own Country) website.

 

Between 2006 and 2008, Indonesia was the undisputed leader in human H5N1 infections (122 cases & 112 deaths over 3 years), a dubious mantle claimed from Vietnam which led the pack between 2003 to 2005.  In 2009 Egypt took the title, and except for Cambodia’s brief run up in 2013, has held it since.

 

Over the past three years Indonesia’s bird flu cases have dwindled down to single digits, with only 2 cases reported in 2014. Their case fatality rate, however, remains among the highest in the world at 83.9% – more than double that we’ve seen in Egypt and a full 50% higher than the global average.

 

In today’s report we learn that a 40 year-old man and his son fell ill 4 days apart (son first) earlier this month, both were treated and released by different local hospitals – then readmitted as their conditions worsened – and both died within 48 hours of each other. 

 

Diagnosis of H5N1 did not come until each was at or very near the end of their life, a delay perhaps exacerbated by the decline in local H5N1 cases reported over the past 5 years. Media reports have linked their infections to a visit to the man’s sister’s farm where poultry had recently died, but their exact exposure remains under investigation.

 

 

Bird Flu Case report 198 and 199

Bird Flu Case report 198 and 199

Ministry of Health, through the Directorate General of Disease Control and Environmental Health announced two new cases of bird flu have been confirmed by the Center for Biomedical and Health Technology Association, Agency for Health Research and Development.

The first case of an employee initials TS (L, 40), a resident of the city of Tangerang, Banten province. On March 15, 2015, the case began to complain of not feeling well, but still works. Dated March 17, 2015, symptoms of fever, coughing and outpatient treatment to a private hospital. Dated March 21, 2015 TS Hospital emergency room treatment to other private, chest X-ray results show dextra pleuropneumonia . Because fixed fever and cough accompanied by weakness and nausea, in the evening treatment case back to the hospital and treated with a working diagnosis of pleural effusion dextra et causa pneumonia . On March 23, 2015, and a worsening case admitted to the ICU with a diagnosis of pleural effusion dextra, pneumonia and liver dysfunction. The next day the date of March 24, 2015 and grew more difficult cases diagnosed as Suspect Bird Flu, getting worse and and died at 16:25 pm. Dated March 25, 2015, stating Balitbangkes PCR laboratory test results TS Positive cases of H5N1.

The second case initials MAIPS (L, 2 years) is a subsidiary of TS cases, lived one house with his parents. Dated March 11, 2015, symptoms of fever, cough and runny nose then went to a private hospital and treated. On March 16, 2015, the case out of the hospital, but at home complaining of bloating and cough. Circumstances of the case there is no change, the case complained of tightness and referred to other private hospitals. Because of deteriorating, dated March 26, 2015, the case was referred to the Friendship Hospital hour 02:40 pm, and died at 4:10 pm. Dated March 26, 2015, stating Balitbangkes PCR laboratory test results MAIPS Positive cases of H5N1.

DG team and PL, Research and Development Agency, the Department of Health and PHC Tangerang Tangerang City, Rapid Response Unit Strategic Animal Diseases (URCPHMS) - Ministry of Agriculture has been an epidemiological investigation into the homes of people and the environment. In case the house does not have a good pet birds or other, but in the neighborhood there are many cases of people who maintain ornamental birds and pigeons. Possible risk factors in the case, among others, domestic poultry neighbors around the house case; and the direct and indirect contact with domestic poultry sister case in the District. Bogor.

With the increase in these two cases, from 2005 until this news was published, the cumulative number of AI cases in Indonesia is 199 cases with 167 deaths.

Director General of Disease Control and Environmental Health dr. Mohamad dawn, MPPM as the National Focal Point for International Health Regulations (IHR) has been informed about the case to the WHO.

The government together with the whole community has made various efforts to control bird flu since 2005. In the 10-year period (2005-2014) looks downward trend avian influenza in animals and humans. During the nine months from June 2014 until February 2015 no cases of Bird Flu in Indonesia.

The success of AI control is determined by the role and support of the whole community, especially the role of society in prevention efforts. Efforts to do community is to avoid contact with sick or dead birds suddenly; maintain personal hygiene and the environment clean and healthy life behavior; and recognize the symptoms of Bird Flu include fever / high heat, cough and sore throat. If there are signs of AI immediately went to the clinic or hospital.

This information is published by Center for Public Communication, Secretariat General of the Ministry of Health. For more information please contact via telephone: 021-52907416-9, fax: 021-52921669, Call Center: 021-500567 and 021-30413700 or e-mail address puskom.publik@yahoo.co.id ; info @ Ministry of Health .go.id ; kontak@depkes.go.id .

 

Thursday, March 26, 2015

Watching Indonesia: Media Reports Two H5N1 Cases In Tangerang

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Tangerang is located 25 km west of the Capital City, Jakarta.

 

# 9870

 

 

A hat tip to Crof for picking up a Kompas report (see Indonesia: Father, son die of H5N1) which states there are positive test results for H5N1, although the Indonesian MOH website and their ancillary Sehat Negeriku site have not posted any acknowledgement of these cases.

 

Another media report lists these cases as merely `suspected, with test results still awaited. 

 

Hopefully we’ll get some official statement one way or the other in the next day or so.

 

 

Residents Cipondoh death investigated suspected Avian Health Office of Tangerang 

 Merdeka.com - After death, two family members of citizens of Jakarta Timur, Kota Tangerang, as infected with bird flu virus, the local health office immediately sent a team to the victim's home. "We have sent a team to check the victim's home and the environment. In order to ascertain what the cause of death of the victim, "said the head of the City Health Office of Tangerang, Roostiwie, Thursday (26/3).

Information obtained, a man with the initials N (40 years), and 2-year-old son died of bird flu virus. District residents Jakarta Timur, Kota Tangerang, it tested positive for the H5N1 bird flu. N unknown died in hospital on Tuesday (24/3) at 16.30 pm. N had experienced shortness of breath and fever after his condition deteriorated. Kids N hospitalized following this morning at around 04.00 pm. Children N also briefly hospitalized, but then referred to the Friendship Hospital Jakarta . However, his life was helpless.

While in the hospital, both are suspected of having bird flu, so must a blood test. The government asked people not to fret. Currently, the Ministry of Health and related agencies were investigating the locations visited by the victim. Namely in the neighborhood, the neighborhood, to the hospital. Roostiwie could not conclude whether the two victims died from bird flu does. For the Health Office and the Ministry of Health is still doing research. "We are still waiting for the results," said Roostiwie.

 

While Indonesia once led the world in H5N1 reports, in recent years they have only reported a handful of cases each year. 

Tuesday, June 24, 2014

Indonesian MOH Statement On New H5N1 Case

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# 8775

 

The H5N1 virus, which long reigned as the emerging pathogen thought `most likely to succeed’, has been largely supplanted by H7N9 and MERS in the headlines over the past 16 months - but still circulates in poultry and wild birds in Asia and the Middle East - and still manages to jump to humans on occasion. 

 

Exactly why reports of human infection with the H5N1 virus is less common these past couple of years is unknown, but this welcome period of relative quiescence is no guarantee that the virus won’t flare back up again, sometime in the future.

 

While there were media reports late last week indicating a new fatal H5N1 case in Indonesia, today the MOH has published a detailed account.  

 

The patient, a 33 year-old male, progressed from a `cold-like’ illness to pneumonia to ARDS (Acute Respiratory Distress Syndrome) and then to death, over a two week period. During that time he was seen at two clinics (June 1st & 2nd)  and admitted to a private hospital (June 4th) and then transferred to an FB (Flu Burung) Referral hospital on June 13th where he died on the 14th.

 

While no apparent exposure risks were detected at the victim’s home, investigators point out the patient might have been exposed at a live bird market he visited in East Jakarta, when he purchased live chickens on May 27th.

 

Although the number of new cases reported in Indonesia has plummeted over the past couple of years, sadly, the same cannot be said for the mortality rate from this virus. Today’s case marks Indonesia’s 165th fatality out of 197 known cases, making for a dismal survival rate of just over 16%.

 

 

Bird Flu Case Reports to 197

Ministry of Health, through the Directorate General of Disease Control and Environmental Health announced a new case of bird flu have been confirmed by the Center for Biomedical and Health Technologies Daar, Balitbangkes. Case on behalf of RA (male, 33 years old) District residents Cakung, East Jakarta, DKI Jakarta, an employee.

 

On June 1, 2014, symptoms of colds and flu in the case and went to a private clinic. Next day, on June 2, 2014, the case went to a private hospital clinic with the diagnosis of urinary tract infection (UTI). And because there is no change and complained of nausea, vomiting and swollen eyes, on June 3, 2014 the case back to the private hospital for treatment with the diagnosis of Acute Respiratory Infections (ARI) and Dyspepsia. Conditions of the case does not go changing, so on June 4, 2014 cases of inpatient admission in private hospitals the same.

 

On June 5, 2014, complained of shortness of cases and consulted with a pulmonary specialist to diagnose bronchitis and coronary artery disease (CAD). Next day, on June 6, 2014, the case was getting packed and transferred to the ICU with the images contained thoracic infiltrates. Then there is deterioration with diagnosed pneumonia with acute respiratory distress syndrome (ARDS). On June 13, 2014, the case was referred to the FB Referral Hospital, and died on June 14, 2014 early morning at 01.00 hrs.

 

Epidemiological investigations have been conducted into the homes of people and the environment by Integrated Team MoH RI, Jakarta Health Department, East Jakarta Health Agency, Health Center Pulogebang, Cakung Health Center, Center for Veterinary Research (Bbalitvet), Marine and Agriculture Binas DKI Jakarta Sub-dept East Jakarta Livestock and Fisheries, Animal and Fish Health centers DKI, acquired risk factors, namely the possibility of environmental contacts in one market in East Jakarta, where the case of direct purchase live chickens slaughtered in the market on May 27, 2014.

 

Case the home environment is clean, no poultry in the complex. The house is adjacent to the township case tenement, but there is no population that raise chickens, there are only 2 who keep birds in cages suspended from the home page.

 

With the increase of such cases, since it was first discovered in 2005 till this news was published, the cumulative number of bird flu cases in Indonesia is 197 cases with 165 deaths.

 

Executing tasks Director General of Disease Control and Environmental Health Ministry of Health, Prof.. Dr. dr. Agus Purwadianto, SH, M.Si, Sp.F (K) as the focal point of the International Health Regulations (IHR) has informed the case to the WHO.


Saturday, May 10, 2014

Second Indonesian Pilgrim Positive For MERS In Jeddah

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Credit Wikipedia

 

# 8595

 

Despite assurances by local officials and headlines in the Arabic press calling the  MERS scare ‘overblown’, we really don’t know just how this emerging coronavirus story will play out.  It may remain primarily a localized problem, or if we are really lucky, recede back to whence it came. 

 

But there are no guarantees of either of those outcomes.

 

As a major hub of international travel, one that receives millions of religious pilgrims every year, the Arabian peninsula is perhaps better suited than most places to disseminate an emerging disease – even one that (for now) doesn’t appear to be easily transmissible.

 

Currently, there are media reports of suspected cases being tested in India, Pakistan, Egypt, and Indonesia – plus many other places I’m sure.   Two places keeping excellent track of these reports are FluTrackers and Crofsblog

 

So far, we are told that most of these suspected cases have tested negative – but given the surge in cases in Saudi Arabia and the UAE over the past month - the odds increasingly favor seeing more exported cases of MERS turn up around the world. 

 

Today the Jakarta Post is reporting that two Indonesians on Umrah in Saudi Arabia have contracted the virus, and one has died.  The survivor is isolated in King Fahd hospital in Jeddah.  The fact that they fell ill before returning home was more a matter of luck than of design.

 

Second Indonesian found with MERS in Saudi Arabia

The Jakarta Post, Jakarta | National | Sat, May 10 2014, 3:00 PM

An Indonesian citizen in Saudi Arabia has been diagnosed with  Middle East respiratory syndrome (MERS) Coronavirus.

According to a press release from the Indonesia Consulate General in Jeddah, Jumallang Kaneng Lejja, 84, had arrived in Saudi Arabia to go on umrah (minor haj pilgrimage) on April 15, and was scheduled to return to Indonesia on April 25, as reported by tribunnews.com.

Jumallang, from Makassar, South Sulawesi, was admitted into the King Fahd Specialist Hospital on April 28 complaining of chest pains.

On April 29, the Health Ministry reported that another Indonesian —  NA, 61 — had died of MERS after being treated for seven days at King Saud Hospital in Jeddah, Saud Arabia.

(Continue . . .)

 

 

While it appears that nosocomial transmission of this virus currently plays a bigger part in its spread than does community transmission – and that good infection control procedures can contain it – thus far, hospitals in the Middle East haven’t demonstrated a lot of success in doing so.


Should this virus be exported to a region of the world where infection control and public health capabilities are less capable – say in parts of Asia or Africa - this virus could find an even more hospitable environment in which to flourish.

 

Which is why the international public health community must remain vigilant for any sign that this virus has gained a foothold outside of the Middle East.

Thursday, May 08, 2014

Indonesia Steps Up MERS-CoV Response

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Source Indonesian Ministry of Health

 


# 8587

 

As the most populous Islamic nation in the world, Indonesia sends more religious pilgrims to Umrah and the Hajj than any other country, with more than 220 thousand taking part in 2012.  Despite these numbers, due to a 2013 20% cutback in the number of Hajj visas available to Indonesia, the waiting list to go is now about 12 years.

 


With Ramadan less than two months away, the number of Indonesian pilgrims headed to, and returning from, the Holy sites in Saudi Arabia is on the rise. 

 

And with that, we are seeing multiple reports of `suspected’ MERS cases being investigated in Indonesia. While none of these cases have yet been confirmed, the Indonesian Ministry of Health issued a number of statements today regarding testing of pilgrims, and travel advice to the Middle East.

 

The following comes from the Ministry of Health’s Center for Public Communication  Shehat Negeriku (Healthy Country) website.

 

Mers CoV: RS AND SURVEILLANCE PERSON ALERT 24 HOURS

08/05/2014,

Authorities alerted the hospital and officers to work 24-hour surveillance, including officers in Port Health Office in anticipation of the spread of the virus Corona. MERS Case CoV ( Middle East Respiratory Syndrome Corona Virus ) is moderate severity and Indonesia already has experience in the case of SARS and bird flu some time ago. It could be a good capital in the penanagan MERS.

Acting statement said. Director General of Disease Control and Environmental Health Prof. dr. Agus Purwadianto when asked by reporters following the escalation of cases MERS CoV increases worldwide.

According to Prof. Agus, until yesterday (7/5), certainly have not found a single positive case MERS CoV in Indonesia.

Meanwhile, following the escalation of MERS CoV in Saudi Arabia, Ministry of Health appealed to the pilgrims to postpone the departure umra pilgrimage in accordance with a travel advisor of the Government of Saudi Arabia.

"We continue to urge the (delay) to date, while we reviewed the continued development of the corona virus. Therefore, the risk of transmission is still there and we can not guess, "added Prof. Agus.

Added that the most important thing is to encourage this delay is currently no cure for the corona virus.

The second consideration, the risk is currently gathering with many people in Saudi Arabia. Where fear of transmitting the virus to the Indonesian pilgrims.


thus fitting the Umrah and Haj pilgrims, especially elderly to delay departure. At least, until teams of experts from WHO could ascertain the status of his case. Currently the Government is awaiting the results of the team. MoH will follow the provisions of international rules.

"It's not just about the only Umrah pilgrims," ​​said Prof. Agus.

This information is released by Center for Public Communication, Secretariat General of the Ministry of Health. For further information, please contact Hello MOH hotline code> lokal> 500-567; SMS 081281562620, Fax: (021) 52921669, website www.depkes.go.id  and email address kontak@depkes.go.id .

 

Another post, on the same site, indicates that the turn-around time for MERS testing is 24-hours.

 

24-HOUR BODY READY TO THANK LITBANGKES SAMPLE MERS-CoV

08/05/2014

Head of the Ministry of Health Prof. Balitbangkes. dr. Tjandra Yoga Aditama expressed Agency Health Research and Development Ministry of Health is ready to accept samples for 24 hours to check whether the samples infected Middle East Respiratory Syndrome Corona Virus or MERS-CoV.


"Our laboratory received samples prepared 24 hours. Please be delivered, "he said during a press conference at the Friendship Hospital (7/5). According to Prof. Tjandra, Balitbangkes is awaiting delivery of a sample of Medan and Bali to ensure corona virus or not.

(Continue . . .)

Another report, this time from Channel News Asia indicates that thermal scanners have been set up at airports,  that health checks are being conducted on all returning pilgrims, and that currently 11 people are being tested for the virus.

 

Indonesia stepping up measures to prevent MERS

By Devianti Faridz

POSTED: 08 May 2014 19:48

JAKARTA: Amid reports of more potential infections, Indonesia is stepping up measures to prevent the deadly MERS-CoV virus from entering the country.

Thermal scanners have been activated in 13 international airports across the country and pilgrims returning home from the Middle East must undergo health checks.

Pilgrims returning home from umrah must fill in a health alert card before they are inspected on arrival.

(continue . . .)

 

 

Despite the appeals for the elderly and others with comorbidities to postpone their Hajj or Umrah trip, for many of them, the opportunity to make the pilgrimage may not come around again in their lifetime.  

 

Meaning that many may choose to risk making the journey, despite falling into one of the `high risk groups’.

Monday, March 03, 2014

EID Journal: H5N1 Clade 2.3.2.1 In Indonesia

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Diversity of circulating H5N1 Clades – Credit WHO

 

# 8345

 

While we tend to talk about H5N1 (aka `bird flu’) as if it were a single entity, in reality, the virus has continually evolved and mutated since its emergence was first noted in 1996. At least 20 distinct clades of the virus have been identified thus far,  with numerous variants among each clade.

 

`Clades’ are essentially branches on the virus’s family tree. Each new branch has a clearly identifiable lineage from its parental strain, but has mutated far enough away to become a new strain.  And different clades can possess different characteristics .

 

Different areas of the world have seen different clades set up hen-house keeping, with clade 2.3.2  very common in South East Asia, clades 2.2.1 and 2.2 endemic in Egypt and clades 2.1.1, 2.1.2. and 2.1.3 circulating throughout Indonesia.


 

While not every new clade has what it takes to thrive and persist, one of the more successful `newer’ clades making inroads over the past few years has been clade 2.3.2

 

I wrote of the spread of this emerging clade back in 2011 in What Goes Around, Comes Around and EID Journal: H5N1 Branching Out. In the spring of 2010 we began to see reports of poultry vaccine failures in Vietnam due to the spread of a mutated version this clade (further classified as clade 2.3.2.1), which led to this statement FAO Warns On Bird Flu.

 

In December of 2012, after several months of reports of large poultry die offs in Indonesia, we first heard that his emerging 2.3.2.1 clade had been detected on the Island of Java (see VOA Report On The Indonesian Duck Die Off & Report: Clade 2.3.2 H5N1 Detected In Indonesia).  A month later, we saw reports that Indonesia: H5N1 Clade 2.3.2 Reaches Bali.

 

While we’ve heard relatively little out of Indonesia on the bird flu front over the past year, today we have a detailed look at this new H5N1 clade that arrive in Java in 2012, via a dispatch in the CDC’s EID Journal.

Genetic Characterization of Clade 2.3.2.1 Avian Influenza A(H5N1) Viruses, Indonesia, 2012

Ni Luh Putu Indi DharmayantiComments to Author , Risza Hartawan, Hendra Wibawa, Amanda Balish, Ruben Donis, C. Todd Davis, Gina Samaan, and Pudjiatmoko Hardiman

Abstract

After reports of unusually high mortality rates among ducks on farms in Java Island, Indonesia, in September 2012, influenza A(H5N1) viruses were detected and characterized. Sequence analyses revealed all genes clustered with contemporary clade 2.3.2.1 viruses, rather than enzootic clade 2.1.3 viruses, indicating the introduction of an exotic H5N1 clade into Indonesia.

<SNIP>

Conclusions

Detection of a novel clade of A(H5N1) virus in Indonesia marks a potential turning point in the molecular epidemiology of this virus. Indonesia has the highest number of human A(H5N1) infections because of ongoing outbreaks in poultry (14,15).

Whether this new virus will become entrenched, as did clade 2.1.3 viruses over the past decade, remains to be seen, as do its effects on the incidence of human infection. Potential cocirculation of subtypes of 2 different clades warrants review of diagnostic methods and vaccination strategy to maximize effectiveness of disease control interventions.

The lack of antigenic relatedness between the clade 2.3.2.1 and 2.1.3.2 viruses must be considered when evaluating A(H5N1) serologic diagnostic reagents used in Indonesia. This change also may have implications in selecting prepandemic candidate vaccine virus for the region. Furthermore, poultry vaccines may need to be matched antigenically to circulating virus if clade 2.3.2.1 virus continues to circulate in Indonesia.

Introduction of this virus is a stark reminder of the value of control measures to reduce the spread of subtype H5N1 and the need for enhanced surveillance of humans and poultry to monitor changes in its genetic and immunologic features.

 

 

Last November, in EID Journal: The Expanding Variants Of H5N1 we looked at three new variations of the H5N1 virus (this time clade 2.3.4) detected in Vietnam between 2009 and 2012.  And last month, in Moving Viral Targets, we saw a recommendation – based on a virus isolated in Hubei - that a new clade 7.2 candidate vaccine virus be developed.

 

And there is no reason to believe we won’t see new genetic permutations like these continue to come down the pike in the months and years to come.

 

A reminder that influenza viruses (of all types) are moving targets, and that we dare not become complacent simply because the novel viruses in circulation right now aren’t particularly good at transmitting from one human to the next.


For more influenza clades and variants than we can possibly keep track of, tomorrow is always another day.

Friday, February 14, 2014

Tracking The Mt. Kelut Eruption

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# 8299

 

Indonesia is the most seismically active region of the world, and not only experiences frequent earthquakes, but is also home to more than 130 active volcanoes.  Last month, we watched the Indonesia: Mt. Sinabung Eruption Webcam as more than 20,000 residents were forced to leave their homes.


Yesterday, Mt. Kelut erupted with far greater force – displacing tens of thousands - and reports indicate the ash plume is now hundreds of miles long, and rises nearly 50,000 feet into the air.

 

In 1919, Mount Kelut (also known as Kelud) erupted unleashing a deadly lahar (mudflow) that killed more than 5,000 people.  Since then, Kelut has erupted several times, including a relatively minor eruption in 2007.

 

Normally I’d recommend a webcam link, but it appears the camera feed was taken down by the seismic activity just before, and during, the eruption. It is possible it will be restored at some point.

 

Since I’m not a volcanologist, I’ll happily refer you to Dr. Erik Klemetti’s Eruptions Blog , for the latest details.

 

Other resources, with frequently updated information, include:

 

http://www.volcanodiscovery.com/

http://volcano.si.edu/reports_weekly.cfm   (Smithsonian Global Volcanism Program)

 

And for Volcanoes in the United States, you can check http://volcanoes.usgs.gov/ :

Saturday, January 04, 2014

Indonesia: Mt. Sinabung Eruption Webcam

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Time lapse  review of last 24 hours – Credit http://www.lookr.com

 

# 8128

 

Some of history’s greatest volcanic eruptions have come out of the Indonesian archipelago (Krakatau in 1884, Tambora in 1815, Toba 75000 years ago), and while Mt Sinabung is hardly apt to reach anywhere near those proportions,  it has been rumbling off and on for several months after 400 years of slumber.

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Photo-Map Credit – Wikipedia

 

Over the past 24 hours more than 30 eruptions have been reported on Mt. Sinabung, and evacuations have been extended to more than 20,000 people living in the area.   We’ve a report from Xinhua News , but first a link to a webcam which not only gives you a live view, but allows you to rapidly review the past 24 hours of activity.

 

http://www.lookr.com/lookout/1360477531-Sukameriah#action-play-day

 

 

This report from China’s Xinhua News.

 

Indonesia's volcano erupts again, more people evacuated

English.news.cn   2014-01-04 19:39:07
 

JAKARTA, Jan. 4 (Xinhua) -- Mount Sinabung, one of the most active volcanoes in Indonesia, erupted again on Saturday, shooting a column of ash 4,000 meters to the sky as the number of evacuees rose, official said.

Powerful burst of hot ash and gravel erupted from the rumbling volcano, located in Karo district of North Sumatra, at least 30 times since Saturday morning and hot ash has slid off by up to 5 kilometers from the crater to southeast, pushing the authorities to extend evacuation zone to 20 km from 5 km previously, Sutopo Purwo Nugroho, spokesman of national disaster agency said.

"The column of hot ash now is the biggest ever compared with those frequently spewed (since the volcano erupt in Sept.) The hot ash has slid off to the southeast, covering two villages," he told Xinhua by phone.

The authorities evacuated all the villagers on Friday, adding the total number of displaced person to 20,331 on Saturday from 19, 286 on the previous day, said Sutopo.

Besides, the authorities also extended emergency relief period ended on Jan. 5 to Jan. 18, he said. "The people are recommended to persistently be cautious and abide the authorities' guidance," said Sutopo.

The 2,457-meter Mount Sinabung in Karo district of North Sumatra has rumbled to life since September after being quiet for 400 years. It has erupted on and off since then, but went into overdrive frequently in November and December.

On. Dec. 31, Mount Sinabung erupted, spewing ash 7000 km to the sky, one of the strongest since September.

The Mount Sinabung is among the 129 active volcanoes in the vast archipelago country, which is prone to seismic upheaval as it lays on the Pacific "Ring of Fire" encircling the Pacific Ocean.

Tuesday, November 26, 2013

Indonesian Veterinarian Tests Negative For H5N1 Infection

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# 8009

 

In a follow up to Sunday’s blog  (see Watching Indonesia Again), the veterinarian who was placed into isolation after developing a fever and respiratory symptoms  in the wake of doing poultry inspections has tested negative for the H5N1 virus.  The early symptoms of H5N1 infection are pretty much the same as with any respiratory viral infection, which means we tend to see a number suspected cases turn out to be negative.

 

This from Solopos.com.

DA Veterinarian Bird Flu Negative

Solopos.com, KLATEN - DA, vet initially suspected of contracting the H5N1 virus after examining poultry in Balong Kulon village, Village Kragilan, Gantiwarno Subdistrict, Klaten, declared bird flu negative.

 

"Around 09.00 pm last [Tuesday] we got good news from dr Moewardi. That the results of laboratory tests of veterinary negative DA. Now he is no longer in the isolation room and moved in the treatment room, "said Head of the Department of Agriculture (Dispertan) Klaten, Wahyu Prasetyo, told reporters on Tuesday (26/11/2013).

 

Previously, a few days ago, the vet came to Hamlet Balong DA Kulon, Kragilan Village, District Gantiwarno. It was to follow up on reports of local residents about the birds that died suddenly and allegedly exposed to the H5N1 virus that causes bird flu.

 

At that time, the vet came to the location to do the spraying. A few days later, the DA is in a condition not fit ill with bird flu-like symptoms such as high fever accompanied by shortness of breath, cough, and headache. He was treated in dr Moewardi for further examination.

Sunday, November 24, 2013

Watching Indonesia Again

 

image

 

 

# 8005

 

We’ve a pair of local media reports this morning out of Indonesia indicating that a veterinarian who recently conducted inspection of poultry in the Klaten Regency of Central Java, Indonesia has been hospitalized (in isolation) with a suspected H5N1 infection.

  

At this point all this appears precautionary, as their  suspicion of H5N1 is driven by the patient’s clinical symptoms (which could also match seasonal flu, and many other viral infections) and his recent exposure to poultry. 

 

A positive H5N1 test has not been announced.

 

While the number of H5N1 cases reported out of Indonesia has dropped markedly over the past couple of years, ten days ago we were informed of Indonesia’s third bird flu fatality of 2013 (see Indonesia: MOH Reports H5N1 Fatality), and reports of poultry die offs and poultry culling remain common.

 

 

Veterinarian Allegedly Infected with H5N1 after Check Poultry

Solopos.com, KLATEN - A veterinarian initials DA suspected bird flu after checking poultry in a number of areas in the region of Klaten. Currently victims undergoing treatment in the isolation room dr. Moewardi, Solo, DA to ensure the correctness of contracting the H5N1 strain of virus.

 

The vet suspected of contracting the virus that causes the disease avian influenza (AI) was served in the Division of Animal Husbandry Agriculture (Dispertan) Klaten. Head of Division (Head) Ranch Dispertan Klaten DA Sri Muryani exposing alleged H5N1 was mid last week.

 

When contacted Solopos.com, Sunday (11/24/2013), he explained earlier this week with a team of health Dispertan DA checks Klaten Klaten in some areas. Among areas examined in the region and Manisrenggo Gantiwarno.

 

Initially, Wednesday (20/11/2013), the DA had a high fever accompanied by shortness of breath, cough, and headache. Because not heal, DA health check to one of the private physician who is not far from where he lives.

 

Based on the symptoms experienced DA, known indications of bird flu infection. "Because we do not want to missed, DA finally taken to the hospital. Moewardi to ensure the disease on Thursday (21/11/2013) afternoon, "he told Solopos.com Sunday.

A second report, also from Solopos.com, repeats that this is just a suspected infection, but also carries a warning from the Klaten Head of Livestock Dispertan - Sri Muryani – for people to be wary of the signs of infection in their poultry, stating:

 

"We are not sure which area of ​​bird flu. Hopefully, when people know the symptoms of bird flu may provide information to us and direct culling poultry suspected of AI, "he said.

 

We’ll have to wait for lab results before we know if this veterinarian is actually infected with the bird flu virus.  This is, however, another reminder that while we are more focused on H7N9 and MERS-CoV at the present, the H5N1 virus remains a threat and must be closely monitored as well.

Friday, November 15, 2013

Indonesia: MOH Reports H5N1 Fatality

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# 7977

 

 

My thanks to Gert van der Hoek, on Flutrackers, for posting an update from the Indonesian Ministry of Health this morning detailing that country’s latest H5N1 fatality – that of a 31 year-old woman (DL) from East Bekasi, West Java Province – making the third case reported in Indonesia this year.

 

While once the major source of human H5N1 infections, and still the world’s leader in total number of identified cases (n=195), in recent years the number of cases being reported out of Indonesia has dropped markedly (9 in 2012, 12 in 2011).

 

Here then is the translated report from the Indonesian MOH.

 

Update Bird Flu Case-195

November 15, 2013 | 3:39 pm

Flu-Bird-Update

Ministry of Health, "the Directorate General of Disease Control and Environmental Health" announced a new case of bird flu have been confirmed by the Center for Biomedical and Healthcare Technology Association, Balitbangkes.

Case on behalf of DL (female, 31 years) residents of East Bekasi, West Java Province, a housewife. Dated 1 November 2013 starting symptoms of fever and nausea. On 3 November 2013 on the case of a private outpatient clinic and was advised to check into the laboratory within 3 days if there is no change. Since there is no improvement, dated 5 November 2013 case then went to the private hospital outpatient clinic and laboratory permeriksaan done with diagnosed Typhoid Fever. Furthermore, on 6 November 2013 the case went to a different private hospital emergency department with complaints of fever, nausea, vomiting and was treated at the hospital. On June 8 November 2013 state case with complaints worsened cough and shortness. At the date of 11 November 2013 around 02.00 am in the morning, the case of death will be referred to as avian influenza referral hospitals.

Epidemiological investigations have been conducted into the homes of people and the environment by the Ministry of Health Integrated Team, West Java Provincial Health Office, Department of Health and Department of Animal Husbandry obtained Bekasi possible risk factors, namely environmental contact with the ornamental birds in the case. In case the home environment there are about 50-60 birds are scattered about in four locations. About ± 500 meters from the house there is a case of general market spending in the occasional case of the market.

With the increase of these cases, since 2005 until the news was published, the cumulative number of bird flu cases in Indonesia is 195 cases with 163 deaths.

Director General of Disease Control and Environmental Health Yoga Aditama Prof.dr.Tjandra as the focal point of the International Health Regulations (IHR) has been informed about the case to the WHO.

This information is released by Center for Public Communication, Secretariat General of the Ministry of Health. For further information, please contact Halo MOH hotline <country code> lokal> 500-567; SMS 081 281 562 620, fax: (021) 52921669, www.depkes.go.id website and e-mail address kontak@depkes.go.id.

 

 

With the level of bird flu activity in Cambodia, the expected return of H7N9 in China, and colder temperatures moving across Asia and the Middle East, we are likely to see more avian flu infections over the next few months.

Monday, October 07, 2013

Indonesia Reports 194th H5N1 Case

image

 

 

# 7840

 


My thanks to Gert van der Hoek of FluTrackers for picking up this item posted on the Indonesian Ministry of Health website, detailing the events surrounding the death of a 28-year-old truck driver from the H5N1 virus. While still leading the pack with the most H5N1 cases worldwide, the number of reported cases out of that archipelago nation has dropped dramatically this year, with this being only the second case announced by their Ministry of Health.

image

Chart current as of Aug 29th, 2013

 

The narrative describes the patient as having been seen for fever, aches and back pain on September 18th, and treated as an outpatient until the 20th, when he was finally hospitalized.  The patients condition steadily worsened until the 25th, when he was placed in intensive care, and on the 26th – was finally suspected of having H5N1.

 

On the 27th, after a week in the original facility, he was transferred to Friendship Hospital, where he died the same day.  The high case fatality rate in Indonesia (83% compared to global average of 59%) may be due - in part - to delays in diagnosis and the providing of treatment with antivirals.


The epidemiological investigation indicates that exposure may have come from racing pigeons raised in his neighborhood.

 

Here is the machine translated MOH release:

 

Bird Flu Case Report-194 in Indonesia

October 3, 2013 | 7:55 am

Ministry of Health, Directorate General of Disease Control and Environmental Health announced a new case of H5N1 have been confirmed by the Center for Biomedical and Healthcare Technology Association, Balitbangkes.

 

Case on behalf of the U.S. (Male, 28 years) who Cibitung, Bekasi, West Java Province, is a bottled water company driver.

 

Chronology of the case, on 16 September 2013 starting symptoms of fever, aches and back pain. Then, on 18 September 2013, the case of outpatient treatment to one of the private hospitals in Bekasi. But because there is no change, the case back for treatment and was admitted to the hospital on 20 September 2013.

 

In hospital care, the rising fever accompanied by cough and shortness. On 25 September 2013 the disease more severe cases, fever and increasingly crowded conditions, and cases in intensive care in the ICU. The next day on 26 September 2013 in the morning, suspected cases of suspected bird flu. Subsequently, the case was referred to the Friendship Hospital for treatment on 27 September 2013. However, the case died at about 20:10 pm on the same day.

 

Epidemiological investigations have been carried to the hospital, the case and the surrounding environment by the Ministry of Health Integrated Team, Team Ministry of Agriculture, Department of Animal Husbandry and Health Department of West Java Province, Department of Health and Bekasi District Veterinary Office, obtained the possible risk factors for contact environment, with ornamental birds and in the case of pigeons. Furthermore, approximately 50 feet in front of the house there is a court case that once a week is used as an arena for pigeon racing. In addition, around the neighborhood there are many cases of birds, especially pigeons were maintained by the residents.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news broadcast is 194 cases with 162 deaths.

 

Director General of Disease Control and Environmental Health, Prof.. dr. Tjandra Yoga Aditama as the focal point of the International Health Regulations (IHR) has been informed about the case to the WHO.

 

This information is released by Center for Public Communication, Secretariat General of the Ministry of Health. For further information please contact via telephone: (021) 52907416-9, Fax: (021) 52921669, Rapid Response Center (PTRC): <country code> lokal> 500-567 and 081 281 562 620 (sms), or e-mail contacts @ depkes.go.id

Wednesday, July 17, 2013

Indonesia: Hajj Restrictions Only A `Recommendation’

 

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Credit Wikipedia

 

# 7490

 

An article appearing in the Jakarta Globe today (h/t Shiloh on FluTrackers) indicates that Indonesian officials regard the warnings from Saudi Arabia not to allow `the elderly, chronically ill, pregnant women, or children’ to make the Hajj this year due to MERS-CoV threat as mere recommendations, not a mandate.

 

 

As you may recall, last Friday in KSA MOH Updates Health Protection Advice For Umrah & Hajj) Saudi Arabia’s MOH recommended that certain vulnerable groups including the elderly, immunocompromised, chronically ill, pregnant, and children postpone their Umrah or Hajj plans this year due to the MERS-CoV threat.

 

Later that day Crof carried an even more assertive report from the Arab Media (see Saudi Arabia: To halt MERS, no Hajj visas for old and sick) which appeared to move these visa exclusions beyond mere `recommendations’.

 

On Saturday (see KSA Limits Hajj & Umrah Visas Over MERS-CoV) we saw additional reportage from the BBC, with pretty much the same message. 

 

The following report indicates that in Indonesia, at least, these restrictions are not being viewed as binding. A small excerpt follows, so you’ll want to click the link to read the report in its entirety.

 

 

Indonesia Denies Further Hajj Restrictions Amid MERS Concerns

By Dessy Sagita & Arientha Primanita on 8:36 pm July 17, 2013.

(EXCERPT)

Indonesia, already stinging from a 20 percent reduction in hajj pilgrims this year, has no plans to introduce additional restrictions on candidates. The Ministry of Religious Affairs already bars the chronically ill from completing the pilgrimage. Anggito Abimanyu, the ministry’s director-general of hajj and umrah, called the warnings a mere recommendation.

 

“From all I know it is a recommendation,” Anggito  said. “We are not obliged to follow it. Everyone who is on the list will go on hajj this year”

 

Some 168,000 Indonesian Muslims will make the pilgrimage to Mecca this October, completing what will be, for many, a once-in-a-lifetime trip to Islam’s holiest site. Indonesia has the largest hajj quota in the world, but waits in this Muslim-majority nation can still stretch to more than a decade.

(Continue . . . )

 

 

Last year, this article reports that 382 Indonesians died while making the Hajj, most of them elderly.

Sunday, June 23, 2013

BMC Public Health: H5N1 In Indonesia, Diagnosis, Treatment & CFR

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# 7422

 

One of the enigmas surrounding the H5N1 virus is the wide disparity in fatality rates between countries. As you can see from the chart above, Indonesia’s CFR (Case Fatality Ratio) is more than twice that of Egypt.

 

Of the nations that have reported cases, Bangladesh has the best record, with only a 14% fatality rate.

 

Granted, these numbers are likely skewed by differences in surveillance, testing, and reporting around the world, but they are what we have to work with.

 

One of the unknowns is the relative health impact of different clades of the H5N1 virus (until recently, Indonesia had only dealt with clades 2.1.1, 2.1.2. and 2.1.3, but now adds 2.3.2. – while clades 2.2.1 and 2.2 are endemic in Egypt).

 

But other factors have been posited, including delays in seeking healthcare and, once sought, the speed and quality of diagnosis and treatment.

 

A study, recently published in BMC Public Health, looks at the treatment and outcome of 124 cases of H5N1 infection reported in Indonesia between 2005 and 2010, and finds serious delays in the time between seeking medical treatment and an accurate diagnosis and antiviral treatment for the virus.

 

Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation

Wiku Adisasmito, Dewi Nur Aisyah, Tjandra Yoga Aditama, Rita Kusriastuti, ¿ Trihono, Agus Suwandono, Ondri Dwi Sampurno, ¿ Prasenohadi, Nurshanty A Sapada, MJN Mamahit, Anna Swenson, Nancy A Dreyer and Richard Coker

BMC Public Health 2013, 13:571 doi:10.1186/1471-2458-13-571

Published: 11 June 2013

Abstract (provisional)
Background

Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world's highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes.

Methods

Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival.

Results

Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p < 0.0001). We found substantial variability in the time to viral testing (p = 0.04) by type of medical care provider. Antivirals were started promptly after diagnosis (median 0 days).

Conclusions

Delays in the delivery of appropriate care to human cases of avian influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

 

The therapeutic effects of antivirals, like oseltamivir, are the most pronounced in the first 48 hours of infection. After that, some benefit may be derived, but its effects are greatly diminished.

 

In Indonesia, this study found the average time between seeking medical treatment, and receipt of antivirals, was 7 days.  Too late to have much effect.

 

The authors write in the discussion section:

 

A low clinical suspicion of disease by health care workers likely remains an important impediment to early diagnosis, virological confirmation, and appropriate treatment initiation [13].

 

The signs and symptoms during the first two days of disease in cases reported here were mostly non-specific. This nonspecific clinical presentation of influenza A (H5N1) disease raises challenges.

 

The differential diagnosis of cases may include other influenza-like illnesses, dengue, or typhoid [14], to the exclusion of influenza A (H5N1). In an earlier report, only 12% of influenza H5N1 cases were initially diagnosed as having influenza H5N1
[13].

 

There’s a good deal of data included in this report, including demographic information on cases, CFRs based on the type of medical facility where patients were first seen, and a detailed list - by patient symptoms – of the time to seeking medical care, time to testing, and time to antiviral treatment. 

 

The authors conclude by writing:

 

Conclusions


Reducing health care system delays in the initiation of specific treatment for patients infected with influenza H5N1 is no easy matter. The non-specific nature of  the disease, especially in the early days, suggests a number of options that might be considered.

 

The application of rapid diagnostic tests on presentation to confirm or refute the diagnosis might enable clinicians to tailor their treatment better. Alternatively, the initiation of treatment when clinical suspicion is raised might offer benefits to the minority who actually have influenza H5N1.

 

Both of these approaches have cost implications that need to be determined. Prospective clinical studies too may offer more robust data on clinical symptoms and signs associated with differentiating H5N1 from other diseases as well as determining those likely to fare least well clinically and thus benefit most from influenza specific clinical interventions.

Friday, June 21, 2013

Indonesia Reports H5N1 Fatality

 

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Map Credit Wikipedia

 

# 7417

 

 

With H7N9 and MERS-CoV capturing the limelight, H5N1 avian flu has gotten very little press over the past few months, but it hasn’t gone away. It is still endemic in wild birds and poultry in some regions of the world, and on occasion, spills over into humans.

 

For the past two days Shiloh and Gert van der Hoek on FluTrackers have been following media reports of a suspected fatal H5N1 case in Bekasi, West Java. The victim was reportedly a 2 1/2 year old male.

 

Today, the Indonesian Ministry of Health has confirmed that case, linking probable exposure to a local poultry market near the child’s home.

 

 

Bird Flu Case Report-193

June 21, 2013 | 12:51 pm

Flu-Bird-Update

The Ministry of Health of Indonesia through the Directorate General of Disease Control and Environmental Health, and has been confirmed by the Center for Biomedical and Health Technology Association, Balitbangkes Strathmore University, announced a new case of H5N1 avian influenza infection, on behalf of the RBP (Male, 2 years 6 months) residents Jakamulya South Bekasi, Bekasi, West Java Province.

 

Monday (10/6) reported cases had onset of fever, then went to the doctor in private practice pediatrician and given medication for fever. Because it is still fever, concerned parents to seek treatment RSHG and taken care of by Thyphoid fever diagnosis. However, on Monday (18/6) cases of high fever, cough and progressive shortness of breath experienced. Because of this, refer to RSHB RSHG. Cases in intensive care in the ICU and ventilator. On Wednesday (19/6), based on the analysis of medical, indicated cases of bird flu.

 

However, due to the limitations of the tool, refer the case to the RSPP RSHB Jakarta. At approximately 7:40 pm, a case of getting treatment in the ICU AI RSPP. The hospital has tried its utmost to provide medical help, but due to the deteriorating condition (coma), RBP (late) could not be saved and breathed his last on the same day at approximately 8:40 pm.

 

Epidemiological investigations have been conducted into the homes of people and the environment by the Ministry of Health Integrated Team, BBTKL-PP Jakarta, Bekasi City Health Department and the Department of Animal Husbandry Bekasi. Based searches, acquired risk factors, namely the possibility of contacts polluted environment in the market which is about 200 meters from the case, because two days before the hospital on Saturday (8/6) cases invited his mother went to the market to buy chicken pieces.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news broadcast is 193 cases with 161 deaths. Meanwhile at the world level, the total number of cases of H5N1 infection since the beginning found to date amounted to 630 cases with 375 deaths.

 

"WHO data will change, there are 6 states that reported cases of H5N1 avian influenza infection in 2013", said Prof. Tjandra.

 

Previously, only 5 countries had reported cases of H5N1 avian influenza infection in 2013, namely Bangladesh (1 case, 1 death), Cambodia (11 cases, 8 deaths), China (2 cases, 2 died), Egypt (4 cases, 3 dead), Vietnam (2 cases, 1 death).

 

This information is released by Center for Public Communication, Secretariat General of the Ministry of Health. For further information, please contact Halo MOH hotline 500-567; SMS 081 281 562 620, fax: (021) 52921669, www.depkes.go.id website and e-mail address

 

 

Human infections with the H5N1 virus – while rare - are always a concern:

  • Because of the high fatality rate among known cases
  • And because each time the virus jumps from its normal (avian) host to a human (or other mammal), it gives it another opportunity to adapt and change.

Despite hundreds (perhaps thousands) of such opportunities, the virus remains poorly adapted to human physiology.  It can produce severe illness – even death – but only rarely is transmitted on to another person.

 

For now, it is primarily a threat to poultry, and to a lesser extent, those who work with, or come in close contract with, poultry.

 

But as we discussed earlier this week in WHO: H5N1’s Pandemic Phase Status, the world remains in an ALERT phase for the H5N1, H7N9, and MERS-CoV virus.

 

The current WHO phase of pandemic alert for avian influenza A(H5N1) is: ALERT

Wednesday, January 09, 2013

Indonesia: Updated H5N1 Poultry Vaccine

 

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# 6837

 

 

Late in 2012 we learned that a `new’ clade of H5N1 had been detected in Indonesia (reportedly since September), and that hundreds of thousands of ducks had suddenly died on the island of Java (see Dr. Alan Hampson Interview On Indonesia’s New Bird Flu Clade).


H5N1 (aka `bird flu’) is not a single strain of influenza, but rather, a group of similar viruses sharing the same HA (hemagglutinin) and NA (neuraminidase) genes segments, that has continually evolved and mutated since its emergence in 1996.

 

You can see the evolution of the virus in the chart below, starting with Clade 0, first detected in 1996.

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(click to load larger image)

Over the years more than 20 genetically separate clades of the virus have emerged (not all continue to circulate), with many minor variants of each clade thrown in the mix. 

 

Different areas of the world have seen different clades set up residence, with clade 2.3.2 (and now 2.3.2.1) very common in South East Asia, clades 2.2.1 and 2.2 endemic in Egypt and clades 2.1.1, 2.1.2. and 2.1.3 circulating in Indonesia.

 

One of the more successful`new’ clades making inroads over the past few years has been 2.3.2.  I wrote of the spread of this emerging clade two years ago in What Goes Around, Comes Around and EID Journal: H5N1 Branching Out).

 

In the spring of 2010, after reports of poultry vaccine failures in Vietnam, we learned of a mutated version this clade (further classified as clade 2.3.2.1), which led to this 2011 statement FAO Warns On Bird Flu.

 

So far, media reports have only reported on clade 2.3.2 in Indonesia, not the mutated 2.3.2.1 strain.

 

While no surge in human infections with this new clade have been reported in Indonesia, it has become apparent that the current poultry vaccine used there is not up to the task of protecting flocks against it.

 

Today news, via the Jakarta Post, we have news of a new poultry vaccine expected to be made available in Indonesia next month.

 

C. Java to distribute new bird flu vaccines in Feb

Ainur Rohmah, The Jakarta Post, Semarang, Central Java | Archipelago | Wed, January 09 2013, 3:45 PM

 

The Central Java administration will start distributing in February vaccines for a new strain of bird flu, identified as H5N1 clade 2.3.2, that has killed thousands of ducks in Yogyakarta, Central Java and East Java.

 

Central Java Animal Husbandry Agency chief Whitono said on Wednesday that the master seed of the vaccines--discovered last December in Sukoharjo, Central Java--was currently being produced by the Agriculture Ministry’s Animal Husbandry Department.

(Continue . . . )

Last month, in Egypt: A Paltry Poultry Vaccine, we looked at a new study – conducted by the Virology department at St. Jude Children’s Research Hospital -  appearing in the journal Poultry Science, that gauged the effectiveness of six commercially available H5 poultry vaccines currently deployed in Egypt.

 

Of the 6 vaccines tested, only one (based on a locally acquired H5N1 seed virus) actually appeared to offer protection.

 

Poultry vaccines that provide only partial protection can mask infections, but may not prevent the spread (and possible mutation) of a virus.  A situation that experts, like Professor C.A. Nidom, of the Institute of Tropical Disease, Airlangga University have warned about in the past (see Indonesia: Debate Over Poultry Vaccination)

 

Although many countries rely on them, poultry vaccines are considered by the OIE (World Organization For Animal Health) short-term solution to combating the avian flu virus.

 

In Avian influenza and vaccination: what is the scientific recommendation?, the OIE reiterates their strong recommendation that humane culling be employed to control avian influenza, and advising that vaccines should only be used as a temporary measure.

 

While the OIE concedes that some nations may require the use of vaccines for `several years', they strongly urge that countries move away from that program and towards the more conventional culling policy.

 

They call this shift away from vaccines an `Exit Strategy’, a policy towards which countries like China, Indonesia, Vietnam, and Egypt – for political and economic reasons - have shown little inclination to follow.

Monday, January 07, 2013

Indonesia: H5N1 Clade 2.3.2 Reaches Bali

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# 6829

 

Not quite a month ago we learned that a `new’ clade of H5N1 had shown up in in Indonesia, causing the deaths of hundreds of thousands of ducks (see Report: Clade 2.3.2 H5N1 Detected In Indonesia) on the island of Java. 

 

Although new to Indonesia, clade 2.3.2 has been circulating across Asia for several years. I wrote of the spread of this emerging clade in 2011 in What Goes Around, Comes Around and EID Journal: H5N1 Branching Out).

 

In the spring of 2010 we began to see reports of poultry vaccine failures in Vietnam due to the spread of a mutated version this clade (further classified as clade 2.3.2.1), which led to this statement FAO Warns On Bird Flu.

 

The H5N1 virus is constantly changing, and as it does, forms distinct genetic groups, or clades. Since its discovery in 1996, the H5N1 virus has evolved into more than 20 distinct clades (and subclades), with many variations within each.

 image

(click to load larger image)

 

Some of these clades have flared briefly and then died out, supplanted by more biologically `fit’ versions of the virus. But even so there is a good deal of variety among the strains in circulation today.

 

Clade 2.3.2 (and now 2.3.2.1) is very common in South East Asia, clades 2.2.1 and 2.2 are endemic in Egypt and up until recently, Indonesia had only dealt with clades 2.1.1, 2.1.2. and 2.1.3, but now adds 2.3.2.

 

Until this past week, all of the reports we’ve seen of this newly emergent clade in Indonesia have come from the island of Java. 

 

Three days ago, Gert van der Hoek on FluTrackers posted a machine translation of a VOA Indonesia article (New Bird Flu Clade Detected in 3 districts in Bali) indicating the new clade had jumped to the vacation island of Bali.

 

Today, an English Language report from the Jakarta Post, Bali Edition, carries details of this latest discovery.

 

Bali braces for bird flu epidemic

by Muliarta on 2013-01-07

The local health authorities have begun implementing the necessary measures to deal with the ongoing outbreak of avian influenza affecting the duck population, and the possible spillover of the disease into the human population.

 

The measures have been taken following confirmed reports of avian influenza killing thousands of ducks in farming areas in three separate regencies: Buleleng, Tabanan and Klungkung.

 

Laboratory tests have confirmed that the ducks were killed by the new, more malignant strain of the avian influenza virus known as H5N1 Clade 2.3.2. A similar strain of the virus killed hundreds of thousands of ducks across farming regions in Java weeks before the first reported case in Bali.

(Continue . . . )


Although the arrival of this new clade has sparked fears of more human infections, so far, we’ve not seen any sudden increase in reports of human cases in Indonesia.

 

Bali, a popular international tourist destination, has seen more than a half dozen high profile human H5N1 cases over the past several years.

 

In order to protect the island’s economy, in 2005 it was decreed that only locally raised chickens could be sold on the island.

 

But like many other laws and edicts concerning poultry trade in Indonesia, they have gone largely ignored. Ducks fetch a higher price on the island of Bali than on Java, providing ample incentive to smuggle poultry.

 

While it isn’t known whether this new strain arrived via illegal trade, or migratory birds, its arrival has nerves on edge. Bali public health officials have alerted three local hospitals to be ready to receive human cases, and a public awareness campaign is underway.

 

H5N1 remains largely an avian-adapted virus, and for now primarily a threat to poultry.

 

The concern, of course, is that with continual changes to the virus, one of these days it may better adapt to human or mammalian physiology.

 

Which is why, even after 10 years after its return in 2003, we continue to follow developments with keen interest.