Latest Indonesian update

WHO is monitoring the situation in Indonesia and so far the news still god news.

The World Health Organization has just released the following update
to the situation in Indonesia.  Let's keep our fingers crossed and hope
that everything is contained.

Avian influenza ­ situation in Indonesia ­ update 16


31 May 2006


Situation update


Indonesian health authorities and WHO have further
strengthened their response to the family cluster of cases
in Kubu Simbelang village, Karo District, North Sumatra. As
of today, 54 surviving family members and other close
contacts of cases have been identified and placed under
voluntary home quarantine. All of these people, with the
exception of pregnant women and infants, are receiving the
antiviral drug, oseltamivir, for prophylactic purposes.
Public health teams visit these people daily, checking for
symptoms.


In addition, active house-to-house surveillance for
influenza-like illness is being conducted throughout the
village, which has around 400 households. A command post for
fever surveillance has been functioning in the village since
last week.


As of today, no new cases suggestive of H5N1 infection have
been detected since 22 May. This finding is important as it
indicates that the virus has not spread beyond the members
of this single extended family. No hospital staff involved
in the care of patients, in some instances without adequate
personal protective equipment, have developed the disease.
The last person in the cluster, who developed symptoms on 15
May and died on 22 May, refused hospitalization. He moved
between two villages while ill, accompanied by his wife. The
wife is under surveillance and has not developed symptoms.


Despite multiple opportunities for the virus to spread to
other family members, health care workers or into the
general community, it has not, on present evidence, done so.


Current level of pandemic alert


Based on an assessment of present evidence, WHO has
concluded that the current level of pandemic alert is
appropriate and does not need to change. The level of
pandemic alert remains at phase 3. This phase pertains to a
situation in which occasional human infections with a novel
influenza virus are occurring, but there is no evidence that
the virus is spreading in an efficient and sustained manner
from one person to another.


WHO has recommended continued close monitoring of the
situation in Kubu Simbelang for the two weeks following 22
May, the date when the last known case in the cluster died.
As a precautionary measure, Indonesian authorities have
decided to extend this recommended period to three weeks.


Preliminary results of the investigation


This information differs in some details from information
released in previous updates, but is derived from extensive
investigations by senior national and international
epidemiologists, from WHO and the US Centers for Disease
Control and Prevention, who have developed a clearer picture
of the situation.


The cluster involves an initial case and seven subsequent
laboratory-confirmed cases. All cases are members of an
extended family: sisters and brothers and their children.
Family members resided in four households. Three households
were next-door neighbours in the village of Kubu Simbelang,
Karo District, North Sumatra. The fourth household was
located about 10 kilometres away in the nearby village of
Kabanjahe.


The initial case in the cluster was a 37-year-old woman who
sold fruits and chillies at a market in the village of
Tigapanah. Her stand was located about 15 metres away from a
stand where live chickens were sold. The investigation
uncovered no reports of poultry die-offs in the market.
However, the woman kept a small number of backyard chickens,
allowed into the house at night. Three of her chickens
reportedly died before she became ill. She is also known to
have used chicken faeces from these household chickens as
fertilizer in her garden.


A parallel agricultural investigation has not, to date,
detected H5N1 virus in PCR tests of approximately 80 samples
from poultry, other livestock and domestic pets, and chicken
fertilizer taken from the vicinity.


The initial case developed symptoms on 24 April, was
hospitalized on 2 May, and died on 4 May. No samples were
collected for testing prior to her burial, but she is
considered part of the cluster as her clinical course was
compatible with H5N1 infection.


The initial case had one sister and three brothers. The
sister and two of the brothers subsequently developed
infection. The remaining cases occurred among children in
these families.


The confirmed cases include five males and two females with
an average age of 19 years (range from 1 to 32 years). Six
out of the seven confirmed cases developed symptoms between
3 May and 5 May. These cases include two sons of the initial
case, her brother from Kabanjahe, her sister, the sister's
baby, and the son of a second brother living in an adjacent
house. This second brother, the last case in the cluster,
developed symptoms on 15 May. Six out of the seven cases
were fatal.


Exposures


On the night of 29 April, nine family members spent the
night in a small room with the initial case at a time when
she was severely ill, prostrate, and coughing heavily. These
family members included the initial case and her three sons;
the brother from Kabanjahe village, his wife, and their two
children; the 21-year-old daughter of another brother (who
did not become infected); and another young male visitor.
Following this event, three family members ­ the woman's two
sons and the visiting brother from Kabanjahe ­ developed
symptoms from 5 to 6 days later.


The woman's sister, who lived in an adjacent house,
developed symptoms at the same time, as did her 18-month-old
daughter. Prior to symptom onset, this sister, accompanied
by her daughter, provided close personal care of the initial
case.


The last case in the cluster provided close care for his son
throughout his hospital stay, from 9­13 May. The son was a
frequent visitor in the home of the initial case and was
present there on 29 April.