Denial of H5N1 Confirmatory Lab Results in Indonesia

Commentary

Denial of H5N1 Confirmatory Lab Results in Indonesia
Recombinomics Commentary 21:08
November 18, 2008

Apart from destroying the resident's poultry, in order to anticipate the spreading of the bird flu illness in the Semarang City territory, three chicken abattoirs in the Gayamsari Subdistrict were forced also to have to be closed forevermore.

The above translation describes the closure of three slaughterhouses near the residence of the fatal H5N1 infection in Semerang. This case (15F) was lab confirmed, as detailed by local media reports. In addition to a positive rapid test, the sample was PCR positive and yielded H5N1 virus. In addition, the serum antibody levels in the patients increased more than four fold. However, in spite of repeated reports from wire services (AP and Reuters) quoting the physician treating the deceased patient, Siti Fadilah Supari, head of the Indonesian Ministry of Health has been quoted as saying that both lab tests were negative.

This glaring inconsistency was ignored by ProMED, who accepted the denial of positive lab results at face value. Earlier, ProMED also accepted at face value a statement by Nyoman Kandun that a relative of an H5N1 lab confirmed case died of dengue fever, which was highly suspect due to the linkage between the index case and the lab confirmed H5N1 infection in the relative. This H5N1 cluster was followed by another cluster where the index was said to have died from typhus, even though his brother was H5N1 lab confirmed. The reporting of the lab case was delayed when the Ministry of Health changed its reporting procedure from confirmation date to periodic reports with intervals as long as six months.

The change in reporting led to concerns, because International Health Regulations require reports in 24-48 days after lab confirmation. Although WHO stated that the announcement by Indonesia did not necessarily mea that the delay would apply to WHO notifications, WHO has not issued a timely Indonesian situation update since Indonesia announced the change in policy.

WHO was given added authority to investigate human cases infected with unusual influenza serotypes, such as H5N1. The denial of the latest lab confirmed case by the Ministry of Health indicates that internal health requirements are not being met by Indonesia. Although a clarification by Indonesia is not expected, a statement by WHO is warranted.

The addressing of this case and recent unreported H5N1 familial clusters should be investigated by WHO and detailed in situation updates on H5N1 in Indonesia.