Indonesia says no H5N1 cases in suspicious cluster

Lisa Schnirring Staff Writer

Nov 20, 2008

(CIDRAP News) – Indonesia's health ministry has ruled out H5N1 avian influenza in a cluster of 17 suspected cases in South Sulawesi province, countering earlier reports of positive hospital and university tests, Reuters reported today.

According to an earlier report from the Jakarta Post, the patients—all from Sudiang subdistrict and most of them children—were hospitalized in Makassar with symptoms that resembled avian influenza infection. A hospital source had said rapid tests indicated the H5N1 virus and that officials were awaiting further test results from Hasanuddin University.

A Nov 14 Reuters update on the suspected case cluster quoted Chandra Yoga Adhitama, the health ministry's acting director of communicable disease control, as saying the patients were hospitalized as a precaution after chickens died in the area. He also told Reuters that the patients' conditions were generally good and that their samples would be sent to Jakarta for testing at the health ministry's laboratory.

Then on Nov 15, the Post reported that Halik Saleh, a spokesman for the hospital's avian flu team, said the university tests also indicated the patients had the H5N1 virus but that the hospital decided not to use either institution's test results and would instead wait for results from the health ministry.

Lily Sulistyowati, a health ministry spokeswoman, told Reuters today that the patients' tests were negative for H5N1. She gave no further details.

Reports of potential H5N1 case clusters raise concern because, if confirmed, they suggest the possibility of human-to-human transmission, which would increase the risk of a pandemic.

News about human H5N1 infections in Indonesia has been sketchy since June, when the health ministry said it would no longer promptly report H5N1 cases and instead give only periodic updates. Some health officials have said the lack of timely reporting will hamper efforts to monitor the world's pandemic risk level.

On Nov 13 the country's health minister, Siti Fadilah Supari, denied media reports that a 15-year-old girl who died in central Java had avian influenza. News services had earlier cited one of the girl's doctors and a local health official as saying tests from two laboratories indicated she did have an H5N1 infection.

On some avian flu blog sites, participants have been translating reports from Indonesia's Bahasa-language media outlets to comb for new details about the suspected case cluster. According to some machine-based translations, which are sometimes difficult to follow and can be unreliable, two more patients linked to the cluster were reportedly admitted to the hospital. Also, some reports claimed that polymerase chain reaction tests by the university on the patients were positive for H5N1.

Sharon Sanders, editor-in-chief of FluTrackers, a well known Web message board that focuses on avian influenza and preparedness issues, told CIDRAP News that her community hasn't been able to determine if the 17 to 19 patients are infected with the H5N1 virus, based on all of the conflicting information.

"We simply do not know what conclusions to draw based on the recent denial by the Indonesian Ministry of Health of the apparent H5N1 death on November 7 of 15-year-old Dewi Sartika, from central Java," she said.

Sanders said the lack of transparency about the current H5N1 status in Indonesia is troublesome because the disease is endemic and current human H5N1 clinical samples are not being shared internationally. "We will continue to monitor the situation in Indonesia to ascertain, to the best of our ability, H5N1 status in Indonesia," she said.

Mike Coston, a former paramedic and author of the Avian Flu Diary blog, another well-known site for news and analysis, told CIDRAP News that media reports of supposedly positive H5N1 tests give him pause, "but on the whole, I believe the rapid recovery of all 17 suspect cases argues against these being genuine H5N1 patients."

"This highlights the folly of the Indonesian-stated policy of not confirming H5N1 cases as they occur," Coston said. "Even if these patients are negative, it makes it difficult to automatically take the government's word for it."