Makassar H5N1 Simulation Raises Pandemic Concerns

Recombinomics Commentary 11:40November 24, 2008
Makassar municipality organized a bird flu pandemic simulation in Tamangapa sub district, Manggala district, Makassar, South Sulawesi in an effort to disseminate know-how and to train related institutions on how to cope with a bird flu pandemic.The two-hour simulation held on Saturday involved at least 300 people from various institutions, including the Health Agency, the Food Self-Reliance and Marine Agency, the Education Agency, the Communication Agency, the National Police, the Indonesian Army and the public service center.
Naisyah disclosed that the municipality had scheduled to set up simulations at busy public places, for example in shopping mall centers, hospitals, schools, harbors and airports. Meanwhile, seven out of 17 bird flu suspected patients in Wahidin Sudirohusodo general hospital in Makassar who have been declared bird flu free have been sent home, while the rest were still at the hospital, for further treatment.
The above comments describe an H5N1 “simulation” in Makassar, Indonesia, the site of a large lab confirmed H5N1 outbreak which has been denied by the Ministry of Health. This denial has been taken at face value by ProMED, even though the government offered no explanation of why such are large group of patients was hospitalized and why guards were stationed in the hall of the isolation wing. Moreover, although these patients appear to be well on the road to recovery, many are still hospitalized.Media reports indicate the first seven tested were PCR confirmed, consistent with earlier lab results. Although the government has denied these reports, the aggressive education campaign, involving the police and military raises concerns, as does the citing of a mild case who recovered.
Mild cases of H5N1 were reported in Egypt in the spring of 2007. The cases were primarily in children who rapidly recovered. H5N1 was isolated and the sequences were published by NAMRU-3. The rapid recover was generally attributed to prompt treatment with Tamiflu, which was also used for the cluster in Makassar.Mild H5N1 that is efficiently spread is cause for concern. H5N1 that is easily spread human to human can become more deadly via recombination with more virulent versions of H5N1 and Tamiflu resistance can be acquired via the increasing levels of H274Y in H1N1 seasonal flu.
The silence by WHO remains alarming. When Indonesia announced the news blackout on prompt reporting of lab confirmed H5N1, WHO noted that a failure to notify Indonesian citizens did not preclude WHO notification and the news blackout did not involve clusters. However, all cases subsequently described in WHO updates have been cases confirmed weeks or months prior to the WHO update, and involved small clusters. Moreover, the latest cases in Semarang and Makassar have been flatly denied by the Ministry of Health, and WHO has remained silent.