Sunday, February 22, 2009

H5N1 Confirmed Case Concerns in Tangerang Indonesia


Recombinomics Commentary 01:55
February 23, 2009

two residents of the Regency and the Tangerang City South are contaminated with the virus H5N1 or Bird Flu. They were Kaila Nabila (2.9) the resident of the Village of Cilenggang Rt 02/04 the District Cilenggang the Subdistrict Serpong the Tangerang City South and Maya Suparni (15) villagers Mekar Jaya the Subdistrict Sepatan the Tangerang Regency.

information from Litbangkes, Kaila Nabila positive affected H5N1.

The above translation describes two cases with bird flu symptoms. One (2.9M) has died and has been lab confirmed, while the other is a hospitalized suspect case. The two cases are about 10 miles apart (see satellite map).

The number of confirmed cases and clusters in Tangerang has been high. The clusters included the first confirmed cases in Indonesia, in 2005. A recently released phylogenetic tree has four isolates from human cases in 2008. These sequences have been placed on deposit at GISAID and continue to evolve away from the clade 2.1 pandemic target sequence, which was from the first confirmed case.
The continued reports of H5N1 confirmed cases or clusters in Tangerang remains a cause for concern.

Clusters in Indonesia last year led to a news blackout and a significant delay on reporting of cases. Moreover, many milder cases in Indonesia are treated with Tamiflu and not tested. This protocol contributes to the high case fatality rate, which has been close to 80% since 2005 and suggests a high level of unreported milder cases.

The recent fixing of Tamiflu resistance, H274Y in H1N1 seasonal flu has increased concerns that co-infections involving season flu with H274Y and H5N1 in hosts being treated with Tamiflu will selected Tamiflu resistant H5N1.

The latest confirmed and suspect cases in Tangerang continue to increase those concerns.

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