Suspect H5N1 Bekasi Fatality In Indonesia
Recombinomics Commentary 18:36
March 9, 2009
Andriansyah (8), fourth child of the couple and Mimin Ilyas, the village of Kandang, Sukakarya Village, Kecamatan Karang Bahagia, Kabupaten Bekasi died in this Friendship Hospital, East Jakarta, Sabtu (28/2/2009).
"My child has been sick since a week ago.
The above comments describe the recent fatal suspect H5N1 case (8M) in Bekasi (see updated map). One confirmed case was described in the latest WHO update on Indonesia. That case developed symptoms last year and died Januray 2. A second confirmed case was acknowledged by the MOH announcement last week and was subsequently acknowledged in local media.
However, most of the cases have died recently, and although at least one was said to have been lab confirmed, none have been officially classified as confirmed cases. WHO updates have lagged and have not confirmed the cases recently announced by the MOH. WHO updates on Indonesia and have only described two cases which developed symptoms last year.
Only one of the suspect cases has survived, but remains hospitalized. This clustering of cases in Bekasi this year has raised concerns that transmission to humans has become more efficient and exposure to the sub-strain commonly isolates from human cases has increased. Initially most poultry isolates did not mach human H5N1, which had a novel cleavage site. However, more closely related poultry isolates began to appear in 2007, which may be higher today. Phylogenetic analysis of the H5N1 isolated from patients in 2008 indicates those recent human cases have retained the novel cleavage site.
The continuing increase in fatal Bekasi cases, couple with the lack of WHO updates on these cases, continue to increase concerns.