Indonesia Denies H5N1 Lab Confirmatory Cluster in Sulawesi
Recombinomics Commentary 16:15
November 20, 2008
Initial tests of the first seven patients indicated the presence of the H5N1 avian virus.
The hospital was now awaiting confirmation of the results from blood tests done by the Micro Laboratory of the Hasanuddin University Medical School, he said.
The 17 were hospitalised this month after falling sick shortly after a rash of unexplained chicken deaths in the area.
"The result of the tests is negative," said Lily Sulistyowati, spokeswoman of the ministry, without giving details.
The above translations describe a large PCR confirmed H5N1 cluster in Sulawesi, Indonesia. The above wire service quotes do not include confirmation that the poultry deaths were due to H5N1 and provide yet another denial of lab confirmed H5N1cases reported by local media.
Although Indonesian denials have been met with skepticism previously, the latest case in Semarang, as well as the current cluster in Sulawesi, appears to signal a new level of denials. Previous cases were highly suspect, but lacked lab confirmation. The latest cases however, were lab confirmed, based on local media reports or wire service quotes from the lead physician, but were still denied by the Ministry of Health.
In the latest cluster, the circumstantial evidence strongly supports the local reports of H5N1 PCR confirmation. The local poultry was H5N1 positive and at least four local slaughterhouses were closed permanently. Fourteen of the patients were placed in isolation (which had a capacity of 14) with guards stationed at the isolation wing. Three other hospitals were readied to receive additional bird flu patients. Two more patients were recently admitted, including a sibling of one of the hospitalized patients. The patients recovered after being treated with Tamiflu, but remained hospitalized until today.
The denial of H5N1 confirmation of this large cluster also adds insight into the earlier statements by Ministry of Health head, Siti Fadilah Supari, who cited rapid treatment for the fall in H5N1 cases. Of course rapid treatment does not reduce H5N1 infections unless the patients are highly contagious. Early treatment would lead to recovery, which could also lower viral titers, leading to false negatives and failures to lab confirm. Therefore rapid treatment could lead to a lowering of confirmed cases, and an artificial elevation of case fatality rates, because milder recovered cases would not be counted. The case fatality rate in Indonesia s the highest in the world and has been around 80% since the first cluster was reported (including one confirmation) in 2005.
If confirmed, the 19 suspect cases in Sulawesi would be the largest H5N1 cluster reported to date, but today’s denial does not increase the confirmed cases or clusters in Indonesia, but significantly increases the level of concern.
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