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Southeast Asia
Suspected bird flu cases on rise across the country
2006-03-03
Suspected bird flu cases are being detected in the country at an alarming rate, with more people falling sick in Surakarta in Central Java, Madiun and Malang in East Java and Batam in Riau Islands province.

An as-yet unnamed 12-year-old girl suspected of contracting bird flu died Wednesday night after being treated at the Moewardi Hospital in Surakarta.

Her body has been sent to her hometown in Boyolali, Central Java, for burial, hospital director Mardiatmo told Antara.

Blood tests for the victim have been sent to a Jakarta laboratory for confirmation.

Another seriously ill suspected bird flu patient is being treated in isolation at the hospital.

"Clinical symptoms, including coughing and a high fever, indicate that he is bird flu-positive. The patient also used to live near large-scale quail breeding centers," Tri Lastiti, the deputy director of the hospital, told The Jakarta Post.

The 31-year-old man, identified as Daryoto, was believed to have been infected by the carcasses of dead birds, which had been dumped in the area during the past month.

"Thousands of quails died every day and their remains were just thrown away into a nearby river," Nanik, Daryoto's wife, said.

Central Java Governor Mardiyanto said earlier the provincial administration would launch a large-scale poultry cull of infected birds. The culls would occur in five of the province's 35 regencies -- Karanganyar, Boyolali, Sukoharjo, Sragen and Klaten.

Mardiyanto ordered people to be on the alert for the virus and immediately report any suspected bird flu outbreaks among poultry to their local animal husbandry office.

"If people see scores of chickens dying, they should report this to the nearest office. Animal husbandry and health officials will soon follow up their reports," Mardiyanto said.

In Bandung, the number of suspected bird flu patients rose by 11 to 66 as of Wednesday. The latest patient was admitted to the city's Hasan Sadikin Hospital on Wednesday.

In Madiun, East Java, the condition of a 12-year-old patient from Singkil village, Ponorogo, who is believed to be infected with the virus, remained serious.

"The patient is still in intensive care by our team of doctors, and cannot be visited yet," a Dr. Soedono Hospital spokesman said Thursday. A sample of the patient's blood has been sent to Jakarta for testing and the results would be available within a week, the spokesman said.

In Malang, a seven-year-old boy was admitted to the intensive care unit at the Saiful Anwar Hospital with suspected bird flu symptoms.

However, Gatoet Ismanoe, a doctor of the hospital, said the boy, who had earlier been treated at the Muhammad Saleh Hospital in Probolinggo, was still under observation to determine his illness.

In Batam, the local animal husbandry office sprayed disinfectant at Panglong village in Nongsa district Thursday, after laboratory tests found bird flu in the area's poultry.

At least eight chickens were found dead in the area with blue and swollen heads -- recognizable symptoms of the flu.
Suspected bird flu cases on rise across the country


Wahyoe B. Wardhana and Fadli, The Jakarta Post, Malang/Batam

Suspected bird flu cases are being detected in the country at an alarming rate, with more people falling sick in Surakarta in Central Java, Madiun and Malang in East Java and Batam in Riau Islands province.

An as-yet unnamed 12-year-old girl suspected of contracting bird flu died Wednesday night after being treated at the Moewardi Hospital in Surakarta.

Her body has been sent to her hometown in Boyolali, Central Java, for burial, hospital director Mardiatmo told Antara.

Blood tests for the victim have been sent to a Jakarta laboratory for confirmation.

Another seriously ill suspected bird flu patient is being treated in isolation at the hospital.

"Clinical symptoms, including coughing and a high fever, indicate that he is bird flu-positive. The patient also used to live near large-scale quail breeding centers," Tri Lastiti, the deputy director of the hospital, told The Jakarta Post.

The 31-year-old man, identified as Daryoto, was believed to have been infected by the carcasses of dead birds, which had been dumped in the area during the past month.

"Thousands of quails died every day and their remains were just thrown away into a nearby river," Nanik, Daryoto's wife, said.

Central Java Governor Mardiyanto said earlier the provincial administration would launch a large-scale poultry cull of infected birds. The culls would occur in five of the province's 35 regencies -- Karanganyar, Boyolali, Sukoharjo, Sragen and Klaten.

Mardiyanto ordered people to be on the alert for the virus and immediately report any suspected bird flu outbreaks among poultry to their local animal husbandry office.

"If people see scores of chickens dying, they should report this to the nearest office. Animal husbandry and health officials will soon follow up their reports," Mardiyanto said.

In Bandung, the number of suspected bird flu patients rose by 11 to 66 as of Wednesday. The latest patient was admitted to the city's Hasan Sadikin Hospital on Wednesday.

In Madiun, East Java, the condition of a 12-year-old patient from Singkil village, Ponorogo, who is believed to be infected with the virus, remained serious.

"The patient is still in intensive care by our team of doctors, and cannot be visited yet," a Dr. Soedono Hospital spokesman said Thursday. A sample of the patient's blood has been sent to Jakarta for testing and the results would be available within a week, the spokesman said.

In Malang, a seven-year-old boy was admitted to the intensive care unit at the Saiful Anwar Hospital with suspected bird flu symptoms.

However, Gatoet Ismanoe, a doctor of the hospital, said the boy, who had earlier been treated at the Muhammad Saleh Hospital in Probolinggo, was still under observation to determine his illness.

In Batam, the local animal husbandry office sprayed disinfectant at Panglong village in Nongsa district Thursday, after laboratory tests found bird flu in the area's poultry.

At least eight chickens were found dead in the area with blue and swollen heads -- recognizable symptoms of the flu.
Posted by:Fred

#10  Frank, I wasn't accusing you of being PC. Rather its the idea that once the pandemic starts we are all equally at risk is PC nonsense. Without going into a long complex explanation. Containment measures are additive and the number of cases in an area is a direct function of how effective the local containment measures are. The key variables are how effective the government is and how 'public spirited' the citizens are.
Posted by: phil_b   2006-03-03 19:30  

#9  lol - that's the FIRST time I've ever been accused of being Politically Correct

*slap* Slap*

I'll see you at dawn, sir. Bring a second
Posted by: Frank G   2006-03-03 18:32  

#8  Frank, I've thought a lot about this and much of what you read is politically correct drivel.

In a nutshell, I think even when we have thousands of cases a day, its still containable. However, whether it is contained or not will depend on local factors.

The case in Batam caught my attention. Batam is a 45 minute ferry ride from Singapore and several thousand people cross a day. If anywhere can contain an infectious H2H bird flu outbreak, Singapore can. So watch what happens when there is an outbreak there.
Posted by: phil_b   2006-03-03 18:11  

#7  could be Phil B, but just as intercontinental jet travel will expose people much more rapidly, we've all been exposed to bacteria and viruses that our ancestors (at least Cont. U.S.) would NEVER have been exposed to. We have antibodies for things which will never naturally occur where we now reside. I'm hoping the outbreak will be short, like you, I'm sure. Could be a real bitch in Indonesia, Burma, China, et al....
Posted by: Frank G   2006-03-03 17:58  

#6  The issue is, how will the pandemic start? Will it start with a big cluster of cases as Moose suggests or will it start slowly with an almost imperceptable increase in cases over time?

I think the latter, primarily because I think there are multiple changes the virus has to acquire in order to transmit efficiently in humans. One prominent virologist estimated 25 genetic changes are required for efficient transmission in humans. I know enough about evolution to know that the bulk of those changes can only be acquired through infecting people and are only retained (in the gene pool) if (once) sustained transmission occurs.

So until sustained transmission occurs all we have is a series of isolated bird to human infections and short chains of H2H transmission. Once sustained transmission occurs and we will see a steadyly increasing cluster (and then clusters). How fast the cluster increases depends on how many of those adaptations the virus has acquired. Initially, it will just have enough adaptations to maintain sustained transmission (RO just over 1) and we will see a slow increase in cases in the cluster, which is what we are seeing in Bandung.

How long it takes before we get efficient transmission and rapid spread is anyone's guess, but the 1918 pandemic indicates 1 to 2 years.
Posted by: phil_b   2006-03-03 17:26  

#5  11 to 66 does not a pandemic make, phil_b, especially when most of them have had bird contact to an extent that most people never do.
Posted by: Darrell   2006-03-03 16:27  

#4  If the disease also affects them

At least one cat has been diagnosed with the avian flu HN51 in France already.
Posted by: lotp   2006-03-03 16:15  

#3  
"...entire nation's supplies of poultry could be wiped out--their major source of protein. Starve or risk the flu?"

Well...the folks in the PI with the worm problems can always market their worm meat!

Posted by: Vinkat Bala Subrumanian   2006-03-03 16:06  

#2  I project the first official outbreak will work much like this:

First of all, about 25-100 people will all come down with the flu at once. The official response, good, bad, or indifferent will *seem* to work, with no new cases and much rejoicing that "we have stopped the spread" of the disease.

Then, within a short time, a smaller number of people will come down with the disease outside of the original infection area. These cases will be incorrectly put down to "ones we missed", and the sense of relief will still be there.

And then, much further outside the original infection area, there will be several outbreaks, all seemingly unconnected to each other. And then the explosive growth of the disease starts to happen in earnest.

Every control measure taken will be "a day late and a dollar short". The local region will be quarantined only after it has spread through the country. The country will be quarantined only after it has spread to several adjacent countries, etc.

Avian flu will give us some "special effects", too. That is, even though we will be focused on the sick people, entire nation's supplies of poultry could be wiped out--their major source of protein. Starve or risk the flu?

Other domestic animals, such as dogs and cats, are everywhere in the world and spread out among the human population. If the disease also affects them, the human-animal transfer could intensify the spread of the disease enormously.
Posted by: Anonymoose   2006-03-03 10:05  

#1  In Bandung, the number of suspected bird flu patients rose by 11 to 66

My comments got lost due to stuff. I made the point that Bandung is where the first cases of human bird flu occured in Indonesia and the current rate of ongoing infections strongly indicates to me we have sustained transmission, which means the pandemic has started here.

Whether it can be stopped is an interesting question that given time, I will say more on later.
Posted by: phil_b   2006-03-03 09:21  

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