SITREP - WHO | Avian influenza- situation in Indonesia � update 26

Avian influenza- situation in Indonesia – update 26

29 July 2005

Laboratory evidence now shows that the 8-year-old girl from Tangerang, Banten Province, is a probable avian influenza A/H5 case, based on analysis of serological samples. Two WHO Reference Laboratories at the University of Hong Kong and the Centers for Disease Control and Prevention USA, detected high positive rising microneutralisation titres specific for H5N1 in 2 samples taken 3 days apart.

She was the daughter of the confirmed case reported previously. Laboratory results for the 1-year-old daughter are still pending. Genotyping of the PCR-amplified isolate from the confirmed case shows high homogeneity with other H5N1 isolates from poultry in Java, and no evidence of reassortment.

Extensive epidemiological and environmental studies are ongoing around this family cluster. The Minister of Agriculture stated that laboratory results detected H5-infected bird faeces in a bird cage opposite side of the road of the family's house; cloacal and throat swabs of the pet bird inside the cage were negative for H5. This is the first, and, thus far, the only, indication of a possible source of exposure. Other environmental sampling was negative.

The Ministry of Health is continuing to monitor over 300 contacts. None of the contacts have shown any symptoms to date. Seroprevalence results are still pending. Surveillance has been intensified in affected areas and throughout the country. Forty-four referral hospitals have been identified and are being prepared to receive possible cases. Health education campaigns are being conducted nationwide.

The government has reinforced coordination between relevant government bodies, including the Ministries of Health and Agriculture, and is monitoring the situation in close collaboration with the World Health Organization.

WHO Avian influenza- situation in Indonesia � update 26

SITREP - WHO | Avian influenza � situation in Indonesia � update 25

Avian influenza – situation in Indonesia – update 25

21 July 2005

The Ministry of Health in Indonesia reported that a 38-year-old father who died on 12 July was the country’s first laboratory-confirmed H5N1 positive human case of avian influenza. His two daughters also died of severe pneumonia illness compatible with H5N1 infection, but laboratory confirmation is not yet available. Limited samples were available from the 8-year-old daughter who died on 14 July, and the 1-year-old daughter who died on 9 July.

The 8-year-old became ill with fever, diarrhoea, then cough, on 24 June. She was brought to Siloam Gleneagles Hospital, Tangerang, on 28 June, where she died with respiratory distress 20 days after onset. The 1-year-old became ill on 29 June with fever, diarrhoea, then cough, finally respiratory distress, and died 10 days after onset. The father became ill on 2 July with fever, mild cold, then cough and was taken to the same hospital on 7 July where he died 10 days after onset. Samples from the 38-year-old tested positive for avian influenza H5N1 virus by the WHO H5 reference laboratories at the Department of Microbiology, University of Hong Kong, and the Centers for Disease Control and Prevention, Atlanta USA. Samples from the two children are undergoing testing.

The remaining four residents of the house (two members of the family and two household workers) remain healthy and show no symptoms to date. The Ministry of Health is closely following over 300 contacts, including health-care workers, family members, school and office colleagues and neighbours. None of these contacts has shown any symptoms to date.

An investigation is currently underway with team members from Indonesia's Ministry of Health, Ministry of Agriculture, United States Naval Medical Research Unit 2, and WHO to identify potential sources of the infection. Serum samples have been collected from contacts of the cases, starting from the family and neighbours, health-care workers, while any possible poultry contact is being investigated (e.g. market sellers, retail food outlets, pet birds). Environmental and veterinary sampling is being carried out by the Ministry of Agriculture.

Health education to hospital and other health-care workers has been continuing since January 2004, when avian influenza was first reported in Indonesia. The Ministry of Health, working with WHO has carried out seminars and workshops to strengthen surveillance of influenza-like illness, outbreak investigation, and appropriate isolation and barrier nursing. Stockpiling of personal protective equipment to protect health and veterinary workers, and procurement of antivirals for treatment and prophylaxis, as appropriate, is continuing. Information has been provided to assist the community with general health precautions, including frequent hand-washing, avoiding contact with sick animals, and safe and hygienic handling and cooking of poultry.

WHO Avian influenza � situation in Indonesia � update 25