SITREP - WHO | Avian influenza � situation in Indonesia � update 32

Avian influenza – situation in Indonesia – update 32

29 September 2005

The Ministry of Health in Indonesia has today confirmed another fatal human case of H5N1 avian influenza. The patient, a 27-year-old woman from Jakarta, developed symptoms on 17 September, was hospitalized on 19 September, and died on 26 September.

Confirmatory testing was conducted at a WHO reference laboratory in Hong Kong.

Initial investigation has revealed that the woman had direct contact with diseased and dying chickens in her household shortly before the onset of illness.

The woman is the fourth laboratory-confirmed case of H5N1 infection in Indonesia. Three of these cases were fatal.

As a result of intensified surveillance and heightened public concern, growing numbers of people with respiratory symptoms or possible exposure to the virus are being admitted to hospital for observation and, when appropriate, treatment. Until a conclusive diagnosis is made, these patients are classified by the Ministry of Health as suspect cases. While many do not have symptoms compatible with a diagnosis of H5N1 infection, screening of patient samples is being undertaken in national laboratories as part of efforts to ensure that no new cases are missed.

Laboratory testing to confirm human infection with H5N1 avian influenza is technically difficult; some tests produce inconclusive or unreliable results. To ensure a reliable assessment of the situation in Indonesia, authorities are, after initial screening, continuing to send samples from people considered likely to have H5N1 infection to WHO reference laboratories for diagnostic confirmation.

According to FAO, highly pathogenic H5N1 avian influenza is now endemic in poultry in many parts of Indonesia. As influenza virus activity in Indonesia may increase during the wet season, from November to April, human exposure to animal virus could be greater during the coming months. Further sporadic human cases can be anticipated.

WHO Avian influenza � situation in Indonesia � update 32

SITREP - WHO | Avian influenza � situation in Indonesia � update 31

Avian influenza – situation in Indonesia – update 31



22 September 2005

The Ministry of Health in Indonesia has today confirmed a further human case of highly pathogenic H5N1 avian influenza. The case, in an 8-year-old boy, was confirmed as positive for H5N1 infection by a WHO reference laboratory in Hong Kong. The boy remains in hospital for observation and treatment. Current investigations in Indonesia have produced no evidence that the H5N1 virus is spreading easily from person to person.

Background on avian influenza in Indonesia

Since mid-2003, Indonesia has experienced outbreaks of avian influenza in its poultry population. Prior to the new case announced today, two human cases of H5N1 infection in Indonesia have been laboratory confirmed, one in July and another in September. All three cases have been investigated by the Indonesia health authorities, with WHO support, and searches for further cases have been conducted.

As investigations have produced no evidence that the H5N1 virus is spreading easily from person to person, WHO has not raised its current level of pandemic alert. WHO will, however, continue to monitor the situation closely. Given the experience of other H5N1 affected countries in Asia, the detection of further human cases in Indonesia or elsewhere would not be surprising.

Laboratory confirmation of cases in Indonesia has led to heightened public concern, intensified surveillance for further cases, and strengthened government commitment to contain the disease. As a result, several patients with respiratory symptoms and a history of possible exposure to the avian virus are being evaluated as part of ongoing surveillance efforts. Samples from these patients have also been sent for analysis by the WHO reference laboratory in Hong Kong.

Overall assessment

In all affected countries, most human cases of H5N1 infection have been linked to contact with poultry. In a few instances, limited human-to-human transmission of the virus may have occurred following close contact with a patient during the acute phase of illness. In all known instances, such transmission has been limited and has not led to larger outbreaks in the general community, indicating that the virus does not spread easily among people at this time.

WHO has sent all countries a document outlining recommended strategic actions for responding to the avian influenza pandemic threat. Recommended actions aim to strengthen national preparedness, reduce opportunities for a pandemic virus to emerge, improve the early warning system, and accelerate vaccine development.

WHO Avian influenza � situation in Indonesia � update 31

SITREP - WHO | Avian influenza - situation in Viet Nam � update 30

Avian influenza - situation in Viet Nam – update 30

19 September 2005

The Ministry of Health in Viet Nam has retrospectively confirmed an additional fatal case of H5N1 infection that dates back to July. The case, in a 35-year-old male farmer from Ben Tre Province, developed symptoms on 25 July and died on 31 July.

The newly confirmed case brings the total in Viet Nam since mid-December 2004 to 64 cases, of which 21 were fatal.

WHO Avian influenza - situation in Viet Nam � update 30

SITREP - WHO | Avian influenza - situation in Viet Nam � update 30

Avian influenza - situation in Viet Nam – update 30

19 September 2005

The Ministry of Health in Viet Nam has retrospectively confirmed an additional fatal case of H5N1 infection that dates back to July. The case, in a 35-year-old male farmer from Ben Tre Province, developed symptoms on 25 July and died on 31 July.

The newly confirmed case brings the total in Viet Nam since mid-December 2004 to 64 cases, of which 21 were fatal.

WHO Avian influenza - situation in Viet Nam � update 30

SITREP - WHO | Avian influenza � situation in Indonesia � update 29

Avian influenza – situation in Indonesia – update 29

16 September 2005

The Ministry of Health in Indonesia has today confirmed a fatal case of human infection with H5N1 avian influenza. The case occurred in a 37-year-old woman who resided in Jakarta. She developed symptoms on 31 August, was hospitalized on 6 September, and died on 10 September.

The positive test results were received from a WHO reference laboratory in Hong Kong.

The government has launched investigations, assisted by WHO, aimed at identifying the source of the woman’s infection and tracing her close contacts, including family members, neighbours, and hospital staff engaged in her treatment.

The woman lived in an area with multiple opportunities for exposure to chickens and ducks. No recent poultry deaths have been reported in the area. Poultry samples have been taken by agriculture authorities as part of the ongoing investigation.

This is the country’s second laboratory-confirmed case.

In July 2005, a cluster of 3 deaths in one family was investigated. H5N1 infection was confirmed in the 38-year-old father but laboratory test results for his two daughters did not meet criteria for acute H5N1 infections. WHO reports only laboratory-confirmed cases.

Investigation of the July family cluster was unable to determine the source of exposure. Testing and monitoring of more than 300 close contacts failed to detect any further cases.

WHO Avian influenza � situation in Indonesia � update 29