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AVIAN INFLUENZA, HUMAN (60): INDONESIA (BALI), FATAL, SUSPECTED
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Mon 10 Oct 2011
Source: Jakarta Globe [edited]
Bali officials are on alert again after 2 children at Denpasar's
Sanglah General Hospital were diagnosed with the H5N1 strain of avian
influenza. Five- and 10-year-old siblings, resident in Bangli
district, were admitted to the hospital on Friday night [7 Oct 2011]
with symptoms of avian influenza and placed in isolation. The
hospital's medical and nursing director, Anak Agung Ngurah Jaya
Kusuma, said on Sunday [9 Oct 2011] that the children had been in
direct contact with dead poultry around their house and were treated
at a local health clinic before being brought to Sanglah.
Officials are still waiting for results of further tests from Udayana
University and the Health Ministry.
Bali Animal Husbandry Agency head Putu Sumantra said a team had been
deployed to Bangli, but preliminary results showed no trace of H5N1
[presumably in poultry - Mod.CP]. He said that given the preliminary
test, he was not ready to conclude that the birds had died of avian
influenza. "Nevertheless, we remain vigilant. Some of the dead birds
have been sent for further lab tests; the area has been sterilized,
and we have taken samples from family members," he said.
A total of 2 people died of the virus in 2007 and 2008 [in Bali], but
the province has still not enacted a 2005 gubernatorial regulation
banning the import of poultry into the island from other areas.
Denpasar agricultural quarantine chief Saiful Muhtadin said many
attempts have been made to smuggle poultry into Bali, especially
through Padangbai and Gilimanuk harbors.
[Byline: Made Arya Kencana]
Date: Mon 10 Oct 2011
Source: Avian Flu Diary [abridged & edited]
Roughly 48 hours ago [8 Oct 2011], FluTrackers posted an Indonesian
MetroTV report on 2 children (a 5-year-old boy and a 10-year-old boy)
hospitalized on Friday [7 Oct 2011] with severe respiratory symptoms
on the resort island of Bali. Given their reported contact with
chickens and the endemic nature of the H5N1 virus in Indonesia, bird
flu was immediately suspected. Over the next 2 days, the news hounds
on FluTrackers and Flu Wiki posted more than 24 translated reports on
these 2 children, and yesterday [9 Oct 2011], we learned that
preliminary testing indicated bird flu, and that both children were on
This morning [10 Oct 2011], we have had word that both children have
died and that H5N1 has been confirmed. While a number of news reports
are reporting these deaths, TEMPO Interaktif seems to have the most
details. The TEMPO Interactive reports that the 2 children from
Tembuku Village, Bangli, Bali allegedly died from bird flu early
Monday morning [10 Oct 2011]. The bodies of the brothers are still
stored at the General Hospital Center for Sanglah.
According to other reports, prophylactic Tamiflu is being provided to
family members and close contacts of these boys, and the community has
been told that Tamiflu will be provided to anyone who had contact with
sick or dead chickens.
All of this is highly reminiscent of the events of August 2007, when
an outbreak of H5N1 killed 2 women (and was suspected in the death of
one of the women's 5 year-old daughter) on the island of Bali. Bali,
with a population of just under 4 million, is a popular international
tourist destination, although its reputation has suffered in recent
years due to outbreaks of bird flu, dengue, and rabies.
A number of countries, including the US and Australia, have issued
travel health warnings for Bali and for the rest of Indonesia [with
respect to risk of rabies virus infection - Mod.CP]. Although news
reports of bird flu outbreaks and human cases in Indonesia have
declined over the past couple of years, the virus remains endemic in
that country and continues to mutate and spread.
Reporting and surveillance in Indonesia, as in much of the world,
leaves much to be desired, so while Indonesia reports 146 total deaths
from the H5N1 virus, the actual number is unknown. With these 2 new
deaths, a good deal of attention will be focused on Bali over the next
couple of days to see whether additional cases show up.
[Byline: Michael Coston]
ProMED-mail Correspondent Mary Marshall
[ProMED-mail acknowledges receipt of another report with similar
information from Dr. Andri Jatikusumah, M.Sc., Direktur Eksekutif,
Center for Indonesian Veterinary Analytical Studies (CIVAS), Jl.RSAU.
No 4, Atang Sanjaya, Kemang Bogor.
Reports of human cases of avian influenza A/(H5N1) virus infection
from Indonesia have not always been confirmed by laboratory diagnosis
at a WHO-accredited institution. While the 2nd report announcing the
death of the 2 siblings states that the diagnosis of avian influenza
A/(H5N1) virus infection has been confirmed, the 1st report states
that it is not yet certain that the deaths of the domestic poultry in
the village where the children lived were the result of avian
influenza virus infection. Further information is awaited.
Denpasar in Bali, Indonesia can be located in the HeathMap/ProMED-mail
interactive map at:
Avian influenza, human (59): transmission in mammals 20110926.2921
Avian influenza, human (58): H5N1 188.8.131.52 clade, WHO 20110902.2682
Avian influenza, human (57): alert 20110829.2654
Avian influenza, human (56): Cambodia (KC) 20110819.2525
Avian influenza, human (55): data analysis 20110811.2439
Avian influenza, human (54): Egypt, WHO 20110810.2427
Avian influenza, human (53): Cambodia, Egypt 20110803.2338
Avian influenza, human (52): Cambodia (BM) 20110729.2279
Avian influenza, human (45): Indonesia (JK), WHO 20110603.1700]
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