Six More Human Bird Flu Cases In Indonesia, Three Fatal

[Angel]

OXFORD, England -- Indonesia this weekend saw further deaths from avian influenza among increased reports of suspicion and poor health practices in the North Sumatran village that has seen the largest infection cluster confirmed thus far.

Thirty-seven deaths in Indonesia have now been attributed to avian-influenza infection.

A brother and sister from Bandung both died from the disease on May 23, marking the seventh family cluster found in the country. The World Health Organization confirmed that their deaths were the result of the H5N1 strain of avian influenza on Monday.

A 14-year-old girl from Solok, in West Sumatra, has been infected with the disease, an Indonesian Health Ministry official announced. There have been no reports of her condition.

Johannes Ginting, the sole survivor of Indonesia's largest infection cluster, is still in hospital but is refusing all manner of treatment for avian flu, officials from Adam Malik Hospital have said.

Nurrasyid Lubis, deputy director of the hospital, was quoted by the Charlotte Observer as saying: "Johannes doesn't want to be injected, doesn't want to take Tamiflu or other antibiotics. ... We had actually given masks and gloves to the family, and we informed them how dangerous this disease is, but they didn't cooperate with us. We also informed (Johannes) how dangerous it is, but he didn't believe us."

The situation in Indonesia -- which has seen half of all deaths from bird flu worldwide -- is further complicated by suspicion on the part of local villagers. This column reported last week that villagers outraged by their loss of income following bird culls had taken to public ceremonies in which they kill birds with their bare hands and drink the blood.

Now villagers in Kubu Sembilang, site of the aforementioned largest cluster, refuse to believe that the deaths were a result of avian influenza, instead blaming black magic.

The villagers are wary of the fact that seven members of the same family fell ill, apparently as a result of being in close contact with each other, yet none of the villagers who cared for the family has shown any signs of illness. The issue is further complicated by the fact that the WHO has so far been unable to identify how the first family member to be infected initially contracted the disease, as none of the animals in the vicinity of the village has tested positive for H5N1 antibodies.

In previous clusters, however, only blood relatives have been affected -- spouses and in-laws have remained disease-free as grandparents and cousins have fallen ill.

But the suspicious villagers have taken to avoiding the house, which they say has been cursed and is haunted by the ghosts of the dead family, for fear of falling under the curse themselves. Instead, they have been cutting the necks of chickens and drinking the blood, proving themselves free of the curse.

Meanwhile:

-- The Cambodian government is struggling to spread awareness of avian influenza in the face of limited resources.

Cheoun Uork, whose 3-year-old daughter recently died from bird flu, had not heard of the virus until several days after his daughter died, ContraCostaTimes.com reported.

"Had I known about such a warning, I would have taken better precautions to protect my daughter," he said. "She was my only child, and now I have to live with regret over her death."

Due to budgetary constraints, the Cambodian government was forced to focus its bird-flu awareness resources on the five provinces deemed to be at greatest risk of infections and outbreaks. The remaining 19 provinces have seen little in the way of information and methods of disease prevention.

But even in those five provinces where the efforts have been focused -- those bordering Thailand and Vietnam, both of which have seen a number of outbreaks -- there is a sense that the message is not getting across.

Ly Sovann, head of disease surveillance control at the Cambodian Health Ministry, told ContraCostaTimes.com: "Sometimes, people are enjoying music on the radio, and if a commercial or education spot pops up after the song, they will switch to another channel for more music. That is why face-to-face communication with villagers is more crucial for training and encouraging them to take part in prevention of the disease."

Megge Miller, a WHO epidemiologist in Cambodia, was quoted as saying: "There's obviously a lack of awareness in this community (about) what bird flu is. When we went into the field, families were asking questions, 'What is avian influenza? What is this about?'"

-- Russia is beginning the clinical trials of an avian-influenza vaccine produced by Mikrorentgen on 240 human volunteers, MosNews.com reported.

The volunteers, all of whom are over 18, have been selected form groups identified as being at high risk of contracting avian influenza, including those who work at poultry farms.

Over the course of the trial, which is to last five weeks, the volunteers will be injected with the vaccine before returning to their normal lives, periodically monitoring and recording their body temperature.

[Angel]

According to the World Health Organization, six more humans have become infected with the H5N1 bird flu virus strain in Indonesia, of which three have died. 21% of all confirmed human cases of bird flu infection so far have happened in Indonesia - 48 out of 224.

Indonesian authorities can confirm that four of these six cases had been exposed to sick chickens and pigeon droppings. Reports on the sources for other two are still pending. Authorities added that it is highly unlikely any of these six infected humans caught bird flu from another human - all but two of them are from different parts of the country. Two of them, a brother and sister, both got ill at the same time - an indication that one did not infect the other. The brother and sister have died.

There is absolutely no connection between these six human infections and the cluster of seven family members from Kubu Sembelang. There may have been human-to-human transmission among this cluster of seven family members as they shared a small room. H5N1 can transmit from human-to-human if there is continuous, close physical contact.

Laboratory tests indicate there is no evidence that H5N1 has mutated.

After being criticised for their lack of urgency, Indonesian authorities have announced a series of measures aimed at combating the spread of animal and human infection. People who refuse to undergo tests will now face a prison sentence, as will those who refuse to allow their animals to be tested.

Scientists fear that when the H5N1 bird flu virus strain mutates, it will acquire the ability to become human transmissible. The most likely way it may do this is to infect a person who already has the normal human flu. The H5N1 would have the opportunity to exchange genetic information with the human flu virus and pick up its ability to jump from human-to-human. If this happens we could be facing a flu pandemic. How serious a flu pandemic may be for global human health will depend on how virulent the mutated virus is.

H5N1 needs to get embedded deep down into the human lung to make a person sick. This is one of the reasons humans do not catch bird flu easily, even from birds. A sick person cannot easily infect another human because his/her coughs and sneezes expel tiny quantities of the virus - as it is so deep down in the lung. A mutated virus that acquires the ability to become human transmissible most likely will start to infect the upper respiratory tract. If it did this humans would catch it and become ill much more easily, and sick people would expel a larger quantity of virus after each cough and sneeze. Fortunately, upper-respiratory tract infections are easier to treat than lower-respiratory tract infections. If this theory happens, it could mean that a human flu pandemic would occur with a less virulent virus than the present H5N1.

In other words: Currently, H5N1 only infects humans deep down in the lung. That is why it has a high death rate. That is also why humans cannot catch it easily. That is also why humans cannot pass it on easily.