< meta name="DC.Date.Valid.End" content="20050825"> Amendment Nine: Indonesia's Bird Flu

Saturday, June 03, 2006

Indonesia's Bird Flu

Some pretty serious developments over the last 24 hours.
Bandung, W Java (ANTARA News) - A 25-year old nurse identified by her initials as `Ci` is currently being treated at the Hasan Sadikin Hospital here for bird flu-like symptoms.
By the way, talk about a breach of patient fucking confidentiality! Can you imagine this happening here? "A 32 year old man working on the thirty second floor of the Mens Apparel Building has come down with syphilis. He prefers to remain anonymous but his initials are GLK." Jesus! This nurse is having hard enough time it seems, can't we let "her" (why even say the sex?) deal with this without having her name blasted all over the world? Ok, back to the story...
We could not confirm whether she is positive of having been infected by avian influenza virus or not, although she had earlier have contacts with siblings, 18-year old Ad and 10-year old Ai, who died of bird flu virus recently.
They also say she doesn't eat poultry, so it is likely that IF she has bird flu (which they haven't confirmed yet) she got it from the kids who died recently (that familial outbreak). This is an enormous deal for two reasons. First, the reported cases of human-human bird flu transmission have all been in cases of very intense, very close, very intimate human contact. The story only says she had "contacts" with the two bird flu victims, it doesn't say how intense or how prolonged those contacts were. Unfortunately, it sounds like they weren't very intense, and they weren't very long. This suggests some mutation.

Second, of the cases of earlier human-human bird flu transmission, almost every single one was with another family member. There was talk of a genetic trait which made one susceptible to such transmission. While the story doesn't rule out that she was a relative, it also doesn't state it, and I think if she were a relative (given their seeming unconcern for her privacy) they would have printed it. This also suggests some mutating.

Remember, we need to get the test results back. Having bird flu like symptoms and having bird flu are totally different things. But if a nurse has contracted it from an unrelated patient after not very prolonged contact, these tests are likely to reveal the virus is mutating.

The next big update is from Pamulang (outside Jakarta). A seven year old girl has died from bird flu, it now appears (though we're still awaiting confirmation). A couple of things about this case are troubling. First, she was taking Tamiflu before she died. This isn't such a huge deal since her parents also refused hospital admission, but it is nevertheless troubling. Second, her brother also recently died after showing flu like symptoms. He wasn't tested when he died though. This suggests that there is a second cluster.

Now I just checked Drudge's site and it looks like he is getting to run with a story talking about how there have been plenty of human-human transmissions of bird flu but no one has spoken about them before. That is simply untrue. We've known about human-human transmission for quite awhile, but no one was concerned because it was so isolated and almost exclusively a by-product of families living closely together. If he runs with that, he's full of shit (as usual). He's probably wanting to fan the flames of discontent against WHO. But of course, it is a mistake the media makes, not WHO, when stupid reporters quote a doctor and don't really understand what they are being told.

So let's recap, given that some misinformation is about to be dished. First, there have been numerous cases of human-human transmission. WHO has been upfront about that for quite some time. Just because Drudge and other lazy reporters can't be bothered to check the infectious disease communities around the web doesn't mean that WHO or other infectious disease scientists haven't been reporting this for a long while now.

The human transmissions have mostly been limited to family members. A new suspected case of bird flu appears likely to be a case of human-human transmission. This new suspected case is alarming in that there are no signs of familial relationship or prolonged contact. Another cluster of bird flu in Indonesia appears to have been discovered, and there may be human-human (brother to sister) transmission there as well. That's the bird flu update.