Penumbra Pandemia

Jakarta: Victims' neighborhood H5N1-free
via crofsblogs
May 17, 2008

Via The Jakarta Post: Victims' neighborhood H5N1-free. The story has more information about Istiqomah and her brothers. Excerpt:

The city's husbandry, fishery and maritime agency said Friday it did not find the H5N1 virus in any fowls found in the neighborhood of the latest suspected bird flu victims.
Agency head Edy Setiarto said samples taken from poultry in the Gandaria Utara, South Jakarta, showed negative results.
'We took the samples Thursday and had them examined in our lab in Ragunan, South Jakarta, after scanning an area in the subdistrict with a radius of 100 meters,' he said.
'We found out later that day the tests were negative,' he said.
The agency also culled backyard poultry in the area during the inspection, he said.
'We have finished culling poultry on the subdistrict level,' said Edy.
'The Jakarta husbandry, fishery and maritime agency will continue culling poultry in the whole Kebayoran Baru district.'
The procedure, he said, would be finished by the end of this month.
Edy said the agency is trying to determine where the virus might have come from.
Jakarta Health Agency head Wibowo Sukijat said his agency was testing blood samples taken from people who had contact with the suspects before they died.
'We don't know when the tests will be finished,' he said at City Hall.
Sixteen-year-old Istiqomah died Wednesday after being treated at Persahabatan Hospital, East Jakarta, for having respiratory problems, a cough and a fever.http://www.blogger.com/img/gl.link.gif
Her nails on both her hands and feet had turned blue.
Doctors confirmed Istiqomah died of bird flu, Koran Tempo reported Friday.
On May 4, Istiqomah's brother Ahmad Rizki, 15, died at Prikasih Hospital in Pondok Labu, South Jakarta, after showing similar symptoms.
Doctors at the hospital, however, said Ahmad was suffering from typhoid.
Wibowo said blood samples from Ahmad showed he was not infected by the bird flu virus and thus confirmed the doctors' claim.
A family member of the victims, Alamsyah, 24, is now being treated at Persahabatan Hospital with bird flu-like symptoms.

We still have no confirmation from WHO."
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More about the outbreak here.

Avian influenza: two new strains discovered
EL MOUDJAHID via Dutchie at curevents.com
11-05-2008
"A French team of the Centre of International Cooperation in Agricultural Research for Development, CIRAD, announces the identification in Nigeria two new avian influenza viruses.
A highly pathogenic H5N2 strain taken from wild ducks, and a mutant virus H5N1. Both represent potential sources of pandemic.
These findings are the result of a ground survey launched recently by CIRAD in 7 African countries infected in the last two years by bird flu: Burkina Faso, Cameroon, Cote d'Ivoire and Egypt, Niger Nigeria and Sudan."
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"Grippe aviaire : deux nouvelles souches découvertes
EL MOUDJAHID
11-05-2008 à 21:09
Une équipe française du Centre de Coopération internationale en Recherche agronomique pour le Développement, le CIRAD, annonce l’identification au Nigeria de deux nouveaux virus grippaux aviaires. Une souche H5N2 hautement pathogène prélevée sur des canards sauvages, et un virus H5N1 mutant. Tous deux représenteraient des sources potentielles de pandémie.
Ces découvertes sont le résultat d’une enquête de terrain lancée récemment par le CIRAD dans 7 pays africains infectés ces deux dernières années par la grippe aviaire : le Burkina Faso, le Cameroun, la Côte d’Ivoire et l’Egypte, le Niger, le Nigeria et le Soudan."

"Fatal H5N1 Cluster In Jakarta Grows to H2H2H
Recombinomics Commentary 22:38
May 14, 2008
Alamsyah(24), the older brother Istigomah (casualties who diedhttp://www.blogger.com/img/gl.link.gif because of suspect bird flu) took part in being treated in RS Persahabatan, Jakarat Timur. Alamsyah was run off with on Tuesday May 13 2008 yesterday, because of suffering the sign of bird flu

The above translation describes the hospitalization of a third sibling in Jakarta. Two siblings have already died with bird flu symptoms. No sample was collected from the index case, but the second brother was H5N1 confirmed. The hospitalization of the third brothers along with disease onset dates suggests H2H2H transmission, which is among the longest transmission chains reported to date."
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More about the outbreak here.

"H5N1 Clade 2.3 in Japan Signals Global and Genetic Expansion
Recombinomics Commentary 05:21
May 15, 2008
it differs from the virus which in the past is verified in the country, presently has become popular in Indonesia and Vietnam

The above comments on the H5N1 in whooper swans in Japan indicate clade 2.1 or clade 2.3 has moved into long range migratory birds.http://www.blogger.com/img/gl.link.gif Comments from South Korea on similarities between the H5N1 there and H5N1 in Vietnam suggest that H5N1 in both countries is clade 2.3 (Fujian strain). Although movement of H5N1 via migratory birds in eastern Asian is not well defined, an elaborate distribution route in areas west of China has been defined by surveillance and analysis of clade 2.2.
Clade 2.2 was initially reported at Qinghai Lake in central China in May, 2005. The spread outside of China was first reported in outbreaks in Siberia and Mongolia in the summer of 2005. The high concentration of H5N1 in long range migratory birds suggested H5N1 would migrate into Europe, the Middle East, and Africa, where it had never been reported previous. These predictions were confirmed by reports of H5N1 in these regions in late 2005 and early 2006. All isolates were clade 2.2, which was also found in south Asia in India, Afghanistan, and Pakistan.
In the summer of 2006 a new wild bird outbreak was reported at Uvs Lake in Mongolia. This clade 2.2.3 strain subsequently migrated to the east in South Korea and Japan in late 2006 and early 2007. The Uvs Lake strain also migrated to the west, and was reported in Kuwait in early 2007. Although there were few reports of H5N1 in Europe in late 2006 and early 2007, outbreaks were reported in the Czech Republic, Germany, and France in the summer of 2007. All outbreaks were the Uvs Lake strain, which was subsequently widely reported in Europe and Saudi Arabia at then end of 2007.
Although there was considerable heterogeneity in the H5N1 in circulation, all isolates were clade 2.2. The reports of clade 2.3 in whooper swans in Japan and poultry in South Korea raises concerns that the clade 2.3 will follow the paths of clade 2.2 and increase the geographical reach and genetic complexity of H5N1.
The outbreaks in South Korea are at record levels and the locations in Japan are further north than prior outbreaks. The detection of these outbreaks in late spring raises concerns that the H5N1 was brought into the area recently by birds migrating north in the East Asian flyway. Japan and Korea are within intersecting flyways that can move the clade 2.3 into Siberia and Mongolia, while northern movement along the east Asian flyway would move clade 2.3 into North America.
The mixing of clade 2.2 and clade 2.3 in migratory birds could lead to significant recombination and genetic drift, which may then move into new regions as evidenced by the new locations in Japan and the high concentration of H5N1 in South Korea.
Primorie has already reported H5N1 for the first time and its proximity to South Korea and Japan raise concerns that clade 2.3 has already moved into Russia. Details on the sequence of the H5N1 in Russia would be useful.
Enhanced surveillance in Russia and Mongolia, as well as Alaska is warranted by these new movements of H5N1 and the first reports of clade 2.3 in Japan and South Korea."

"H5N1 Clade 2.3.2 in Korea Raises Pandemic Concerns
Recombinomics Commentary 15:42
May 15, 2008
H5N1' Elder brother virus ' 2.3.2' Was confirmed as the channel virus

The above translation confirms that the H5N1 in South Korea is the Fujian sub-clade 2.3.2. This sub-clade has the HA cleavage site of RERRRKR and the most recent clade 2.3.2 isolate in the phylogenetic tree in the WHO vaccine target update is A/common magpie/Hong Kong/645/2006, which is among the Fujian isolates that annually appear in Hong Kong around the beginning of the year.
This identification increases the likelihood that the H5N1 in South Korea and Japan this season is linked to the northern migration of wild birds infected with clade 2.3.2 from the south. Movement of clade 2.3.2 into areas where clade 2.2 has been reported would result in recombination and acquisition of clade 2.2 polymorphisms. Analysis of newly acquire polymorphisms in the above isolate indicates that most are shared with clade 2.2 isolates.
The report of clade 2.3.2 in whooper swans in Japan increases the likelihood that these type of exchanges will increase, and clade 2.2 migrating into Europe, the Middle East, and Africa will have additional clade 2.3.2 polymorphisms. Moreover, the report of 2.3.2 in South Korea and northern Japan increases the likelihood that clade 2.3.2 will migrate into areas where clade 2.2 was reported previously, as well as Alaska, which lies within the East Asia flyway that is delivering clade 2.3.2 to Korea and Japan.
The finding of clade 2.3.2 in Korea and northern Japan significantly increases pandemic concerns and the likelihood that H5N1 will once again significantly expand its global reach and genetic diversity."

"Misinformation Associated With Canadian Train Fatality
Recombinomics Commentary 18:25
May 11, 2008
OPP Const. Marc Depatie said he believed the woman who died had boarded the train in Jasper, Alta., as part of a tour group. Depatie said there were reports she had flu-like symptoms when she boarded.
Tests results on the sick woman taken off the quarantined train stuck in Foleyet, northern Ontario, show she is negative for influenza A and B and she and the other five patients seem to be getting better, said Dr. Donald Low.
The rapid antigen tests are negative for influenza and Respiratory Syncytial Virus (RSV).
'Now they are doing the molecular testing, a more sensitive test. I suspect they'll be negative,' he said.

The above comments from media reports on Friday raise a number of transparency issues concerning the medical emergency on then train in Canada. The fatal case was said to have had influenza symptoms prior to board the train in Jasper, Alberta and her death sparked a medical emergency, which was compounded the flu-like symptoms in other travelers belonging to the same tour group.
However, subsequent media reports indicating most of all of the six travel companions have tested positive for influenza A and the fatal case died of “natural” causes. However, the deceased was initially described as being in her 60's, followed by 86, followed by an identity who was 43 and from South Africa. The relatively young age of the deceased has increased concerns.
The official press release did not indicate the infectious disease was influenza A, and claimed there was no infectious outbreak on the train, apparently based on the fact that the ill passengers has symptoms prior to boarding the train, and contacts had not yet shown any symptoms.
However, since contact with the tour group had been only 2-3 days, the lack of symptoms did not indicate a lack of transmission. Similarly, the false negatives linked to the initial rapid tests on the symptomatic tour group members indicated any influenza testing on the train would be unreliable.
The attribution of the death of the index case is similar to claims linked to the index H5N1 case in Iraq as well as the index case in Azerbaijan. Both were said to have died from complications of a heart condition, and both where subsequently H5N1 confirmed when contacts began to die.
The travel history of this tour group remains unclear. Earlier reports indicated they originated in Australia and traveled through Asia before arriving in Canada. However, the index case is from South Africa, so the true travel history remains unclear.
Similarly, the serotype of the seasonal flu has not been released, and the timing of the lab confirmation of seasonal flu relative to the release of the other passengers remains unclear.
Detail on the influenza serotype, travel history, and autopsy of the deceased patient would be useful."

Ärhäkkä tauti levisi junassa Kanadassa
STT
Julkaistu: pe 9. toukokuuta 2008, klo 22:40
"Kanadalaiset lääkärit tutkivat junassa puhjennutta tautia, jonka takia lähes 300 ihmistä oli karanteenissa. Sairastuneet olivat nousseet junaan Jasperin kansallispuistossa Kalliovuorilla.
Seitsemällä ihmisellä oli influenssan kaltaisia oireita. Yksi matkustaja ehti kuolla ja toinen kuljetettiin helikopterilla sairaalaan.
---
Viranomaiset eristivät junan Foleyetissa Pohjois-Ontariossa. Vaunuihin ei päästetty muita kuin lääkäreitä ja sairaanhoitajia."
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Train quarantined in Ont. after passenger dies
CTV.ca News Staff
Updated Fri. May. 9 2008 3:21 PM ET
"--- A Via Rail train passenger train, carrying more than 270 people, was quarantined in the northern Ontario town of Foleyet after officials notified police of a medical emergency on Friday morning.
As many as 10 passengers fell ill, suffering from flu-like symptoms.
Const. Marc Depatie added that it's the 'totality' of the circumstances that led police to believe the death and illnesses are not linked.
Authorities also reached that conclusion upon advice from health experts and reports that the woman was feeling unwell when she got on the train in Jasper, Alta., as part of a group of tourists.
---
Depatie said the victim's body remains on the train as of Friday afternoon as --- teams are finalizing their plan before they launch their investigation.
Provincial police Staff Sgt. Rob Knox told The Canadian Press that one person was airlifted to hospital but the other passengers and crew members are still in quarantine.
A physician had been travelling on the train, which was en route from Vancouver to Toronto, and tried to attend to the victim after she became ill from a yet-undiagnosed ailment.
She later died, and the doctor's attention to other passengers who became ill.
The passenger who was airlifted to hospital was diagnosed with a respiratory illness and is now in stable condition, according to Knox.
The remaining five sick passengers are said to be in good spirits and stable condition.
A spokeswoman for Via Rail told CP that the train departed Vancouver three days ago and hadn't reported any problems before Friday. The illnesses appeared to have been contained to two train cars.
'As far as determining what it is, we're not there yet,' OPP Sgt. Laura Nichols told CTV.ca from the North Bay Communications Centre on Friday morning.
The Canadian Press reported that only emergency response personnel are being allowed on or off the train.
Meanwhile, a CN Rail sleep station has evacuated and local health facilities are on standby.
'The train is going to be here for quite a while,' town chairperson Deborah DesRochers told CTV's Canada AM.
The matter has become one of federal jurisdiction because the train travelled through a number of provinces, said DesRochers.
Health Minister Tony Clement's office released a statement saying his department and the Public Health Agency of Canada have been notified of the quarantine.
'Federal officials are collaborating with provincial and regional counterparts to assess the situation and take action as appropriate,' the statement said.
Clement has been briefed and has directed his officials to collaborate with provincial, regional and local authorities both in Foleyet and at all points along the route the train travelled.
Foleyet is a town of 380 about 100 kilometres southwest of Timmins."

Kiina määräsi koko maan valmiustilaan tappavaa virusta vastaan
Julkaistu 03.05.2008, klo 13.56 (päivitetty 03.05.2008, klo 17.50)
Reuters, AP via YLE Uutiset
"Kiinan terveysviranomaiset varoittivat lauantaina koko maata nopeasti leviävästä enteroviruksesta, joka on maaliskuusta lähtien tappanut ainakin 23 lasta. Tartunnan on saanut lähes 4000 ihmistä.
Lapsista 22 on menehtynyt Fuyangin kaupungissa Kiinan itäisessä Anhuin maakunnassa. Kiinan terveysministeriön mukaan virus uhkaa levitä kuumina kesäkuukausina. Perjantaina 18-kuukautinen poika kuoli viruksen aiheuttamaan tautiin eteläisessä Guangdongin maakunnassa.
Paikallisviranomaiset on määrätty raportoimaan kaikista tautitapauksista vuorokauden sisällä. Päiväkotien ja esikoulujen hygieniavalistusta tehostetaan.
Sairastuneet ovat 2 - 6-vuotiaita. Lapset kärsivät kuumeesta, rakkuloista, suun haavaumista tai kutiavasta ihottumusta käsissä ja jaloissa. Sadat ihmiset ovat edelleen sairaalahoidossa ja osa heistä on kriittisessä tilassa.
Enterovirusten aiheuttamat epidemiat ovat yleisiä Suomessakin, ja yleensä lapset toipuvat taudista nopeasti. Aasiassa yleinen enterovirus 71 saattaa kuitenkin aiheuttaa pahimmillaan vakavia keskushermostoinfektioita ja jopa kuoleman.
Vakavaoireisten EV-71 -epidemioiden osuus on kasvanut maailmanlaajuisesti kuluneiden kymmenen vuoden aikana. Vakavimmat epidemiat ovat olleet Malesiassa vuonna 1997 ja Taiwanissa vuonna 1998. Taiwanissa virus surmasi lähes 80 ihmistä."
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So far the case fatality rate (CFR) seems to have been under 0,5 %. It's interesting: why are the Chinese officials now alarming the world for a disease that has lower CFR than the seasonal influenza?

WHO denies avian flu warning for Beijing Olympics
The Associated Press via the CTV
GENEVA
Updated Thu. May. 1 2008 10:07 AM ET
"The World Health Organization denies it is recommending that visitors to China for this summer's Olympic Games should pack an antiviral drug to protect themselves against avian flu.
The denial comes in the wake of a report Monday by the Italian news agency Ansa, which said WHO is warning tourists going to Beijing for the August sports event to arm themselves with the drug Tamiflu 'in case of exposure to the disease virus.'
The Ansa story quotes Walter Pasini, director of the WHO Collaborative Centre of Medicine for Tourism in Rimini, Italy.
But WHO spokesman Gregory Hartl said Wednesday that Pasini does not work for the international agency itself and the report quoting him has 'set off alarm bells' ---.
'We would categorically deny that WHO's ever made any kind of recommendation to this effect or that there would be any need or justification ... in any context, including going to the Olympics in Beijing,' Hartl said.
Pasini could not be reached for comment late Wednesday.
The WHO's website shows there have been 30 cases of avian flu, also known as H5N1, reported in all of China since 2003 -- three of them so far this year -- and 20 of them ended in death.
The hardest-hit country has been Indonesia, with 133 cases, including 108 deaths. Worldwide, there have been 382 cases, with 241 deaths since 2003, the website said."
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Denying Pasinis' commentary, Hartl denies that the WHO Collaborative Centre of Medicine for Tourism is working for the WHO?

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO 30 April 2008
Epidemic and Pandemic Alert and Response (EPR)
WHO
30 April 2008


Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.
All dates refer to onset of illness.
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The case fatality rate (CFR) seems to be about 63 % for all WHO detected cases and about 70 % for 2007-2008 this far.

Avian influenza – situation in Indonesia – update 42
ndemic Alert and Response (EPR)
WHO
30 April 2008
"The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 3-year-old male from Wonogiri District, Central Java Province developed symptoms on 14 April, was hospitalized on 21 April and died on 23 April. Investigations into the source of his infection indicate exposure to sick and dead poultry.
Of the 133 cases confirmed to date in Indonesia, 108 have been fatal."

EV71: China tries to calm fears
April 30, 2008 at 08:35 AM
Crofsblogs H5N1
Via the Guardian Unlimited: China tries to calm fears over virus outbreak. This is of interest because it shows how China is detecting and responding to unexpected diseases. Excerpt:

The Chinese government has dispatched medical experts to eastern Anhui province in a bid to curb a rapidly spreading outbreak of an intestinal virus that has killed at least 20 children.
But officials sought to calm fears amid reports that almost 1,900 children have been taken ill with enterovirus 71, or EV71, which can cause hand, foot and mouth disease.
Newspapers have published scathing criticism of local officials, attacking them for waiting weeks to raise the alarm, and even calling for them to be sacked.
The issue is particularly sensitive because of the uproar caused by the authorities' handling of the Sars epidemic of 2003. Then, they sacked the health minister and pledged to construct an "open and transparent" reporting scheme after it emerged that they had not told the World Health Organisation (WHO) of the outbreak until news emerged independently.
Today central government officials said the outbreak could not be compared to Sars and added that it had taken time to discover the cause of the outbreak.
'You can't talk about EV71 and Sars in the same breath. Sars was a new infectious disease, and anyone could be infected. Sars was also very deadly,' Yang Weizhong, deputy chief of the Chinese Centre for Disease Control and Prevention, said in a webcast.
'In the initial stages of [this] probe a lot of effort was expended, to rule out some serious infectious diseases like Sars, bird flu and meningitis,' he added.
The first cases of EV71 emerged in Fuyang city in early March, but the outbreak was only reported on Sunday - 40 days later. Since then, the number of recorded infections has soared, with hundreds more emerging daily and reports of cases in neighbouring Henan province."
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If: "'You can't talk about EV71 and Sars in the same breath. Sars was a new infectious disease, and anyone could be infected. Sars was also very deadly,' Yang Weizhong ---"
Then why: "'In the initial stages of [this] probe a lot of effort was expended, to rule out some serious infectious diseases like Sars, bird flu and meningitis,' he added.
The first cases of EV71 emerged in Fuyang city in early March, but the outbreak was only reported on Sunday - 40 days later."
It seems that the Chinese official is saying that the disease (EV71) was remaining unidentified, that is, a new infectious disease for whole 40 days before the Chinese bothered to alert the rest of the World.

"Bird flu drill gives residents golden lesson
Emmy Fitri
The Jakarta Post
Jembrana, Bali
Sun, 04/27/2008 12:48 PM
There's no such thing as 'bird flu' in Dangin Tukad Daya village in Jembrana, about two hours' drive west of Denpasar. The avian influenza has become Flu Yang Mematikan (deadly influenza), the words splashed across banners of various sizes placed at eye-catching spots throughout the village.
The banners seem to give a hint of what's in store.
On Friday, some residents complained of severe respiratory problems and other cold symptoms. A laboratory check confirmed they had avian influenza caused by H5N1 -- originally a poultry disease.
When one villager reported his chickens had died, officials from the local animal husbandry agency came to examine the carcasses: bird flu was confirmed. The officials took the standard procedure of culling all chickens in a 1 kilometer radius from the infected backyard farm.
In the afternoon, Jembrana Regent I Gede Winasa publicly announced an extraordinary situation after receiving reports from virology and epidemiology tests on the incidents.
By Saturday, 20 villagers had caught the influenza and were rushed to nearby hospitals. Many others were given antiviral prophylaxes to prevent widespread illness.
Health Minister Siti Fadillah Supari declared the village an avian influenza epicenter, which meant get-tough measures were required, such as quarantining the infected residents and shutting off access to and from the village. The school was closed and the students were sent home. Local administration officials distributed supplies for the quarantined families.
---
Everything went as planned in the scenario with residents showing a degree of candor and the necessary spontaneity to play their roles.
The village is hosting a three-day bird flu pandemic drill, which started Friday. About 1,000 people were involved in the drill, which was funded by the Atlanta-based Centers for Disease Control and Prevention.
---
Since reporting its first human case of bird flu infection in 2005, Indonesia has led the world's human bird flu death toll with a staggering 107 deaths. Two of the fatalities were in Bali.
One of the victims was a resident of Dangin Tukad Daya, while the other was from Tabanan. The drill, therefore, was warmly welcomed by the administration and most of residents.
Putu Arini -- who played a wife whose husband became the first patient reported to a community health clinic -- said she was glad she was involved in the drill.
'It (the simulation) will surely be useful. I learned about bird flu after a villager died of bird flu last year. We were told then not to keep free-range chickens. I haven't had any chickens since then. ---'
---"

Why bird flu? Why a pandemic simulation?
Emmy Fitri
The Jakarta Post
April 27, 2008
Jembrana, Bali
"--- On Friday, the Health Ministry started a pandemic simulation in Bali. The simulation kicked off at Dangin Tukadaya village, two hours' drive west of Denpasar. The village is home to 4,300 people. Last year, the village reported two human deaths from bird flu.
The Health Ministry's head of infectious disease control directorate, Tjandra Yoga Aditama, is in charge of the simulation.
For the simulation scenario, he said, the H5N1 has been transmitted from human to human, making the village the pandemic's epicenter.
Jembrana regent is slated to announce the condition to the media, while the Health Ministry has the authority to declare the situation after receiving confirmed laboratory results from virology tests.
'People are banned from leaving their houses to prevent the infection spreading, chickens are culled and the antiviral prophylaxis is distributed to the masses,' said Tjandra.
---
More than 66 million people in Indonesia could be affected by the disease if a pandemic occurs, according to official estimates.
Furthermore, there would be tremendous economic and social losses; those infected would not be able to maintain their usual economic activities and there would be widespread unrest with people fighting over antiviral medicine, hospital beds and information from authorities. The economic and social losses have not yet been quantified.
Chief executive of the National Commission for Avian Influenza and Pandemic Preparedness, Bayu Krisnamurthi, said such a simulation was urgently needed in Indonesia in order to evaluate the newly completed National Pandemic Plan.
The country is now in phase three, said Bayu citing the World Health Organization. During this phase the disease can be transmitted from animal to human but not from human to human.
Earlier this year, at least two pandemic simulations were held on a much smaller scale in Serang and Tangerang of Banten province. Other countries, like Singapore and South Korea, have held similar pandemic simulations using computers. They didn't, however, involve real life conditions.
'We plan to have at least eight simulations on various scales throughout this year,' he said.
---
The virus is endemic in Indonesia's sprawling islands, where the majority of the population depend on agriculture for their livelihood.
---
Only three of the country's 33 provinces have not reported any bird flu cases among poultry.
'Since it's endemic and has been here all along, we need to find ways to live with it. It's literally in our hands,' Bayu said.
Hand-washing campaigns have begun. In most human cases of avian flu, the victims had been in direct contact with a sick or dead ---.
Indonesia has the highest number of human deaths from avian influenza, reaching 107 this week. Worldwide, 350 people have been infected with the disease.
---
Poor sanitation is frequently cited by officials as the major contributor of human deaths from the virus.
There is no cure for the virus if detected too late as it ravages the lungs within a matter of days. However, the antiviral oseltamivir, if taken within the first two days, can save lives.
The symptoms at the onset of avian influenza are similar to those of the common cold, making detection difficult. Once it gets worse, detection becomes easier as severe pneumonia starts to occur.
A decade after bird flu's emergence, several cases worldwide were categorized as human-to-human cases, known as cluster cases. This shows the possibility of human-to-human transmutation exists and is not a matter of how but when.
Indonesia needs to be prepared for the possible pandemic. Louis Pasteur said in his book The Demon in the Freezer, 'Chance favors the prepared mind.'"

"Soldier With Mild Confirmed H5N1 Raises Pandemic Concerns
Recombinomics Commentary 15:08
April 22, 2008
Tests have shown that the virus detected in the patient's body was an H5 strain, according to the Korea Center for Disease Control and Prevention. It will take up to three weeks for a lab to confirm whether or not the strain is the deadly H5N1 strain, which has caused massive outbreaks in the Jeolla region since April 1.
The young corporal, identified only by his family name Cho, was sent to help kill infected chickens and ducks on Friday and Saturday. He suffered from high fever and was transported to an army hospital Sunday.
Authorities said his sickness was not related to the bird flu and that his condition has improved.

The above comments provide more detail on the H5N1 infected soldier in South Korea. The 'H5' designation for the soldier is similar to comments on the H5 infected birds in South Korea. There is no data supporting anything other than H5N1 for the outbreaks in South Korea. In the OIE report, some were H5N1 confirmed while others were HPAI H5 confirmed at the time of filing. No H5 had been confirmed to be low path H5.
The rapid recovery could have been due to both antibiotic and Tamiflu treatment, if the patient had secondary bacterial pneumonia. However, the bacterial infection does not invalidate the H5 detection.
More detail on how the soldier was infected would be useful. Pictures of culling operations showed cullers in PPE’s from head to toe. Moreover, cullers are usually on prophylactic Tamiflu (oseltamivir).
The denial of the associated of bird flu symptoms with H5N1 infections raise concerns of additional H5N1 patients that are not considered H5N1 infections because of arbitrary and capricious definitions. The infected culler also raises concerns about infected farmers who have not used PPE’s or Tamiflu.
The H5 positive result raises concerns of widespread mild H5N1 patients in South Korea as well as Bangladesh and India. The passage of H5N1 through human hosts increases the likelihood of human adaptation and efficient transmission.
More information on the patient, PPE’s and prophylaxis would be useful."

Indonesians hold major drill for bird flu pandemic
BALI, INDONESIA
Friday, April 25, 2008 at 10:09 a.m.
AP
"Indonesia launched a major bird flu drill Friday [April 25, 2008] that will test the ability of the nation hardest hit by the virus to respond to a possible pandemic. Thousands were taking part, from local residents to government officials.
The three-day simulation started with the isolation of a village on the resort island of Bali, where a field hospital was being set up to treat people with flu-like symptoms. Before the drill ends Sunday, officials will try to prevent 'infected' travelers from leaving the international airport and spreading the virus to other countries.
'This is a very important event from the perspective of public health,' said Subhash Salunke, of the World Health Organization. ---
Indonesia has been worst affected by bird flu since it started ravaging Asian poultry stocks in late 2003, with its 107 human deaths accounting for nearly half the 240 recorded fatalities worldwide. The government has come under fire for failing to slow the spread of the virus, which is now endemic in poultry in all but two of the countries' 33 provinces.
---
Indonesia says there are limits to what its cash-strapped government can do.
---
scientists worry it could mutate into a form that spreads more easily between humans, with the potential to kill millions worldwide. Indonesia is seen as a potential hotspot for that to happen.
That makes the drill on Bali especially relevant, said Nyoman Kandun, a senior health ministry official. More than 5,000 people were taking part, from government officials and law enforcement officers to doctors and villagers. ---"

"Outoja lintukuolemia Keski-Pohjanmaalla
STT via Plaza.fi
17.4.2008, 18.03 (päivitetty 18.05)
Keski-Pohjanmaalta Kaustiselta on löytynyt kymmeniä kuolleita lokkeja.
Biologi Harri Hongell Länsi-Suomen ympäristökeskuksesta vahvistaa, että turkistarha-alueen läheltä on löytynyt parin päivän aikana nelisenkymmentä kuollutta lintua. Kaustisen kunta on tehnyt asiasta poliisille rikosilmoituksen.
Elintarviketurvallisuusvirasto Evira selvittää lokkien kuolinsyyn."
*****************
Briefly in English:
Dozens of dead seagulls have been found in Kaustinen area, Finland. Biologist Harri Hongell from the environment agency of Western Finland confirms that about 40 dead birds have been found near a mink farm in Kaustinen. The town of Kaustinen has called for police to investigate the reason for the dead birds. Also the Finnish food safety authority Evira is going to investigate the dead birds.

A large flock of about 70 dead seagulls have been found in Kaustinen area in Finland.


A new law about handling sick animals in public facilities and in nature is being proposed in Finland.

"Bird Flu Case Raises Fears of Undiagnosed Infections
China
April 11, 2008
A new case of human-to-human transmission --- reinforces fears that there could be many more undiagnosed human infections in China. It may also point to a potential cure.
Last November, a salesman hospitalised in Nanjing, China, with fever, diarrhoea and pneumonia was given antibiotics for suspected bacterial infection, but tested positive for H5N1 shortly before he died. The next day his father fell ill with a nearly identical virus, and was given plasma from a woman who had received an experimental whole-virus H5N1 vaccine. He recovered (The Lancet, DOI: 10.1016/S0140-6736(08)60493-6).
The month before, an H5N1 patient in Shenzhen also recovered after receiving plasma from someone who had survived the infection, suggesting that antibodies from such survivors are a promising approach to treating H5N1, and should be investigated further.
However, poultry in Chinese markets are required to be vaccinated, and the fact that the Nanjing salesman had visited a live poultry market shortly before he fell ill reinforces fears that many Chinese could be getting H5N1 from vaccinated poultry, which carry the virus but remain healthy. Like the salesman, such people could be misdiagnosed because they have not been near sick birds.
Jeremy Farrar of the University of Oxford's Clinical Research Unit in Ho Chi Minh City, Vietnam, says scientists should study family clusters of H5N1 to learn what allows the virus to infect humans. ---"

"H5N1 Fatality Confirmed in Depok Indonesia
Recombinomics Commentary 13:48
April 6, 2008
The bird flu virus yesterday claimed the Rivera life not the name in fact 16 years, the resident of the Pengasinan District, Kecamatan Sawangan, of Depok. This girl was the 108th bird flu sufferer in Indonesia that died. He blew out the last breath in the Hospital of Penyakit Infeksi Dr Sulianti Saroso, Jakarta.
Casualties's father, Sutisna, 50 years, said the child the three of them that began to be sick since last Tuesday. Rivera often the cough and was difficult to breathe. The 'temperature' of 'his body was also high,' he said.
Sutisna that was increasingly worried brought his daughter to the Hospital of Bhakti Yudha, Depok. There, Rivera underwent treated inap. Two days were treated, the hospital side confirmed his patient was infected by the bird flu virus so as Rivera was sent to the Hospital Dr Sulianti Saroso.

The above translation confirms another H5N1 fatality in Jakarta. The sixteen year old girl lived in Depok, just to south of Jakarta and was hospitalized there prior to transfer to Jakarta, where she died yesterday."

"Large Suspect H5N1Cluster in Central Java Indonesia
Recombinomics Commentary 14:34
April 5, 2008
The seven residents suspect AI have the initials Ar,45, Wh,24, Sn,35, Jm, 40, Dp, 9, Hn, 35, and Ks, 34. Dinas Kesehatan (Dinkes) suspected them tertular the virus H5N1 because all the victim experienced the sign similar to bird flu like the cough, breathless, the temperature of the body on 38 Celcius levels, had a headache, and pilek.
At this time, the casualties were still undergoing the intensive maintenance in the Singorojo Community Health Centre.

The above translation describes the hospitalization of seven suspect bird flu patients in Kendal in Central Java, Indonesia. Large clusters are common in Indonesia, and confirmation is limited by Tamiflu treatment. The largest confirmed cluster reported to date in Indonesia was the Karo cluster in Sumatra. The largest unconfirmed cluster was the Garut cluster in West Java.
In the past testing and treatment was largely limited to patients transferred to large infectious disease hospitals. Distribution of Tamiflu to community center, such as the one described above, allows for earlier treatment, but may decrease the number of confirmed cases."

"Confirmed H2H2H H5N1 Transmission in Pakistan
Recombinomics Commentary 17:14
April 3, 2008
The recently released WHO update on the H5N1 transmission in Pakistan in late 2007 confirms it was human to human to human (H2H2H). The transmission chain is supported by disease onset dates, contacts, and laboratory confirmation of three of the four members in the transmission. This chain would match the largest confirmed chain, which involved more family members, but was limited to two distinct transmission events in Karo, Indonesia.
For the Pakistan cluster, the index case was a veterinarian, who was infected while leading a cull of poultry in October, 2007. He developed symptoms on October 29, several days after the cull. He infected one of his brothers who cared for him. The brother developed symptoms on November 12 and died November 19. This brother infected two other brothers, who both developed symptoms November 21. One brother died November 27, while the other brother recovered.
Thus, of the four cases, two died and two recovered. Of these four, three were laboratory confirmed, but only one of the three (the second dead brother) was confirmed with PCR and virus isolation. The other two were confirmed serologically. The first brother to die was not laboratory confirmed and therefore is officially a probable case, based on clinical course, including pneumonia and death.
The latest update should clear up some of the confusion generated by the delays in reporting, false negatives linked to sample degradation, and conflicting and/or confusing statements, due in part to the delays (first media reports were in early January) and degradation.
This cluster also highlights weaknesses in testing. If this was not a cluster, it is likely that only one of the four cases would be confirmed instead of three of four. The three create a cluster, although the link between the index case and two brothers developing symptoms is the first fatality, who was not lab confirmed.
The identification of serious testing shortfalls through cluster analysis is not unusual. Most clusters have one or more aspects which involve false negatives or lack of sample collection / testing.
There are two such recent examples in Indonesia. In both clusters, no sample was collected from the index case, who died, and both clusters have H5N1 confirmed family members. One cluster was specifically denied and the denial was accepted at face value in a Promed commentary. The second index case has not been identified in the English language media. Neither suspect cluster was mentioned in the WHO update on Indonesia.
These failures to confirm obvious H2H in current clusters remains a cause for concern. Similarly, the confirmed H2H2H cluster in Pakistan raises additional questions about failures to report or confirm additional human H5N1 cases in Pakistan, India, and Bangladesh."
********************

It's the same cluster where one of the brothers took an airplane from Pakistan to New York after attending the H5N1 funerals, got flu-like symptoms on his way, and after getting back to home New York noticed that also his child had flu-like symptoms.

The patients are being tested for antibodies to H5N1. The best target would be the H5N1 in circulation in Pakistan at that time, which was isolated from the first confirmed brother. Therefore, using that H5N1 as a target would generate the most specificity and sensitivity for the antibodies in the convelescent sera of the brothers.
Happily, the Pakistani cluster virus was already grown as for taking the convelescent sera of the New York -based family brother (at least the convelescent sera was claimed to have taken from the US brother). I just wonder why don't they use that one?

Avian, human flu coinfection reported in Indonesian teen
Maryn McKenna
CIDRAP News
ATLANTA
Mar 17, 2008
"An Indonesian teenager has been brought forward as a case of simultaneous infection with seasonal and avian strains of influenza—a possibility that health planners have long warned could give rise to a pandemic flu strain.
In a paper presented today at the International Conference on Emerging Infectious Diseases, Vivi Setiawaty of Indonesia's Center for Biomedical and Pharmaceutical Research and Development described the case of a 16-year-old girl who was tested for flu in Jakarta in April 2007 under a flu-surveillance system established in 2005 by the Indonesian Ministry of Health.
The girl, who had been experiencing flu symptoms for several days, was only mildly ill, with a 100.5ºF fever, sore throat, cough, headache, and body aches, but no difficulty breathing and no signs of pneumonia. (Case reports of H5N1 patients in countries such as Thailand have described more dramatic clinical presentations.)
Throat and nasal-swab samples that were taken on the 6th day of her symptoms tested positive by reverse-transcriptase polymerase chain reaction (RT-PCR) for both avian influenza H5N1 and the seasonal flu strain H3N2 at the Indonesian National Institute of Health Research and Development. Serology test results were less clear. Antibody titers from serum samples taken the 6th day provided a weak indication of H5N1 infection (titer of 1:10) but were negative for H3N2; convalescent sera, on the other hand, gave a strong indication of H3N2 infection (titer of 1:640) but were negative for H5N1.
The test results were confirmed by the Eijkman Institute for Molecular Biology in Jakarta, an arm of the Indonesian Ministry of Research and Technology, according to the paper. The girl's case fell within the period when the Indonesian government was not sharing flu isolates with the international laboratory system maintained by the World Health Organization, and there was no indication whether her isolates were evaluated outside the country.
'This is the first case-report of a human with both influenza A/H5N1 and H3N2 co-infection,' the paper states. 'Such infections are of great concern due to the possibility of genetic reassortment leading to the emergence of a H5N1 strain that is more easily transmitted human to human, and emphasizes the importance of advanced laboratory-based surveillance in geographic regions where both human and avian influenza viruses are co-circulating.'
****************************************
It seems that in addition to the coinfection of the highly infectious H3N1 and H5N1, the girl didn't acquire immunity against H5N1.
There have been 129 WHO confirmed human H5N1 cases in Indonesia. 105 of them have been fatal this far. In Indonesia the WHO confirmed case fatality rate of human H5N1 is now 81 %.

Beyond Bear, Bird Flu Threatens Chinese Markets
Daniel M. Harrison
TheStreet.com
Provided by Solitaire, CurEvents
03/17/08 - 03:11 PM EDT
"A virulent strain of influenza, both human and monetary, is likely to weigh on share prices in Asia over the balance of this week, as Hong Kong and China struggle with spreading sickness from a new superbug and weakness in the U.S. dollar.
While markets in Asia shrug off any nuggets of good news from the U.S., and energy and food costs spur stifling inflation, the pressure is building to get away from the sliding greenback, especially as Bear Stearns(BSC - Cramer's Take - Stockpickr) falls victim to a spiraling economic crisis. In Hong Kong, a building focus is revolving around the politically painful, but increasingly economically viable, question of whether to scrap the Hong Kong dollar 'peg'.
'The Hong Kong dollar link is considered almost sacrosanct within the economy,' writesSean Darby, head of Asian strategy for Nomura Bank in Hong Kong, in a research note this week. Darby adds however that it is increasingly difficult for Hong Kong and China to control inflation with the currency in place.
The Hong Kong dollar is currently pegged at HK$7.8 to one U.S. dollar, while China's currency, the yuan, is pegged more broadly against a dollar-weighted basket. Traditionally, the peg has helped create the huge export and financial market growth that both places are famous for today. As the value of the U.S. dollar has declined, however, controlling inflation and managing profit margins has become a tougher task for many of Hong Kong and China's largest companies.
With $200 billion of U.S. Treasuries being loaned out to cash-strapped mortgage-debt holders, China is finding little use for its dollar-weighted managed currency peg too, as the value of its giant $1.5 trillion holdings looks to be threatened over the longer term.
'In China, [letting the renminbi float freely] would be one way to potentially combat inflation after several tightening measures which so far haven't been effective,' says Jeff Papp, a senior buy-side analyst at Oberweis Asset Management in Lisle, Illinois. 'Inflation escalating is now becoming the biggest risk to the country's economy and markets. I think it makes sense that [an unpegging of the currency] would happen.'
Nomura's Darby adds that there is a 'rising probability of Hong Kong being used as an offshore renminbi trading center.'
As to the impact on equities, the peg debate is reaching far and wide. While bumper second half 2007 earnings for oil refiners PetroChina(PTR - Cramer's Take - Stockpickr) and CNOOC(CEO - Cramer's Take - Stockpickr) mid-week may give markets a brief reprieve from the heavy selling seen in recent weeks, traders are more likely to focus on the shallowing impact of mainland Chinese energy price controls for these companies this year.
As the price of oil has surged to $111 a barrel in the last week, oil refiners and producers, which should benefit from such price rises, are suffering because of Beijing's need to impose price caps on the resale value of the commodity in order to keep inflation under control. The rising cost of oil and the pressure on the national currency are hurting costs, too.
What amount to windfall gains in earnings and share price increases for stateside oil refiners such as Exxon Mobil(XOM - Cramer's Take - Stockpickr) are less-than-competitive returns for stockholders in Chinese rivals such as PetroChina. While Exxon has surged around 5% in the past week, in Hong Kong PetroChina has endured a week of volatility, ending flat. Sinopec Shanghai Petrochemical(SHL - Cramer's Take - Stockpickr) has shed 9% of its value due to price caps, many of which might be avoided in the event of a free-floating yuan and unpegged Hong Kong dollar.
The rising talk of scrapping the greenback's role in Asia's largest economies may also indirectly continue to weigh on the performance of Japanese exporters, such as Nintendo(NTDOY - Cramer's Take - Stockpickr) and Sony(SNE - Cramer's Take - Stockpickr), which rely heavily on a weak yen to maintain high profit margins. Rumors about the scrap of the Hong Kong dollar peg in the past week played a pivotal role in sending the yen through the 100 yen vs. dollar mark for the first time in more than a decade. The knock-on effect of the stronger yen hurts the earnings of Japanese exporters, which lose multi-millions of dollars in profits for every yen that the dollar falls against.

Flu Concern Spreads
While flu in Hong Kong has so far had only a moderate impact on the performance of equity markets, investors are growing increasingly concerned about any further outbreaks, which may weigh on Chinese consumption forecasts. Most of the social implications of the flu are still relatively little reported outside the island. At the close of trading Friday, two expatriate traders included in a weekly market note a photo of themselves drinking with sanitation masks on, under the caption, 'just another night in Hong Kong.'
So far, four children have died in Hong Kong, while all local primary schools have been closed down. Public schools are expected to stay shut for another two weeks, in line with private school holidays. On the weekend, it was announced that a new strain of bird flu has been discovered on the mainland: despite Chinese officials' comments that the flu was 'contained', some doctors now say that the H5N1 virus is mutating, making it harder to treat. Fears are rising of a return to the impact of the SARS epidemic in 2003, when consumer and investor confidence was hammered, as the Hang Seng plunged to a 4-and-a-half year low.
'When SARS hit Hong Kong, this place became a ghost town. I remember myself and a mate being the only people in the entire Lan Kwai Fong [nightlife district] drinking on a Thursday night,' says Gavin Parry, a director of Helmsman Global Trading in Hong Kong. 'Talking to teacher friends, it's very scary. The big problem here could be China. The Pearl River Delta hospitals are already seeing upwards of 5,000 patients a day.'
Consumption stocks are poised to take the worst hit in the event of any escalation of flu, say market participants, with the impact similar to that of the snowstorms in China in February. Airlines such as Air China(AIRYY - Cramer's Take - Stockpickr), China Eastern Airlines(CEA - Cramer's Take - Stockpickr), and Cathay Pacific(CPCAY - Cramer's Take - Stockpickr)are under threat from these potential declines, as well as from higher energy prices. Tech plays such as Baidu.com(BIDU - Cramer's Take - Stockpickr), and Alibaba.com(ALBCF - Cramer's Take - Stockpickr), and retailers Li Ning, and Espirit Holdings are most at risk from short-selling.
Traders say that in the event of selling, investors will look for a final support of around 20,000 points in the Hang Seng.
'Interest rate cuts and Fed bailout packages are just delaying tactics right now,' says Andrew Clarke, a trader for Societe Generale in Hong Kong. 'Investors are going to feel much more comfortable buying shares when the Hang Seng is below 20,000 points than when it is at 22,000.'
---
Daniel M. Harrison is a business journalist specialising in European and emerging markets, in particular Asia. He has an MBA from BI, Norway and a blog at www.theglobalperspective.biz. He lives in New York."

"Lintuinfluenssarokotteen kehittäminen edennyt hyvin
YLE Uutiset
Julkaistu 15.03.2008, klo 07.45 (päivitetty 15.03.2008, klo 09.34)
Suomalaisen lintuinfluenssarokotteen kehittäminen on edennyt hyvin.
Tampereen yliopiston rokotekeskus haki projektiin vapaaehtoisia rokotettavia Turusta ja Helsingistä viime syksynä. Vapaaehtoisia saatiinkin yli 200.
Professori Timo Vesikari kertoo, että käytetyn mallirokotteen pohjalta pyritään kehittämään muunnos, jonka pohjalta voitaisiin kehittää täsmärokote.
Vesikarin mukaan lintuinfluenssarokotetutkimuksessa eletään juuri nyt ratkaisevia hetkiä, sillä seurantaverikokeita otetaan parhaillaan.
Näytteet matkaavat Hollantiin. Tuloksia odotetaan toukokuussa."
********************************
Briefly in English:
Finnish H5N1 vaccination developing well. Blood test results for vaccine efficiency will be available in May.

"ECDC threat assessment - 14 March 2008
Influenza situation in Hong Kong, China
Event background information
Since mid-February, Hong Kong (HK) has been in the active phase of one of its
annual influenza seasons which, like other years, is expected to decline in April. The predominant virus strains are the same as elsewhere in the Northern hemisphere, i.e. a mix of influenza A/H3N2, A/H1N1 and B.
Several outbreaks affecting schools and community settings are currently reported in HK. Furthermore, some severe cases have been admitted to hospital including young children. The Hong Kong Health Protection Centre reported 14 confirmed institutional outbreaks in week 10 (see report1). In the 2006/2007 influenza season, the maximum number of confirmed institutional outbreaks per week was 22 (in week 27). To date, three deaths in children with influenza-like symptoms were reported. For two of them the presence of influenza virus was confirmed by the local authorities (one A/H1N1 and one A/H3N2). In all three cases, SARS and A/H5N1 related disease was excluded.
Following the hospital admission of five school children from the same primary school, the authorities decided in response to parental concern to bring forward closure for Easter holidays of all primary schools in Hong Kong by 10 days. This was the first school closure since 2003 during the SARS outbreak.

Conclusions
Fatal cases occur each year during seasonal influenza epidemics, including among young children, as recently reported in Australia2 and USA3. In Hong Kong, based on the available information, the three deaths reported among children do not seem related as one was not laboratory confirmed for influenza and 2 different influenza virus strains were identified for the 2 other children.
The notification of institutional outbreaks as well as the hospital admission of severe influenza cases and occasional deaths is not unexpected in the context of the current seasonal influenza activity in Hong Kong. Therefore, the current influenza epidemiological situation in Hong Kong is consistent with regular seasonal influenza activity and the usual prevention measures for influenza infection apply, including vaccination4,5.
The current situation in Hong Kong does not change the assessment for the risk for pandemic influenza6.

1 http://www.chp.gov.hk/files/pdf/Flu_daily_update_13_3_08_final.pdf
2 http://www.eurosurveillance.org/ew/2007/070823.asp#4
3 http://www.cdc.gov/flu/weekly/index.htm
4 http://ecdc.europa.eu/documents/pdf/PPHM_Recommendations.pdf
5 http://ecdc.europa.eu/pdf/071203_seasonal_influenza_vaccination.pdf

H5N1 mutates, 90% of patients die
VietNamNet Bridge
16:38' 14/03/2008 (GMT+7)
The Veterinary Agency on March 13 confirmed that the southern province of Soc Trang is the newest place bird flu has been found. Meanwhile, H5N1 virus seems to be more toxic.
---
Nguoi Lao Dong newspaper on March 13 quoted Doctor Nguyen Hong Ha, Vice Head of the National Hospital for Infectious and Tropical Diseases, as saying that H5N1 is mutating because the fatality rate of type A/H5N1 patients is over 90% recently.
Dr. Nguyen Huy Nga, Head of the Veterinary Agency, said the World Health Organisation (WHO) has continuously warned about the mutation of H5N1 virus and the risk of transmission of the virus from humans to humans.
So far this year 18 type A/H5N1 patients have been reported, including 15 deaths, mainly in China, Indonesia and Vietnam (4 cases).
Prime Minister Nguyen Tan Dung has ordered the cabinet to take all actions necessary to fight the spread of the deadly bird flu virus, which has killed four people so far this year.
In directive 279/CT, released on March 13, Dung asked all affected provinces to swiftly quarantine and disinfect sites where outbreaks had occurred, and to tighten restrictions on the movement of poultry. He also said border provinces needed to curb illegal poultry imports.
The Prime Minister warned that local leaders and officials responsible for tackling bird flu would face disciplinary action if they failed to quickly detect outbreaks or to contain the disease.
Veterinary agencies must sterilise poultry farms, slaughterhouses and markets within a month, according to the directive.
The Ministry of Agriculture and Rural Development (MARD), in collaboration with the Health Ministry, will closely monitor any future outbreaks of the fatal H5N1 virus.
The Prime Minister also asked the Health Ministry to ensure there was an adequate supply of medicine and other essential chemicals and equipment in order to respond swiftly in an emergency.
The Ministry of Information and Communications was assigned the task of increasing media coverage of the issue in order to educate the population about necessary preventative measures.
The Prime Minister also called on relevant ministries, domestic and foreign scientists and international organisations to work on an effective bird flu strategy."

"Suspect H5N1 Cluster in Lampung Indonesia Grows
Recombinomics Commentary 13:31
March 14, 2008
Lampung
The Number Of patients was expected by bird flu that is treated in RSU Abdul Moeloek Banda Lampung till today to 11 people.
4 among them the resident Way Laga that could refuse and bolt when being treated in the hospital.
In the meantime one other patient, the man aged the year 22 years had the initials D, came from the Rajabasa Subdistrict.
From 11 patients, 2 including being stated positive was expected avian influenza (AI) and got the intensive maintenance.

The above comments describe an 11th patient hospitalized in Lampung. Poultry in the region have tested positive, as have two of the patients. Patients have been described as having a fever, laryngitis, and bleeding from the nose.
However, the severity of disease in the suspect patients remains unclear. The two positives appear to have left the hospital because of concerns over costs, but were convinced to return when told there was no charge for treatment of bird flu.
The two positives still have a high temperature, but the status of the others was not clear, although all appear to have had some symptoms prior to hospitalization. These symptoms and the likelihood of testing positive may be decreasing because of the Tamiflu treatment. Throat swabs of two were PCR positive, but Tamiflu treatment may lower H5N1 levels in the throat to an undetectable level
Disease onset dates for the two positives are lacking, as are comments that the patients have breathing difficulties. In 2005 there was a confirmed cluster in Lampung, but subsequent clusters have tested negative. However, large Tamiflu blankets have been used in the past.
Clusters in Indonesia are cause for concern because of limited release of sequence data and false negatives following Tamiflu treatment.
More information on the clinical status of the 11 hospitalized patients, as well as disease onset dates for the two confirmed cases, would be useful."
*******************************************
Eleven probable H5N1 patients have complied to be treated in hospital. How many more have refused?

"Large Suspect H5N1 Cluster in Lampung Indonesia
Recombinomics Commentary 12:22
March 13, 2008
The ten patients were treated on the Long community health centre recommendation.
The existence of the assumption of bird flu, because apart from the sign that was suffered by the patient resembled AI, also the existence of the story of the death of the positive poultry was contracted by AI in their village.
From the patient suspek AI this, five including being children.
They were Sanpidi (43) and his child of Imas (10), the older brother was siblings Adi Sutihat (8) and Dani (8 months), Nurdin (52) and his child of Hariyanto (11), Aminah (20), Fedi (2), Aniti (42), Lala (20).
However, from ten patients suspek bird flu, two among them Aniti and Lala refused to be treated in the hospital.
Now two other, Sanpidi and Imas on Wednesday night bolted from the hospital, around struck 21,30 WIB.
According to the official RSU Abdul Muluk, on Thursday (13/2/2008), overnight already did not find the father and this child in isolation space for the sufferers or suspek bird flu.

The above translation describes a ten person cluster in Lampung, Indonesia. Two of the family members have more severe bird flu symptoms, including high fever, and their poultry has tested positive for H5N1. However, as noted above, some family members have refused hospitalization, while others have left the hospital. Family members have been given Tamiflu.
Clusters have been reported in Lampung previously, but the only confirmed cluster was in late 2005, and the cluster had mild H5N1 (all three survived and two of the three were confirmed by antibody levels).
Larger suspect clusters have been reported, and large numbers have been placed on Tamiflu, which may have limited detection of H5N1.
The use of Tamiflu in the current cluster may also limit confirmation."
*********************************************
Maybe it would be worth the pain and prize to start larger scale testing of H5N1 antibody levels in Indonesian population around the areas where there have been large H5N1 outbreaks among either birds or humans.

8 hospitalized in Indonesia for suspected bird flu
Song Shutao
Xinhua via www.chinaview.cn
JAKARTA
March 13, 2008
"Eight people from the same village in Indonesia's Lampung province were admitted to hospital allegedly for developing bird flu symptoms, local press said Thursday.
The patients, including two babies and two teenagers, all come from Way Laga village where dozens of chickens have died of the avian influenza.
They were sent to the state-run Abdul Moeloek Hospital in provincial capital Bandarlampung with high fever and respiratory problems after eating the infected chickens, reported the national Antara news agency.

Lampung is located in the southern tip of Sumatra island.
'The patients are placed in the isolated rooms and have undergone laboratory tests. But it takes several days before we get the results,' the hospital's director Dr Wirman was quoted as saying.
At least 102 people have died from bird flu out of some 125 reported cases in Indonesia since the outbreak was confirmed in 2003.
Jakarta has been the hardest hit city in the country, with 25 deaths resulting from the 29 cases reported."

"HK schools close amid flu fears
BBC News
Wednesday, 12 March 2008, 17:04 GMT
All kindergartens and junior schools in Hong Kong have closed early for their Easter holiday, after a flu-like illness killed three children.
The Education Bureau described the move as a 'precautionary measure'.
More than 30 students from one school have showed flu-like symptoms and three children have died from apparently similar illnesses in recent weeks.
Experts are investigating a link to either bird flu or SARS, a respiratory disease that hit Hong Kong in 2003.
Hong Kong's health chief, York Chow, said the decision to close the schools was made as the high rate of flu-like infections was expected to continue for weeks.
'We hope such precautionary measures will