[Kabar-indonesia] Indonesian Family Likely Got Bird Flu From Each Other: WHO [Asks for Help]

[JoyoNews at aol.com]

5 reports: 

- Indonesian Family Likely Got Bird Flu 
  From Each Other - WHO

- Indonesia Asks For Help Fighting Surge
    In Bird Flu Deaths

- Indonesia's fight against bird flu needs
    international support: FAO

- Ignorance a key factor in H5N1
    infections-experts

- ASEAN health ministers meet to
    boost bird flu fight

Indonesian Family Likely Got Bird Flu 
>From Each Other - WHO

JAKARTA, June 21 (AP)--The World Health Organization has concluded that 
human-to-human transmission likely occurred among seven relatives who developed 
bird flu in Indonesia. 

In a report obtained Wednesday by The Associated Press, WHO experts said the 
cluster's index case was probably infected by sick birds and spread the 
disease to six family members. One of those cases, a boy, then likely infected his 
father, it said. 

The U.N. agency stressed the virus has not mutated and that no cases were 
detected beyond the family. 

Seven of the eight relatives died last month, but one was buried before 
samples could be taken to confirm bird flu infection. 

"Six confirmed H5N1 cases likely acquired (the) H5N1 virus through 
human-to-human transmission from the index case ... during close prolonged contact with 
her during the late stages of her illness," the report said. 

The report was distributed at a closed meeting in Jakarta attended by some of 
the world's top bird flu experts. The three-day session was convened after 
Indonesia asked for international help. The country has recorded the world's 
highest number of human bird flu cases this year, and 39 of those infected have 
died. 

"What is happening in Indonesia? That is the No. 1 question," said Bayu 
Krishnamurthi, Indonesia's national bird flu coordinator. "With all of these 
limited resources - human, financial, institutional - what should we do?" 

The experts were expected to discuss the large family cluster during the 
session. One of the remaining mysteries is why only blood relatives - not spouses 
- became infected. 

The WHO report theorizes the family shared a "common genetic predisposition 
to infection with H5N1 virus with severe and fatal outcomes." However, there is 
no evidence to support that. 

Keiji Fukuda, WHO's coordinator for the Global Influenza Program in Geneva, 
said the Indonesian case appears to resemble other family clusters where 
limited human-to-human transmission occurred following close contact. He said 
scientists must find out whether anything is different about the way the virus is 
behaving. 

"The really critical factor is why did that cluster develop?" he said. 
"What's the reason why people in a cluster got infected?" 

Fukuda said that although the cluster in the farming village on Sumatra 
island grabbed world attention, no country - including Vietnam and Thailand, which 
have largely controlled the virus - is safe from bird flu. 

"This is a virus that you both have to respect a lot and (you) have to be 
concerned about the overall situation, even in areas in which it looks like 
control has been achieved," he said on the meeting's sidelines. "The real question 
is: Can you sustain that control for a virus which is really able to persist 
this way?" 

Bird flu has killed at least 130 people worldwide since it began ravaging 
Asian poultry stocks in late 2003. Experts fear the virus will mutate into a form 
that spreads easily among people, potentially sparking a pandemic. So far, it 
remains hard for people to catch, and most human cases have been traced to 
contact with infected birds. 

Indonesian officials said the country lacks manpower and money to battle the 
H5N1 virus alone. The government has been saddled with a series of natural 
disasters, including the 2004 tsunami and an earthquake last month on Java 
Island. 

Indonesia needs $50 million from donors in the next three years to establish 
a system to help fight bird flu in poultry, according to Peter Roeder of the 
U.N. Food and Agriculture Organization. 

Indonesia has said it needs $900 million over the next three years for its 
overall battle against the H5N1 virus but has only budgeted $59 million. 

--------------------------------------------

Indonesia Asks For Help Fighting Surge In Bird Flu Deaths

JAKARTA, June 21 (Dow Jones) -- Indonesia appealed Wednesday for
international help in fighting bird flu, warning it lacks the
resources to stop an increasingly rapid spread of the deadly H5N1
strain of the virus in the country.

The country needs $50 million from donors over the next three years to
establish a system to help fight bird flu in poultry, said Peter
Roeder, an animal expert from the U.N. Food and Agriculture
Organization, on the sidelines of a three-day meeting of health and
animal experts in Indonesia's capital, Jakarta.

At least 39 people have died from the H5N1 bird flu virus in

Indonesia, and a recent surge in human cases has put the country on
pace to surpass Vietnam as the worst-hit nation. At least 42 people
have died in Vietnam.

"What is happening in Indonesia? That is the No. 1 question that we
very much would like to have the answer from you," Bayu Krishnamurthi,
Indonesia's national bird flu coordinator, asked the panel of experts
at the meeting's opening. "With all of these limited resources -
human, financial, institutional - what should we do?"

Indonesia, hit by a recent string of natural disasters from the 2004
tsunami to a devastating earthquake last month, lacks the manpower and
money to battle the H5N1 virus alone. Indonesian officials have said
the country needs $900 million over the next three years to fight the
virus in humans and animals, but has only budgeted $59 million for
2006.

Roeder said the $50 million in aid money would be used to lay the
groundwork to strengthen surveillance, coordination and rapid response
systems for the country's vast poultry population, which consists of
millions of backyard farms.

"I hope this meeting marks a turning point in the world's
understanding of the fact that we should be addressing this manner in
a holistic way," Roeder said.

Krishnamurthi said education and public awareness were key to fighting
the disease, but that was not easy in a poor country with 220 million
people spread across thousands of islands. He said many people depend
on backyard chickens for their survival.

It is "not an easy task to ask them to kill their chickens because we
are saying it is dangerous for them in the future," he said.

The meeting comes a month after six of seven family members from a
remote farming village on Sumatra island who tested positive for the
virus died. An eighth relative was buried before samples could be
taken, but the World Health Organization considers her part of the
cluster.

Scientists have not been able to link the infected relatives to
contact with sick birds and believe limited human-to-human
transmission occurred. However, no one outside the family has fallen
ill, and the virus is not believed to have mutated.

"Indonesia in 2006 is the hotspot for H5N1 in poultry and,
consequently, in people," said Tim Uyeki, an epidemiologist from the
U.S. Centers for Disease Control and Prevention.

Experts fear the current virus will mutate into a form that is highly
contagious among humans, potentially sparking a pandemic. So far, most
human cases have been traced to contact with infected birds. At least
129 people have died worldwide since the virus began ravaging Asian
poultry in late 2003.

"I can say that if there is widespread human-to-human transmission,
there is no country in the world that is ready," said Keiji Fukuda,
coordinator for the WHO's Global Influenza Program in Geneva.

Southeast Asian health ministers, meanwhile, met in Myanmar on
Wednesday for talks focused on how to respond if bird flu becomes a
pandemic. Some nations in the region, including Myanmar, have been
accused of secrecy and a lack of transparency in quickly reporting
bird flu outbreaks.

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Indonesia's fight against bird flu needs international support: FAO

JAKARTA, June 21 (AFP) -- Disaster-prone Indonesia cannot fight bird
flu on its own and needs support from the international community, an
expert said Wednesday.

The world's fourth most populous country has reported the world's
highest number of human deaths from bird flu this year.

"Why is everyone worried? They are worried because the disease could
spread from Indonesia to the rest of the world, and to make everyone
safe then the world should well pay for it," said Peter Roeder, an
animal health officer from the UN's Food and Agriculture Organisation
(FAO).

He said Indonesia could not be expected to foot the bill for the fight
against the spread of H5N1, which has killed 39 people here,
especially since it had so many other natural disasters and problems
to handle.

"The international community has to take action to invest in the
control of the disease in Indonesia," Roeder told AFP on the margins
of a three-day gathering of experts drafting a strategy for the
government to fight the virus.

He said that just for initial "capacity building", 50 million dollars
was needed over the next three years.

"We need to finish establishing a core team around the program
management unit within the ministry of agriculture... We need
something around 50 million dollars over three years, which is a very
small investment," he said.

"That is the capacity building that is necessary to be able to use the
government's money."

Roeder said international funding remained very limited and was
"disappointingly slow" to arrive.

"Where is the money that was pledged in Beijing?" he asked, referring
to a donors' conference in the Chinese capital earlier this year.

The World Bank said last week that it too was concerned about a
funding shortfall to fight bird flu in Indonesia. It noted that
Jakarta had estimated it needed 900 million dollars to launch an
effective campaign against the virus but donors had pledged only 100
million dollars.

Roeder said that even those funds which have been received have not
yet been effectively prioritised.

"Too much of the investment has gone into human health rather than
animal health," he said, adding that to save people from the disease,
the sources of infection in animals should be eradicated.

"It is a matter of taking actions to reduce or to interrupt the
sustained virus transmission chain," he said.

Earlier, officials said public awareness about how to fight bird flu
in Indonesia was crucial to stem its spread.

"Absolutely crucial is that the population understands what this is
all about, otherwise it will be difficult, if not impossible, to deal
with the problem," said Tom Grein, a World Health Organisation
official from their headquarters in Geneva.

Grein told AFP that such public awareness should be achieved through
"active dialogue" between the organisations concerned.

He warned that in dealing with the virus no single solution or "magic
bullet" existed.

"We need to look at all components across the board... It should be
addressed as a package," Grein said.

Experts from WHO, the FAO, the US Centers for Disease Control and
several universities are meeting for three days at the request of
Indonesia's national committee on bird flu control.

They are tasked with reviewing the avian influenza situation in
Indonesia and will make recommendations to the government for
improving the control of bird flu and provide an assessment for
international donors.

The government has been accused of reacting too slowly to the spread
of bird flu and initially of covering up the extent of its spread and
casualties.

------------------------------------------------------------------------

Ignorance a key factor in H5N1 infections-experts

By Fitri Wulandari

JAKARTA, June 21 (Reuters) - Many people who contracted the H5N1 bird
flu virus in Indonesia were ignorant and never warned about the
disease and children are the ones most vulnerable, medical experts
said on Wednesday.

"Children may be off to play with sick chickens ... an activity that
adults do less of," Thomas Grein, a leading epidemiologist at the
World Health Organisation, told Reuters on the sidelines of an experts
meeting on bird flu.

"Other high risk exercises are slaughtering of sick birds,
de-feathering and preparing food. But if you wash your hands, it can
reduce that risk very dramatically," he said. "But again, this is less
often done by the younger person than adult."

The H5N1 virus has infected 51 people and killed 39 of them in
Indonesia since 2005 and is now endemic in poultry in nearly all of
the country's 33 provinces.

It is common in the far-flung country of 17,000 islands for households
to keep chickens for food and extra income - which means that

everyone, and not just poultry workers, is at risk.

School-age children and children less than 10 years of age make up
over 40 percent of Indonesia's H5N1 human infections. People are not
used to the idea that sick birds could be dangerous and children play
with chickens and are sent to clean up after them.

"It shows that the risk profile is much broader than we expected. It's
not only poultry workers. This is because the virus is found so widely
in backyard chicken," said Steven Bjorge, WHO's medical officer of
communicable diseases.

"There were other diseases in birds but they did not cross over to
humans in the past. That's the situation that they are not familiar
with," he said.

"People need to understand that dead chickens are a high risk factor.
If there is dead chicken, they need to call the authority to clean
them properly and should not let children touch them."

NOT JUST INDONESIA

In Hong Kong, where the virus made its first documented jump to humans
in 1997, nine of the 18 human infections involved children who were
six years old or younger.

The first victim was a three-year-old boy who died 12 days after he
developed fever, a sore throat and a cough in May, 1997. While experts
never confirmed how he came to be infected, he attended a nursery
which kept chicks and ducklings in a pet zoo.

At least two other children attended a school that was next to a
wholesale market and often played in an area used to store chicken
cages that were unwashed and splattered with faeces.

H5N1 infected birds shed plenty of virus in their faeces and experts
say stool particles are a main vehicle of transmission. Kept moist and
cool, the virus can survive for days on faeces.

"If chickens infected with H5N1 are shedding the virus in their faeces
on the floor of houses where people live, then they are more likely to
be exposed to H5N1 infection," said Julian Tang, a microbiologist at
Chinese University in Hong Kong.

"The virus may survive for some time in the chicken faeces, then when
dry, can be inhaled as dust. This may occur if the faeces on the floor
is disturbed by walking, playing. You can breathe or have direct
contact with it, when you are just present in the area, whether
sleeping or doing other things."

"Children are probably more vulnerable because they tend to play on
the floor, more often, where the risk of contact with such infected
material is higher. If they are sent to clean up dead chickens, well,
you have your answer," Tang said.

Ignorance is also believed to have played a role in the deaths of four
young Azerbaijanis in February and March, who de-feathered dead swans
to make pillows before they fell sick.

Feathers too may infected an 18-year-old Indonesian shuttlecock maker,
who died last month. While officials have not said how he got
infected, he sorted feathers for a living.

"Infected birds preen their feathers which could be contaminated with
beak excretions. The virus would then be transferred to the person by
hand or breathing in feather dust contaminated with virus," said John
Oxford, virology professor at the Royal London Hospital. (Additional
reporting Tan Ee Lyn in Hong Kong)

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ASEAN health ministers meet to boost bird flu fight

By Aung Hla Tun

YANGON, June 21 (Reuters) - Southeast Asian health ministers gathered
in Myanmar on Wednesday to better coordinate their fight against bird
flu and other pandemic threats to the region.

"These public health emergencies are beyond the capability of affected
countries to cope with single handedly," Lieutenant-General Thein Sein
said in opening the meeting of health officials from the 10-nation
Association of South East Asian Nations (ASEAN).

Thein Sein, whose own country struggled to contain its first outbreak
of the H5N1 virus in March, said the 3-day meeting would seek to
strengthen cooperation and rapid response against a disease now
endemic in many parts of the region.

Representatives from Japan, South Korea and China are due to join the
meeting on Thursday.

H5N1 re-emerged in Asia in 2003 and has killed 130 people in nine
countries across the world.

Health experts fear the virus could mutate into a form that jumps
easily between people and start a global flu pandemic.

Vietnam, with 42 deaths out of 93 human cases reported, has the
highest casualty rate but it has not had a human case of H5N1 since
last November.

Vietnam said on Wednesday it planned to resume hatching of water fowl
such as ducks and geese, saying the vaccination of more than 242
million birds had played a key role in containing the disease.

However, the virus continues to kill in Indonesia where a teenager was
confirmed on Tuesday as the country's 39th death from bird flu. The
virus is endemic in poultry in nearly all of Indonesia's 33 provinces.

Thailand, once among the worst-hit countries, has not had a human
death since December 2005.

But Thai officials fear it could spread again due to lax surveillance
in neighbouring Cambodia, where six people have died since 2003, and
Laos, which reported a new case in poultry in May.

Laos, Cambodia, Vietnam and Myanmar agreed in May on a Thai-proposed
action plan to boost monitoring of poultry and training of
rapid-response teams.

"I wish to emphasise that in addressing avian influenza, close
coordination and pooling of resources are needed for effective
prevention and control activities," said Thein Sein, the number 5
general in Myanmar's ruling military junta.

Myanmar has said its bird flu outbreak was brought under control after
thousands of birds and eggs were destroyed on hundreds of farms in the
central Mandalay region.

The military government had received emergency equipment and expertise
from U.N. agencies and neighbouring countries.

But Yangon's secretive generals were criticised for taking several
days to inform the public that the disease had spread to the former
Burma.

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Joyo Indonesia News Service
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