[Kabar-indonesia] 7 Reports: IHT: H5N1 Mutated in Indonesia [+Empty Promises]

[JoyoNews at aol.com]

7 reports:  

- IHT: Human transmission of bird flu confirmed  
- Sumatra Bird Flu Case Spread by Human 
  Contact, Indonesia Says
- Indonesia's Anti-H5N1 Avian Flu Funding 
  Remains In Limbo
- Standard: Empty promises fill bird-flu war 
  chest
- Indonesia to upgrade labs for bird flu tests
- WHO plans no immediate increase in 
  bird flu alert: expert
- IPS: Reporters Get the Bird Flu Jitters

International Herald Tribune
June 23, 2006

Human transmission of bird flu confirmed  

By Elisabeth Rosenthal 

An Indonesian man who died after catching the H5N1 bird flu virus from his 
10-year-old son represents the first laboratory confirmed case of human- 
to-human transmission of the disease, a World Health Organization investigation of 
an 
unusual family cluster has concluded, the agency said Friday.
 
The WHO investigators also discovered that the virus had mutated slightly 
when the son had the disease, although not in any way that would allow it to pass 
more readily among people. Flu viruses like H5N1 mutate constantly, although 
most of the mutations are insignificant biologically, as appears to have been 
the case in the Indonesian cluster.
 
"Yes, it is slightly altered, but in a way that viruses commonly mutate," 
said Dick Thompson, a spokesman for the WHO in Geneva, describing the findings of 
the report, which was not publicly released. "But that didn't make it more 
transmissible or cause more severe disease."
 
The greater importance of the slightly modified virus is that it allowed 
researchers from the WHO and the U.S. Centers for Disease Control and Prevention 
to document for the first time that the virus almost certainly was passed from 
person to person.
 
In previous cases where human-to- human transmission was suspected, 
researchers could not test samples from the patients, or the virus in the patients was 
the same as that in poultry in the area.
 
Scientists have long said that the H5N1 virus, which has killed hundreds of 
millions of birds worldwide, does not spread easily to humans or among them. 
But they have worried that it might acquire that ability though normal 
biological processes that involve genetic rearrangement. That could potentially set off 
a devastating human pandemic.
 
More than 200 people have contracted bird flu worldwide, almost all of them 
after very close contact with infected birds.
 
International health officials have been in Indonesia for much of the past 
month, investigating a family outbreak that affected seven relatives in a remote 
region of Sumatra. Six of the seven died.
 
Although Indonesia has been struggling all year to control bird flu outbreaks 
among poultry, the family on Sumatra had no known direct contact with sick 
birds, although the first death was a woman who sold vegetables in a market that 
also sold birds.
 
But scientists have long suspected that H5N1, though an avian virus, could 
also spread between people in rare cases, if there was prolonged close contact.
 
The family members in the cluster had a banquet in late April when the 
vegetable merchant was already ill and coughing heavily. Some spent the night in the 
same small room with her. Some members also cared for their relatives when 
they were sick.
 
In hospitals, doctors and nurses generally wear masks when treating potential 
bird flu victims.
 
The first five family members to fall ill had identical strains of H5N1, one 
that is common in animals in Indonesia. But that virus had mutated slightly in 
the sixth victim, a child, and he apparently passed the mutated virus to his 
father - which allowed the lab to confirm the transmission.
 
Still, Thompson said there was no evidence that the mutated virus was better 
adapted to human infection. To the contrary, the WHO has been following 54 
neighbors and family members who lived near the family in the village for a month 
and none have contracted the virus. "So we know it is not more easily 
transmitted," he said. 
 
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Sumatra Bird Flu Case Spread by Human Contact, Indonesia Says

June 23 (Bloomberg) -- Human-to-human transmission is the most likely
cause of bird flu last month in seven members of a family living on
Indonesia's Sumatra Island, the country's Ministry of Health said.

The cases, six of which were fatal, represent Indonesia's largest
reported cluster of infections caused by the lethal H5N1 avian
influenza strain, the ministry said in a summary of an investigation.
The 7-page document, which was produced in conjunction with the World
Health Organization, was obtained by Bloomberg News today.

Indonesia's struggle to arrest the spread of avian flu in poultry and
prevent human infection is attracting international attention. The
virus has killed a person every six days in the nation this year and
the cluster on Sumatra provides the first evidence of a three-person
chain of infection.

``All of us, including the government of Indonesia, are concerned that
human cases are still occurring and that virus is still present in
many flocks around the country,'' Keiji Fukuda, the coordinator of the
WHO's global influenza program, said in an interview on June 21 in the
Indonesian capital, Jakarta.

Human H5N1 cases provide opportunity for the virus to mutate into a
pandemic form that may kill millions of people.

At least 130 of the 228 people known to be infected with bird flu
since 2003 have died, according to the Geneva-based WHO. World health
officials are tracking the spread of the virus in the event it evolves
to become easily transmissible among people, sparking a flu pandemic.

Genetic sequence analyses showed there was no evidence of genetic
re-assortment in virus samples taken from the Sumatran patients, the
summary said.

``All H5N1 viruses were anti-genetically and genetically very closely
related and similar to H5N1 viruses isolated from poultry and humans
in Indonesia,'' it said.

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Indonesia's Anti-H5N1 Avian Flu Funding Remains In Limbo

JAKARTA, Jun 23, 2006 (Dow Jones) -- An international conference aimed
at bolstering Indonesia's response to its ongoing outbreak of H5N1
avian influenza ended Friday without concrete strategies to address
the government's massive funding shortfall to battle the virus, a
senior government minister indicated Friday.

International donors have yet to contribute "a single cent" toward the
$900 million the Indonesian government has budgeted to fight H5N1 over
the next three years, Coordinating Minister for People's Welfare,
Aburizal Bakrie, told reporters at a press briefing.

"To make a good (H5N1 management) plan...we need that $900 million,"
Bakrie said, without elaborating on how Indonesia would convince
donors to provide the needed funds.

"If we'd like to do it properly and the best way, this $900 million is 
needed."

Bakrie spoke at the conclusion of a three-day meeting of international
human and animal health experts tasked with making recommendations to
bolster Indonesia's anti-bird flu battle.

That battle has stalled due to donor reticence to deliver around $100
million in pledges garnered at a Beijing conference in January,
analysts and government officials say.

World Bank Country Director Andrew Steer said last week that Indonesia
needs to translate its broad bird-flu strategy into more detailed
plans to facilitate donor financing.

Indonesia's lack of measurable progress in addressing its bird flu
outbreak has heightened concerns that the country is a weak link in
global efforts to prevent a pandemic that could kill millions.

Bird flu is endemic in Indonesia's poultry stocks and is spilling over
into the human population. Indonesia has recorded 39 human H5N1
fatalities out of 51 confirmed cases since July, the world's second
highest toll behind Vietnam, World Health Organization data show.

But analysts say Indonesia's efforts to reduce its mounting human H5N1
death toll are stalling due to a lack of donor funding needed for
strategies including mass culls of infected poultry and vaccinations
of virus-free birds.

Indonesia was "moving ahead" in implementing its 2006-2008 National
Avian Influenza Strategic Management Plan, Bakrie said, without
elaborating on how the cash-strapped government would pay for it.

The plan is a two-pronged strategy that includes the control of avian
influenza outbreaks in humans and animals and preparation for the
possible emergence of a human pandemic bird flu strain.

A joint press release issued Friday by the World Health Organization,
the United Nation's Food and Agriculture Organization and the official
Indonesian National Committee for Avian Influenza Control and Pandemic
Influenza Preparedness called for "full funding and urgent
implementation" of the government's strategic plan, without
elaborating on how to prod donors to provide the needed cash.

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The Standard (Hong Kong)
Friday, June 23, 2006

Empty promises fill bird-flu war chest

Chester Yung

The main obstacles in the world battle against bird flu are empty
promises, according to a health expert.

Sanjay Sinho, the health unit director of the nongovernment
organization CARE, said Thursday donor countries at a January World
Bank conference on bird flu in Beijing pledged US$1.9 billion
(HK$14.82 billion) to combat bird flu around the world but only US$300
million has been received so far.

``Pledging is one thing. The physical provision of money is another,''
he said. ``It is hard enough to contain an outbreak of disease when it
is reported immediately and where there are good systems in place.''

Many developing countries have little or no human and animal health
systems to deal with a possible pandemic such as bird flu, he added.

``Much of the money pledged for combating bird flu needs to go toward
issues like compensation for destroyed birds and alternative
livelihoods as well as to strengthening health systems.''

However, the empty promises have undermined these efforts, especially
the surveillance systems at the community level.

``Unfortunately, it is a very common problem and happens in many
places,'' he said. ``It will put more pressure on the national level
[to combat bird flu]'' and the disease could spread faster.

Secretary for Health, Welfare and Food York Chow Yat-ngok earlier
warned poor countries could not afford timely bird-flu tests, and that
this could delay raising an outbreak alert.

In a commentary entitled ``Hard Truths about the Bird Flu,'' Stanford
University Hoover Institution fellow Henry Miller suggested rich
countries should plough more resources into developing nations
primarily for surveillance as this is ``a politically incorrect but
rational strategy''

Miller said: ``They will not only obtain timely warning of an H5N1
strain that is transmissible from human to human, but will also get to
focus the vast majority of their funding on parallel, low- and
high-tech approaches, vaccines, drugs and other public health measures
that will primarily benefit themselves.''

In a report released by brokerage firm CLSA last November, researchers
said corrupt or inept mainland officials and other bureaucratic
problems may thwart the government's efforts to control the spread of
the H5N1 virus in China, described as the ``epicenter'' of the
problem.

The report quoted Caijing, a leading mainland journal, as saying local
officials are still wary of reporting bad news to the central
government, adding that inadequate compensation for culled poultry
stocks reduces farmers' incentive to report outbreaks.

Meanwhile, Sinho feared Indonesia is a likely place where a human bird
flu pandemic may originate.

He said the recent human clusters found in North Sumatra, where seven
members of a family died from bird flu, showed the virus could have
jumped from human to human.

In 2003, H5N1 re-emerged in humans, causing more than 120 deaths
worldwide _ with a mortality rate of more than 50 percent _ although
there is no convincing evidence yet of human-to-human transmission.

Scientists fear the virus could mutate into a strain that is easily
transmissible among humans, triggering a pandemic.

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Indonesia to upgrade labs for bird flu tests

By Fitri Wulandari

JAKARTA, June 23 (Reuters) - Indonesia plans to upgrade its national
health laboratory to meet World Health Organisation standards, a
leading scientist said on Friday, to be able to conduct definitive
bird flu tests at home.

The country currently sends samples to WHO-referenced labs overseas
for H5N1 tests as those conducted by the Jakarta-based National
Institute of Health Research and Development Laboratory (Badan
Litbangkes) are not considered final.

"We will upgrade Litbangkes to biosecurity level three, so we don't
have to send samples to Hong Kong for confirmation," said Erna
Tresnaningsih, head of the research and development centre for
biomedics and pharmacy at Litbangkes.

The H5N1 bird flu virus has become endemic in Indonesia since it was
first discovered in the country's poultry in late 2003. The virus has
infected 51 people and killed 39 of them.

In an interview with Reuters, Tresnaningsih said eight laboratories in
the country would be upgraded this year to conduct initial H5N1 tests,
and samples would be sent to Litbangkes for confirmation.

"The idea is when there is a case in the region, (one of) the eight
labs will test and then they will send the samples to the medical
laboratory in Litbangkes in Jakarta for confirmation," she said.

Of the eight laboratories, two are on Sumatra island, four on Java,
one on Bali and one on Sulawesi.

To cope with an outbreak, Indonesia has put much effort into training
government staff on infection control and bringing their laboratories
up to speed with help from the medical experts in Singapore and Hong
Kong, according to sources in both these places.

Microbiologist Leo Poon, who works closely with the WHO-referenced
laboratory in Hong Kong, said results of H5N1 tests run by Indonesian
laboratories in the past two years have closely mirrored results from
the Hong Kong laboratory.

"They are pretty good. So far, their interpretation is pretty similar
to what we get. I'm quite confident that they are doing a right job
for diagnostic purposes," Poon told Reuters.

However, there have been a few cases where samples were never taken
from Indonesian victims believed to have been infected by H5N1.

"If they were already dead by the time they were taken to hospital,
it's difficult to get samples. But if they had been treated in
hospitals for some time, we would be able to take their samples,"
Hariadi Wibisono, director of animal-borne disease control at the
Health Ministry, told Reuters.

Tresnaningsih said staff at the eight laboratories would be sent to
Singapore where they would be taught how to take samples correctly.

"We want the laboratories to be able to diagnose and read PCR
(polymerase chain reaction) tests and serology tests correctly. We
will train our staff to take specimens correctly because if not, the
samples will come back negative," she said.

She did not know how much the upgrading project would cost, but said
the WHO would help raise funds from Australia and Germany and obtain
testing tools so that all eight laboratories would have the same
facilities as Litbangkes.

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Kyodo News
June 22, 2006

WHO plans no immediate increase in bird flu alert: expert

Christine T. Tjandraningsih

Transmission of the often deadly H5N1 strain of bird flu from one
person to another and then onto a third person in Indonesia is not
likely to trigger a higher global pandemic status, a World Health
Organization expert said in an interview late Thursday.

''Right now, we are not contemplating increasing the pandemic status.
No, this is not under consideration right now,'' Keiji Fukuda,
coordinator of the Global Influenza Program of the WHO headquarters in
Geneva, told Kyodo News.

In a report obtained by Kyodo, WHO health investigators and the
Indonesian Health Ministry concluded ''human-to-human-to-human
transmission'' had most likely occurred among a family of eight in
Kubu Simbelang village in North Sumatra Province last month.

The report, distributed to international experts at the outset of a
three-day bird flu meeting in Jakarta, summarizes the results of
testing and field investigations into eight bird flu cases in the
village, only seven of which are confirmed.

It says the initial infection was probably transmitted by birds to a
37-year-old woman who worked in a market where poultry was sold and
who raised chickens at home, some of which had died within a week of
the onset of her illness.

The woman, who became sick April 24, is thought by investigators to
have then directly infected six family members -- her two sons, a
sister, a brother, a niece and a nephew -- and to have indirectly
infected another brother through the nephew. All but the niece died.

The virus transmission from the woman to her nephew, who then passed
it to his father, ''suggests a third generation of limited,
non-sustained human-to-human transmission,'' the report says.

The WHO confirmed that seven of the eight relatives had bird flu. The
woman was only suspected of being infected.

Except for initial case, ''no exposure to sick or dead chickens or
other animals could be ascertained for any case,'' it says.

According to Fukuda, the WHO will not take additional measures
following the discovery because WHO experts have already known
human-to-human-to-human transmission can occur if a sick person has
close contact with others.

''We have known that that can occur since back in 1997 from Hong Kong
when it first appeared,'' he said.

''It is really more sustained transmission between people who are not
in close contact that we are looking for,'' he added.

New recommendations, however, will be suggested to the government
during the meeting, which concludes Friday.

''Right now, we are reviewing the entire situation in Sumatra, cluster
in 'the area),'' Fukuda said. ''We'll draw up conclusions and
recommendations, so after the talks, there will be more specific
conclusions.''

The report recommends enhanced infection control precautions at
hospitals and provision of personal protective equipment for
healthcare workers and visiting family members considering the woman's
family members got sick after ''close prolonged contact with her
during the later stages of her illness.''

''I think the Indonesian government is trying very hard to cope with
this problem. It is not an easy problem to address and I think that
Indonesia would very much like this problem to go away,'' Fukuda said.

The Jakarta meeting is being attended by experts from the WHO, the
U.N. Children's Fund, the U.S. Centers for Disease Control, Hong Kong
University, Japan's National Institute for Infectious Diseases and
other institutions.

Indonesia's death toll from bird flu is 39 or 40, depending on the
source. The disease has killed at least 130 people around the world
since December 2003.

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Inter Press Service
June 23, 2006

Indonesia

Reporters Get the Bird Flu Jitters

Sonny Inbaraj

MEDAN, North Sumatra -- ''I really feel strongly that the issue of
health and safety of reporters covering avian flu must be addressed by
the management of news organizations,'' said Daenk Haryono of the
North Sumatra-based 'Harian Global' daily.

''Many times I've seen my colleagues go out to the field, not aware
that they should be at least wearing face masks and gloves,'' he
added. ''It seems like the editors just want our stories and couldn't
give a damn about our safety,''

Haryono has every reason to worry. Two reporters have so far been
admitted to hospital, suspected to be suffering from avian influenza
or bird flu. The latest victim from the popular 'Tempo' daily was
rushed to hospital last week when he developed high fever after
covering the mass culling of chickens and the funeral of a bird flu
victim in West Java.

Indonesia, the world's fourth most populous country has reported the

world's highest number of human deaths from bird flu this year, with
51 cases to date and 39 deaths. The world total is 228 cases with 130
deaths. The lethal H5N1 virus is already endemic in birds in
Indonesia.

In North Sumatra, the spectre of a deadly global flu pandemic was
raised early this month when the World Health Organisation (WHO)
admitted it was having difficulty identifying the source of bird flu
infection in a case where seven people in the same family died.

It is Indonesia's largest cluster to date and has raised fears of
human-to-human transmission of the H5N1 virus.

''Good reporting is essential to educate the public about the risk of
outbreaks in their poultry and how to protect themselves in the
eventuality of a human pandemic,'' said David Swayana of the 'Harian
Waspada' daily.

''But news organizations should make preparations to protect their
reporters in the field before they are sent out to report stories on
the illness,'' added the journalist at a training seminar for news
reporters organized by the U.S.-based media development agency
Internews and the United Nations Children's Fund (UNICEF).

The Brussels-based International News Safety Institute has the
following guidelines for news media staff covering stories on bird
flu:

- Avoid direct contact with poultry that has no apparent symptoms, as
well as with sick or dead poultry and any surfaces that may have been
contaminated by poultry or their faeces or secretions;

- Wash your hands thoroughly and as frequently as possible and
definitely after any potential contact. You should use soap and water
where possible, or waterless alcohol based hand rubs when soap is not
available and hands are not visibly soiled;

- You may want to use personal protective equipment like gloves,
masks, overshoes;

- You must monitor your health for 10 days after your last exposure.
If you become unwell with a fever, develop a cough or have difficulty
breathing you must seek medical help immediately.

But to be fair, a few large media organizations in Indonesia do have
guidelines for their reporters.

''It is compulsory for all members of the news crew when they're out
reporting in the field to wear masks and gloves,'' said Fitrianti
Megantara of the Jakarta-based Trans TV. ''It's written down in black
and white for us to follow,'' she said.

Trans TV cameramen, too, according to Megantara, have been instructed
by their management to keep their distance from victims and are
excused from filming in houses where there have been deaths.

She said her TV station's journalists are also subject to a compulsory
blood test for the H5N1 virus if they had been reporting in the field
for a week or more.

While face masks are deemed as standard protection gear, many
journalists complained that villagers often didn't want to talk to
them if they wore one.

''It's really difficult getting interviews if I were to wear a face
mask,'' said Iir Sairoh of the West Java-based 'Radio Cindelaras'. ''I
seem to scare off people with it,'' she added.

But the radio journalist revealed that not wearing a face mask, each
time she conducted an interview has a traumatizing effect on her.

''It's okay when I'm doing the interview, with the adrenalin flowing
to beat the deadline. But after I've filed my piece that's when I
become scared,'' she told the seminar.

''That's when I realise that I haven't had any protection and it just
plays on and on in my head that I'm going to get sick and die,'' said
Sairoh, while sharing her experiences with her colleagues.

Sairoh revealed that once she had a fever after returning from a
village where there was a bird flu outbreak.

''That was very scary and I told myself that if the fever persisted
for another day I would go to the nearest hospital. Fortunately it did
not,'' she said. ''Maybe I'm just a hypochondriac,'' added Sairoh,
laughing it off.

Prof. Luhur Suroso, the avian influenza team head in Medan's Adam
Malik hospital, had this advice for journalists at the seminar.
''Though human-to-human transmission of avian flu still has not been
confirmed scientifically, you need to take precautions while covering
the issue in the field,'' he reminded them.

''There are basic measures you can take to reduce your chances of
catching and spreading the disease,'' said the chest specialist.
''Wearing face masks and gloves should be compulsory for reporters.''

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Joyo Indonesia News Service
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