By Donald G. McNeil Jr. The New York Times
Published: June 16, 2006

Confirmation of the 38th death from avian flu in Indonesia has indicated that the situation in the country is continuing to worsen.

Indonesia is now in second place after Vietnam, which has had 42 deaths, but none this year, while Indonesia's caseload is climbing rapidly and includes many family clusters.

In another development, the Indonesian Health Ministry said Friday that a 14-year-old boy had died Wednesday in Jakarta.

A spokesman said local tests indicated he was infected with the H5N1 strain of the virus but that an international laboratory would confirm the diagnosis.

If the case is confirmed, it would raise Indonesia's death toll to 39.

The World Bank said Monday that the country was mounting a disorganized and underfinanced response to the flu.

On Tuesday, the World Animal Health Organization said Indonesia was no longer even counting most poultry outbreaks; in the last year, it has officially reported the deaths of only 800 chickens, while there have been news reports of the deaths of thousands of birds from 29 of the country's 33 provinces.

Indonesia has an estimated 1.3 billion chickens spread across 18,000 islands.

On June 12, The Jakarta Post quoted several local health experts as saying that the government was not disclosing how widespread the disease was or how many times human-to-human transmission might have occurred.

And last week, Indonesia's health minister, Siti Fadilah Supari, said she was "running out of ideas for how to make the public aware" of the threat and get them to kill sick chickens instead of eating them.

The Indonesian Health Ministry said Thursday that the June 1 death of a 7- year-old girl in Banten Province was the country's 38th from avian flu. The girl's 10-year-old brother died May 29, but he was buried before specimens were taken, so he was not included in the count. Chickens in the family's household had died earlier.

According to wire service reports quoting health officials, the 7-year-old had tested negative for avian flu in nose and throat swabs taken when she was alive, but then tested positive when lung tissue was taken after her death.

Nose and throat swabs - the routine way of diagnosing regular flu - may give false negatives because the bird flu virus attaches to cells deep in the lungs, not to the upper respiratory tract.

Henry Niman, a biochemist who has questioned many of the health organization's official counts, argued that flu cases were underestimated because of that error and because blood tests could also produce false negatives if the blood was drawn too early.

Victims can die before that happens, and the outbreak in Indonesia has a very high death rate: Of the 50 known cases, 38 have died.

An Indonesian newspaper, The Tempo, reported Thursday that one of its reporters who covered the extermination of infected poultry and the funeral of a flu victim near Jakarta had been hospitalized with flu symptoms; the newspaper did not report any test results.

Recently, there have been several reports of Indonesian nurses falling sick after tending to avian flu victims, which could indicate that the virus was spreading more easily between humans.

On June 6, the World Health Organization reported that tests on four such nurses had "convincingly" ruled out avian flu and indicated that one had a seasonal flu instead. Niman said that convincing evidence could be obtained only from blood tests in the near future.

Dick Thompson, a World Health Organization spokesman who recently returned from Indonesia, said he did not know how the nurses were tested, but that he thought the Indonesian health authorities "are really on top of the human cases, investigating them aggressively," even as animal cases were spiraling out of control.

Hong Kong bans poultry

A man in southern China was in critical condition after contracting the H5N1 strain of bird flu, the government said, as neighboring Hong Kong on Friday halted imports of live poultry from the mainland, The Associated Press reported from Beijing.

The 31-year-old truck driver from the city of Shenzhen tested positive June 9 for the H5N1 bird flu virus at the Shenzhen Center for Diseases Control, the official Xinhua news agency said.

http://www.iht.com/articles/2006/06/16/news/flu.php
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Peter Kay