INDONESIA : SICK MAN SOUGHT HELP FROM WITCH DOCTOR WHILE ON THE RUN

W.H.O. DISEASE TRACKERS CHASED DOWN THE MAN TO REMOTE VILLAGE

MAN DIED IN THE ARMS OF HIS WIFE, ON THE WAY TO HOSPITAL

From Bloomberg.com : Dowes Ginting died of bird flu this week in the arms of his wife in the back of a jeep as he was taken to the hospital. For three days he had evaded doctors seeking to test him for the virus that killed him and at least six of his Indonesian relatives, including his son.

The movements of Ginting, a thin, boyish looking 32-year-old who grew limes, chilies and tomatoes in a northern mountain village of the Indonesian island of Sumatra, are part of a health probe that's attracting international attention. He and his relatives -- a brother, two sisters, two nephews, a niece and his son -- represent the largest reported instance in which avian flu may have been spread among people, investigators say.

The World Health Organization says the Sumatran incident may mean the H5N1 avian influenza strain is becoming more adept at infecting humans, not just birds. Scientists are monitoring outbreaks like the one in Sumatra for signs the virus is evolving into a form capable of killing millions.

"It's a good example of what the beginning of a pandemic outbreak might look like,'' said Ira Longini, a biostatistician at the University of Washington in Seattle.

"You would expect familial or hospital-based outbreaks and clusters.''

The WHO's disease-trackers are especially interested in the whereabouts of Ginting before he died to determine whom he risked infecting. He may have caught the virus from his son, who probably was infected by an aunt. This would be the first evidence of a three-person chain of infection, said WHO spokeswoman Maria Cheng in a telephone interview.

Cheng said investigators have yet to identify an infected animal as a source of the outbreak.

Health officials' difficulty tracking down Ginting for the three days leading to his death suggests that Indonesia may have trouble containing a human outbreak that might jump from affected villages to the rest of Southeast Asia.

The Sumatra cases are being traced back to Ginting's 37-year- old sister, Puji, who worked selling limes at the Tiga Panah market about 5 kilometers (3 miles) from her home in Kubu Sembelang.

She developed symptoms on April 27 and died of respiratory disease on May 4, according to the WHO. No specimens were obtained before her burial, and the cause of her death can't be confirmed, the agency said in a May 18 statement.

A preliminary investigation indicates that three of the infected family members -- Puji's two sons and another brother -- spent the night of April 29 in a small room when the woman was coughing frequently, the WHO said in a May 23 statement.

Other infected family members lived in adjacent homes. All the confirmed cases can be directly linked to close and prolonged exposure to a patient during a phase of severe illness, the WHO said in its statement.

It's less clear how Ginting's son was infected,

Ginting helped care for his 10-year-old son at the Adam Malik Hospital in Medan up until the boy's death on May 13, the WHO said. Two days later, after returning to his home in Kubu Sembelang, Ginting began coughing.

Ginting was examined three days later by local health-care workers, who observed avian flu-like symptoms. The WHO's Grein recommended on May 18 that he be isolated and treated in the hospital with the Roche Holding AG antiviral drug, Tamiflu.

Instead Ginting fled local health authorities and sought care from a witch doctor...

Disease trackers located Ginting late on May 21 in a nearby village. Blood samples and swabs of his nose and throat for viral particles were taken that day and flown to a laboratory in Jakarta. Ginting died the following day after tests confirmed he had H5N1, the WHO said on May 23.

Ginting's actions and the local reaction to the deaths have health officials worried about how to contain outbreaks should the virus become contagious among people. Some residents of Kubu Sembelang said they resented the rapid assessment by some government officials that there was avian flu in the village.

Investigators also are following 33 people known to have been in contact with infected family members, Cheng said. Some of the people are taking Tamiflu to prevent the disease, she said. No other suspected cases had been reported, she said.


VILLAGERS QUARANTINED IN NORTH SUMATRA AFTER SEVEN DEATHS

From Forbes.com : "More than 30 people have been asked to quarantine themselves so far in a North Sumatran village hit by bird flu outbreak, officials said.

"People who had close contact with any of seven relatives who have died since last month in the village are being monitored for signs of illness...

"A day after another WHO spokesman, Peter Cordingley, said the UN body was 'stumped' about the original source of the infection, Thompson said that contact with an infected bird is now considered the likely cause.

"Cordingley had on Wednesday described the outbreak as 'the mother of all clusters', but Thompson stressed there is evidence that the virus has not mutated into a form that could be more easily spread from humans to humans.

"The WHO has sent a 10-member team to Kubu Sembelang village, Karo District, to identify those who had close contact with the family. So far more than 30, including more relatives, have been traced and asked to quarantine themselves."


DELAY INVESTIGATIONS MEAN POSSIBILITY OF HUMAN-TO-HUMAN TRANSMISSION IN INDONESIAN CLUSTER CASE TO REMAIN A MYSTERY

From The Australian : Delays in the investigation of the world's largest outbreak of bird flu may prevent health officials from ever knowing if human-to-human transmission of the disease killed six members of the same family in Indonesia.

A team of the world's leading avian flu experts has arrived in the remote village of Kubu Sembelang in North Sumatra to investigate the deaths, which occurred during the past three weeks.

However, the director of the World Health Organisation's Collaborating Centre for Reference and Research on Influenza in Melbourne, Ian Gust, said most of the evidence would already have been destroyed.

"We've found with the investigation of clusters in the past that by the time the investigators get there, it's too late," he said yesterday. "Any infected birds that might have been around have gone or been killed.

"You can't take the adequate samples and you'll never know the cause, and that's a problem."

Indonesian health officials were not responding quickly enough to potential cases of the disease, Dr Gust told The Australian.

"Indonesia is still struggling with it. Vietnam, which had a very serious problem with bird flu, has essentially brought it under control by very vigorous health measures, whereas Indonesia is still getting lots of outbreaks in birds and lots of cases in humans," Dr Gust said.

Infected poultry has been the source of the majority of human infections worldwide. However, the WHO suspects human-to-human transmission may have caused up to half a dozen previous clusters in recent years.

.....there (is) no effective test to confirm human-to-human transmission.