Indonesia : Researchers Confirm Bird Flu Virus Passed From Human To Human During April 2006 "Cluster" Outbreak

World Health Organisation Failed To Raise Alert Level When Eight Members Of Same Family Died From H5N1

"We Dodged A Bullet"

How close did we come to a pandemic outbreak of the bird flu virus amongst humans in 2006?

American researchers now claim we "dodged a bullet", because the H5N1 virus did pass from family member to family member during a surge of deaths in Indonesia in April, 2006 :

Ira Longini and colleagues at the Fred Hutchinson Cancer Research Centre in Seattle looked at two clusters - one in which eight family members died in Sumatra in 2006, and another in Turkey in which eight people were infected and four died.

Experts were almost certain the Sumatra case was human-to-human transmission, but were eager to see more proof.

"We find statistical evidence of human-to-human transmission in Sumatra, but not in Turkey," they wrote in a report published in the journal Emerging Infectious Diseases.

"This does not mean that no low-level human-to-human spread occurred in this outbreak, only that we lack statistical evidence of such spread."

In Sumatra, one of Indonesia's islands, a 37-year-old woman appears to have infected her 10-year-old nephew, who infected his father. DNA tests confirmed that the strain the father died of was very similar to the virus found in the boy's body.

"It went two generations and then just stopped, but it could have gotten out of control," Mr Longini said.

"The world really may have dodged a bullet with that one, and the next time, we might not be so lucky."

The researchers estimated the secondary-attack rate, which is the risk that one person will infect another, was 20 per cent. This is similar to what is seen for regular, seasonal influenza A in the United States.

The Indonesian government admitted there was probably human to human spread in the April-May, 2006, "cluster" of deaths. Here's a report on that.

Back in June, 2006, a spokesman for the World Health Organisaion referred to the Indonesian outbreak, where ultimately eight members of the same family died, as "the mother of all (bird flu) clusters".

There was a very real sense of panic, particularly in the Indonesian government and the World Health Organisation, that this was it, the beginning of a worldwide pandemic. But little of that terror filtered through to the media.

The WHO admitted, back then, it was possible that human to human transmission had occurred, but denied the virus had mutated into one that could pass more easily amongst humans, the event that all concerned fear the most.

If human to human transmission did occur during the Sumatra "cluster" of deaths, it is interesting to look back now on a decision by the World Health Organisation mid last year to not raise the pandemic 'Alert' level they use, and of which we have heard nothing about since June 2006 :

WHO won't yet raise the Global Pandemic Alert level from Phase 3 to Phase 4..

Phase 3 translates as Human Infection : Rare Human To Human Transmission

Phase 4 translates as Human Infections : Small Clusters With Limited Human To Human Transmission, but during which the spread is highly localised.

There is good reason for the World Health Organisation to be reluctant to go with Phase 4.

When they officially confirmed that seven members of the same family had died of the bird flu virus, the Indonesian currency plummeted and stocks in airliners and travel companies plunged on fears of a pandemic cutting into airline industry profits, and of a general weakening of the Indonesian tourism industry due to decreased tourists, scared off by fears of the virus.

It's an incredibly fine balancing act that the World Health Organisation must conduct in raising its bird flu-related alert and warning levels.

Ramping up from Phase Three to Phase Four can slash billions from a nation's economy virtually overnight, as stocks tumble and tourists cancel trips.

But delaying the increased level of threat and warning over human deaths could also see the virus spreading much farther than it might have if the warnings were raised earlier. The further the virus spreads through a country or region, and the more people it kills, the greater the economic damage.

It's clear now that the World Health Organisation probably should have moved the Alert level from Phase Three to Phase Four, because there were clear signs of "clusters" and limited spread of the virus from human to human.

They didn't do this, but the bird flu deaths in humans slowed. In the end the WHO made the right decision and probably saved the Indonesian economy from suffering more damage than it did.

The bullet was dodged.


There were nine officially recognised bird flu-related deaths in Indonesia in only ten days through late March and early April this year, and at least 12 in a 30 day period.

April 7 : A 29 year man who died on Thursday in Central Java was confirmed Saturday as being H5N1 positive.

April 6 : 16 year old girl dies in Jakarta, believed to have had contact with sick chicekns.

April 5 : 29 year man in Central Java dies.

April 4 : 23 year old woman dies.

March 29 : 14 year old boy in West Sumatra dies - 28 year old woman in Jakarta dies.

March 28 : 39 year old man dies in Surabaya.

March 27 : 15 year old boy in West Java dies - 22 year old woman in Sumatra dies.

March 20 : 21 year woman in East Java dies.

March 16 : 32 year old man dies in Jakarta.

March 12 : 20 year old woman dies in East Java.


May, 2006 : Five Members Of Indonesian Family Die From Bird Flu In One Week

June, 2006 : The Bird Flu "Storm" In Indonesia

June, 2006 : Bird Flu Is Now "Probably" Spreading Human To Human In Indonesia

"The Mother Of All Bird Flu Clusters"