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   Biotech / MedicalSARS and Avian Flu

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From: Henry Niman9/21/2005 8:02:36 AM
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RS Sulianti Saroso Object Deny the Yesica Patient

Iqbal Prominent - detikcom
Jakarta - RS the Infection (RSPI) Sulianti Saroso denied it refused a reconciliation patient from RS the Alliance of the Indonesian Church (PGI) Cikini, was named Yesica Triana. The child was 2 years old 2 months died around struck 05.00 WIB, because of being suspected of being attacked by birds flu.

The denial was sent by Director RSPI Sulianti Saroso, Dr Santoso Soeroso in press information in RSPI Sulianti Saroso, Street Sunter Permai Raya, Sunter Great Podomoro, Jakarta North, Wednesday (21/9/2005).

"Yesterday we were contacted by the doctor from RS PGI Cikini to ask whether having the room?" But was explained by me, the room capacity in ICU only was 4 Bed , with 4 machines of respiratory aids. But one of the implements was broken, explained Santoso.

According to Santoso, the ICU RSPI space capacity last night was full. Because, has had three patients was treated, namely Gayatri pearls, Windi Lisa, and the deceased Riska.

"Now, the Yesica condition required him to be treated in ICU. was still, at the time being sent by me so that Yesica is treated there previously," said Santoso.

At that time, Santoso asked RS PGI Cikini to take the sample of Yesica blood to be researched by the team of the Department's research and development of the Health. This method was carried out to know whether Yesica was affected by birds flu or not. "So untrue if RSPI refused the reconciliation patient," defended Santoso.

Santoso then hoped, that each hospital could maximise his handling if diagnosing the illness that quite difficult. So, further Santoso, RSPI will receive the patient who it was suspected was attacked by birds flu, if results of the Department of Health research and development laboratory showed positive birds flu.

"Because here indeed the hospital rujuka him, and same will be adapted to the room capacity," said Santoso.

As being reported, RSPI Sulianti Saroso could refuse the patient from the Sawit durian, Jakarta East that. According to Manager Humas RS PGI Cikini Roosiana, the RSPI Sulianti Saroso refusal because of not yet having results of the laboratory and the Yesica throat caress. (ism)

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To: Henry Niman who wrote (2374)9/21/2005 8:37:59 AM
From: Henry Niman
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From: Henry Niman9/21/2005 9:53:52 AM
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Bird flu deaths force Indonesia to declare epidemic
By Richard Lloyd Parry, Asia Editor of The Times

Indonesia faces an epidemic of deadly bird flu, the country’s health minister said today, after the deaths of four people apparently as a result of the infectious virus.

Eight other people remain in hospital in the capital, Jakarta, suspected of suffering from the disease which has raised fears of a global pandemic which could cost millions of lives.

"This can be classified as an epidemic and most definitely there will be other [deaths] as long as we are unable to positively identify the sources," Siti Fadilah Supari, the Health Minister, said.

"I do not want to wait for more deaths to take place." She later adjusted her comments to say that, although an epidemic had not yet arisen, it could do in the future.

The Indonesian Government also sacked a senior official at the ministry of agriculture, Tri Satya Putri Naipospos, on the grounds that she mishandled the bird flu crisis. It announced that, contrary to earlier statements, it is prepared to cull large numbers of farm birds as a means of stifling an epidemic.

Indonesia has already begun stockpiling anti-viral drugs, and officially declared an "extraordinary situation" - a state of 21 day high alert, which gives it legal powers to confine and forcibly treat anyone showing bird flu symptoms.

A 5-year-old girl who had been showing influenza-like symptoms died in hospital in Jakarta today and eight others are receiving treatment. Several of them came from rural areas with large numbers of poultry. One 9-year-old girl succumbed after visiting Jakarta’s Ragunan Zoo, which was closed after the virus was detected there over the weekend.

The strain of the bird flu virus known as H5N1 has killed 64 people in South-East Asia in the past two years, most of them in Vietnam. Nearly all of the infections have occurred in people who lived in close proximity to chickens or ducks, and is believed to have been transmitted through the droppings or saliva of sick birds.

The great fear is that the virus could mutate and merge with human influenza to take on a new and highly infectious form. Such a process is believed to have created the notorious Spanish flu, which killed between 20 million and 100 million people across the world from 1918 to 1919.

Human to human infections may also have occurred during earlier outbreaks of bird flu in Hong Kong and Europe in 1997, which remained under control.

"It’s obvious that a pandemic will occur, all the conditions are in place," Lee Jong Wook, the director general of the World Health Organisation, said on Monday. "The problem now is time."

Few countries would be prepared for a mass outbreak, especially not in the developing economies of south-east Asia. Until now, Indonesia has insisted that it could not afford to carry out the mass culls of millions of birds that have helped to contain previous outbreaks of the virus in Vietnam and Thailand.

Today it changed its mind. "If we declare one area highly infected, we are going to do a mass slaughter," the Minister of Agriculture, Anton Apriyantono, said.

"We haven’t identified the high-intensive areas but once it is done then there will be [a mass cull]. According to the President, funds will not be a problem - if it needs to be done then we will do it with all our resources."

The Government is in the process of stockpiling Tamiflu, an antiviral pill which can be used to treat bird flu. Reports of the recent infections are already affecting the sales of chicken in shops and street stalls.

"It should be clear that it is no longer the time for choosing between the interests of the poultry industry and those of the public at large," the Jakarta Post newspaper said today in an editorial.

"Has the Government managed to overcome ... the reluctance of hospitals to treat patients, or their excuses that they are full or that they have not received the funds promised by the government to enable them to treat patients for free?"

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To: Henry Niman who wrote (2374)9/21/2005 10:04:55 AM
From: Henry Niman
   of 4232
Expected by birds Flu, Yesica died in RS PGI Cikini

Ahmad Dani - detikcom
Jakarta - Yesica Triana (2 years 2 months) died in RS the Alliance of the Indonesian Church (PGI) Cikini. Ironically, pre-schoolers that was expected terjangkit this virus of birds flu could be refused the Infection Hospital (RSPI) Sulianti Saroso.

Yesica blew out the last breath struck 05.00 WIB, Wednesday (21/9/2005). The citizen Bojong Rangkong, RT 007 RW 006, the Sawit durian District, Jakarta East, that entered RS PGI Cikini on last Tuesday, around struck 17.00 WIB.

Manager Humas RS PGI Cikini, Roosiana, to Detikcom In his office, Street Raden Saleh, Jakarta the Centre, said, when coming, Yesica was experiencing the high and breathless fever.

The hospital side afterwards at once carried out the laboratory inspection. This step was carried out because from the beginning inspection was known trombosit and Yesica blood leucocytes experienced the drastic decline.

Results of the laboratory afterwards showed the existence of the infection on the Yesica lungs. In accordance with the policy of the government, RS PGI Cikini then reconciled Yesica to RSPI Sulianti Suroso. "But because of results of the blood laboratory and the throat membrane him did not yet go out, Yesica was not yet able to be received in RSPI Sulianti," said Roosiana.

The hospital side afterwards was waiting for results of this inspection. But unfortunately, Yesica could not remain. Around struck 05.00 WIB, this child blew out the last breath.

In the RS Cikini Funeral Parlour to struck 14.30 WIB was taking place the dispatch mass of the Yesica body to his holiday accommodation that finally. His plan of Yesica will be buried in TPU the Coconut Hut, Jakarta East. (umi)

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From: Henry Niman9/21/2005 10:14:59 AM
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1 Patient was expected by birds Flu Once to the Ragunan Zoo
Iqbal Prominent - detikcom
Jakarta - One Of The 8 patients were expected terjangkit the virus of birds flu that was treated in the Infection Hospital (RSPI) Sulianti Saroso evidently had visited to the Ragunan Zoo.

This was revealed by Deputy Director RSPI Sulianti Saroso, Dr Sardikin Giriputro in RSPI Sulianti Saroso, Sunter, Jakarta, Wednesday (21/9/2005).

The "patient had gone to the Ragunan Zoo before the place was closed," said Dr Sardikin.

The patient who was meant by Dr Sardikin to be the female child was 9 years old have the initials JM. he was the reconciliation patient from a hospital in the Bekasi area.

JM was indicated was infected by the virus that destroyed 5 lives in Jakarta in the period 3 months. JM entered Cempaka RSPI Sulianti Saroso isolation space around struck 11.00 WIB.

The Ragunan zoo was closed for 21 days since September 19 after his 19 collection poultries were stated positive terjangkit the virus of birds flu.

To them who had visited to the Ragunan Zoo was asked for during immediately memeriksakan himself to the community health centre or the hospital.

RSPI Sulianti Saroso currently treats 8 patients it was suspected terjangkit the virus of birds flu in two rooms, namely Cempaka isolation space and ICU.

Six patients in Cempaka isolation space were Paradise (9), Rosnaningsih (3 years 7 months), the official of the Zoo of Ragunan USA (28), the trader asongan in the Zoo Ragunan GENERAL (39), DW (17), and JM (9). Two patients in ICU space were Gayatri pearls (7) and Windy Lisa (3). (sss)

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To: Henry Niman who wrote (2378)9/21/2005 10:52:00 AM
From: Henry Niman
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From: Henry Niman9/21/2005 11:33:39 AM
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Tests allay Indonesian fear of mutation in virus
By Keith Bradsher The New York Times

HONG KONG A woman's death of avian influenza in Jakarta has caused considerable alarm there, but genetic tests performed in Hong Kong on samples of the virus from the woman showed on Wednesday that the virus had not yet mutated in ways likely to make it more of a threat to people.

The genetic evidence suggests that cases identified so far in Indonesia may be no more dangerous by themselves than the nearly 100 cases recorded since the beginning of last year in Thailand and Vietnam. But the disease remains a potentially serious threat to human health because it could still evolve to become more readily transmissible among people.

The virus in the dead woman "seems like a virus that has gone directly from birds," said Dr. Georg Petersen, the World Health Organization's representative in Jakarta; he called that "reassuring for all of us."

The government of Indonesia had declared Monday that the disease was an "extraordinary event," a step allowing additional spending beyond usual budget restraints, and allowing the government to force suspected victims to be hospitalized and isolated. A half-dozen people with flulike symptoms have been isolated, and Siti Fadila Supari, Indonesia's health minister, warned on Wednesday that the disease was becoming an epidemic, but later withdrew the remark.

The Indonesian government has also begun an extensive slaughter of chickens in or near flocks where birds have been infected with the disease. The culling marks a shift in policy, as Indonesia had resisted large-scale culling last year when the disease spread through Thailand and Vietnam; Indonesia tried then to vaccinate chickens instead.

Petersen said that a genetic sequence analysis of the virus from the dead woman, a 37-year-old worker at Jakarta's airport, had just been completed in Hong Kong.

The sequence showed that the virus was essentially the same A(H5N1) avian influenza virus that had already been circulating in poultry in Indonesia, he said.

Health officials around the world have been watching to see if the virus will evolve the capability to pass easily from person to person, a necessary step for the virus to start a pandemic.

Malik Peiris, the Hong Kong University expert who did the genetic sequence, cautioned that not all the virus had been analyzed yet, but the segments analyzed so far match avian versions of the virus.

This suggests that the virus has not mixed with human flu viruses and thereby acquired the genetic material that would allow it to pass more easily among people.

The death of two young girls with flulike symptoms this week in Jakarta - one Tuesday and one Wednesday - has fed public concern there. But Petersen said that Indonesia had a fairly high rate of infant mortality by international standards and that laboratory tests would be needed to conclude whether the girls had been infected with A(H5N1).

The airport worker's death followed the death of a father and two daughters in Jakarta in July following flulike symptoms.

The father was conclusively diagnosed as having had the virus, while lab tests showed that his 8-year-old daughter probably had the virus and his 1-year-old daughter might have had it.

But health checks on 300 people who had been in contact with the family showed no sign that the virus had spread. Bird feces across the street from the family's home tested positive for the virus.

Chickens wander in many neighborhoods of Jakarta and are an important source of protein in the local diet. Petersen said that avian influenza virus had not yet been found in birds from the neighborhood where the dead airport worker lived.

Avian influenza has been attracting increased attention in Europe because of cases in birds in Russia, Kazakhstan and western China.

Scientists have said that it is impossible to predict when the virus might mutate in a form that spreads easily among people.

But they have warned repeatedly that as ever more birds carry the virus and spread it to other species, notably pigs, it becomes more likely that the virus will adapt to people.

The WHO and health ministries across Asia have been sending viral samples to Hong Kong for testing, partly because the territory's laboratories are very sophisticated and partly because medical researchers here have been studying the disease since 1997, when an outbreak prompted the immediate culling of poultry in the territory.

The WHO added another bird flu death Monday, a 35-year-old farmer, to its count for Vietnam. That brought the total there since the beginning of last year to 64 cases, 21 of them fatal.

There were also 17 confirmed cases of bird flu in Thailand last year, 12 of them fatal.

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To: Henry Niman who wrote (2365)9/21/2005 12:53:23 PM
From: Sam Citron
   of 4232
Hi Henry,

Lots of questions as usual.

Would an epidemiologist consider the July family cluster to be "casual" contact?

Do you assume that the transmission mechanism was solely sputum in coughing being inhaled by another family member or might the fecal matter of an infected individual also be involved? When I think about the large number of cases of infants and young children and consider the poor sanitation facilities in the region, I can't help worrying about fecal transmission.

In the case of the zoo-related cases, as many of the birds there carry H5N1, I can easily imagine a scenario where a sweeper takes the bird droppings airborne in a small cloud of dust that is then inhaled by anyone in the vicinity. I'm surprised that I have not heard anyone else express the possibility of such a scenario.

How many cases have there been of healthcare workers being infected? Were any of these individuals observing universal precautions?

I would urge you to modify your Recombinomics website so as to allow users to post and read comments there. A quasi-dialog would be beneficial to all concerned.


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To: Henry Niman who wrote (2380)9/21/2005 1:14:58 PM
From: Henry Niman
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To: Sam Citron who wrote (2381)9/21/2005 1:19:05 PM
From: Henry Niman
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The casual contact is overall (there are already three family/contact clusters). the key however, is that all of these recent clusters happened at the same time. H5N1 has clearly picked the lock and can enter human cells more efficiently.

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