http://www.mediaindo.co.id/berita.asp?id=77981

The HEALTH Thursday, October 13 2005 17:45 WIB



Infectious diseases
The nurse RS Sulianti Suroso was expected Tertular birds Flu



Depok -- MIOL: Umayani, the citizen RT 06/04, the Steamer District, of the Beji Subdistrict, Depok, that was professional as the nurse UGD in RS Sulianti Suroso, was treated in RS Sulianti Suroso, Sunter because terindikasi birds flu.

One of the neighbours Umayani, Hartoyo, in Depok, Thursday (13/10) had said, since this news spread, the restless citizen because of knowing the illness of birds flu was dangerous. According to him, until this the citizen was still waiting for results of the doctor's inspection in RS Sulianti Saroso concerning the truth of the Umayani indication news to contract birds flu.

He hope for if true Umayani positive was affected by birds flu, then he asked that the Depok Health Service descended to the field, especially the Umayani house environment. Because, further he, Umayani did not maintain the poultry, despite around 150 metre from his house was that maintained the poultry and had several chickens that died.

He said some time before was known that Umayani suffered hot high for two days. "After that he was checked to the closest community health centre, he said he was suggested to be treated in RS Sulianti Saroso," he said.

In the meantime, the Section Head the Prevention of the Illness of the Health Service (Dinkes) the City Depok Grice Sri Nugrah said Dinkes has contacted the local Community Health Centre to check the truth of this news.

"After the Community Health Centre side visited the Umayani residence evidently he has been treated in RS Sulianti." And we not yet could the news whether quite positive was or not affected, said Grice.

Beforehand was known, there were two Depok citizens that terindikasi birds flu, namely Deri Kurniawan (11) the citizen Cimanggis and Good Slamet (55) the citizen of the Teak Base, Limo. "Evidently good Deri or Good suffered the normal lungs." Not birds flu, stated Grice. (Ant/OL-06)

Is this in Indoneasia?

This a HCW in the ICU at the main infectious disease hospital in Jakarta.

"professional as the nurse UGD in RS Sulianti Suroso"

Yes. RS Sulianti Suroso was, I believe, the main hospital in Jakarta where most of the bird flu victims were being treated.

This is a "trigger event" for some people in the Flu Clinic: a healthcare worker treating the sick becoming ill her/himself. Very worrisome.

Yes, its Indonesia. While terrifying, it appears that there were poultry deaths nearby the health workers house. Will be interested to see this confirmed.

also on Antara:


http://www.antara.co.id/seenws/index.php?id=20631

suspect the nurse gave it to the chickens and not the other way around...

Are we seeing the same phenomonen that we did in VN? You know, there were chickens 1/2 mile down the road, he saw a chicken ad on a billboard, she dreamt about chickens = no H:H transmission.

Sage

Commentary at

http://www.recombinomics.com/News/1...CW_Jakarta.html

We already know there is limited H2H in Indonesia. It's possible that the nurse was infected this way (bodily fluids). It's also possible that she caught it from chickens. Or maybe she caught it from the air in hospital, which is the red flag. If it's the latter, we won't be told about it for some time yet IMHO.

Good commentary Dr Niman.

If it is the latter, then we will know about it all too soon, I would think. Lets hope the nurse just forgot to wash her hands!

__________________

"When someone loves you, the way they say your name is different. You just know that your name is safe in their mouth."
Billy - age 4

stephanie

Map Updated

http://www.recombinomics.com/H5N1_M...ta_October.html

http://jkt1.detiknews.com/index.php...0964/idkanal/10

antar manusia = accompany humankind (ie H2H ?)


The expert Animal Pathology had doubts AI did not spread Antarmanusia
Indra Subagja - detikcom
Jakarta - the Health Minister (Menkes) Siti Fadilah Supari always stated the virus Avian influenza Or birds flu did not spread antarmanusia. You trusted the statement? An expert of animal pathology from the University Gadjah Stupid (UGM), Dr Darjono, made AI hesitate did not spread antarmanusia.

Doubt Dr Darjono was sent in Workshop About the prevention of the spread of birds flu in the Hotel of Shangri-LA, Street Sudirman, Jakarta, Thursday (13/10/2005).

Darjono admitted to being disappointed with the achievement of the Department of the Health (the Department of Health) towards the eradication of birds flu. The disappointment was especially upper the Department of Health attitude that not transparent in the sample inspection of blood and the official of the hospital of the family of casualties of birds flu (RS) that handled casualties.

Expertly this UGM pathology felt surprised with results that were sent by the Department of Health that generally said did not have the family or even the official RS that was affected by birds flu. The Department of Health information, he said, like only to reinforce the statement that stated birds flu was not spread antarmanusia.

"His logic if someone was affected by the illness and that must spread to around." There was no illness that so great as AI did not spread. If results against the family and the official RS the negative, that was the funny matter, said Darjono.

Darjono then pointed out the illness of dengue fever dengue fever (DBD) for example the spread of the illness. When a place was found positive DBD must spread to this area. Ought to be also like this logic that was used in the AI spread.

Then Darjono assessed the Department of Health attitude that insisted birds flu did not spread antarmanusia as very awkward. The statement was compatible with the WHO attitude that asked Indonesia to be ready to deal with the pandemic.

"If the family and the official RS did not be that positive and was considered to be negative, then why Indonesia was stated by the pandemic?" This not Nyambung , stated the UGM pathology expert. (iy)

http://jkt1.detiknews.com/index.php...1078/idkanal/10


The minister for agriculture: the Lab in Indonesia was ready the Production of the Vaccine of birds Flu
Fitraya Ramadhanny - detikcom
Jakarta - the Agriculture Minister (the Minister For Agriculture) skimmed the laboratory view in Indonesia was not yet ready to produce the vaccine of birds flu. The laboratory in Indonesia was ready to produce the vaccine of birds flu.

This was stressed the Minister For Agriculture Anton Apriantono to the reporter during the agenda opened the fast together that featuring Yok ate the Chicken and the Free Egg birds Flu in the Bulungan Appreciation Stall, Jakarta, Thursday (13/10/2005). Anton ate the chicken and the egg with the chicken trader and the artist.

Anton also responded to the UGM opinion of the expert of animal pathology that said laboratoruim in Indonesia still had Bio safety That bad to be able to produce the vaccine of birds flu. "To produce the vaccine of birds flu was needed the laboratory with bio safety the level 2 (BSL-2)." And we has had beberaap the laboratory with BSL-2, he said.

The minister for agriculture named the laboratory that filled the standard including the Deptan Laboratory, the Research Hall of Veteneriner IPB Bogor, Department of Health Health Research And Development and Namru. "That several examples of the laboratory that was ready," he said.

Asked by the matter follow from the expert in molecular biology of the Airlangga C.A Nidom University that was carrying out the research about the mutation of the virus of birds flu? Anton stated, his side always carried out routine communication with Nidom because he was one of the members the Expert's Commission the Health of the Deptan Animal.

"However, I not yet could the latest news from the Nidom research," he said. (March)

http://jkt1.detiknews.com/index.php...0893/idkanal/10

Mentioned Deliberate birds Flu was spread
The minister for agriculture asked Irjen corrected him
Niken Widya Yunita - detikcom
Jakarta - Agriculture Minister Anton Apriantono asked for the Inspector General (Irjen) the Department of Zaenal Bachruddin Agriculture corrected pernyataa him that there is the indication of the virus of birds flu ( Avian influenza /AI) deliberate was spread. This Zaenal statement it was thought was based on the opinion, not the fact.

"That was wrong." I asked for Irjen corrected. Because they made the conclusion be based on the opinion. That might not be in the report. Suggested his fact, said Anton ended attended the limited meeting in Vice President's Palace, Street. Medan was Independent South, Jakarta, Thursday (13/10/2005).

According to Anton, was based on the available data, was not found by the existence of the element of deliberateness in the spreading of the virus of birds flu. Deptan handed over this case to the Great Attorney General's Office to be investigated by his truth.

Anton also explained, Deptan seized the illegal vaccine from China in East Java some time before. However the matter of the amount, Anton claimed did not memorise.

The indication of the existence of the side's certain efforts to spread the virus of birds flu all through Indonesia through this illegal vaccine was included in the report on the assumption of corruption in Deptan to the Great Attorney General's Office. The aim of the spreading of this virus of birds flu was so that the legal vaccine is sold in the market. (gtp)

http://jkt1.detiknews.com/index.php...0857/idkanal/10

Diagnosed by typhus, 3 Suspect Birds flu left RSPI
In an orderly manner Irawan Nurrachman - detikcom
Jakarta - the Patient Suspect Birds flu that was treated in the Infection Hospital (RSPI) Sulianti Saroso increasingly decreased. After being ascertained free birds flu, three patients are still permitted to come home on Thursday (13/10/2005) this.

The three of them were Umiyani (36), the citizen of the Steamer, Depok, West Java, the Segment of the Diamond (5) from Tangerang, and Fikri (3), the citizen Pekayon, the Market Wednesday, Jakarta East.

Umiyani was treated in RSPI since last October 4. He was permitted to come home because of results of serology and PCR him was negative. According to the specialist doctor of the lungs, Adrian, in RSPI Sulianti Saroso, Street Sunter Baru, Jakarta North, Umiyani that when entering RS suffered hot high and the cough only suffered typhus.

Whereas the Segment, according to the child's specialist doctor, Sri Sulastri, results of the serology test and PCR him was also negative. The segment that was treated since October 6 terindikasi B type para-typhus and C. Whereas Fikri that was treated since October 7 was affected by B para-typhus and C, as well as typhus, that is the infection in the digestion channel.

The Other patient Stable

In the meantime, the condition six patients that still was treated in RSPI Sulianti most showed the improvement except Ramdani (54). The Ramdani condition that was treated in ICU space was still worsening, the condition for his lungs did not yet show the improvement.

The Ramdani illness was aggravated with the disturbance in the function of the heart and his kidney. As far as this is concerned his status still Suspect Birds flu. However the hospital side has taken the sample of blood and the bribe terggorokan him.

Whereas the colleague seruangan him, Gayatri pearls (7), his condition increasingly mambaik. "He has been stable and active although still was weak." At this time he not with breath aids again. But we will continue to the monitor. If his condition descended we will rise again, said the doctor Sri.

Now the Ruben condition (5 months) and Ageng (2) that was treated in space of the roses isolation, his condition was stable. Likewise with Ahmad Zaenuddin (23) and Herman (24) that was treated in Cempaka isolation space. At this time the doctor was still being waiting for results of the laboratory towards serology and PCR both of them. If free birds flu, both of them were permitted to come home in time 1-2 days more.
(umi)

Read also:
· The virus of birds Flu will It Was Suspected spread in Jakarta and Lampung
· The status KLB birds Flu not yet will be pulled out
· Flu Burung
Deptan Berantas Vaksin Ilegal
· Tambahan 10 Juta Dolar Australia untuk Tangani Flu Burung

http://www.kompas.com/metro/news/0510/13/162735.htm

Pemkab Tangerang banned efforts of the Pig Livestock in Legok
Tangerang, Thursday
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The Related news:
• The pig and the Poultry were forbidden to be traded in Tangerang
• The breeder in Tangerang Restless, the Pig and the Poultry had difficulty being sold
• Pig compensation that will be destroyed in Tangerang was agreed to


Pascamerebaknya the plague of birds flu (avian influenza) some time before, the Government of the Regency (Pemkab) Tangerang, Banten, forbade several local businessmen and the immigrant to raise pigs in the Legok Subdistrict, as anticipation of the prevention.

The regent Tangerang Ismet Iskandar to the press, Thursday (13/10) said to anticipate the prevention of the illness of birds flu, the livestock breeding businessman was forbidden to raise pigs in the Legok territory. The reason is, the efforts can cause the animal illness and the social instability.

According to Ismet, some time before the illness of birds flu attacked the pig and the other poultry in this territory. Then from so, must be made by the ban so that that is not repeated again. The case of birds flu could be made to be valuable by the lesson.

The "pig and the affected poultry the illness was afterwards destroyed by the authorised authority so as this area was free from avian influenza," he said.

In recent times circulated information had the livestock breeding businessman from Jakarta that wanted to build the processing factory of meat, breasts, and the waste of the pig for fertiliser in Legok and the Kresek Subdistrict.

In connection with that, Ismet said the side of Pemkab Tangerang gave the guarantee that the Kresek territory will not be made the place of pig livestock breeding. However, to convince the citizen, the Regent Ismet at once came to the Sidoko Kecematan Kresek Village, to hold a dialogue with the local citizen.

Nevertheless, he said the citizen currently has been might not be restless. His article, the information deliberate was blown out by the side that was not responsible.

The source: Ant
The writer: Prim

I'm a little fuzzy on the whole Red Flag !!! thing. Is it more significant than a DOT !!!

/Just asking...

I was pondering the same question.

http://jkt1.detiknews.com/index.php...0654/idkanal/10

The virus of birds Flu will It Was Suspected spread in Jakarta and Lampung
Indra Subagja - detikcom
Jakarta - the Jakarta Citizen and Lampung must be on the alert. The plague of birds flu ( Avian influenza ) was estimated will spread in the two territories. Oops!

Expanded him the plague of the virus turn off this happened because of the government (the Department of Agriculture) the difficulty handled his spreading in the IV sector or ( Backyard , that is in the level of the household that maintained the nonpedigreed chicken, the duck and entok.

This was sent by Kesehatan Breakingprep Hewan Dirjen Breakingprep Peternakan Deptan Sjamsul Bahri Director in the Hotel of Shangri-LA, Street Jenderal Sudirman, Jakarta, Thursday (13/10/2005).

"We the difficulty in this sector." Because this animal was released just like that, so as the vaccination program was difficult to be carried out and the level of the success of the low then vaccination, he said.

Because of that to the inhabitants around Jakarta that still was maintaining the poultry, Deptan asked them to be aware of the action Bio security hygienic .

They were appealed to to clean the pen and reported immediately like that had the chicken or his kept birds that died suddenly to Dinkes local. "So as Dinkes could immediately carry out spraying of disinfectant," he said.
(umi)

Read also:

The status KLB birds Flu not yet will be pulled out
Birds flu
Deptan combatted the Illegal Vaccine
In addition 10 Million Dollar Australia to handle birds Flu
Vienna one Goddess died resulting from Difficult pneumonia, Not AI

I don't quite get your question, but many posters both here and at the agonist board see bird flu infected healthworkers as the most convincing indication for H2H spread.

If a nurse caught BF from a patient in a hospital setting, it proves H2H transmission. Moreover, it suggests increasingly efficient H2H since HCW's are aware that the patient is sick and tend to wear gloves and be careful.

If the nurse caught BF from chickens in his backyard, then it's not really a red flag. So it's crucial to know the details of what happened here.

Please note also one of the other stories above where a veterinarian wuestions the statement that there is no H2H going on.

Toaster2
Valued Member

From now on you will ignore me...I make no sense...

/No, really...

A red flag is comprised of many RED DOTS

__________________
.
"then don't mind me, cause I ain't nothing but a dream"

Oct 13 17:20


The Depok CITIZEN, the NURSE in RS SULIANTI TERINDIKASI birds FLU


Depok (between News) - Umayani, the citizen RT 06/04, the Steamer District, of the Beji Subdistrict, Depok, that was professional as the nurse UGD in RS Sulianti Suroso, was treated in RS Sulianti Suroso, Sunter because terindikasi birds flu.

Someone tetanga Umayani, Hartoyo, in Depok, on Thursday had said, since this news spread, the restless citizen because of knowing the illness of birds flu was dangerous.

According to him, until this the citizen was still waiting for results of the doctor's inspection in RS Sulianti Saroso concerning the truth of the Umayani indication news to contract birds flu.

He hope for if true Umayani positive was affected by birds flu, then he asked that the Depok Health Service descended to the field, especially the Umayani house environment. Because, further he, Umayani did not maintain the poultry, despite around 150 metre from his house was that maintained the poultry and had several chickens that died.

He said some time before was known that Umayani suffered hot high for two days.

"After that he was checked to the closest community health centre, he said he was suggested to be treated in RS Sulianti Saroso," he said.

In the meantime, the Section Head the Prevention of the Illness of the Health Service (Dinkes) the City Depok Grice Sri Nugrah said Dinkes has contacted the local Community Health Centre to check the truth of this news.

"After the Community Health Centre side visited the Umayani residence evidently he has been treated in RS Sulianti." And we not yet could the news whether quite positive was or not affected, said Grice.

Beforehand was known, there were two Depok citizens that terindikasi birds flu, namely Deri Kurniawan (11) the citizen Cimanggis and Good Slamet (55) the citizen of the Teak Base, Limo.

"Evidently good Deri or Good suffered the normal lungs." Not birds flu, stated Grice. (*)

What is yet amazing is why we have not yet seen a deluge of HCW's who work at these village-level community health centers becoming infected.

This appears to be a first nurse who is working at the RS Sulianti Suroso, which is Indonesia's infectious disease center.

There are thousands of community health centers with kind, helpful people employed at them, who see tens of thousands of people daily. We see no news from those locations.

The infectious spread within the treating hospital is expected. It happened in Hanoi. It's happening here.

We know, irrespective of what posters or the MSM or WHO say, there has been highly probable H2H in Vietnam in the Hanoi treating hospital. We see it now in Indonesia.

The virus appears to be "stable" on a plateau in terms of its infectiousness, with one exception. Niman points out that the familial groupings appear to be getting larger.
As a counterbalance, my experience in the slums and village areas in Java and Sulawesi, when I've peered in and visited the homes of my guides, are 2 room affairs, the outer room and the sleeping room. Everyone, all the relatives, the entire family, sleep in a single room, or at night, in the two rooms. So, H2H happens under very close contact circumstances. We knew that from Vietnam. We see it again in Indonesia.

Does it not appear that the virus is yet stable in terms of its interaction with humans, while it expands in its geographic encompassment?

This is my opinion on dots vs. flags.

Dots are basically equal information that connected paints a picture (the typical dot-to-dot game)

Flags are so significant as to say "forget the previous dots, the picture has just changed!"

As GR pointed out, H5N1 has been fairly stable to date with gradual changes.
I am watching for the one case that says "new ball game"
This could be it. Might not be also, but I will watch closely for exponential growth from this focal point.

Does this make sense?

I think so.

To say that the Indonesian situation is 'messy' is grossly understating matters. We have one reported case of a nurse who is ill. Barring confirmation, she may or may not have H5N1 - anyone know what's going on with ordinary flu over there right now?

If she does have it - did she contract it from a patient? If so, was she always wearing PPE? Was PPE up to what we'd consider an acceptable standard, available? Or did she contract it from chickens living nearby, chicken poop in her shoes from walking near infected birds...

And Guadia's right - I hadn't considered the point he raised. We're not hearing of cases among the volunteers & HCW in the primary settings - yet.

I'm inclined to think that right now at least, in Indonesia, this is furthering itself in terms of becoming established in the environment with frequent, is small, outbreaks among poultry. Unless thousands of cases are simply 'disappearing' or being defined away, it would APPEAR that it's still not that easy to catch from birds & H-H remains infrequent. For now. If that's indeed what's going on there.

What I'm going to watching for is this...

with migration through Europe 'hotting up', it will be spreading there with increasing reports of dead migratory fowl. I'll be getting right nervous as native species become infected & some, no doubt, will. Eventually - we'll see A-H human cases, sporadic. But if we see a case or more that is initially contracted through contact with infected wild birds or poultry, or someone coming back from say.... Bali AND furthermore, in the absence of other exposures back home that or those cases transmit to other people - look out.

I suspect when that happens, the snowball will be rolling at mach speed.

__________________
Bunnies love me, this I know
'Cause Arubi tells me so.

Knowing the critical care clinicians in Jakarta, I am sure they follow strict infection control procedures to the 10th degree. However, my greatest concern is that when one performs open airway procedures in the ED/ICU is an N-95 good enough? We are approaching this as the N-95s alone during open airway procedures are not enough and that we use PAPRs during intubation, open suction and other open airway interventions.

The life I save may be my own!

did anyone notice the rumor that h5n1 had been a deliberate contaminant in illegal vaccines in order to spur the sale of legal vaccines? It is buried in one of the above news clips.

Also note that there was another report of someone who had had no contact with birds.

We therefore appear to have 2 people in the same place who might never have had a contact with birds.

This is really bad.

Add to the equation that the latest stats indicate up to 17 days incubation time. If you count backwards then they could have been walking around with it for some time.

My conclusion is that if we are seeing this, then within 8 days we should see more healthcare workers. I doubt whether the facilities they have can contain a H2H ready H5N1 flu virus.

There was a mass protest over a week ago; if this were easily transmissible, we would be seeing a spike in cases. We've seen none. It's not an 8 day start date or a 17 day start date for infections to appear. Those are ending window dates.

We must ask ourselves objectively if Flu Pig in Disease Outbreaks is correct. Is this just an avian disease that has the ability to infect humans if they get a "loading dose" one time or many?

I'm not dismissive. I'm being objective. I think the virus will pick up the ability to jump species. If it's in a year or five, it's ok with me. I have leaned what I need to, and am prepared in the moment...thanks to each of you who have shared and tussled or butted heads with me. I bleieve I know my risks and I'm ready at any time.

If ya don't get the "dot" thingy......

Never mind. It'd take too long to explain.

When you feel you have what you need to cope should it hit right now, then you've done what you can. At that point, it doesn't matter if it shows up in the next 10 years or next 10 decades.

Don't know how long it's going to take for the efficient H-H leap to happen. Don't know if it will maintain a relatively high mortality but that's all up in the air.

There is something we really have to think strongly about - if this ends up becoming a real problem in domestic birds, we're going to see some real agricultural hardships for a great many people. Farmers will have a very tough time making ends meet if they rely on poultry & consumer confidence will drop. Yeah, it's hard to catch now but who will want to risk catching it from poultry or their products?

__________________
Bunnies love me, this I know
'Cause Arubi tells me so.

Can you explain the 17 days incubation? I apparently missed it. Thanks.

Other possibilities? Many mild cases which don't impel sick to seek treatment, not diagnosed, not treated, not reported? Some measure of herd immunity in Indonesia already? (Recall: Asymptomatic 80+ year old with antibodies to H5N1, grandfather of Vietnamese young man and sister). There is always the conspiracy/cover-up possibility of many more infections not being reported.

The long incubation period indicates it is not very good at infecting people and flupig is probably right and you need a big loading dose to get infected.

The significance of the healthcare worker is, no healthcare workers infected indicates H2H is rare and most cases are B2H. When healthcare workers get infected, especially those outside an ICU, it indicates significant H2H is occuring.

i don't presume the 80+ year old grandfather was indonesian or occurred in indonesia right?