Indonesia bird flu virus spreads among blood relatives
Pastor Dale Morgan
Indonesia bird flu virus spreads among blood relatives*
Updated 11/7/2006 9:45 AM ET
A vendor woman sits next to ducks as she waits for customers at a market
in Jakarta, Indonesia. Indonesian health care workers have observed that
flu outbreaks appear to come in family clusters, but only in people
linked by blood.
FLU HITS 2 NATIONS HARDEST
It's not easy to catch. Only 256 people in the world have had it.
But the bird flu, known as H5N1, is one of the most lethal viruses
known, killing more than half of the humans it has infected.
Despite draconian eradication efforts, including the slaughter of
millions of poultry in Asia and Europe, the virus has spread.
Indonesia and Vietnam have borne the brunt. Vietnam holds the record for
human cases with 93 illnesses, 42 of them fatal, but hasn't had a case
this year. The virus rages in Indonesia, which has had 72 human cases,
including 55 deaths.
By Elizabeth Weise, USA TODAY
KUBU SEMBELANG VILLAGE, KARO DISTRICT, SUMATRA — Seven people died of
bird flu here in May, and the villagers still remember the day when
national government officials arrived, clad head to toe in white bubble
suits meant to protect themselves from infection, infuriating the
villagers and health workers who were already here.
Despite an hour-long drive in September along dirt roads to get to the
village, Diana Ginting, head of the local Health District office, told a
group of reporters from local papers and USA TODAY that interviews with
the villagers were out of the question because of that anger.
A small matter, but emblematic of how difficult it can be to deal with a
nationwide health emergency in a country with a newly empowered
population reveling in freedom, democracy and the end to iron-clad
policies sent down from the capital of Jakarta.
Today the country is in the midst of the worst outbreak of the deadly
flu virus anywhere in the world.
Indonesia only threw off the yoke of dictatorship in 1998, holding its
first free national election in 2002. One of the main objectives of the
new democratic government has been to decentralize power.
That has meant that Indonesia hasn't been able to mount a strong,
centralized assault against avian influenza in poultry and humans.
Instead, it's fighting an outbreak-by-outbreak battle. Just last month,
four people died.
Health care workers have observed that outbreaks appear to come in
family clusters, but only in people linked by blood.
"No husbands and wives are infected; it's all brothers and sisters,
mothers and children," says Ginting. She and others believe there must
be a genetic component to susceptibility to the disease.
This view was confirmed in a report issued last week by the World Health
Organization in which researchers said human-to-human transmission
appears to be confined to genetically related people. People infected
with the bird flu variant common in Indonesia seem to be able to infect
only other people who carry the same genetic trait. In other words,
birds give it to people, but people can give it only to blood relatives.
The disease is very common in poultry flocks across Indonesia. By some
reports, as many as 30% of poultry in the country is infected with the
dangerous form of bird flu.
But the response that appears to have worked well in Vietnam,
vaccination of poultry, has been harder to implement in Indonesia. "As
Indonesia is decentralized up to the district level, currently
vaccination is carried out on the basis of availability at each
location," says Aphaluck Bhatiasevi with the United Nations Food and
Agriculture Organization in Jakarta.
Vaccine availability is low compared to the high number of chickens. Of
the country's 55 million households, about 80% have backyard poultry,
according to the U.N.'s Children's Fund.
"Preventive vaccination campaigns would require 1.2 billion doses of
vaccine per year just for backyard chickens in Indonesia," Bhatiasevi
says. Because of limited resources, she says that's simply not possible.
Last month, Indonesia's Agricultural Ministry announced it would
introduce regulations requiring that poultry be kept in coops. But
whether cities and towns can enforce that is an open question.
Worldwide the virus is killing a person about every four days, more than
double the 2005 rate. And Indonesia accounts for 58% of the deaths this
year and 36% since bird flu first became a threat in 2003.
With every human case, the virus has one more chance to mutate into a
form that is easily contagious between people.
People in the West don't always appreciate how horrible the H5N1 virus
is, says Irna Safrina, head of central disease control for the Karo
district of Sumatra. Bird flu is not an easy sickness or death. It
starts with a high fever that keeps rising, immune to the effects of
anti-fever medication, she says.
Next comes difficulty breathing. People usually succumb within two or
three days. And even when they're on ventilators to pump air into their
lungs, patients remain aware of what's happening. "They were all
conscious until they died, in a lot of pain," Ginting says.
Weise was in Indonesia as part of a U.S. State Department-sponsored
science journalism speaking tour.