VZCZCXRO4577
OO RUEHCHI RUEHDT RUEHHM
DE RUEHJA #6150/01 1351127
ZNR UUUUU ZZH
O 151127Z MAY 06
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 4277
RUEHPH/CDC ATLANTA GA IMMEDIATE
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC IMMEDIATE
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RHMFIUU/BUMED WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
RUEKJCS/SECDEF WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEKJCS/CJCS WASHDC
RUEHBY/AMEMBASSY CANBERRA 9464
RUEHFR/AMEMBASSY PARIS 0857
RUEHRO/AMEMBASSY ROME 1873
RUEHIN/AIT TAIPEI 1798
RUEHHK/AMCONSUL HONG KONG 2134
RUEHBJ/AMEMBASSY BEIJING 3436
RUEHHM/AMCONSUL HO CHI MINH CITY 0068
RUEHGZ/AMCONSUL GUANGZHOU 0226

UNCLAS SECTION 01 OF 04 JAKARTA 006150 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EAP/IET, A/MED AND S/ES-O 
DEPT FOR OES/FO, OES/EID, OES/PCI, OES/STC AND OES/IHA 
DEPT PASS TO USDA/FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG 
DEPT ALSO PASS TO USDA/FAS/FAA/DYOUNG AND USDA/APHIS 
DEPT ALSO PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL 
DEPT ALSO PASS TO HHS/BILL STEIGER AND AMAR BHAT 
PARIS FOR FAS/AG MINISTER COUNSELOR 
CANBERRA FOR APHIS/DHANNAPEL 
ROME FOR FAO 
NSC FOR JMELINE 
BANGKOK FOR RMO, CDC, USAID/RDM/A 
USPACOM ALSO PASS TO J07 
 
E.O. 12958: N/A 
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU
SUBJECT: INDONESIA REPORTS LARGE AVIAN INFLUENZA (AI) 
CLUSTER IN MEDAN 
 
REF: A) Jakarta 6148;   B) Jakarta 6024 and previous 
 
JAKARTA 00006150  001.2 OF 004 
 
 
¶1. (SBU) Summary: Six members of a Medan family have tested 
positive for the H5N1 virus by NAMRU-2, and five have died 
as of May 15.  Four of these have been confirmed by both the 
University of Hong Kong (UHK) and CDC Atlanta.  Two members 
from this cluster remain hospitalized, with one intubated 
and progressing poorly.  A final hospitalized relative has 
tested negative for H5N1.  A nurse who treated the infected 
patients has also tested negative for H5N1.  There have been 
no new cases since the initial emergence of this large 
family cluster.  WHO and NAMRU-2 officials are helping the 
Ministry of Health (MOH) investigate the cluster.  NAMRU-2 
also confirmed that a 38-year female from Surabaya who died 
May 11 tested positive for H5N1, as did a 12-year old male 
from West Jakarta.  The WHO is sending extra epidemiologists 
to assist in the investigations.  End Summary. 
 
Large AI Cluster in Medan 
------------------------- 
 
¶2. (SBU) Since May 4, six members of a North Sumatra family 
have died, with five shown to have been infected with avian 
influenza (Ref A).  No samples were taken from the 40 year 
old female index case prior to her burial.  Two other family 
members remain hospitalized with the prognosis quite poor 
for one.  Indonesian and U.S. scientists have expressed 
concern about this extended family cluster and the rapidity 
of cases/deaths.  However, they believe the fact that 
secondary cases have not arisen is a positive sign. 
 
¶3. (SBU) Center for Disease Control and Prevention (CDC) 
influenza specialist Dr. Tim Uyeki, currently on TDY in 
Jakarta, has noted there is a need for additional 
information about the Medan cluster before human-to-human 
transmission can be ruled out.  However, not surprisingly, 
distraught relatives are not cooperating with health 
officials.  Dr. Uyeki believes that GOI officials still need 
to sort out both animal and human exposures.  (Note: There 
have been clusters in Indonesia before, but because of lack 
of epidemiological evidence, there has been exists little 
information on the causes of the clusters). 
 
¶4. (SBU) The MOH said that on May 12, the Directorate 
General of Disease Control and Environmental Health (P2M) 
shipped specimens to Hong Kong University.  NAMRU-2 also 
shipped samples on May 12 to the CDC.  As of 15 May, both 
UHK and the CDC have confirmed infection in four of the 
patients. 
 
 
 
Case Profiles 
------------- 
 
¶5. (SBU) NAMRU-2 provided the following profiles of the 
Medan patients: 
 
-- The index case is a 40-year female named Puji.  She 
 
JAKARTA 00006150  002.2 OF 004 
 
 
became ill April 27, was hospitalized May 2 at a local 
clinic, and died May 4.  Authorities did not take samples 
from her so they cannot determine whether she died of an 
H5N1 infection.  She also suffered from tuberculosis.  The 
patient attended a community cookout April 29 at a soccer 
field behind her residence at which both chicken and pork 
were served.  Each of the victims confirmed to be infected 
with H5N1 attended the cook out. 
 
-- Puji's 19-year old son Roy Karo Karo suffered the onset 
of AI symptoms on May 4, was admitted to the Adam Malik 
hospital May 8, and expired May 9.  NAMRU-2 found samples 
drawn from him AI positive May 11 and the CDC confirmed on 
May 15. 
 
-- Another of Puji's son, 18-year old Boni Karo Karo, 
displayed AI-like symptoms May 6, was hospitalized at Adam 
Malik May 8, and died May 12.  NAMRU-2 found samples drawn 
from him AI positive May 12 and the CDC confirmed on May 15. 
 
-- Puji's sister, 29-year old Anta Ginting, became ill May 
4, was hospitalized at Adam Malik May 8, and died May 10. 
NAMRU-2 found samples drawn from her AI positive May 11 and 
the CDC confirmed on May 15. 
 
-- Anta Ginting's daughter, 18-month old Rena, experienced 
AI symptoms May 3, was taken to a local clinic May 6, 
admitted to Adam Malik hospital May 9, was removed from the 
hospital May 12, returned to the same hospital May 13, and 
subsequently died May 14.  NAMRU-2 confirmed her as AI 
positive May 11. Neither CDC nor UHK have confirmed. 
 
-- The brother of the index case, 25-year old Jonas Ginting, 
became ill May 4, was admitted to Adam Malik hospital May 8, 
ran away May 12 and returned to the same hospital May 13. 
He is now on a ventilator.  NAMRU-2 confirmed him as AI 
positive May 11 and the CDC confirmed May 15. 
 
-- Puji's nephew, 10-year old Rafael, suffered an onset of 
AI symptoms May 3, was sent to Adam Malik hospital May 9, 
and declared dead May 14.  NAMRU-2 confirmed him as AI 
positive May 11; CDC results are pending. 
 
-- Puji's other sister, 35-year old Terang, fell ill May 8 
with vague symptoms not suggestive of H5N1, and was 
hospitalized May 9 (presumably at Adam Malik).  She has 
tested negative for H5N1 at NAMRU-2. 
 
The village where the Ginting family resides is reportedly 
in a mountainous region 2 1/2 hours from Medan, the capital 
of North Sumatra.  It is reportedly a non-Moslem area, where 
there are very few ducks but many swine and chicken.  Local 
veterinary officials also reported no recent cases of AI in 
poultry.  They said initial sampling of manure behind the 
family's home and testing of poultry in the area came up 
negative. 
 
One AI Death in Surabaya 
-------------------------- 
 
JAKARTA 00006150  003.2 OF 004 
 
 
 
¶6. (SBU) NAMRU-2 has also confirmed that a 38-year female in 
Surabaya who died May 11 tested positive for avian 
influenza.  The University of Hong Kong has confirmed this 
result.  Dr. Palilingan, Head of Research on human-to-human 
AI transmission at Dr. Sutomo Hospital told Congen Surabaya 
the patient was admitted to RKZ (Catholic) Hospital on May 
8th.  She subsequently died on May 12th.  Palilingan said 
authorities tested her for AI, sent the samples to the MOH 
lab in Yogyakarta, but that the results had not yet been 
released.  Paliling also noted that two hospital employees 
that tended to the AI patient, a nurse and another staff, 
are now suffering with high fevers.  They have also been 
tested locally for AI and dengue fever, which is now 
prevalent in Surabaya, but the results have not been made 
public. 
 
MOH Hosts Emergency Meetings 
---------------------------- 
 
¶7. (SBU) The Executive Director of Indonesia's National AI 
Committee, Bayu Krisnamukti, chaired emergency meetings at 
the MOH on the Medan cluster on May 14.  Many officials 
attended, including from the WHO and the MOH, CDC and NAMRU- 
¶2.  Bayu stated that the GOI would focus its AI efforts on 
13 provinces and districts.  He said the priorities would be 
animal and human investigations; surveillance and early 
detection; alerting of hospitals and clinics; controlling 
the source of the virus.  Bayu also announced that there 
would be an emergency cabinet meeting on May 16 to discuss 
the cases. 
 
¶8. (SBU) Immediately after the Bayu meeting, Uyeki met at 
the MOH's Command Post (Posko) with Dr. Nyoman Kandun, 
Director General of Disease Control and Environmental Health 
(P2M), Dr. Haryadi Wibisono, Director of Infectious Diseases 
at P2M, and other MOH and WHO officials to discuss the large 
Medan cluster, the potential for limited human-to-human 
transmission and possible next steps.  Key points that 
emerged included the importance of sending investigative 
teams to the field and ensuring coordination.  A WHO 
official said that an epidemiologist from its South East 
Asia Regional Office (SEARO) in New Delhi should arrive in 
Indonesia and proceed to Medan on May 15.  In addition, a 
veterinarian epidemiologist from WHO Bangkok could travel to 
Indonesia as early as May 16, with another epidemiologist 
from Geneva perhaps following.  The WHO epidemiologist in 
Medan thinks that the situation is under control at this 
time.  NAMRU-2 and Dr. Uyeki of the CDC are also working 
closely with the MOH. 
 
Human AI Case Profile 
--------------------- 
 
¶9. (U) With the five new confirmed H5N1 case in humans in 
the past week, the number of confirmed H5N1 cases in humans 
has jumped to 41, with 31 deaths. An additional seven cases 
are probable.  All told, 47 cases are confirmed or probable 
with 35 resulting in fatalities (74 percent). 
 
JAKARTA 00006150  004.2 OF 004 
 
 
 
¶10. (SBU) NAMRU-2 data indicates the following AI-related 
case profile as of May 15: 
 
-- Number of laboratory confirmed (positive PCR and/or 
serology) human AI cases: 41, of which 31 have been fatal 
(fatality rate of 76 percent). 
 
-- Number of probable AI cases:6, with 4 deaths (fatality 
rate of 67 percent). 
 
-- Number of cases awaiting verification by the US CDC: 3 
 
-- Number of possible AI cases under investigation: 
approximately 22. 
 
-- Number of excluded AI cases: 286. 
 
PASCOE