VZCZCXRO2813
OO RUEHCHI RUEHDT RUEHHM
DE RUEHJA #6495/01 1421246
ZNR UUUUU ZZH
O 221246Z MAY 06
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 4659
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 9495
RUEHFR/AMEMBASSY PARIS 0863
RUEHRO/AMEMBASSY ROME 1877
RUEHIN/AIT TAIPEI 1804
RUEHHK/AMCONSUL HONG KONG 2138
RUEHBJ/AMEMBASSY BEIJING 3444
RUEHHM/AMCONSUL HO CHI MINH CITY 0072
RUEHGZ/AMCONSUL GUANGZHOU 0230

UNCLAS SECTION 01 OF 03 JAKARTA 006495 
 
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: MEDAN AVIAN INFLUENZA CLUSTER UPDATE 
 
REF: A) Jakarta 6150    B) Jakarta 6148 
 
JAKARTA 00006495  001.2 OF 003 
 
 
¶1. (SBU) Summary: Fatal cases of H5N1 infection have 
occurred in three separate locations in Indonesia since May 
18, 2006.  These include a seventh family member associated 
with the cluster of cases in Northern Sumatra (refs A and 
B).  Another family member identified with infection last 
week remains hospitalized.  Ministry of Health (MOH) 
investigators have offered no evidence of the source of 
infection.  Centers for Disease Control and Prevention (CDC) 
influenza specialist Dr. Tim Uyeki departed for Medan May 19 
to help the Ministry of Health (MOH) investigate the family 
cluster.  Another likely AI victim emerged in Surabaya last 
week, the second in as many weeks.  This time it was a 26- 
year old male from Jepara Central Java, who died May 20. 
Finally, a 39-year old male died at the main Infectious 
Diseases Hospital in Jakarta.  NAMRU-2 and the MOH's 
laboratory at NIHRD (Litbangkes) diagnosed all three cases. 
Samples have been shipped to the University of Hong Kong 
(UHK) and the CDC in Atlanta for confirmation.  All told, as 
of May 22, post reports 50 human AI cases as confirmed or 
probable, with 38 resulting in fatalities (76 percent).  End 
Summary. 
 
Medan Cluster Update 
-------------------- 
 
¶2. (SBU) Six family members have been confirmed with H5N1 
infection in North Sumatra, with another listed as probable 
following laboratory analysis at NAMRU-2.  Counting the 
index case, H5N1 infection is strongly suspected in eight 
cases, making this the largest family cluster studied.  The 
eighth victim died 22 May, reportedly after having sought 
relief from traditional medicine.  He was never 
hospitalized, although had taken Oseltamivir for three days 
before he died.  Afflicted family members had contact with 
the index case prior to the development of her illness. 
(Note: This most recent case has been remarkable for the 
rapid and cooperative investigation and laboratory 
diagnoses.  The specimens were collected in the afternoon of 
May 21 and flown immediately to Jakarta, where laboratory 
technicians at NAMRU-2 and MOH-NIHRD worked through the 
night and provided the GOI with results on the morning of 
May 22. 
 
¶3. (SBU) Centers for Disease Control and Prevention (CDC) 
influenza specialist Dr. Tim Uyeki traveled to Medan May 17 
to help Dr. Tom Grein from the World Health Organization 
(WHO) in Geneva and the Ministry of Health (MOH) with the 
ongoing investigation of the family cluster.  These two 
epidemiologists are working collaboratively with the 
district health department to set up surveillance within the 
village and among contacts with the cases.  The team is 
making progress in investigating the cluster, including 
interviewing some family members and limited visits to the 
village over the past week.  There is still no evidence of 
additional cases outside of the family cluster.  Family 
members who have had contact with the latest case are being 
provided with Oseltamivir.  The WHO team, including Dr. 
Uyeki, will likely stay in the community throughout the 
 
JAKARTA 00006495  002.2 OF 003 
 
 
week.  Unhindered access to the international and MOH team 
to the area remains a process of negotiation among local 
villagers within the community. 
 
¶4. (SBU) The FAO sent a team to North Sumatra on May 16 to 
investigate H5N1 infections in animals. To date, neither the 
FAO nor the Ministry of Agriculture (MOA) has found clear 
evidence of recent infections in swine, chickens or manure 
in the area, although the index case reportedly lost three 
chickens before the development of her symptoms and had 
worked closely with manure from poultry.  However, MOA 
contacts told us May 19 that the MOA found sero-positive 
chickens, ducks, and pigs in the area.  (Note: In February 
2006, the MOA laboratory identified H5N1 infection in 
poultry in the same district as the North Sumatra family 
cluster.  With funding from USAID, FAO will rapidly expand 
its animal surveillance and control program to North 
Sumatra). 
¶5. (SBU) The CDC and UHK have sequenced isolated viruses 
from all five of the initial wave of victims, and the CDC 
reports that while the sub-lineage of these viruses are 
unique from other human viruses in Indonesia, they are 
similar to previously characterized bird viruses from the 
North Sumatra region.  The viruses are purely avian in 
nature and no significant changes have been identified to 
suggest greater transmissibility among humans. 
Additional Deaths in Java 
------------------------- 
 
¶6. (SBU) Another victim has died in the Surabaya, East Java, 
the second in as many weeks.  According to the daily "Jawa 
Pos", the 19-year old male from Jepara Central Java died 
last Saturday, May 20 at Siloam Hospital in Surabaya.  The 
victim was reportedly hospitalized May 9 but died before he 
could be transferred to Dr. Sutomo Hospital, an AI reference 
hospital.  According to Siloam Hospital officials, the 
patient was admitted with pneumonia and high fever.  As his 
condition worsened, the medical staff suspected AI infection 
and took blood samples which they sent to the MOH laboratory 
in Jakarta.  In addition, a 39-year old male employed in the 
production of shuttle cocks used in badminton fell ill 19 
May and passed away May 21 at the Infectious Diseases 
Hospital in Jakarta.  In both instances, NIHRD and NAMRU-2 
identified H5N1 infection in the diagnostic samples. 
Confirmation is pending at the U.S. CDC and the UHK. 
 
Human AI Case Profile 
--------------------- 
 
¶7. (U) The recent activity in the past week has brought the 
number of confirmed H5N1 cases in humans in Indonesia to 44, 
with 34 deaths.  An additional 6 cases are probable.  All 
told, as of May 22, post reports 50 human AI cases as 
confirmed or probable, with 38 resulting in fatalities (76 
percent). 
 
¶8. (SBU) NAMRU-2 data indicates the following AI-related 
case profile as of May 22: 
 
-- Number of laboratory confirmed (positive PCR and/or 
 
JAKARTA 00006495  003.2 OF 003 
 
 
serology) human AI cases: 44, of which 34 have been fatal 
(fatality rate of 77 percent). 
 
-- Number of probable AI cases: 6, with 4 deaths (fatality 
rate of 67 percent). 
 
-- Number of cases awaiting verification by the US CDC: 4. 
 
-- Number of possible AI cases under investigation: 
approximately 18. 
 
-- Number of excluded AI cases: 302. 
 
PASCOE