VZCZCXRO0353
OO RUEHCHI RUEHDT RUEHHM
DE RUEHJA #7166/01 1580646
ZNR UUUUU ZZH
O 070646Z JUN 06
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC PRIORITY 5390
RUEHPH/CDC ATLANTA GA PRIORITY
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 9558
RUEHFR/AMEMBASSY PARIS 0892
RUEHRO/AMEMBASSY ROME 1882
RUEHIN/AIT TAIPEI 1809
RUEHHK/AMCONSUL HONG KONG 2143
RUEHBJ/AMEMBASSY BEIJING 3460
RUEHHM/AMCONSUL HO CHI MINH CITY 0077
RUEHGZ/AMCONSUL GUANGZHOU 0235

UNCLAS SECTION 01 OF 03 JAKARTA 007166 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EAP/MLS, EAP/IET, A/MED AND S/ES-O 
DEPT FOR G/AIAG/JLANGE AND RFENDRICK 
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/WSTEIGER/ABHAT/MSTLOUIS 
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: AVIAN INFLUENZA UPDATE 
 
REF: A) Jakarta 6812 and previous 
 
JAKARTA 00007166  001.2 OF 003 
 
 
¶1. (SBU) Summary:  Over the last four weeks, Indonesian 
authorities have investigated four potential avian influenza 
(AI) clusters with assistance from the World Health 
Organization (WHO) and NAMRU-2.  These include the well- 
documented North Sumatra family cluster that resulted in 
seven confirmed H5N1 cases; a brother and sister in Bandung, 
West Java; a family in Solok, West Sumatra; and two children 
in the Jakarta suburb of Tangerang.  Health care workers in 
Medan and Bandung who reported some association in the 
treatment of confirmed H5N1-infected patients have been 
hospitalized, but H5N1 infection has been ruled out.  NAMRU- 
2 and the Ministry of Health (MOH) have determined that a 15- 
year-old male from Tasikmalaya, West Java who was admitted 
to a Bandung hospital on May 28 was infected with H5N1. 
NAMRU-2 and the MOH laboratory continue to collaborate on 
testing of H5N1 suspects. Despite the increase in human 
cases, the U.S. Centers for Disease Control and Prevention 
(CDC) has found no evidence to conclude that the H5N1 virus 
in Indonesia has changed to become more transmissible. 
Indonesia currently ranks second in the world in both H5N1 
cases (51 confirmed) and deaths (39).  End Summary. 
 
Update on Recent AI Clusters 
---------------------------- 
 
2.(SBU) As of June 7, one patient from the North Sumatra 
cluster remains hospitalized and will likely recover.  Other 
recent AI cluster activity includes the following: 
 
--The WHO-H5 Reference Center at Hong Kong University has 
confirmed that an 18-year-old male and 10-year-old female 
from Bandung, West Java were infected with the H5N1 virus. 
Both patients died after hospital admission on May 22.  The 
CDC confirmed the 10-year-old female as H5N1 positive.  Two 
nurses who had treated the two siblings at Hasan Sidikin 
Hospital in Bandung, West Java (reftel) subsequently 
complained of influenza-like symptoms.  However, NAMRU-2 and 
the MOH laboratory have diagnosed both as H5N1 negative. 
 
--On 22 May, a previously healthy 14-year-old female from 
Solok, West Sumatra reported to a local health clinic in 
Bukit Sileh with a fever (six days) and cough.  Two of the 
patient's sisters had died on 14 and 21 May after exhibiting 
several days of fever, coughing and dyspnea.  The clinic 
referred the patient to M. Djamil Hospital in Padang, were 
she is currently undergoing treatment for an acute 
respiratory disease.  A MOH team, including a NAMRU-2 
clinician, investigated and found that the victims had 
processed and cooked an ill chicken prior to the development 
of symptoms.  Also, reports of dead and dying birds were 
evident within the community.  NAMRU-2, the MOH and the WHO- 
H5 Reference Center in Hong Kong have confirmed H5N1 
infection in the 14-female, who is recovering.  While only a 
single case was confirmed, this remains a suspected family 
cluster. 
 
--A 15-year-old male from Tasikmalaya, West Java reported to 
 
JAKARTA 00007166  002.2 OF 003 
 
 
Hasan Sadikin Hospital in Bandung on May 28 with an illness 
consistent with H5N1 infection.  The patient died shortly 
after admission.  Samples analyzed at NAMRU-2, the MOH and 
Hong Kong University have determined that he was infected 
with an H5N1 virus. 
 
Conflicting Test Results for Probable AI Cluster 
--------------------------------------------- --- 
 
¶3. (SBU) In addition to the confirmed clusters described 
above, there have been conflicting test results in the case 
of probable H5N1 infection in two children from the Jakarta 
suburb of Tangerang. A five-year-old male and seven-year-old 
female were afflicted with influenza-like symptoms and 
respiratory distress after contact with dying poultry in a 
nearby slaughterhouse. Both were treated at Fatmawati 
Hospital in Jakarta on May 28.  The five-year-old male has 
died but the seven-year-old female remains alive. However, 
despite epidemilogic evidence of exposure to dying chickens, 
after extensive testing, neither NAMRU-2, the CDC, nor the 
University of Hong Kong have confirmed H5N1 infection from 
multiple specimens taken from the children.  At the same 
time, tests for H5N1 at the MOH laboratory were positive. 
NAMRU-2 has cause to believe that the MOH laboratory has 
experienced a recent problem with specimen contamination. 
 
Nurses H5N1 Negative 
-------------------- 
 
¶4. (SBU) Investigators associated with the WHO have 
identified two nurses in Medan who had some contact with 
earlier confirmed H5N1 cases and who complained of mild 
recent illness.  A 42-female nurse reported cough and fever 
on June 1, and was treated with Tamiflu (oseltamivir) at 
Adam Malik Hospital in Medan.  As of June 7, the nurse has 
left the hospital and her whereabouts are unknown.  A second 
nurse had showed less specific symptoms on May 28th (sore 
throat, cough, myalgia, no fever), but had normal x-ray 
readings and received no Tamiflu treatment.  She remains 
well.  NAMRU-2 and the MOH laboratory have determined that 
samples from each nurse were negative for H5N1-infection. 
However, an H1N1, or normal influenza A virus, was found in 
samples taken from the 42-year old nurse. 
 
¶5. (SBU) Human influenza A (H1N1) and A (H3N2) and influenza 
B viruses circulate throughout the year across Indonesia. 
In the last six months, NAMRU-2 has diagnosed at least five 
health care professionals who have interacted with H5N1 
cases with non-avian, normal human influenza viruses.  NAMRU- 
2 maintains surveillance in 30 sites across Indonesia and 
provides isolates and information to the WHO Influenza 
Reference Centers for the purpose of vaccine preparation. 
 
Human AI Case Profile 
--------------------- 
 
¶6. (SBU) In the past week, the number of confirmed H5N1 
cases in humans in Indonesia rose from 47 to 51, with 39 
deaths.  NAMRU-2 data indicates the following AI-related 
 
JAKARTA 00007166  003.2 OF 003 
 
 
case profile as of June 06: 
 
-- Number of laboratory confirmed (positive PCR and/or 
serology) human AI cases: 51, of which 39 have been fatal 
(case fatality rate of 76 percent). 
 
-- Number of probable AI cases: 5, with 3 deaths (fatality 
rate of 60 percent). 
 
-- Number of cases awaiting verification by the US CDC three 
 
-- Number of possible AI cases under investigation: 
approximately 13. 
 
-- Number of excluded AI cases: 310. 
 
PASCOE