The Ministry of Health in Indonesia has confirmed an additional seven cases of human infection with the H5N1 avian influenza virus. Six of the cases were fatal.
One fatal case, in a 38-year-old woman, occurred in the city of Surabaya, in East Java. She developed symptoms on 2 May, was hospitalized on 7 May, and died on 12 May. The case is the first reported from this area.
The remaining six cases are from the village of Kubu Sembelang in the Karo district of North Sumatra. All six are members of an extended family, and all but one lived in neighbouring houses.
Associated with the Kubu Sembelang outbreak is a seventh family member, a 37-year-old woman. She developed symptoms on 27 April and died of respiratory disease on 4 May. No specimens were obtained before her burial, and the cause of her death cannot be confirmed. She is, however, considered the initial case in this family cluster.
The six confirmed cases in Sumatra include the woman’s two sons, aged 15 and 17 years, who died respectively on 9 May and 12 May. The 28-year-old sister of the initial case died on 10 May. This sister had an 18-month-old girl, who died on 14 May. The fifth confirmed case, who is still alive, is the 25-year-old brother of the initial case. The sixth confirmed case is the 10-year-old nephew of the initial case. He died on 13 May.
One additional family member, who had been hospitalized, has subsequently been ruled out based on both negative laboratory results and the absence of clinical symptoms compatible with H5N1 infection.
This is the largest cluster of cases, closely related in time and place, reported to date in any country and is being carefully investigated by Indonesia’s ministries of health and agriculture and by WHO epidemiologists. The source of exposure for the initial case is still under investigation, with exposure to infected poultry or an environment contaminated by their faeces considered the most plausible source.