Experts descend on Jakarta to sort out bird flu outbreaks

An international team of experts are meeting in Jakarta this week to assess the avian flu situation in Indonesia.

Experts from the World Health Organisation (WHO), the UN Food and Agriculture Organisation (FAO), UNICEF and agencies including the US and European centres for disease control will meet in Jakarta to look at the introduction of measures to reduce bird flu in Indonesia, where human cases of H5N1 infection have risen at a disturbing rate over the past year.

This follows the confirmation by the Ministry of Health in Indonesia of the country's 50th case of human infection with the H5N1 avian influenza virus.

The latest case was in a 7-year-old girl who developed symptoms on 26 May, was hospitalized on 30 May, and died on 1 June.

Her 10-year-old brother died of respiratory disease on 29 May, but no specimens were taken for testing and the cause of his death is undetermined.

An investigation has discovered a history of chicken deaths in the household and neighbourhood before the illness developed but laboratory tests of surviving family members and close contacts have revealed no further cases.

The experts are meeting as a result of a request from the Indonesian government, and is being welcomed as a sign that Indonesia is concerned about the threat posed by H5N1 both for its citizens and the global community.

The meeting comes as criticism of Jakarta's response to the H5N1 threat is growing, in particular its failure to control the spread of the virus in animals.

Many experts also say that while Indonesia continues to meet with international experts it is doing little to implement their recommendations.

It seems Indonesia's National Committee for Avian Influenza Control and Pandemic Influenza Preparedness asked the WHO and its animal health counterpart, the Food and Agriculture Organization, to bring a variety of experts to Indonesia to study the scope of the problem and make recommendations on how best to deal with it.

Since Indonesia began reporting human cases of H5N1 last July, infections have been occurring at the rate of one a week on average and the WHO says they are concerned about cases which are turning up across a vast region and the number of clusters occurring.

To date of the 49 confirmed cases, 37 have died but a number of other people are suspected of having had the virus, but died and were buried or cremated before samples could be taken to test for infection.

Of the 10 countries that have recorded human cases of H5N1, Indonesia to date has had the second highest number of cases; only Vietnam exceeds that of Indonesia.

But Vietnam's efforts to combat the virus in poultry flocks appear to have been successful and the country has not reported a human case of H5N1 since last November.

Many of the Indonesian cases have occurred in clusters of two or three, although last month the largest cluster of cases seen to date, eight members of a single family, had health authorities around the world on alert.

The WHO suspects that particular cluster probably involved human-to-human-to-human spread, the first time such prolonged transmission is thought to have occurred.

Also of concern is the fact that many of the human cases in Indonesia have occurred in areas where no outbreaks of the virus have been reported in poultry.

Experts say that points to gaps in the country's veterinary surveillance capacity.

The lethal H5N1 strain of bird flu has spread over the past two years from South East Asia to Europe the Middle East and west Africa, sparking fears of a global pandemic.

To date Indonesia and Vietnam have the highest number of cases of the deadly H5N1 virus accounting for 81 of the 123 confirmed human deaths from the virus since 2003 and of the 50 cases confirmed to date in Indonesia, 38 have been fatal.

Indonesia has apparently come under intense pressure at a donors' meeting in Vienna this month planned as a follow up on $1.9bn in pledges made in Beijing in January to help developing countries tackle H5N1.

A joint mission by the World Bank, FAO and WHO also offered 30 pages of recommendations for action by Jakarta in April.

Although a WHO official has said Indonesia has made progress in identifying and tackling human infection recently, there is a danger of stigmatising the country, suspicion on both sides appears to be contributing to a stalemate on how to finance Jakarta's plans.

Indonesia has asked for $900m over three years to help fight bird flu since the Beijing meeting, though western experts say a figure of $200m is more realistic.