The World Health Organisation (WHO) has confirmed five bird flu deaths in Indonesia and says that the disease has now spread to the Horn of Africa.
According to the WHO four of the Indonesian deaths were in members of one family in North Sumatra and one was in the country's second largest city, Surabaya, in East Java where a 38-year-old catering businesswoman who had dealt with live pigs and pork meat died last week.
Earlier eight members of a single family in North Sumatra were infected and six of them have since died, conclusive test results on the sixth death are still pending.
To date 30 of the 38 human cases of bird flu in Indonesia have proved fatal.
Experts are now studying "cluster" cases of the disease for indications that the H5N1 virus may have mutated into a form easily passed between people which could trigger a global human pandemic.
The virus has already infected poultry in 27 of Indonesia's 33 provinces, including Irian Jaya and the resort island of Bali.
Critics have castigated the Indonesian government for being reluctant to carry out mass bird slaughters in infected areas.
Tests have confirmed the two-year-old girl infected in a rural village in Djibouti, in the Horn of Africa has the H5N1 virus and three of her siblings are also suspected of having bird flu.
According to the WHO Djibouti health authorities are attempting to track the spread of the infection following reports of a small number deaths in chicken deaths in early April but have been hampered by the country's limited resources.
The WHO says the situation has been rendered even more complicated by an outbreak of dengue fever, which can mask the occurrence of other febrile illnesses with abrupt onset of symptoms.
The WHO says that there is concern as many households in Djibouti keep small numbers of poultry, and the extent of infection in animals was poorly understood.
The slaughtering of poultry was apparently halted when angry villagers refused to cooperate unless they received immediate compensation.
Djibouti has appealed for international help to fight the disease.
The addition of the latest cases takes the bird flu death toll to 120 out of the 213 people in 10 countries infected by the disease.
Virtually all victims caught the disease from poultry.
At present the virus remains a disease in birds and is difficult for humans to catch.
Bird flu first emerged in the far east in 2003 but has spread to Africa and Europe in recent months.
Although more than 200 millions birds have died, the disease has rarely spread to humans but experts fear the virus might mutate into a form which transfers between people.