The outbreak of human avian influenza cases initially sparked fears that the H5N1 virus had mutated into influenza virus easily transferred among humans. However, the World Health Organization (WHO) and other medical experts believe the virus has not mutated into a transmittable pandemic form of the virus, and there is instead another explanation for the cluster of seven victims in the Indonesian village of Kubu Sembelang.
The WHO believes a 37-year old woman was infected while working at a poultry market. Prior to her death, the woman is believed to have passed the virus to her 10-year old nephew who passed it to his father. It is likely that the virus continued to spread among the family due to prolonged exposure to infected family members. According to the WHO, ?all confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness.?
While this outbreak represents the first time the virus has spread from one person to a second and then on to a third, it is not the first time that the virus has spread as the result of human-to-human contact. WHO spokesman Dick Thompson notes that there have been “maybe four to five” cases of human-to-human transmission since late 2003. For example, evidence of human-to-human transmission was seen in Thailand in 2004. As reported in the January 27, 2005, issue of the New England Journal of Medicine, the virus probably spread from an 11-year old girl in to her aunt and mother.
Given the precedence of transmission among humans and the spread of the virus among the Indonesian family without a corresponding mutation, other health experts believe that genetics may have played a dominant role in the virus?s transmission. One such expert, Robert Webster, a virologist at St. Jude Children’s Research Hospital in Memphis, stated, ?there have been family clusters. So there has to be certainly a genetic aspect to it.? Furthermore, another leading expert, Hiroshi Kida of Japan’s Hokkaido University, believes that people infected with H5N1 virus have a carbohydrate receptor?called alpha 2,3?on cells lining their throats. Typically, human influenza viruses bind with another receptor prevailing in humans called alpha 2,6. According to Kida, “I think people who are infected with avian strains are special. They must have alpha 2,3 receptors.?
While the Indonesian cluster does not appear to be the result of a mutation to a pandemic form of the virus easily spread among humans, there are still worrying trends found in this cluster. This case acutely demonstrates that poorer countries are in desperate need of assistance in combating the spread of the bird flu. Due to economic constraints, Indonesia is struggling to implement policies and procedures that will aid in the detection and prevention of further outbreaks of the virus. According to Steven Bjorge, a WHO epidemiologist, ?we’re finding out the longer our team stays up in that area is [sic] that there are many, many outbreaks in chickens that always go unreported.”
Additionally, in the case of Indonesia, the central government is struggling to earn the trust of its citizens as it tries to combat the further spread of the bird flu. For example, the central government has not implemented a policy of culling infected flocks of poultry in part because it does not have the finances to compensate its farmers for their decimated flocks and, therefore, does not want to provoke a backlash from citizens who depend on home-grown poultry for their livelihood. It is instructive to note that in a show of protest against the central government, about 100 Karo chicken traders killed live chickens with their bare hands and have promised to hold a traditional feast that includes slaughtering pigs and poultry and cooking them in blood.
In comparison to Indonesia?s struggles, it is believed to be endemic in nearly every one of the country?s 33 provinces; Thailand and Vietnam appear to have at least temporarily staunched the spread of the virus. As a result, it appears that Indonesia is in desperate need of aid that will enable it to implement a greater surveillance capability and properly compensate its poultry farmers should the government decide to cull infected flocks. Entities with operations in Indonesia, although appropriate globally, would be well advised to have continuity of operation plans in place and well publicized among employees should concerns rise of infection. Further, providing education to employees on transmission and mitigation would also go far in thwarting unnecessary panic. Finally, while the issue currently involves only chicken farmers, shows of solidarity may also include workers from other industries; should this occur, the Indonesian economy may experience serious setbacks. It is in the world?s interest to deliver this aid, as an outbreak of a pandemic influenza virus will affect the entire world and not just Indonesia.
