Robert Roos  News Editor

Jun 19, 2008 (CIDRAP News) – The World Health Organization (WHO) said today that Indonesia has officially notified it of two recent fatal human cases of H5N1 avian influenza that were reported previously by the news media.

The reporting to the WHO of the cases in a 16-year-girl and a 34-year-old woman comes 2 weeks after Health Minister Siti Fadilah Supari said Indonesia would stop announcing cases as they occur and instead list them only at longer intervals, perhaps as long as 6 months. The comments raised questions about the government"e;s compliance with the International Health Regulations (IHR), which call for countries to promptly report human cases of avian flu and certain other diseases to the WHO.

David Heymann of the WHO drew a distinction between Indonesia"e;s public announcements of H5N1 cases and its reports to the WHO, according to a Reuters report published today.

"The minister [Supari] has told WHO they will not continue to share publicly whenever there is a new case but they will inform the WHO in conformity with IHR," said Heymann, who is the WHO"e;s assistant director-general for health security and environment.

Heymann told Reuters the WHO encourages all governments to provide information freely to their populations, but it is their decision.

Today"e;s WHO statement, citing information from the Indonesian health ministry, said the 16-year-old girl was from South Jakarta and fell ill on May 7; she was hospitalized May 12 and died 2 days later. There was evidence that she had been exposed to sick and dead poultry, the agency said.

Supari had reported the girl"e;s case to the Associated Press (AP) 2 weeks ago but had described her as a 15-year-old.

The WHO said the 34-year-old woman was from Tangerang district, west of Jakarta. She became ill May 26 and died Jun 3 after a day in a hospital. An investigation into the source of her exposure was continuing.

The AP on Jun 13 had reported that a 34-year-old woman named Susi Lisnawati had died of avian flu on Jun 3. Several government officials who requested anonymity had confirmed the case, but the government had not informed the woman"e;s husband that she had the virus, according to the story.

The two latest cases raise the WHO"e;s H5N1 count for Indonesia, the hardest-hit country, to 135 cases with 110 deaths. The global count has reached 385 cases, including 243 deaths.

Heymann told Reuters that Indonesian authorities were trying to confirm another suspected H5N1 case that was fatal.

According to Reuters, another WHO official said the agency has a good relationship with Indonesia, despite the country"e;s reluctance to share H5N1 virus isolates. Indonesia is seeking guarantees that it will receive a supply of any vaccines developed from the isolates it provides.

"There is a strong working relationship between the WHO country office and the government," John Rainford, a WHO spokesman in Geneva, told Reuters. "Even if there is a conflict on issues like virus-sharing, it hasn"e;t eroded the ability to carry out joint investigations."

A WHO official who requested anonymity told CIDRAP News this week that the agency had been aware of recent H5N1 cases in Indonesia despite the delay in receiving official notification.

Speaking before the latest case confirmations, the official said, "The fact that you don"e;t yet have official notification of any cases doesn"e;t mean there isn"e;t unofficial awareness." He said the two recent cases didn"e;t change WHO experts"e; assessment of the risk posed by the virus.

If the cases had signaled more of a threat, the information would have been handled differently, he suggested. "If we were dealing with something much more serious, I think there would be a very, very different approach by all involved in getting the information. If you had a cluster of something behaving in an unusual fashion, the pressure to share it would be very high."