Jun 1, 2006 (CIDRAP News) – Indonesian officials reported still another human case of H5N1 avian influenza today on the basis of local tests, while the cause of the recent family cluster of cases in Sumatra continued to elude investigators.

A hospitalized 8-year-old girl from Pamulang, on the outskirts of Jakarta, tested positive for the virus in a local laboratory, according to an Associated Press (AP) report quoting Nyoman Kandun of the Indonesian Health Ministry. The story gave no other details on her case.

Indonesia"e;s confirmed avian flu toll stands at 48 cases with 36 deaths, according to the World Health Organization. The 8-year-old girl"e;s case and a fatal case in a 15-year-old boy, reported yesterday, have not yet been confirmed by a WHO-accredited laboratory.

Indonesia had 15 cases, 11 of them fatal, in May, according to WHO reports. The country"e;s toll is second only to that of Vietnam, which has had 93 cases and 42 deaths, but none in recent months.

The recent case cluster in North Sumatra province accounted for seven of the 15 cases in May. A WHO official said at a press conference in Jakarta today that investigators still haven"e;t determined what touched off the case cluster, which, officials have said, probably involved limited human-to-human transmission.

"There are three possible sources of infection, but there is no conclusion," said WHO epidemiologist Stephen Bjorge, as quoted by Agence France-Presse (AFP). As suggested by the WHO previously, he said the 37-year-old woman who was the first family member to get sick might have been infected by her sick chickens, by chicken feces she used as fertilizer, or at a "wet" market where chickens are sold.

Meanwhile, Indonesian Health Minister Siti Fadilah Supari today denied that the family cluster involved human-to-human transmission, according to the AP. "I say firmly that it has not yet been transmitted from humans to humans," she said.

However, Indonesian authorities plan to continue monitoring the village where the cluster occurred for 3 more weeks, a week longer than recommended by the WHO, according to the AFP report.

Bjorge said Indonesia is doing too little to control the disease in birds, AFP reported. "The situation is that there is a leak in the roof, and the ministry of health is just mopping up the floor every day," he said. "And the leak in the roof is this continuing transmission of the virus from bird to bird."

He said Indonesia needs to launch mass culling of infected birds and increase testing of birds suspected of infection.

The AP reported that authorities killed about 1,300 chickens today within a half mile of the home of the 15-year-old boy whose fatal case of avian flu was reported yesterday. The boy lived in the Tasikmalaya district of West Java province.