Apr 4, 2006 (CIDRAP News) – The H5N1 avian influenza virus caused the deaths of two Indonesian girls, one late last month and the other dating back to July 2005, authorities said today.

A 20-month-old girl from Kapuk, West Jakarta, who died on Mar 23, suffered from a fatal H5N1 infection, bringing to 30 the number of human cases of the illness in Indonesia. Twenty-three of those people died of the disease.

The World Health Organization (WHO) announced confirmation of the toddler’s infection today. The agency said investigation has shown that chickens near her home were dying about a week before she got sick. Although chicken deaths are ongoing in her Kapuk neighborhood, authorities have not yet identified the cause, WHO added.

Observation and testing of the girl"e;s contacts are under way, WHO said. Although initial tests have been negative, follow-up continues.

In addition, an 8-year-old girl who died last July has finally been confirmed as a victim of H5N1, an Indonesian health ministry official told Reuters news service today. (Some earlier reports had listed her age as 9.)

News reports from Indonesia in July said the girl had tested positive for the virus locally. The government had had problems obtaining blood samples for testing at the WHO reference laboratory in Hong Kong, the Reuters report said today. Indonesian authorities received the new test result yesterday, according to Reuters.

The girl was part of a suspected family cluster of the first human H5N1 illnesses in Indonesia: her father, 38, and sister, 1, also died in July. Her father tested positive for the H5N1 virus, but the sister wasn’t tested, according to an Australian Broadcasting Corporation (ABC) report today.

“Some experts believe the lack of proper testing facilities in Indonesia is hampering the fight against the disease,” the story said, without giving names or other details.

The story added that WHO has confirmed 8-year-old"e;s case as well, although WHO has not yet posted the information online. Assuming it is confirmed, the case will raise Indonesia’s death toll to 24 fatalities in 31 cases and increase the WHO"e;s global count to 109 deaths out of 192 cases.

In other news, China appears to be acceding to international requests to share more information on avian flu. The nation will provide samples from four human patients to the WHO, said Wang Yu, director of the Chinese Center for Disease Control and Prevention, as reported by Xinhua, the government’s news service.

Xinhua said China forwarded two samples to WHO last December as well. Still, the sharing of samples is far from complete, given that China has reported 16 H5N1 cases with 11 deaths.

Recent human cases in Guangzhou and Shanghai have challenged Chinese authorities’ supposition that cases in rural areas are the result of the healthcare system and health conditions, Wang said in the Xinhua story. The urban cases show the virus can still infect people in places where the healthcare system is more advanced and hospital access is better.

“Although there’s no evidence that the two patients had clear exposure to dead poultry, it doesn’t mean there’s no virus in poultry in the city environment,” added Wenqing Zhang of the WHO’s global flu program.