Feb 6, 2006 (CIDRAP News) – As the number of human cases of avian influenza in Indonesia continues to climb, the country is ramping up efforts to stem its spread.

The World Health Organization (WHO) today confirmed four more H5N1 infections, including two fatalities.

Of the two fatal cases, one was in a 22-year-old West Java man who died Jan 26, WHO reported. He sold bananas at a market in East Jakarta that also features poultry vendors. The other was in a 15-year-old boy, also from West Java, who died Feb 1, about a week after poultry deaths were reported in his neighborhood.

One nonfatal case was that of a 9-year-old girl from West Java who was hospitalized on Jan 19 and has fully recovered, WHO said. The other confirmed illness was in a 5-year-old boy from Lampung province who fell sick in October 2005. He is the brother of a 20-year-old man who had a confirmed case and also recovered fully.

The boy and his brother were both exposed to sick poultry in the course of slaughtering birds. The boy"e;s initial tests were inconclusive, WHO said, but the infection was confirmed retrospectively from antibody levels in blood samples taken while he was sick and during his recovery.

The confirmatory testing brought WHO"e;s case count for Indonesia to 23, including 16 deaths. Yet even before the organization updated its records, Indonesia was reporting another death. The country announced its 17th fatality (and 24th case) after a 38-year-old woman died in West Java on Feb 4, according to a story today from United Press International (UPI). Local tests found the woman had H5N1 infection, but samples were being sent to the WHO-affiliated laboratory in Hong Kong for confirmation.

Concerned by the continuing human cases, the Indonesian government is planning door-to-door poultry surveillance efforts, the agriculture minister said today, according to The Jakarta Post.

The goal of the inspections is to prevent the spread of the H5N1 virus, said the minister, Anton Apriantono. Door-to-door visits are already being conducted for poultry in Sumedang and Purwakarta districts in West Java, and other regions could receive the same treatment soon, he said.

"We are trying to be proactive," Apriantono said.

Elsewhere it appears that the virus may be continuing its march among people and poultry.

In Iraq, a second fatal human case of H5N1 infection has been confirmed, according to an Agence France-Presse (AFP) story published today. The second case involves Hamma Sur Abdullah, 40, who is the uncle of the first case-patient, a 15-year-old girl who died in January. A Cairo laboratory confirmed his death was the result of H5N1 infection, a senior Kurdish health official told AFP. Additional testing is being conducted at a lab in Britain on samples from the uncle, as well as on samples from a woman from the same region who is currently hospitalized in Iraq.

Seven patients with suspected H5N1 cases were being treated in Iraq, AFP reported, as international experts began an on-the-ground assessment in the Kurdish north. Other news agencies put the figure as high as a dozen suspected cases. Samples from the suspected cases are being tested in Cairo.

Since the first Iraqi died of H5N1 in January, more than 900,000 chickens and migratory birds have been culled, according to the Integrated Regional Information Networks (IRIN) of the United Nations. Farmers in the Sulaimaniyah area are seeking compensation for their losses, IRIN reported today. More than 200 farmers protested peacefully on Feb 4.

Poultry infected with an H5 virus have been found in Bulgaria, a discovery that prompted officials there to block people"e;s access to a wetlands area, according to Reuters news service.

A Reuters story published today said samples from a paralyzed, infected swan were being sent to Britain for further testing. H5 has been confirmed in the swan, but authorities await more tests to determine if it is H5N1.

"Scores of birds" died in the wetlands area, and about 30 ducks died at a farm near Varna on Sunday, the Reuters report said. Samples from the ducks were being sent to a lab in Sophia, the head of the veterinary office in Varna told Reuters.

"We"e;re getting ready for a possible outbreak," Alexander Alexandrov, head of the regional veterinary office in Dobrich, told UPI. "People should forget about taking farm animals to water at the two lakes until spring, when the last [migratory] duck is gone."