Nov 17, 2005 (CIDRAP News) – Tests have confirmed that a 16-year-old girl and a 20-year-old woman who died in Indonesia last week had avian influenza, raising Indonesia"e;s case tally to 11, the World Health Organization (WHO) said today.

The announcement follows China"e;s report yesterday of its first two confirmed human cases of H5N1 avian flu on the mainland. The WHO has registered a total of 130 cases, including 67 deaths, since December 2003.

Indonesian cases
Both of the Indonesian victims were from Jakarta, the WHO said. The 16-year-old girl became ill Nov 4, was hospitalized Nov 6, and died 2 days later, the agency said. The 20-year-old woman fell ill Nov 5, was hospitalized Nov 9, and died on the 12th.

The cases were confirmed by the WHO reference laboratory in Hong Kong, officials said.

The WHO statement gave no information about how the two patients contracted the disease. The 20-year-old woman had been mentioned as a suspected case in news reports earlier this week, which said she had a neighbor whose chickens had died recently. An Associated Press (AP) report today said both victims had been exposed to sick chickens.

Seven of Indonesia"e;s 11 human cases of avian flu have been fatal, according to the WHO.

WHO recognizes Chinese cases
Today"e;s WHO statement also confirmed the cases announced by China yesterday. They involved a 9-year-old boy in Hunan province who has recovered and a 24-year-old female poultry farmer in Anhui province who died Nov 10.

Two other cases possibly related to the two confirmed ones remain under investigation. The boy"e;s 12-year-old sister died Oct 17 of "severe bilateral pneumonia and acute respiratory distress syndrome," but the cause will probably never be known for sure, because no adequate samples are available for testing, the WHO said. Media reports said the girl"e;s body was cremated.

Also being probed is the case of a 36-year-old middle school teacher who comes from the same locality as the two siblings and was hospitalized with pneumonia Oct 24, the WHO said. "Definitive test results are pending," the statement said. The teacher has recovered, according to previous reports.

Hank Bekedam, the WHO"e;s chief representative in Beijing, said the Chinese cases don"e;t suggest that a pandemic is starting, according to the AP. "If there"e;s evidence of human-to-human transmission, there will be small clusters. We are not at that stage," he said.

Leader vows China will defeat virus
Chinese Premier Wen Jiabao vowed today that China will win the avian flu battle, even as two new poultry outbreaks were reported.

"We have conquered the SARS [severe acute respiratory syndrome] epidemic in 2003, and we will surely conquer the bird flu virus," Wen said while inspecting a facility where a human vaccine and drugs for avian flu are made, according to the Chinese news agency Xinhua.

The latest outbreaks are in the northwestern region of Xinjiang and the central province of Hubei, according to an Agence France-Presse (AFP) report today. China now has had 13 poultry outbreaks since Oct 19, news services say. Two days ago authorities announced their intention to vaccinate all 5.2 billion poultry in the country.

Bekedam predicted China will have more poultry outbreaks this winter, which will increase the chance of more human cases, the AP reported. "In this cold weather, the virus can survive longer in the climate and therefore have a bigger chance to infect poultry," he said.

China gets credit for response
Many news reports this week have favorably contrasted China"e;s response to the human cases and recent poultry outbreaks with its slow and secretive response to the SARS outbreak, which emerged in southern China late in 2002. The slow response was widely blamed for allowing the disease to spread to Hong Kong and from there to many other countries in early 2003.

An AP report today said that when a farmer in Inner Mongolia recently reported finding dead chickens, health workers arrived 30 minutes later. Within 11 hours, avian flu was confirmed and the flock of 7,000 birds was destroyed.

Authorities have culled millions of chickens and banned all live poultry sales in response to the recent outbreaks, the story said.

John Mackenzie, an Australian disease specialist who helped investigate SARS, said the Chinese government probably has recognized the problems that secretiveness can cause, the AP reported.

However, the AP quoted another specialist, Linfa Wang of Australia"e;s Animal Health Laboratory, as saying China still isn"e;t well equipped to deal with a major animal-disease problem. "The infrastructure is not ready to handle a major disease outbreak," he said. "The human area is way ahead of the animal health area."

In other news, Hong Kong announced that it will begin checking the temperatures of people coming in from mainland China. Starting tomorrow, the city will use infrared thermal imaging machines to screen travelers for fever at the city"e;s two busiest land border crossings, Bloomberg News reported today. The same precaution was used during the SARS crisis.

New outbreak in Vietnam
In Vietnam, avian flu has surfaced in poultry in the northern province of Son La, the14th province or major city to be hit in the latest wave of outbreaks, according to a Bloomberg News report based on a story in the Saigon Times Daily.

Since Oct 1, poultry outbreaks have occurred in 10 provinces and cities in northern Vietnam, including Hanoi and Haiphong; two provinces in central Vietnam; and two provinces in southern Vietnam"e;s Mekong Delta, the report said.