Jul 20, 2005 (CIDRAP News) – Indonesian officials confirmed today that a man and his two young daughters who died earlier this month had H5N1 avian influenza, though they had had no known contact with infected poultry.

The 38-year-old man and his daughters, aged 1 and 9, were the first Indonesians to die of the illness. Indonesia has had a number of poultry outbreaks but only one previous human case, an asymptomatic one reported last month.

Indonesian Health Minister Siti Fadillah Supari said laboratory tests in Hong Kong on samples from the man and one daughter confirmed that they had the virus, according to news services.

Supari said it could be concluded that all three died of the illness. "We don"e;t distinguish between the three," an Agence France-Presse (AFP) report quoted her as saying.

Though there was no evidence that the three victims had been exposed to infected poultry, Supari said person-to-person transmission of the virus seemed unlikely, according to an Associated Press (AP) report. She said the virus strain that killed them had not mutated.

"It"e;s the conventional H5N1 virus and not a new strain," Bloomberg News quoted Supari as saying.

Health agencies fear that the H5N1 virus will evolve so as to allow easy person-to-person transmission, leading to a pandemic. Only one probable instance of person-to-person transmission has been documented so far, that of an 11-year-old Thai girl who apparently passed the virus to her mother and an aunt last September. Person-to-person transmission was also suspected in some family case clusters in Vietnam this year.

The Indonesian cases bring CIDRAP"e;s unofficial count of H5N1 deaths since late 2003 to 59, including 40 in Vietnam, 12 in Thailand, and 4 in Cambodia. Adding the three deaths to the World Health Organization"e;s current numbers yields a total of 111 cases with 57 deaths. The WHO has not yet recognized two fatal cases that the media reported recently in Vietnam.

Dr. Georg Petersen, a WHO representative in Indonesia, said he was not too worried that the three victims had no known contact with sick birds, because the source of infection is often very hard to find, according to the AP.

Petersen said that in view of Indonesia"e;s history of avian flu outbreaks, the deaths were not a big surprise, according to the AFP report. He added that the three victims "may have had contact with chicken droppings."

Bloomberg News said the three people lived in Tangerang, about 15 miles west of Jarkarta. The report said 1-year-old Thalita Nurul Azizah died Jul 9, followed by her father, Iwan Siswara Rifei, on Jul 12 and her 9-year-old sister, Sabrina Nurul Aisyah, on Jul 14.

Supari and Petersen said none of the 315 people who may have had contact with the family have fallen ill, according to the Bloomberg report. The health ministry has taken samples from the contacts and is monitoring them.

A veterinary official said all farms within 20 kilometers of the victims"e; home were being tested for avian flu, and results were expected back next week, the AP reported.

The only previous human case of H5N1 avian flu in Indonesia involved a poultry worker who was tested last March, though he had not been sick. He was found to have a low level of antibodies to the virus, according to results reported in June.

Indonesia has had a number of H5N1 outbreaks in poultry, going as far back as August 2003. In May of this year, some pigs in the Tangerang district—the same district where Rifei and his daughters lived—were found to have H5N1 infections without signs of illness. The pigs lived near poultry farms that had been hit by the virus.