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The World Health Organization has said that “it is extremely worried” about a cluster of H5N1 avian influenza, related human deaths in Indonesia. The reason Indonesia is causing such concern is because was no sign of diseased poultry in the immediate area raising the possibility that the infection spread from human to human contact.

Indonesia, an archipelago of 17,000 islands with a population of 220 million people, has a collage of local, regional and national bureaucracies that often give the impression that no one is truly “in charge”. In May of 2006 Indonesia averaged one human bird flu death every 2 1/2 days in May, putting it on pace to soon surpass Vietnam as the world's hardest-hit country.

There have been 43 deaths out of 53 human cases so far in Indonesia this year, a significant proportion of the 73 human deaths recorded worldwide since the start of 2006.Undoubtedly, the Asian region has been hardest hit by the virus, which spreads through contact with infected birds.

Indonesia has reported the virus has been detected in 30 out of 33 provinces.

Seven family members became infected in the Kubu Sembelang village, Karo District, of North Sumatra. Of the seven who are infected, six have died.

Although the investigation is still ongoing, preliminary findings indicate that three of the confirmed cases spent a night in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman’s two sons and a second brother. Other infected family members lived in neighboring homes.

All seven people affected were in close contact with the initial patient when she was severely ill, but researches are searching for other alternatives besides human-to-human transmission. After studying the eight-gene virus, no mutations that would indicate that the virus has begun to be spread through humans was found. Researchers are working on the hypothesis that the family members involved in the cluster were genetically more susceptible to H5N1, since spouses did not get sick.

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.

U.N. health experts warn that the virus could (if it hasn’t already) either mutate or obtain new genetic material, allowing it to spread more easily among humans, which could spark a global pandemic and kill tens of millions of people. This fear is why Indonesia is being kept under a watchful eye.

Indonesia has taken much criticism lately for not being more efficient in stopping the spread of the bird flu. An Indonesian leader explained that they have had a difficult time containing the virus because the country faces unique challenges. Its population is spread over 17,000 islands, domestic fowl roam everywhere, and there is widespread resistance to the central government among many of its diverse cultures.

In an effort to control the possible outbreak the country's largest zoo was closed after 19 birds tested positive for avian flu. A zoo vendor and a guide may have come down with the illness and had been admitted to the capital's leading infectious disease hospital.

In order to deal with the possibility of an outbreak hundreds of millions of poultry have been culled. There have also been changes to commercial bird rearing and also better preparedness to deal with outbreaks.

Indonesia has formed a special team to prepare for any bird flu pandemic and coordinate foreign assistance and funding. The formation of this steam under the ministry’s National Pandemic Aid Plan was announced in September 2005.

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