Test results have now convincingly ruled out H5N1 infection in all four nurses.
Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.
The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.
The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present.
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The CDC provided flu isolates to the University of Colorado researchers to identify using the FluChip. The samples included flu strains that infect humans, horses, birds and swine. CDC shared its technical expertise on influenza and worked alongside University of Colorado staff in CDC laboratories to process the influenza samples, test the FluChip technology and analyze the results. Combined results after two rounds of tests showed that the FluChip allowed users to obtain correct information about both type and subtype - considered a full characterization of a strain - from 72 percent of the samples. Full information on type - but only partial information on subtype - was obtained for 13 percent of the samples, while 10 percent of the samples could be identified by type only (no information about subtype). It took about 11 hours to conduct the tests and learn the identities of the strains, report the scientists.
"We were surprised and pleased at how well the chip performed in these early tests," says Dr. Rowlen. The researchers from CDC and University of Colorado are continuing to refine the FluChip and hope to bring the total time required to get full type and subtype characterization to under one hour.
Developing improved gene chips for flu diagnosis depends, in part, on the ready public availability of genomic sequence data, notes Karen Lacourciere, Ph.D., NIAID influenza program officer. In addition to flu genome sequence databases housed at the Los Alamos National Laboratory and CDC, the researchers also used information from the NIAID-supported Influenza Genome Sequencing Project. NIAID rapidly makes this sequence information publicly available through GenBank, an international, searchable online database funded by NIH. This resource is enhancing researchers' ability to select target sequences for next generation diagnostic chips, Dr. Lacourciere says.
NIH and CDC are two of the 13 major components of the Department of Health and Human Services.
www.cdc and www.nih.