The WHO provided their third update in eight days on West Java, Indonesia. Information is still being process by WHO and the local public health authorities but it is clear that some disturbing things are occurring in the Garut district, West Java. Three confirmed cases of H5N1 have been reported, two of which were fatal. Nine people in Garut either have tested positive for H5N1 or have strong epidemiological evidence of an H5N1 infection, six of these nine have died. This part of Indonesia is remote and trips to the clinic (from where they are sent to the hospital and samples are taken) are rare. So far, the cases have been confined to three neighboring villages. There are questions about the possibility of human-to-human transmission in a few of the cases. The strain of H5N1 in the Garut district appears to be a new strain. It has some novel changes that distinguish it from other strains in Indonesia. It is not clear yet what the significance of these changes is yet.

The WHO has confirmed that a 17 year old female died yesterday of H5N1. This brings the total case number in Indonesia to 56, with 44 fatalities. Indonesia has reported over 44 fatalities from H5N1 is just a little over a year. H5N1 is moving with astonishing speed through the thousands of Indonesians Islands virtually unchecked. The fatality rate in Indonesia and the speed at which it has spread has expert very worried. There is no end in sight for Indonesia either; it will take them a long time to control their situation.

The WHO confirmed today, that the 16-year-old boy mentioned yesterday died from H5N1. There are three new deaths being reported in Indonesia tonight that have been attributed to H5N1 via local tests. More info will follow if WHO confirms these results.

China and the WHO announced today that China had the first human fatality from H5N1, back in 2003. The case was misdiagnosed as SARS.

A 16-year-old boy from West Java, Indonesia has died from H5N1. WHO confirmation is expected within the next few days.

Thailand has kicked off a massive campaign to stop bird flu. They have mobilized thousands of volunteers to check ever house in 29 provinces for sick chickens. Hopefully this will stop or slow the spread of bird flu there.

Test on a Vietnam man suspected of having H5N1 have come back negative. He has been in a coma for over seven days now with symptoms similar to those of a H5N1 infection. The doctors are not sure what is causing his illness and are running more tests.

The Thailand Public Health Ministry (PHM) has confirmed that a 27-year-old man that died on Thursday was infected with H5N1. He was from the Uthai province and had exposure to poultry that were possibly infected with H5N1. The day after the PHM confirmed the results of his tests, the Livestock Development Department’s disease control bureau announced that the chickens from the 27-year-old mans house tested negative for H5N1. They are repeating their testing and have urged the PHM to do the same.

There were two positive results for H5N1 in humans reported in Thailand today. The first one is a 61-year-old woman from the Lop Buri province. She has initially tested positive and this has been confirmed by local officials. A source in Thailand mentioned in an email tonight, that another person (demographics were not released) in Chachoengsao province has tested positive for H5N1. This source believes that the individual in Chachoengsao has a better chance of retesting positive for H5N1 than the 61-year-old woman. The catch is that the patient in Chachoengsao has no history of contact with poultry. The results of secondary testing on both patients are expected tomorrow.

The situation in Indonesia is rapidly deteriorating. Indonesia sent three Ministers (Health, Agriculture and Welfare) to the Karo district of North Sumatra today to assess the situation. They were meet by angry villagers who tried to rip their protective gear off. The army was eventually called in to restore order. The villagers do not want their birds to be culled. It has also become clear that the seven individuals represent two different clusters.

Vietnam is getting worried about a resurgence of H5N1. Thailand up until a few weeks ago had one of the best surveillance systems in place for detecting H5N1. Vietnam is realizing that they have not been able to prevent a massive population boom in ducks (they do not show symptoms when infected by H5N1) and that H5N1 will probably resurface in the next few weeks.

Thailand appears to be in a state of confusion over bird flu. There are conflicting reports about positive human H5N1 cases and the number of people under observation. Officially, there have been no more human cases of H5N1 but local officials are saying two people tested positive yesterday. The Nation notes that 6 of the 765 people that had some part in the culling of infected birds this past weekend have developed fevers. Most interestingly, they note that four have tested negative for H5N1 and the other two have been given Tamiflu. These 765 people under surveillance are from one province.

Thailand has also declared all 76 provinces “animal epidemic control areas” because of H5N1.

The CDC published an article in the Proceedings of the National Academy of Science (PNAS) on influenza reassortment (two different virus strains combine into a hybrid) this week. It has garnered a tremendous amount of media attention, as proof that a pandemic is unlikely, which is not accurate. The researchers at the CDC tried to combine a common influenza virus with H5N1 to create a pandemic strain. They did not succeed. The Director of the CDC, Dr. Julie Gerberdng provided a nice summary of what the research actually shows, “These data do not mean that H5N1 cannot convert to be transmissible from person to person; they mean it's probably not a simple process and more than simple genetic exchanges are necessary.”

Thailand is still running tests on suspected cases.

A potential family cluster has surfaced in North Sumatra, Indonesia (the same area where the previous cluster occurred). The six family members are all hospitalized with symptoms of bird flu. The local doctor said that symptoms were similar to the previous cluster. All of the family members were potentially exposed via dead chickens.