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The recent death of a man from Sunter, North Jakarta, from bird flu has put the country on alert and highlighted that after years of struggling with the virus, Indonesia is still not free from its dangers.

A 23-year-old man identified as P.D.Y. died after being treated for six days at Satya Negara Hospital. His blood test came back positive for the H5N1 virus, making him the first victim of bird flu in 2012.

Health officials suspect he was infected by a pigeon that he kept. His 5-year-old brother was rushed to Persahabatan Hospital in North Jakarta after developing a cough and a fever, but was cleared of bird flu.

In October, two young siblings died in Bali from bird flu after having had contact with dead fowl in their neighborhood in Bangli district.

Prior to that, Indonesia’s last official human death from avian influenza was a woman in Tangerang, who died in July 2010.

Unfinished Problem

Health Minister Endang Rahayu Sedyaningsih acknowledged on Tuesday that despite all its efforts, Indonesia had been unable to completely wipe out bird flu in the country.

“Bird flu is indeed an unfinished problem in Indonesia. We need to stay alert,” she said.

She said as long as the infection remained endemic among poultry, there would always be the risk that the virus would infect humans.

Muhammad Azhar, the agriculture ministry’s avian influenza control coordinator, has said it is particularly difficult to control the spread of bird flu because backyard farming is such an ingrained part of the culture.

He said large companies that dealt with huge amounts of poultry posed less of a threat than backyard poultry farms because the big companies implemented tough bio-security measures.

The Ministry of Health has found that in some traditional markets in Jakarta, traces of the H5N1 virus are found not only on sick poultry, but also on knives and cutting boards as well as the chicken sellers themselves, although they were not infected.

Most of the sellers, however, did not realize the danger that they were facing, according to the ministry.

But Dr. Marius Widjajarta, chairman of the Indonesian Consumer Protection Foundation for Health (YPKKI), said bird flu continued to pose a threat because the government had abandoned its campaign to improve hygiene standards in the country.

“In 2006 and 2007, when bird flu first emerged in Indonesia, the awareness campaign was massive, but now it has been quiet. Almost nothing has been done,” he said. “How do you expect to change public behavior if you don’t tell them constantly?”

More Dangerous Now?

Emil Agustiono, secretary of the National Committee on Zoonosis (Komnas Zoonosis) and an epidemiologist, said climate change had also changed the character of the H5N1 virus.

“Climate change has caused humidity levels to increase, and unfortunately the survival abilities of various viruses have increased because of that,” he said.

But he quickly assured that so far, the feared genetic mutation that could cause human-to-human transmission of bird flu had not happened.

“A genetic mutation that would allow for the transmission of the virus from human to human is our main concern, but we have been lucky,” he said. “Studies have shown that it has not happened yet.”

In 2007, the health minister at the time, Siti Fadillah Supari, expressed her concern that some countries were trying to manipulate the virus by genetically engineering it to allow for human-to-human transmission and possibly turn it into a bioweapon.

Emil said such experiments had been done, and that Siti’s concern was proven correct: the virus had been altered, becoming capable of transmitting it from human to human.

“Luckily the experiment has been shut down because it was extremely dangerous,” he said.

Meanwhile, he said Indonesia had sufficient regulations to prevent H5N1 infections, however the problem was in the implementation of the regulations.

For example, most people who keep backyard poultry ignore the regulation on the minimum distance between their house and poultry cages. It is also nearly impossible to completely prohibit backyard farming.

Emil said another problem was that bird flu symptoms resembled those of the common flu, meaning most people will seek help too late.

Ari Fahrial Syam, an internist at Cipto Mangunkusumo Hospital in Jakarta, said health workers needed to be more familiar with birth flu symptoms, and had to be aware if patients had been in recent contact with poultry.

Most of the symptoms, he said, are similar to those of the common flu: coughing, runny nose, fever, nausea and diarrhea. If the symptoms are more severe than usual, he suggests that people immediately seek medical help.

Marius, from the YPKKI, also criticized the lack of bird flu referral hospitals. He said Jakarta had no regional hospital specifically for bird flu patients. Most referral hospitals such as the Sulianti Saroso and Persahabatan are general hospitals.

“The governor should be ashamed. Tangerang has one [hospital that can handle bird flu patients], but Jakarta has none,” he said.

Before he died, P.D.Y. had been referred to Sulianto Saroso, but the infectious diseases hospital did not have a free isolation room to treat him.

On Alert Again

Ali Gufron Mukti, the deputy health minister, said the ministry had formed bird flu handling teams in anticipation of the disease spreading in Jakarta.

Agriculture Minister Suswono said his ministry was monitoring the disease across the archipelago and called on people to immediately report any sudden death of birds and poultry.

In Jakarta, the city’s maritime and agriculture office is conducting sweeps to check on possible bird infections.

“The sweeps are meant to ascertain that poultry and pet birds are free from the avian influenza virus. If any birds are found to be infected then they must be destroyed,” said the office’s chief, Ipih Ruyani.

Indonesia has seen the most official bird flu fatalities. In 2011, nine of the 11 global bird flu infection cases were fatal. Since it first emerged in 2003, bird flu has infected more than 500 people, most of them in Indonesia.

Additional reporting by Arientha Primanita & Dofa Fasila