The number of deaths from avian flu in Indonesia is the highest worldwide, due to a slow response rate and surveillance challenges, say specialists.
"At 83 percent, Indonesia has the world's highest fatality rate from avian flu," Brenda Langdon, pandemic influenza adviser in the office of the UN Resident Coordinator in Jakarta, told IRIN.
With the recorded infection of a 21-year-old female in Bandung city in west Java on 9 December, the number of people with the virus in Indonesia has risen to 171 since 2003, of whom 141 have died.
Avian influenza - also known as bird flu or H5N1 - is a highly contagious infectious disease among poultry and other birds.
The virus is transmitted from farm to farm by the movement of birds and people (with contaminated shoes or clothing), and from birds to unsuspecting people who touch them, according to the World Health Organization (WHO).
Since it was first detected in central Java in 2003, the disease has spread to 31 out of 33 provinces nationwide, caused more than US$500 million in economic losses and disrupted the livelihoods of more than 10 million people who rely on poultry, according to the UN Food and Agriculture Organization (FAO).
The likelihood of dying from bird flu in Indonesia is nearly three times higher than in Egypt, which had the highest number of recorded bird flu cases this year but a fatality rate of only 32 percent, Langdon noted.
With no human vaccine available, intensive medical attention (Tamiflu is the main anti-viral treatment) is required within the first 24 to 48 hours of reported symptoms. However, many patients wait too long before seeking medical attention.
"Jamu [traditional medicine] is still a strong tradition here so people try that before going to the clinic," Langdon said. "But there are also financial constraints, given the administrative and transportation fees that patients have to pay to access healthcare here."
Indonesia spans almost 4,000km from Jakarta in the west to Jayapura (capital of Papua Province) in the far northeast, almost the same distance as London to Baghdad.
The size and geography of Indonesia - 17,000 islands host 250 million people, the world's fourth most populous country - make virus surveillance particularly difficult.
"It could be that milder cases simply aren't being detected due to the size and decentralization of the country, so only the really serious cases are being noticed," said Langdon.
With a small number of human infections but a high fatality rate, more effort needs to go into preventing H5N1 from spreading in animals rather than only focusing on treatment when it reaches humans, according to the WHO office in Jakarta.
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions