An Indonesian man and two of his children died in the past two weeks from bird flu, the country's first known fatalities from the highly lethal virus now circulating in much of Southeast Asia, health officials reported Wednesday.
Avian influenza has already killed at least 56 people in Vietnam, Thailand and Cambodia since early last year. While the virus has struck poultry across much of Indonesia, contributing to the deaths of millions of birds, the country had been spared human infection until a farmworker tested positive for the disease last month with an extremely mild case.
Then, two weeks ago, a year-old girl from Tangerang in Jakarta's western suburbs died soon after being hospitalized with a high fever and respiratory problems. Her father, Iwan Siswara Rafei, 37, died four days later, followed the next day by his 8-year-old daughter.
"We don't distinguish between the three," Health Minister Siti Fadilah Supari said when announcing bird flu as the cause of their deaths. "But how they got infected is still unknown."
The deaths of the three family members have raised the possibility that the illness was spread person-to-person. Until now, nearly all human cases have been contracted from infected poultry. International health experts have warned that if the virus evolves into a form that can be transmitted easily among humans, it could set off a global pandemic.
Georg Petersen, the World Health Organization's chief representative in Indonesia, said it remained unclear whether the virus was passed among Rafei and his daughters or whether they all caught it from birds, perhaps by touching objects contaminated by poultry droppings.
Rafei, who worked as an employee in the government finance department, did not raise poultry. Health officials said they had no evidence that members of his family had close contact with birds.
Some health officials had raised suspicions about bird flu after Rafei and his daughters died, but the Health Ministry did not blame the deaths on the virus until tests were completed at a specialized laboratory in Hong Kong. A sample from Rafei tested positive for the virus, health officials said, citing the results received Wednesday. A specimen from his older daughter showed antibodies, indicating she had been exposed to bird flu, though the sample tested negative for the virus. No test was done for the younger daughter because she was buried without a sample being taken.
Until recently, some Indonesian health experts had tried to calm public fears about bird flu by suggesting that the virus strain circulating among poultry there was different from the one responsible for the human deaths in Indochina. Scientists are now conducting an analysis to determine whether the strain that caused Rafei's death is the same as that afflicting Indonesian birds, according to Petersen.
Health officials are monitoring more than 300 people who had contact with Rafei and his daughters, including relatives, neighbors and health care workers. None has fallen sick with the flu so far, officials said. Some of these people are also being tested for the virus.
Special correspondent Yayu Yuniar contributed to this report.