From The New York Times
By DONALD G. McNEIL Jr.
Published: July 21, 2006

Indonesia is about to surpass Vietnam as the country hardest hit by avian flu. And while Vietnam has not had a single human case or poultry outbreak this year, public health officials and experts say the situation in Indonesia is likely to get worse.

The flu is ubiquitous in thousands of backyard flocks, and it appears to be killing more birds every month, increasing the likelihood of human cases. Forty-two people have in Indonesia died since the first human case was confirmed a year ago.

“It’s like trying to fix the roof while there’s a storm going on,” said Dick Thompson, a spokesman for the World Health Organization. “Until the animal situation gets under control, there’s going to be this steady drip, drip, drip of human cases, and that’s a problem.”

Although the A(H5N1) flu arrived relatively late in Indonesia, it soon spiraled out of control, and deaths have mounted quickly.

Unlike Thailand, which quenched outbreaks by killing millions of chickens, or Vietnam, which used mandatory vaccination, Indonesia has tried a mix of limited culling and vaccinating in rings around the cull — so far, with little success.

Mathur Riady, chief of livestock for Indonesia’s Health Ministry, said recently that more than a million birds had died of the flu between January and March, about the same number as died all last year.

The biggest obstacle to beating the disease, international flu experts say, is the country’s decentralized government. Health officials in the capital, Jakarta, have been described as having powers extending no further than their office walls, while real power resides with the governors of the 33 provinces and the elected bupatis, or regents, of 480 districts.

“It’s a real mishmash,” said Dr. Jeffrey C. Mariner, a veterinary medicine professor at Tufts University who is helping the United Nations Food and Agriculture Organization train new veterinary workers. “You have to sit down with each decision-making unit and get them all on board. It’s hard to mount a coordinated response.”

As a result, the country is not only slow to report human cases, it no longer even reports poultry outbreaks to the World Organization for Animal Health in Paris.

Full article:
http://www.nytimes.com/2006/07/21/world/asia/21flu.html?_r=1&n=Top%2fNews%2fHealth%2fDiseases%2c%20Conditions%2c%20and%20Health%20Topics%2fAvian%20Influenza&oref=slogin