The authorities are stepping up measures to guard against bird flu as the disease continues to spread among poultry on the island, and in neighbouring Lombok, while the mother of two children who died of the disease has also died of flu-like symptoms.
The two children from Jehem in Bangli died of the disease last week. Their mother, Ni Wayan Purnami, died at the family home on Monday.
Dewa Made Siangan, head of the Bangli Health Department, said Purnami had previously tested negative for the disease, despite showing symptoms.
“We asked her to seek medical treatment in Sanglah after her two children were cremated, but she refused,” Siangan said, adding that confirming bird flu would now be impossible as the woman’s body had been immediately buried by family members.
Siangan said that Purnami’s death was particularly worrying, as it suggested the possibility of human-to-human transmission, though this could not be confirmed.
He said regency officials would be receiving extra training and equipment to deal with the disease, and that Tamiflu medicines would be made available to those working with suspected bird flu patients.
A.A. Bintang Ari Sutari, head of Tembuku, the district which includes Jehem village, said that the community had been shaken by the recent deaths, and needed to be given more information in an effort to ensure full cooperation with the authorities.
“The family and the villagers are still emotionally depressed after the string of deaths,” Sutari said.
Domestic birds in Jehem, the home village of the children, have been culled, and extensive tests carried out in surrounding communities.
According to officials from the Bali Animal Husbandry Department, a recorded 1,366 chickens have died of suspected bird flu so far this year.
“The spread of the disease mostly involves infected chickens bought by individuals at local markets and then brought into their respective houses,” department head Putu Sumantra said.
Sumantra said the disease, which can spread to humans who have close contact with infected birds, was easily transferred from district to district through the trade in poultry.
“That’s why all the relevant agencies have agreed to tighten measures to control and monitor the transportation of poultry from one regency to another, as well as from the suppliers to the markets,” he said, adding that vehicles routinely used for moving poultry were now being regularly disinfected by department staff.
“Previously, the spraying of disinfectant was carried out in markets and large-scale poultry farms only,” he said.
Meanwhile, Health Department officials have continued to test humans living near infection sites, though according to chief Nyoman Sutedja, no positive cases have yet been identified.
The Bangli Regency Hospital, where the two children who died last week were initially treated, has been ordered to pay more attention to the risk of bird flu. The disease was not initially identified in the children, who were treated for pneumonia, before their condition worsened and they were transferred to the main government hospital at Sanglah in Denpasar.
Three hospitals in Bali are designated as bird flu treatment centres: Sanglah, Gianyar Hospital and Tabanan Hospital.
So far bird flu has been identified in eight of Bali’s nine regencies and municipalities. The disease has also been found in neighbouring Lombok. Hundreds of chickens in the Lombok capital, Mataram, are suspected to have died of the disease last week, while two suspected human cases have been recorded. The affected patients – an 11-month-old baby from Praya in West Lombok district and 53-year-old man from Central Lombok district – are being treated at the main hospital in Mataram.
In Bali, according to Sumantra, only Gianyar has recorded no confirmed cases in the current outbreak.
“This is quite surprising, especially given how quickly the disease is spreading,” he said.
He stressed that the current occurrence was on a much smaller scale that the last large outbreak in 2007.
“Back then, around 4,000 birds died, but this time the figure is much smaller,” he said. Most cases were recorded on small, village level smallholdings, rather than in large commercial poultry farms, where birds were usually vaccinated, Sumantra said.
“Those on larger commercial farms tend to be vaccinated on a regular basis so aren’t as vulnerable,” he said.
Meanwhile, tourism officials have expressed concern that a high-profile outbreak with more human fatalities could damage the tourism industry.
Regional assembly member Ketut Kariyasa Adnyana said urgent measures were needed to avoid such an outcome.
“The provincial and district authorities should take immediate steps to address this problem. We can’t afford to let it get out of hand,” he said.
Ida Bagus Gede Sidharta Putra, the chairman of Bali branch of the Indonesian Hotel and Restaurant Association (PHRI), said measures were being taken to counter the threat from bird flu, and that tourist restaurants would stop serving poultry products if the outbreak continued to spread.
“This will have a significant impact on tourism if we don’t carry out preventive measures. We will continue to monitor avian flu cases,” he said.
Another PHRI official, Perry Markus, called on tourism business to be vigilant in matters of hygiene.
“Employees should keep clean, especially if they have poultry in their neighbourhoods,” he said.
One of the many professional chefs across the island, Komang Adi Arsana, said, however, that properly cooked poultry products were rendered safe, even if infected.
“All poultry is well-cooked, even overcooked to 100 degrees Celsius and served fresh. Many natural ingredients used in Indonesian cuisine also contain probiotics that help protect the body from harmful bacteria,” he said.