Health officials in Indonesia confirmed on Thursday that a 44-year-old man died of avian influenza just outside Jakarta last week. That brings the country's total number of bird flu deaths to 42, equaling Vietnam for the highest number of victims in the world.
Indonesia has been struggling to contain the spread of the H5N1 virus since the first human case in South Sulawesi just over a year ago.
Though the latest fatality ties the country with Vietnam for the highest number of human deaths, Vietnam has not registered a single death from the bird flu this year. Health officials credit Vietnam's extensive campaign of poultry vaccinations and mass slaughter of sick birds for that success.
In Indonesia, the virus has been detected in poultry in 27 of the country's 33 provinces.
World Health Organization spokeswoman Sari Setiogi says Indonesia's early detection and surveillance of the disease has been very good, but educating the public about the threat is a challenge. She says people in Indonesia live closely with poultry, even in urban areas. An estimated 300 million chickens are raised in backyards.
"I mean they put backyard chickens for example at night inside the house instead of in a pen or something like that. For them it's something very usual. So we have to again and again remind them that the public should avoid contact with sick or dead poultry," said Setiogi.
Critics say Indonesia has been slow to implement strategies to curb infection among birds, and has been particularly reluctant to slaughter poultry because of the high cost of compensating farmers. Mass culling is widely unpopular. The country has allocated $3.3 million to pay farmers for the birds, but that works out at little more than a dollar per chicken, significantly less than the market value.
Scientists fear the H5N1 virus could change to become easily passed between humans, triggering a pandemic that would put millions of lives at risk. So far, almost all human victims contracted the virus from sick birds.
Health officials recently said the H5N1 virus had mutated slightly in a cluster of cases in Sumatra last May, in which the virus passed from human-to-human, though experts say the mutation died out with its last victim. WHO spokeswoman Setiogi says preventing a pandemic requires a global effort.
"If the virus is in animals, it means it could spill over into humans, however a pandemic strain could emerge anywhere, not just in Indonesia," she said.
The country has asked for $900 million from international donors over the next three years to help fight the disease.
More than 130 people have died from the virus since 2003, with cases in Europe, Africa and Asia.