Surveillance for Severe Acute Respiratory Infection as one approach to enhance Global Health Security in Indonesia

Latar Belakang: Sistem surveilans nasional untuk infeksi saluran pernafasan akut berat (SARI) dapatmemberikan informasi penting tentang sirkulasi virus influenza, menyediakan sistem untuk mengendalikankejadian luar biasa yang mengancam keamanan dan keselamatan masyarakat serta menyediakandata untuk sistem surveilans influenza global (GISRS). Kemampuan Indonesia untuk mendeteksi dan mengendalikanpenyakit menular penting untuk keamanan kesehatan dunia. Penelitian ini bertujuan untukmenilai sistem surveilans ISPA berat Indonesia (SIBI) dan pemanfaatan untuk memantau patogen prioritaslainnya sebagai upaya meningkatkan keamanan kesehatan global. Metode: penilaian atribut surveilans melalui review laporan, analisis data dan interview staff yang terlibatdalam sistem surveilans. Semua kasus yang memenuhi kriteria SARI pada bulan Mei 2013 – April 2015 ikutserta dalam penelitian. Data epidemiologi dan virologi dianalisis. Kelengkapan dan kemudahan sistem untukmencapai tujuan surveilans influenza dan mendukung surveilans penyakit infeksi baru (emerging) dikaji. Hasil: Sebanyak 1,806 kasus SARI dan 1,697 (94%) spesimen dilakukan pemeriksaan virus influenza.Sebanyak 200 (12%) positif influenza, terdiri dari 46% influenza A(H3N2), 18% A(H1N1)pdm09 dan 37%influenza B. Hasil penilaian terhadap sistem surveilans didapatkan kesesuaian pelaksanaan untuk semuaatribut surveilans melebihi target >80%, kelengkapan laporan online 95%, kesesuaian kasus terhadapdefinisi kasus 100%, kasus yang diambil spesimen 94% dan hasil laboratorium diinput ke database secaraonline 100%. Sistem surveilans untuk dengue dan infeksi arbovirus lainnya sudah terlaksana di unitrawat jalan dan gawat darurat di sentinel SARI surveilans. Kesimpulan: SIBI dapat disesuaikan untuk menggabungkan surveilans penyakit lain yang menunjukkankegunaan dan fleksibilitas dalam mendukung keamanan kesehatan global. Kata kunci: keamanan kesehatan global, surveilans, influenza, Indonesia AbstractBackground: The existing national surveillance system for severe acute respiratory infection (SARI) providescritical information on influenza virus circulation, provides a system to control influenza outbreaks that threatenthe safety and security of the population and feeds data into the global influenza surveillance and responsesystem (GISRS). Indonesia’s ability to detect and control communicable diseases is critical for global healthsecurity. The aim of this study was to assess the SARI surveillance system and utility for monitoring other prioritypathogens as an effort to enhance global health security. Methods: Surveillance attributes were assessed by reviewing records, data analysis and through interviewedwith staffs involved in the surveillance system. All patients at six sentinel hospitals who meet the SARI casedefinition during May 2013 – April 2015 were enrolled. Epidemiological and virological data were analyzed.The surveillance system utility for its influenza surveillance objectives and flexibility to support surveillance ofemerging infectious diseases were assessed. Resuts: A total of 1,806 SARI cases were reported of which 1,697 (94%) had specimens tested for influenza viruses.Of those tested, 200 (12%) were positive, of which 46% were influenza A(H3N2), 18% A(H1N1)pdm09and 37% influenza B viruses. The system exceeded the targets of >80% adherence for most attributes: 95% forcompleteness of online reporting, 100% for cases adhering to the case definition, 94% for cases with specimenscollected and 100% of laboratory results uploaded to the online database. A surveillance system for dengue andother arbovirus infections was established in the outpatient/emergency units at the SARI surveillance sentinel.Conclusion: SIBI was adjusted to incorporate surveillance for other priority diseases indicating its utility andflexibility to support global health security Keywords: Global Health Security, surveillance, influenza, Indonesi

Factors that influence adherence to antiretroviral treatment in an urban population, Jakarta, Indonesia

INTRODUCTION Although the number of people receiving antiretroviral therapy (ART) in Indonesia has increased in recent years, little is known about the specific characteristics affecting adherence in this population. Indonesia is different from most of its neighbors given that it is a geographically and culturally diverse country, with a large Muslim population. We aimed to identify the current rate of adherence and explore factors that influence ART adherence. METHODS Data were collected from ART-prescribed outpatients on an HIV registry at a North Jakarta hospital in 2012. Socio-demographic and behavioral characteristics were explored as factors associated with adherence using logistics regression analyses. Chi squared test was used to compare the difference between proportions. Reasons for missing medication were analyzed descriptively. RESULTS Two hundred and sixty-one patients participated, of whom 77% reported ART adherence in the last 3 months. The level of social support experienced was independently associated with adherence where some social support (p = 0.018) and good social support (p = 0.039) improved adherence compared to poor social support. Frequently cited reasons for not taking ART medication included forgetting to take medication (67%), busy with something else (63%) and asleep at medication time (60%). DISCUSSION This study identified that an increase in the level of social support experienced by ART-prescribed patients was positively associated with adherence. Social support may minimize the impact of stigma among ART prescribed patients. Based on these findings, if social support is not available, alternative support through community-based organizations is recommended to maximize treatment success

Rumor Surveillance and Avian Influenza H5N1

We describe the enhanced rumor surveillance during the avian influenza H5N1 outbreak in 2004. The World Health Organization’s Western Pacific Regional Office identified 40 rumors; 9 were verified to be true. Rumor surveillance informed immediate public health action and prevented unnecessary and costly responses

Estimated incidence of influenza-associated severe acute respiratory infections in Indonesia, 2013-2016

Background: Indonesia’s hospital- based Severe Acute Respiratory Infection (SARI) surveillance system, Surveilans Infeksi Saluran Pernafasan Akut Berat Indonesia (SIBI), was established in 2013. While respiratory illnesses such as SARI pose a significant problem, there are limited incidence- based data on influenza disease burden in Indonesia. This study aimed to estimate the incidence of influenza- associated SARI in Indonesia during 2013- 2016 at three existing SIBI surveillance sites.Methods: From May 2013 to April 2016, inpatients from sentinel hospitals in three districts of Indonesia (Gunung Kidul, Balikpapan, Deli Serdang) were screened for SARI. Respiratory specimens were collected from eligible inpatients and screened for influenza viruses. Annual incidence rates were calculated using these SIBI- enrolled influenza- positive SARI cases as a numerator, with a denominator catchment popula-tion defined through hospital admission survey (HAS) to identify respiratory- coded admissions by age to hospitals in the sentinel site districts.Results: From May 2013 to April 2016, there were 1527 SARI cases enrolled, of whom 1392 (91%) had specimens tested and 199 (14%) were influenza- positive. The overall estimated annual incidence of influenza- associated SARI ranged from 13 to 19 per 100 000 population. Incidence was highest in children aged 0- 4 years (82- 114 per 100 000 population), followed by children 5- 14 years (22- 36 per 100 000 population).Conclusions: Incidence rates of influenza- associated SARI in these districts indicate a substantial burden of influenza hospitalizations in young children in Indonesia. Further studies are needed to examine the influenza burden in other potential risk groups such as pregnant women and the elderly.This work was supported by the U.S. Centers for Disease Control and Prevention [Cooperative Agreement Number 5U51IP000346-05]

Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings

10.1371/journal.pone.0073243PLoS ONE88-POLN

Avian Influenza H5N1 Transmission in Households, Indonesia

BACKGROUND: Disease transmission patterns are needed to inform public health interventions, but remain largely unknown for avian influenza H5N1 virus infections. A recent study on the 139 outbreaks detected in Indonesia between 2005 and 2009 found that the type of exposure to sources of H5N1 virus for both the index case and their household members impacted the risk of additional cases in the household. This study describes the disease transmission patterns in those outbreak households. METHODOLOGY/PRINCIPAL FINDINGS: We compared cases (n = 177) and contacts (n = 496) in the 113 sporadic and 26 cluster outbreaks detected between July 2005 and July 2009 to estimate attack rates and disease intervals. We used final size household models to fit transmission parameters to data on household size, cases and blood-related household contacts to assess the relative contribution of zoonotic and human-to-human transmission of the virus, as well as the reproduction number for human virus transmission. The overall household attack rate was 18.3% and secondary attack rate was 5.5%. Secondary attack rate remained stable as household size increased. The mean interval between onset of subsequent cases in outbreaks was 5.6 days. The transmission model found that human transmission was very rare, with a reproduction number between 0.1 and 0.25, and the upper confidence bounds below 0.4. Transmission model fit was best when the denominator population was restricted to blood-related household contacts of index cases. CONCLUSIONS/SIGNIFICANCE: The study only found strong support for human transmission of the virus when a single large cluster was included in the transmission model. The reproduction number was well below the threshold for sustained transmission. This study provides baseline information on the transmission dynamics for the current zoonotic virus and can be used to detect and define signatures of a virus with increasing capacity for human-to-human transmission

Towards control of avian influenza H5N1 virus in Indonesia: Human infection, and the role of live bird markets.

Indonesia has been heavily affected by the emerging avian influenza (AI) H5N1 virus, with continued outbreaks in farmed birds and periodic detection of human cases. The epidemiology of human AI H5N1 infection in Indonesia is poorly understood, and control measures at the animal-human interface such as in live bird markets (LBMs) have had limited impact. This thesis had two aims: (a) to examine the epidemiology of human AI H5N1 infection and, (b) to inform disease control measures in LBMs in Indonesia. Methods: For the first aim, public health surveillance data from June 2005 till July 2009 were analyzed to assess exposures and risk factors for infection, case clustering and disease transmission patterns in outbreak households. For the second aim, a cross-sectional study was conducted to assess environmental contamination in LBMs and to identify risk factors and critical control points. A non-experimental field intervention trial was conducted to assess the practical application of implementing interventions in two LBMs. Results: Multivariable analyses showed that age and type of exposure to virus impact the risk of H5N1 infection and case clustering. First degree relatives to an index case, especially siblings were at most risk of becoming secondary cases in a household. The overall attack rate in households was 18.3% and the secondary attack rate was 5.5%. Secondary attack rate remained stable with household size. The disease transmission models found that the majority of cases resulted from zoonotic transmission of the virus, and most evidence for human-to-human transmission came from one large outlier cluster of eight cases. The reproduction numbers were below the threshold for sustained transmission. The mean interval between onset of illness between cases in a household was 5.6 days. Direct exposure to sources of virus tripled the odds of infection. Contaminated garden fertiliser was found to be a possible source of human infection. Widespread environmental contamination with the H5N1-virus was found in 47% (39 of 83) LBMs sampled in the cross-sectional study. Slaughter, workflow zoning and sanitation practices impact the risk of environmental contamination. Five critical control points were identified to help control this contamination. The intervention trial found that control measures could be feasibly implemented using a combination of infrastructure and behaviour change interventions. Use of a participatory approach to translate control measures into practice was well received by stakeholders. Conclusions: The epidemiological findings can be used to reduce the risk of zoonotic transmission of the virus, prevent secondary cases and provide baseline comparison for the early detection of changes in virus transmissibility. The LBM studies demonstrated that control measures can be introduced in LBMs in a low resource setting such and that the interventions should reflect resources available, stakeholder needs and critical control [email protected]