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

Fixed Dose Combination for TB treatment

According to the World Health Organization, a third of the world’s population is infected with tuberculosis. The disease is responsible for nearly 2 million deaths each year and over 8 million were developing active diseases. Moreover, according to WHO (2000), tuberculosis deaths are estimated to increase to 35 million between 2000-2020. The majority of tuberculosis patients worldwide are still treated with single drugs, or with 2-drug fixed-dose combinations (FDCs). To improve tuberculosis treatment, 2- and 3-drug FDCs were recommended by the World Health Organization (WHO) as part of the DOTS strategy. Since 1999 a 4-drug FDC was included on the WHO Model List of Essential Drugs. Today, FDCs are important tools to further improve the quality of care for people with TB, and accelerate DOTS expansion to reach the global TB control targets. Fixed dose combination TB drugs could simplifies both treatment and management of drug supply, and may prevent the emergence of drug resistance .Prevention of drug resistance is just one of the potential benefits of the use of FDCs. FDCs simplify administration of drugs by reducing the number of pills a patient takes each day and decreasing the risk of incorrect prescriptions. Most tuberculosis patients need only take 3–4 FDCs tablets per day during the intensive phase of treatment, instead of the 15–16 tablets per day that is common with single-drug formulations It is much simpler to explain to patients that they need to take four tablets of the same type and colour, rather than a mixture of tablets of different shapes, colours and sizes. Also, the chance of taking an incomplete combination of drugs is eliminated, since the four essential drugs are combined into one tablet. FDCs are also simpler for care-givers as they minimize the risk of confusion. Finally, drug procurement, in all its components (stock management, shipping, distribution), is simplified by FDCs. Adverse reactions to drugs are not more common if FDCs are used. Nevertheless, whenever side-effects to one or more components in a FDC are suspected, there will be a need to switch to single-drug formulations. Quality, safety and efficacy of FDC drugs are determined by the manufacturing process i.e. by compliance of the manufacturer with the requirements of good manufacturing practices (GMP) and pharmacopoeial specifications. National TB programmes must establish a QA system WHO established a laboratory network that tests the quality of FDCs in the marketplace and registers products upon request from the pharmaceutical industry. (Med J Indones 2003; 12: 114-9) Keywords: fixed dose combination, tuberculosis, treatmen

SARS - infectious disease of 21^st century

<p>Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. According to the World Health Organization, a suspected case of SARS is defined as documented fever (temperature &gt;38°C), lower respiratory tract symptoms, and contact with a person believed to have had SARS or history of travel to an area of documented transmission. A probable case is a suspected case with chest radiographic findings of pneumonia, acute respiratory distress syndrome (ARDS), or an unexplained respiratory illness resulting in death, with autopsy findings of ARDS without identifiable cause. In this article some SARS epidemiological data in Indonesia will also presented. There are 7 SARS suspected cases and 2 probable cases were registered in Indonesia on the period of 1 March to 9 July 2003, and no more cases were reported after that time. How will be SARS progression in the future will be a subject of discussion among scientist, and we will have to wait and be prepared for any development might occur<strong>.</strong><em> <strong>(Med J Indones 2005; 14: 59-63)</strong></em></p><p><strong>Keywords:</strong> <em>SARS, Case Definition, Etiology, Indonesia</em></p

Smoking problem in Indonesia

Smoking is an important public health probLem in Indonesia. Up to 60% of male adult population as well as about 4% of female adult population are smokers. In fact, some of Indonesian kretek cigarettes have quite high tar and nicotine content. Besides health effect, smoking habit also influence economic status of the individuals as well as the family. In health point of view, even though reliable nation wide morbidity and mortality data are scarce, report from various cities showed smoking related diseases, such as Lung cancer, COPD, effect of pregnancy, etc. Other problem is a fact that smoking habit start quite in early age in Indonesia. This article also describe factors complicate smoking control program as well as several things to be done to strengthen smoking control program in Indonesia. (Med J Indones 2002; 11: 56-65) Keywords : smoking, Indonesia, impac

TB &amp; Tobacco

<p>One third of the world population is infected with tuberculosis, and over 8 millions people were developing each year. On the other hand tobacco is responsible for 3 millions death in the world. For Indonesia, our country has the third biggest TB cases in the world. Whereas Indonesia is ranked as having the fourth largest number of smokers in the world. A relationship between smoking and TB has been suspected for a long time, even though the epidemiological evidence has not been convincing so far, as well as the pathophysiology and the biomolecullar changes. At present time there are more and more epidemiological data to suggest relationship between TB and tobacco. Further research should be done to get more indepth relationship as well as avoiding the confounder factor. To be able to perform TB control as well as tobacco control successfully there should be emphasize on synergistic public health approaches. Tuberculosis –which Indonesia got 3^rd rank in the world- as well as smoking problem –which Indonesia got 4^th rank in the world- are two important public health problem for the country. If there are relationship between tobacco and tuberculosis, health problem faced by Indonesian even become bigger. Knowledge about tuberculosis as well as tobacco among Indonesian population is very essential to improve the public health situation. Tuberculosis control programme as well as smoking control programme are essential tools for the well being of Indonesian people. <strong><em>(Med J Indones 2003; 12: 48-52)</em></strong> </p><p><strong>Keywords</strong>: <em>tobacco, tuberculosis, epidemiological data </em></p

Sick building syndrome

<p>Sick building syndrome describes a number of mostly unspesific complaints of some occupants of the building. The exact pathophysiological mechanism remains elusive. It is a multi factorial event which may include physical, chemical, biological as well as psycological factors. In many cases it is due to insufficient maintenance of the HVAC (heating, ventilation, air conditioning) system in the building. Sign and symptoms can be uncomfortable and even disabling, which may include mucus membrane irritation, neurotoxic symptoms, asthma like symptoms, skin complaints, gastrointestinal symptoms and other related symptoms. There are various investigation methods to diagnose sick building syndrome, and on site assessment of the building is extremely useful. Prevention through a proactive air quality monitoring program is far more desirable than dealing with an actual sick building. Indoor air and the sick building symdrome serves as a paradigm of modern occupational and environmental medicine. <em><strong>(Med J Indones 2002; 11:124-31)</strong></em></p><p><strong>Keywords:</strong> <em>indoor air pollution, sick building syndrome, building related illness</em></p

Household size and secondary attack rate for outbreaks of avian influenza H5N1 infection.

a<p>SAR declines to 0.047 when outlier cluster is excluded.</p>b<p>SAR declines to 0.044 when outlier cluster is excluded.</p

Interval between onset of illness for cases (n = 34) in outbreaks of avian influenza H5N1 infection.

<p>Panel A shows the interval between onsets of illness of index and secondary cases in outbreaks. Panel B shows the interval between onsets of illness of serial cases in outbreaks. Black denotes cases not exposed to zoonotic sources of virus and white denotes cases exposed to zoonotic sources of virus.</p