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

Prevalence and distribution of Taeniasis and Cysticercosis

Taenia saginata and Taenia solium are found through the whole world, especially in developing countries. These tapeworms live in the small intestines of humans. Cattle and pigs are the intermediate animal hosts. Serious signs and symptoms are found if T. solium is infecting the central nervous system. Cases with epileptic seizures and abnormal behavior are often found in endemic areas. In Mexico among 68.754 human serum samples 0,06-2,97% were found positive for cysticercosis. Apparently there was an association between high sero prevalence rates and low socio-economic conditions. In several countries in Latin America, prevalences were between 0,1-8,7%, whereas prevalences between 0,05-10,4% were detected in Asia and Africa. In Indonesia taeniasis/cysticercosis are mostly found in three provinces i.e. North Sumatra, Bali and Irian Jaya. Cases were also discovered in North Sulawesi, Southeast Sulawesi, East Nusa Tenggara and West Kalimantan. The prevalences of taeniasis/cysticercosis in Indonesia were between 1,0-42,7%. The highest prevalence rate was in Irian Jaya (Papua). Not many reports are available for cysticercosis in cattle and in pigs in the world, including Indonesia. The collection of epidemiological data such as on prevalence rates and distribution are needed for a successful control program. In addition community health education should be implemented in control programs

Prevalence and distribution of Taeniasis and Cysticercosis

Taenia saginata and Taenia solium are found through the whole world, especially in developing countries. These tapeworms live in the small intestines of humans. Cattle and pigs are the intermediate animal hosts. Serious signs and symptoms are found if T. solium is infecting the central nervous system. Cases with epileptic seizures and abnormal behavior are often found in endemic areas. In Mexico among 68.754 human serum samples 0,06-2,97% were found positive for cysticercosis. Apparently there was an association between high sero prevalence rates and low socio-economic conditions. In several countries in Latin America, prevalences were between 0,1-8,7%, whereas prevalences between 0,05-10,4% were detected in Asia and Africa. In Indonesia taeniasis/cysticercosis are mostly found in three provinces i.e. North Sumatra, Bali and Irian Jaya. Cases were also discovered in North Sulawesi, Southeast Sulawesi, East Nusa Tenggara and West Kalimantan. The prevalences of taeniasis/cysticercosis in Indonesia were between 1,0-42,7%. The highest prevalence rate was in Irian Jaya (Papua). Not many reports are available for cysticercosis in cattle and in pigs in the world, including Indonesia. The collection of epidemiological data such as on prevalence rates and distribution are needed for a successful control program. In addition community health education should be implemented in control programs

Taeniasis/cysticercosis among Family Members in Villages of Jayawijaya District, Papua

The area of Jayawijaya, including the Subdistricts of Wamena and Assologaima, is a hyperendemic area of taeniasis/cysticercosis. The disease is considered as a household disease because often if one family member is infected with the disease we can also expect other family members with the same disease. The aim of this study is to obtain data on the condition of taeniasis/cysticercosis in families living in a complex of houses (silimo) and to know the distribution of cysticercosis patients living together with taeniasis patients (adult worm carriers). A limited study was conducted using a test on the detection of antibodies against antigen Taenia solium and the ELISA-coproantigen test. The immunoblot test used purified glycoproteins (GP) as a Taenia solium antigen. Antibodies anti-cysticercosis were detected in 51.7% of 89 human sera samples. The seroprevalence of families in Wamena (68.4%, 26/38) was higher in comparison with that in Assologaima (35.3%, 18/51), men (61.2%, 30/49) were more infected than women (40.0, 16/40). In addition positive ELISA-coproantigen was found in 2.4% (3/42) of the families in Assologaima, whereas in 5 families in Wamena as well as in Assologaima family members were found seropositive without an individu with coproantigen positive in their families living in their respectively silimo’s. In hyperendemic areas of taeniasis/cysticercosis one can be infected by his family living in the same complex of houses as well as by other families. All adult worm carriers are contaminating the whole environment

Factors Associated With Occurrence of Cysticercosis Among Wamena People’s, at Jayawijaya District, Papua Province, In 2002

Cysticercosis is a disease caused by the larva of Taenia solium, the pig tapeworm, whereas taeniasis solium is caused by the adult worm, which lives in the small human intestines. The prevalence of taeniasis/cysticercosis in Indonesia varies from 1.0% to 42.7% and until now is found predominantly in three provinces i.e. Bali, North Sumatera and Papua. The highest prevalence was found in Papua during the year 1997 (42,7%). This case-control study was designed for finding factors in connection with the existing cysticercosis in Sub-district Wamena, District Jawawijaya. The number of cases consisted of all patients suffering from cysticercosis aged more than 8 years, found by questionaires during a survey for Taeniasis, Cysticercosis and Neurocysticercosis, conducted by the team from January till February 2002 and the control group consisted of individuals without cysticercosis during the survey. The diagnosis of cysticercosis was determined with ELISA by antibody detection of the parasites in the serum of both groups. Among the total number of variables several factors were found significantly associated with the existence of cysticercosis after calculation as a whole i.e. washing hands (OR 4.9 95%CI:2.55-9.61), profession (OR 2.11 95%CI:1.14-3.91), frequency of bathing (OR 2.59 95%CI:1.31-5.13), source of clean water (OR 2.41 95%CI:1.31- 4.44) and sanitation (OR 6.25 95%CI:3.14-12.44). Community health education is recommended on topics such as the habit of washing hands, bathing with clean water and using standard toilets. It is suggested that the local government provides clean water facilities and general sanitation facilities