Situation Avian influenza (AI) in Indonesia and public participation in the handling

Until now, bird flu (Avian influenza) are still consuming a lot of attention of the world. Although other diseases such as dengue, tuberculosis, malaria and diarrhea have morbidity and mortality rates are much greater than bird flu, but they are not potentially cause a pandemic. Bird flu pandemic could cause negative impact of extraordinary social, economic and human security. It is estimated that a bird flu pandemic would result in economic losses reached U.S. $ 800 billion and caused the death of 50-160 million people worldwide. However, it is difficult to predict the emergence of bird flu pandemic as the difficulty of estimating the occurrence of earthquakes.

There are 3 of pandemic flu is a world epidemic, the Spanish Flu (1918), caused by H1N1 virus and caused 40 million deaths; Asian Flu (1957), caused by H2N2 virus and caused 4 million deaths; Hong Kong Flu (1968), caused by H3N2 virus and causing 1 million deaths. WHO (2005) states that the bird flu pandemic is different from the flu. Bird flu pandemic may occur in all countries in the world with the spread of patients and deaths and the spread of extensive drug supply is not evenly distributed. This can be a bad influence on economic and social development.
Therefore, all must prepare for bird flu pandemic, and pandemic occurs when increased, WHO will provide a warning to the world. 3 of pandemic alert period (WHO), which includes the Inter-pandemic phase 1 (infection in animals with low risk of transmission manusi) and phase 2 (infection in animals with a high risk of transmission to humans), which includes the Pandemic Alert Phase 3 (infection of the human, currently there is no / very limited human transmission), phase 4 (human infection with evidence of human transmission is limited) and phase 5 (human infection with the human transmission of a growing group) and pandemic phases covering 6 (pandemic, namely human transmission is efficient, effective and continuing).

Assumption time pandemic include:

1. Epidemic lasted 250 days, or death 1773/day average.

2. Epidemic peak achieved in 100 days and at the peak of the epidemic has left 177,300 people.

3. The spread of the epidemic within a radius of 200 days to reach 600 km.

4. It takes 90 days to locate an epidemic and pandemic vaccine supply efforts.

Possible influenza pandemic occurs when a mutation of virus A (H5N1), sub-type of exchange of genes of different viruses / reassortment in humans and pigs that make up a new subtype of the virus can spread rapidly among humans.

According to data owned by P2PL Director General, Ministry of Health of the Republic of Indonesia until 8 September 2006 Indonesia was ranked first as the country with the most cases of bird flu after Vietnam (93 cases, 42 died) from a total of 244 cases of bird flu in the world. Bird flu infections can occur when there is contact with dead poultry / sick poultry droppings (manure) and a polluted environment (unknown) with the incubation period for 1-7 days (with the possibility of human to human transmission in Thailand during the incubation can be 8 -- 17 days).

Classification of cases of bird flu suspect, probable and confirmed with the general characteristics: fever with temperature greater or equal to 38oC, cough, sore throat, runny nose, shortness of breath, have antibody titer of 115 with a third test with horse erythrocytes, and contact with poultry / pork (or products) in the last 7 days, or live in areas with dead poultry. In addition there are other features in the form of an increase in antibody titer or 4 times in a short time heavy happens pneumonia / respiratory failure / died without any other cause (for probable cases) and positive cultures of influenza virus A (H5N1), H5N1 positive PCR, the immunoflourescence found a positive antibody test, or an increase in specific antibody titer of influenza H5 5 times in serum pair (for the case confirmed).

The science of bird flu in humans was developed and many newly discovered evidence. Although the H5N1 virus is not very easily infect humans, but still have to watch out for H5 viruses evolve constantly and is one of the most likely virus to cause pandemic influenza H9 virus in addition. Research conducted in the Bali by the WHO, health office, and the Faculty of Veterinary Medicine Univ. Udayana supporting evidence that the 928 subjects (farmers, traders, chicken, etc.) who are at high risk are not exposed to the H5N1 virus had antibodies to H5N1 in serological.

The study also discusses the current situation of avian influenza in Indonesia. Bird flu increased significantly since May 2006, and until 17 September 2006 was recorded in 65 patients of whom 49 died (75.4%). 32% of the confirmed cases are children under the age of 14 years. Usually, an average of 5 days from the onset of new patients coming to hospital. Most cases came in late and the situation on the degree of 3 or 4 levels of disease weight. Possibility of high mortality in bird flu cases have been caused by late detection (not available rapid test sensitive), late diagnosis (often mistaken for other diseases), provision of antiviral treatment late and less than perfect for at the hospital and on the way when referenced.

In this regard, the government issued several policies, among others:

1. All cases of bird flu should be treated in all referral hospitals have been appointed.

2. Prepared 44 referral hospitals across Indonesia, and will be increased to 100 in the near future.

3. Other hospitals can perform initial assessment before referring to the universal attention and vigilance should be performed in an adequate isolation.

4. Providing anti-viral drug oseltamivir for prevention or treatment.

The government also regional and international cooperation in dealing with bird flu, issued a decree supporting the Decree of the Minister of Health conduct various training, seminars, symposia and workshops in various aspects of avian influenza control, and involve community organizations / NGOs, leaders and community leaders. 8 regional diagnostic laboratories and laboratory Research and Development Agency has developed a BSL-3 so as to check the live virus.

On the other hand, there are some problems faced in terms of tackling and controlling bird flu in Indonesia. There are deficiencies / keterbasan financing, inadequate infrastructure (including knowledge and skills of workers, especially in the area), and perceptions, knowledge and public awareness of bird flu is not the same. Indonesia's vast territory with over 13,000 islands are inhabited, more than 220 million inhabitants, and many remote areas making it difficult to reach the bird flu as a decentralized system the young who have not led to an awareness of the importance of efforts in the health sector has been decentralized.

Therefore, the government announced an independent business community in controlling bird flu with WE BASMI , namely:

1. To Stalls poultry, poultry traffic control and move from the settlements.

2. Informed immediately in case of sick or dead poultry and humans suddenly ill or died due to suspected bird flu.

3. Implement biosecurity to prevent entry of the virus to poultry and human environment and, if already infected poultry or humans in order not to prevent widespread.

4. Secure the families of sick or dead birds suddenly.

5. Wash hands with soap and water, clean the bird cages with disinfectant regularly.

6. Ask the community work together to clean the environment.

7. Immediately to the health center / clinic if symptoms of bird flu was found.

8. Destroy the infected poultry of avian flu and cooked poultry meat and poultry products until cooked.

9. Imunisasikan high-risk people with human flu vaccine, and vaccination of poultry is potentially transmit the virus (poultry, pet birds, ducks, geese) is good and right.