Avian+Flu+in+Indonesia

 “Indonesia is facing an uphill battle against a virus that is difficult to contain. Major human and financial resources, stronger political commitment and strengthened coordination between the central, province and district authorities are required to improve surveillance and control measures.”


 * "Major constraints ([])**

A highly decentralized administration, under-resourced national veterinary services, lack of engagement with commercial poultry producers, insufficient international and national financial and human resources for control campaigns and the challenges of implementing a comprehensive communication strategy are the major constraints the country is facing, he noted."

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Training for local radio journalists in keeping safe from AF: []

Indonesia has the highest number of confirmed deaths worldwide.

TV Campaign in Indonesia http://www.komnasfbpi.go.id/awarenesstv_eng.html Public Awareness campaign: http://www.comminit.com/en/node/134310/293 Criticism about how Indonesia has handled the situation: http://www.scottmcpherson.net/journal/2007/8/27/time-to-stop-pussy-footing-with-indonesia.html Visual Art studio (maybe help with campaign art): http://nana.macangadungan.com/?paged=3

The motherload of community mobilization campaigns. They've basically done EVERYTHING. http://www.jhuccp.org/topics/ avian_flu/CBAIC_BCCstrategy. pdf

Here is the write up from USAID http://www.jhuccp.org/topics/ avian_flu.shtml (scroll down to indonesia)

26 January 2009, 01:02:55 PM
 * Avian influenza – situation in Indonesia**
 * 22 January 2009 -- The Ministry of Health of Indonesia has announced two new confirmed cases of human infection with the H5N1 avian influenza virus. A 29-year-old female from Tangerang District, Banten Province developed symptoms on 11 December 2008, was hospitalized on 13 December and died on 16 December. The investigation indicated that she visited a wet market to buy fresh produce, including chicken meat, on a daily basis. Household contacts were placed under medical observation, where none developed illness.

The second case, a 5-year-old female from Bekasi City, West Java Province developed symptoms on 23 December 2008, was hospitalized on 27 Dec 2008 and died on 2 January 2009. The investigation indicated that she visited a wet market to buy chicken meat and eggs two days prior to symptom onset. Contacts were placed under medical observation, where none developed illness.

Laboratory tests confirmed the presence of the H5N1 avian influenza virus in both cases.

Of the 141 cases confirmed to date in Indonesia, 115 have been fatal. || Maps: http://www.who.or.id/avian/map_avian.php

 Prevention of Avian Influenza Infection
 * Consumer of chicken and chicken products:**
 * Chicken meats and eggs in the market are safe but they must be thoroughly cooked. Meat should be thoroughly cooked until it is no longer pink.
 * Do not eat half cooked meat (chicken, duck etc).
 * Don't eat raw eggs or soft-boiled eggs.
 * Food handlers and people who prepare food for household consumption:**
 * Don't buy chicken meat that has dark, bruised or hemorrhagic spots.
 * Don't buy unusually cheap chicken meat (as this may suggest that the animal was sick before slaughter).
 * Don't buy eggs that have cracked shells or have dirt, feces or feathers on them. Wash eggs thoroughly before cooking.
 * Don't use dirty hand to touch the nose, eyes, or mouth. Wash hands frequently, especially after handling chicken meat, duck meat, offal and eggs.
 * Use separate chopping boards for meats, vegetable, cooked and raw food.
 * Management of pets:**
 * Watch out for any animal deaths.
 * Avoid contact with dead poultry/birds and their feces. If contact is really necessary, cover your hands, nose and mouth. Wash your hands with soap and water for 10 seconds afterwards.
 * When burying dead birds or their feces, avoid generating dust. Spraying or sprinkle water to dampen the area first. Bury bird carcass and feces at a depth of at least 1 metre.
 * When the dead birds and their feces have been properly disposed, clean cages and other contaminated areas very well with detergent and water. Influenza viruses are relatively easy to kill using detergents and disinfectants.
 * Living in bird flu affected area:**
 * If you find sick or dying birds (of any species) in your neighborhood, report it to the Provincial Agriculture department (Dinas Peternakan). Wear gloves and put a cloth over your mouth if you have to touch these birds. Wash your hands with soap and water for at least 10 seconds after touching the birds.
 * Avoid entering farms or wet markets where live birds/poultry are kept.
 * After walking around areas that may be contaminated (such as farms, markets or backyards with poultry), clean your shoes as carefully as possible with soap and water.
 * When cleaning shoes, make sure that you do not flick any particles into your face or on your clothes. Wear gloves or put a plastic bag over your hands.
 * Influenza-like symptoms (e.g. fever >38** °C **, cough, sore throat, runny nose and muscle aches):**
 * Cover your nose and mouth when coughing or sneezing. Use a tissue and throw it away once used. Teach children to do this as well.
 * Always wash your hands with soap and water after any contact with secretions from nose or mouth as these can carry the virus.
 * Children are especially prone to touching their face, eyes and mouth with unwashed hands. Teach children the importance of hand washing after coughing and sneezing.
 * If you go to the doctor, wear a mask or cover your nose and mouth with a cloth.
 * If you have fever and breathing difficulties, go to the health centre and ask them if you have influenza.

About avian flu in general: http://www.who.int/wer/wer8126.pdf

=//World bank campaign// (past): http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/EASTASIAPACIFICEXT/EXTEAPREGTOPHEANUT/EXTEAPAVIFLU/0,,contentMDK:20980002~menuPK:2718905~pagePK:64168445~piPK:64168309~theSitePK:2706883,00.html= Both the Ministry of Health (MOH) and the Ministry of Agriculture are in the process of preparing National Preparedness Plans. Indonesiahas adopted a nine-point strategy for the control of HPAI focused on the sectors of small-scale independent producers and village and backyard producers which are considered to be the highest risk because of low bio-security and high-risk animal husbandry practices. This strategy includes vaccination, animal and human health surveillance, and depopulation. MOH has also been very involved in preparing for a possible outbreak in the human population and in investigating those deaths that have occurred. Technical assistance has been very important in strengthening these responses and in making plans for future activities. In the medium-term, strengthening the current effort will require significant additional resources as surveillance is maintained and the epidemic in the avian population controlled and reduced. If human cases occur in significant numbers there will be a vast increase in resource requirement as surveillance is enhanced and control measures, including isolation and treatment, put in place. The __[|Avian and Human Influenza Control and Preparedness Project]__ for Indonesia is currently in the pipeline, with a planned total cost of **US$80 million**. Most recently, on August 24, 2006, the World Bank agreed with the government of Indonesia and key partners on the details of a**US$15 million grant** to control avian flu and provide compensation for culling and vaccines. The preparation of this grant was announced on September 16, 2006 at a media conference on the sidelines of the annual meetings of the Bank and the IMF in Singapore. Also in Indonesia, the Bank has already provided **US$200,000** to the National Committee on Avian Influenza Control and Pandemic Influenza Preparedness, and **US$130,000** to study options to restructure the poultry farming and marketing systems to reduce disease risks.

Indonesia's response to avian flu: http://siteresources.worldbank.org/INTEAPAVIFLU/Resources/2706872-1152284511396/AI_Indonesia_Report7[2].pdf

Avian Flu in Indonesia =H5N1 virus may be adapting to pigs in Indonesia= Robert Roos News Editor Mar 31, 2009 (CIDRAP News) – Scientists report that H5N1 avian influenza viruses may be adapting to pigs, as evidenced by the finding that H5N1 viruses isolated from pigs in Indonesia were less harmful to mice than were H5N1 viruses from chickens. The finding suggests that in growing in pigs, the virus may have become less harmful to mammals in general, the authors report. That sounds reassuring, but the authors say it may mean the virus is one step closer to turning into a human pandemic strain. In the study, scientists from Japan and Indonesia collected viruses from chickens and pigs in Indonesia, grew them in laboratory cell cultures, and used them to infect mice. They found that the viruses from pigs were less lethal to mice than the viruses from chickens, according to their recent report in the //Archives of Virology.// "We found that swine isolates were less virulent to mice than avian isolates, suggesting that the viruses became attenuated during their replication in pigs," the report states. Pigs are seen as a possible intermediate host that can help avian flu viruses adapt to humans, because the epithelial cells in pigs' trachea can be infected by both avian and human flu viruses, the article notes. If avian and human viruses infected a pig at the same time, they could mix or reassort, giving rise to a novel strain that might be able to spread in humans. The flu pandemics of 1957-58 and 1968-69 were caused by avian-human hybrid viruses, though it is not known if they arose in pigs. But even if they don't mix with human strains, avian flu viruses that infect pigs are believed capable of adapting to them—gaining the capability to grow efficiently in swine cells—and thereby adapting to other mammals, the authors write. Humans occasionally are infected with swine flu viruses, something that has been reported at least twice this flu season in the United States, according to the Centers for Disease Control and Prevention. So far, H5N1 infections in pigs have been reported rarely or gone unnoticed because infected pigs show no signs of illness, the scientists write. But the authors, who include Chairul Nidom of Airlangga University in Surabaya, Indonesia, report that they found H5N1 infections in pigs in Indonesia in 2005, 2006, and 2007. They determined that the swine viruses were closely related to viruses in chickens found nearby, indicating H5N1 spread from chickens to pigs at least three different times. They gathered three viruses from pigs and two from chickens on East Java in 2006 and 2007. They first determined that all the viruses grew well in embryonated eggs and in cultures of canine kidney cells, demonstrating that both avian and swine strains could grow in mammalian cell cultures. They then infected groups of mice with a range of doses of the five isolates. The results showed that all three pig viruses were less virulent in mice than the chicken viruses were, as measured by how large a dose it took to kill half of the mice. Two of the pig isolates were "strongly attenuated" in mice. In a genetic analysis, the scientists found several amino acid differences that might explain the lower virulence of the swine isolates, but they "were unable to determine which mutations were strongly correlated to low virulence in mice because these mutations are frequently found among avian and human H5N1 viruses," the report says. The authors offer this interpretation of their findings: "Since our swine strains were isolated from pigs with no apparent influenza-like symptoms, the decrease of pathogenicity in mice suggests that the H5N1 viruses may have lost their pathogenicity in mammals during replication in pigs. Given that for the H5N1 viruses to cause a pandemic, they would likely become attenuated in humans, becoming attenuated in mammals may be a prelude to the generation of a pandemic strain." They add that because H5N1 infections in swine increase the risk that a pandemic strain could emerge, the findings point up the need for "continuous surveillance and management of H5N1 viruses in pigs." The findings may mean that H5N1 viruses from swine will be less virulent in mammals generally, but it's not clear that the viruses have truly adapted to swine, said Richard Webby, PhD, a virologist, flu researcher, and associate member of the Department of Infectious Diseases at St. Jude Children's Research Hospital in Memphis. Noting that the study authors used only five isolates, Webby said, "Trying to make too much of a conclusion from that number would be premature. The two least lethal viruses were both from swine, but one [swine isolate] was lethal. So perhaps if these become adapted to mammals, they're potentially going to be less pathogenic." Whether H5N1 viruses become more or less virulent when they adapt to mammals is a very important question, he said, adding that the findings "might be to some extent reassuring." Regarding the authors' statement that attenuation of the virus in mammals might be a prelude to the development of a pandemic strain, Webby commented, "I guess the thought behind that is that for a pathogen to be successful, it's got to transmit readily, so if it makes the host too sick, so they go to a hospital or die, the chances of its transmitting to someone else are reduced." But Webby told CIDRAP News that it's not clear that H5N1 viruses have really become established in swine anywhere. "If these viruses have gone into swine, I think the key is whether they become established in swine. If that happened, we'd be concerned. I think the consensus now is that pigs are like humans; they can be infected, but it's unlikely there'd be a lot of transmission." He said US Department of Agriculture researchers have infected pigs with H5N1 viruses and found that the viruses didn't grow at all. But those researchers used viruses that didn't come from pigs in the first place. He noted that pigs often are fed broken eggs or even chicken carcasses, and such pigs might carry the virus in their snouts without becoming truly infected. Webby suggested that researchers now should "put these swine viruses back into swine and see if they actually are more adapted to swine than the avian viruses."
 * An intermediate host**
 * Prelude to a pandemic strain?**

Powerpoint with most info we need Avian Flu in Indonesia

Avian Flu in Indonesia

Over 1,000 people take part in a simulation of a bird flu outbreak in Bali
BALI, Indonesia, 9 May 2008 – A three-day drill to test Indonesia’s capacity to cope with a possible avian influenza outbreak was held on the island of Bali last month. Some 1,000 people in Jembrana District took part in the simulation, which tested all aspects of community response in case of a pandemic. Several families were chosen to portray suspected bird flu victims. After the deadly virus ‘struck’ a resident of Dangin Tukadaya village, police and military personnel carried out a series of containment measures, including closing schools and shops and cordoning off the village to try to stop the virus from spreading outside the epicentre. “Even though it was a simulation, it was pretty scary,” said Inyoman Narma, one the residents who acted as if he had contracted bird flu. “Everything happened so fast. After the security personnel came, the streets were empty. I really hope this never happens.” Developing a warning system Indonesia accounts for 108 of the 241 total human fatalities of avian influenza reported so far worldwide. The country’s bird flu control programme faces big challenges, such as how to regulate the backyard farming that is widely practiced in the sprawling archipelago. The Indonesian Health Ministry's Director General for Communicable Diseases and Environmental Health, Dr. I Nyoman Kandun, who oversaw the drill, said the simulation was held to help develop a proper warning system to respond to a possible flu outbreak. "We want to be prepared for influenza pandemic should it occur here in Indonesia. That’s why we are testing many sectors, including hospitals, security, transportation and communication," said Dr. Kandun. Working together UNICEF Indonesia, with support from the Canadian International Development Agency, has been working closely with the communication section of the Indonesian Health Ministry and the Indonesian Committee for Avian Influenza and Pandemic Preparedness (KOMNAS FBPI). Together, they aim to raise awareness and formulate emergency communication protocols. “UNICEF has been supporting a major campaign to raise awareness of avian influenza. It is now expanding its programme into pandemic preparedness,” said UNICEF Indonesia Representative Dr. Gianfranco Rotigliano. “It is vital that Indonesia is prepared for a possible flu pandemic. Solid preparation will undoubtedly save many lives.” KOMNAS FBPI Chief Executive Bayu Krisnamurthi said the exercise was an excellent learning tool, but added that much more needs to be done. "We must remain vigilant,” said Mr. Krisnamurthi. “Each and every country owes it to the rest of the world to be prepared and protect one another from this or any other deadly virus.”
 * [[image:/avianflu/images/ibc_indonesia_flusimul1.jpg caption="UNICEF Image: Indonesia, Bird Flu simulation"]] ||
 * © UNICEF/2008/ Purnomo ||
 * Children read a newspaper while wearing masks during a massive simulated bird flu pandemic in Bali, Indonesia. ||
 * By Arie Rukmantara**
 * [[image:/avianflu/images/ibc_indonesia_flusimul2.jpg caption="UNICEF Image: Indonesia, Bird Flu simulation"]] ||
 * © UNICEF/2008/ Purnomo ||
 * A resident of Dangin Tukadaya village lies on a stretcher as she plays the role of a suspected bird flu victim in order to assess emergency preparedness. ||
 * [[image:/avianflu/images/ibc_indonesia_flusimul3.jpg caption="UNICEF Image: Indonesia, Bird Flu simulation"]] ||
 * © UNICEF/2008/ Purnomo ||
 * During the simulation, people were told to stay home and avoid contact with their neighbours while authorities distributed antiviral drugs and searched for 'victims'. ||