AUSTRALIA–INDONESIA JOINT SYMPOSIUM IN SCIENCE AND TECHNOLOGY
Jakarta, 13-17 September 2006
Epidemiology and clinical features of Avian Influenza in Indonesia: Questions and lessons learnt
Dr Santoso Soeroso, Director, 'Sulianti Saroso' Hospital, Jakarta, Indonesia
In August 2003, the introduction of H5N1 viruses in poultry occurred in Tangerang, a district nearby Jakarta. However only on July 12, 2005 the first human avian influenza case emerged in the same district. On 19th September 2005, the Government of Indonesia had announced unusual events of Avian Influenza in humans. By now 65 human cases were found, with 49 fatalities (Case fatality Rate = 75,4 per cent), most of them living in Java. It is noteworthy that unlike rural preponderance in Thailand and Vietnam, most Indonesian cases were living in urban areas. Over 500 cases have been investigated and most of them were excluded by laboratory based examination. Most of the confirmed cases were young adults and only 32 per cent children under 14 years of age. Time between onset and notification = 5 days, whereas time between notification and laboratory result available (RT-PCR and HI test) was within 3 days for 70 per cent of cases. The vast majority of cases on admission were in stage 3 and 4 of clinical severity, indicating late referral to the designated referral hospitals. Common laboratory characteristics on admission were leucopenia, lymphopenia, thrombocytopenia (of mild and moderate severity), and elevated aminotransferases. While common radiological findings were as follows, it often emerged within 7 days, and most of the cases had bilateral pneumonia either diffuse, multifocal or patchy infiltrates. The complications that lead to fatality were ARDS (Acute Respiratory Distress Syndrome), Sepsis and multi organ failure.
A big family cluster consists of 8 member have been reported from Karo, North Sumatra. However there have been no recent H5N1 viruses from animals for direct comparison in time and location. Like many other H5N1 human cases in Indonesia, lack of animal counterparts make cause-effect analysis difficult.
Recently suspected family clusters have also been identified in Makassar, South- Sulawesi. In view of the pandemic phases situation, Indonesia remained at the WHO pandemic alert phase 3 with primarily animal infections and some human infections. Family clusters due to self limited unsustainable human to human transmission do not change phase 3 to the next level of pandemic alert.
Dr Santoso Soeroso's current position is Director of 'Sulianti Saroso' Infectious Disease Hospital, Jakarta. He graduated from Medical Faculty, Diponegoro University, Semaraang, Central-Java in 1973. He was also appointed as Vice Chairman of Health Technology Assessment Unit, Ministry of Health (2003- ), Chief of Verification and Case Management of Avian Influenza Team, Ministry of Health and Member of Expert Panel of the National Committee on Avian Influenza and Influenza Pandemic Preparedness (2006- ).
