Indonesia: FAO Case Study

The Community-based Management of AHI in Asia newsletter was initiated by the AHI-NGO-RC/RC Asia Partnership, comprised of the IFRC, CARE, and IRC and funded by the Asian Development Bank. The newsletter shares lessons learned with NGOs and other international organizations using participatory, community-based methods to manage avian influenza in high-risk areas. The full newsletter for April can be viewed here: http://www.adpc.net/communityAHI%2DAsia/eLib/Library-files/AHI/Meeting-2008-103/Regional%20Community4.pdf.

In June 2008, the partnership will be releasing a toolkit for community-based work aiming to strengthen community-based prevention and control of H5N1 in Asia by "highlighting experiences in community-based management of (H5N1) in Asia through the collation of case studies and the identification of key issues." The toolkit will be available in June at this link:
www.adpc.net/communityAHI-Asia/


Below are some truncated highlights from this month's case study about the FAO's work in Indonesia:

"PARTICIPATORY TOOLS AS A MEANS TO EMPOWER COMMUNITIES TO PREVENT AND CONTROL HPAI IN INDONESIA’ "

FAO in Indonesia has been working with the Ministry of Agriculture and local governments to establish the Participatory Disease Surveillance and Response (PDSR) system, a village poultry HPAI prevention and control programme nationally coordinated via provincial-level Local Disease Control Center (LDCCs). The general concept is that participatory tools and processes serve as a platform for the rapid mobilization and coordination of animal health services in a community-based Highly Pathogenic Avian Influenza (HPAI) control programme.

With rapid detection and response to HPAI outbreaks in village poultry considered key to bringing the disease under control in Indonesia, the PDSR project was piloted in early 2006 to train and operationally support government veterinarians and other animal health officers in a participatory disease control programme for village poultry enabling rapid detection and response. By the end of May 2008, the project will have approximately 2,100 fully operational PDSR officers, with local support provided by provincial-level LDCCs.

The major outcome of the project so far has been a significant strengthening of veterinary services – i.e. increased technical expertise as well as increased technical and operational capacity to conduct activities in the field.

The project has also facilitated direct engagement of communities with local government livestock services, improved national coordination between national and local governments, increased awareness of AI at the community level, improved detection and response to HPAI outbreaks, facilitated HPAI prevention and control activities by communities and the government, and increased the overall understanding of HPAI disease epidemiology.

Some Lessons Identified for Community-Based Management of AHI
The PDSR project recognized that the optimal disease control unit is the village, not the household. Furthermore, due to the endemic nature of the disease as well as the lack of immediate compensation for culled flocks, PDSR teams face significant challenges in maintaining their relations with communities.

Perhaps the most significant lesson identified so far is that village poultry are not ‘the problem’: controlling HPAI does not require ‘fixing’ a problem with village poultry, but rather protecting them as a means to ensure healthy and economically viable villages and communities.

Stakeholders now understand that the role of commercial producers in maintaining and spreading poultry disease should not be underestimated.

Link to full newsletter: http://www.adpc.net/communityAHI%2DAsia/eLib/Library-files/AHI/Meeting-2008-103/Regional%20Community4.pdf

2 New Suspected Cases of Bird Flu Reported in South Korea

"Two more suspected cases of bird flu have been reported in the southwestern region of South Korea amid intensifying efforts to prevent further spread of the deadly disease, government officials said Tuesday. The Ministry for Food, Agriculture, Forestry and Fisheries said it is checking cases reported at two chicken farms in Iksan, North Jeolla Province, to determine whether the recent deaths of poultry there were caused by avian influenza. The two farms, which reported the deaths of 2,500 and 450 chickens, respectively, are located around 25 kilometers from an area where a bird flu outbreak was confirmed last Thursday, the ministry said. Samples tested positive in preliminary tests but the ministry said further investigation is required.The latest cases in Iksan brought the number of suspected avian influenza outbreaks to 49 as of Tuesday morning. Of them, 26 have been confirmed to be related to a highly pathogenic avian influenza virus, according to authorities."

Story found here: http://www.koreatimes.co.kr/www/news/nation/2008/04/117_22912.html

Epidemic and Pandemic Alert and Response

"Epidemics and pandemics can place sudden and intense demands on health systems. They expose existing weaknesses in these systems and, in addition to their morbidity and mortality, can disrupt economic activity and development.
The world requires a global system that can rapidly identify and contain public health emergencies and reduce unneeded panic and disruption of trade, travel and society in general.
The revised International Health Regulations, IHR(2005) provide a global framework to address these needs through a collective approach to the prevention, detection, and timely response to any public health emergency of international concern.
An integrated global alert and response system for epidemics and other public health emergencies based on strong national public health systems and capacity and an effective international system for coordinated response is necessary. Epidemic and Pandemic Alert and Response (EPR) has six core functions:
* Support Member States for the implementation of national capacities for epidemic preparedness and response in the context of the IHR(2005);
* Support national and international training programmes for epidemic preparedness and response;
* Coordinate and support Member States for pandemic and seasonal influenza preparedness and response;
* Develop standardised approaches for readiness and response to major epidemic-prone diseases;
* Strengthen biosafety, biosecurity, and readiness for outbreaks of dangerous and emerging pathogens outbreaks;
* Maintain and further develop a global operational platform to support outbreak response and support regional offices in implementation at regional level."
Article retrieved from: http://www.comminit.com/redirect.cgicimo=1&r=http://www.who.int/csr/en/

Challenges for pandemic preparedness in developing countries

The Communications Intiaitive has done a nice summary of the recent paper from the CDC on challenges to preparedness in developing countries. Improving the planning process and developing feasible mitigation strategies are two things we're very concerned with in the CORE and H2P projects on pandemic preparedness. The highlights below:

"Improving Planning Processes
To minimise the impact of an influenza pandemic, good preparedness plans need to be developed. With the increasing risk for a pandemic caused by the spread of avian influenza A virus (H5N1), most countries have started such planning. ...[T]he approaches used by industrialised countries may not be feasible or appropriate for developing countries. Feasible, user-friendly tools are needed to assist these countries. [The World Health Organization] WHO has developed several such tools, including a checklist for national preparedness. However, these tools describe the general approaches to pandemic preparedness and are not specifically designed for countries with limited resources. For developing countries more practical tools are needed, among them models to estimate the impact of a pandemic in developing countries, a list of feasible interventions to mitigate the impact of pandemic without available pharmaceutical interventions, and planning guidelines for hospitals with limited resources.

Increasing Availability of Antiviral Agents and Vaccines
If the next pandemic occurs in a few years, vaccines and antiviral agents, particularly neuraminidase inhibitors, may not be available as a main intervention in developing countries. Availability needs to be increased to fill the gaps between developed and industrialized countries.

Providing Better Medical Care
Several issues need to be addressed to provide adequate medical care during a pandemic. First, essential medical supplies such as masks, gloves, and antimicrobial agents should be available in hospitals and clinics. Second, healthcare personnel should be trained for infection control measures. Third, healthcare and public health systems need to be maintained to minimize the impact of a pandemic.

Developing Feasible Mitigation Strategies
More feasible and effective strategies should be developed as soon as possible to mitigate the negative impact of an influenza pandemic in developing countries. Since the availability of pharmaceutical interventions in developing countries is less likely, nonpharmaceutical interventions such as social distancing and personal hygiene may be the only available interventions.

Strengthening Core Capacities
Improving pandemic preparedness without establishing a proper national program for seasonal influenza is unrealistic. For example, increasing the availability of pandemic vaccines without increasing the use of vaccines for seasonal influenza is difficult. It is also difficult to implement infection control measures in hospitals and personal hygiene during a pandemic if they are not routinely implemented for seasonal influenza and other infections."

For the Communications Initiative Summary and link to the full article: http://www.comminit.com/en/node/268647/293

22nd H5N1 Death in Egypt

"A 30-year-old woman died of bird flu in Egypt on Friday bringing the total death toll from the deadly H5N1 strain in the country to 22, the local health ministry said. Walaa Ahmed Abdel Geleel first showed signs of the lethal virus on April 2 and was admitted April 9 to a Cairo hospital, where she died, the MENA news agency reported. A total of 49 Egyptians, mostly women and children, have been infected by bird flu since the first case was reported in the Middle East country in February 2006."

Full story here: http://en.rian.ru/world/20080411/104874535.html

Human to Human Transmission in China

Chinese doctors confirmed that a son recently passed the H5N1 virus to his father. However, testing of other close relatives has not indicated any further spread. Human to human transmission occurs from time to time when there is close contact and doesn't necessarily mean the virus has mutated to pass more effeciently to humans. It's extremely important that the global health community pay close attention to all clusters, though.

"Chinese doctors have reported that human-to-human transmission likely occurred in a small family cluster of H5N1 avian flu cases in China late last year.
A 52-year-old man from Jiangsu province fell ill with the virus after helping care for his son, 24. The younger man died from his infection Dec. 2 but the father recovered.
In an article published electronically by the British journal The Lancet on Tuesday, Chinese doctors reported that molecular analysis showed that viruses from the two men were virtually identical. They were fully avian viruses, meaning they hadn't swapped genes with any human flu viruses or viruses from another mammal."



http://chealth.canoe.ca/channel_health_news_details.asp?news_id=24945&news_channel_id=1020&channel_id=1020

H5N1 returns to South Korea

South Korea recently experienced its first outbreak in poultry this year and it's coming later than usual:

"It is the first time an infection of the highly pathogenic strain of bird flu has been reported this late in the year here. So far in Korea, highly pathogenic bird flu cases were only reported between November and February. Authorities have linked the later outbreak to climate change.
The deadly H5N1 strain can affects humans and even kill them if they come in contact with infected birds.

Authorities will cull 308,000 chickens and destroy eggs at seven farms within 500 m from the infected farm. The first bird flu case was reported in Korea in 2003. No human victims have been reported. Between 2003 and March this year, 372 people were infected and 235 died in China, Vietnam, Indonesia, Cambodia, the Philippines and Thailand. "

http://english.chosun.com/w21data/html/news/200804/200804040018.html

Situation in Indonesia

"The Ministry of Health of Indonesia has announced three new cases of human H5N1 avian influenza infection. The cases are not linked epidemiologically. The first is a 15-year-old male student from Subang District, West Java Province who developed symptoms on 19 March, was hospitalized on 22 March and died on 26 March .
The second case is an 11-year-old female student from Bekasi City, West Java Province who developed symptoms on 19 March, was hospitalized on 23 March and died on 28 March.
The third case is a 21-month-old female from Bukit Tinggi, West Sumatra Province who developed symptoms on 17 March, and was hospitalized on 22 March. She is presently recovering in hospital.
The source of infection for all three cases is still under investigation.
Of the 132 cases confirmed to date in Indonesia, 107 have been fatal." Retrieved from: http://www.who.int/csr/don/2008_04_02/en/index.html