An Epidemiological Approach of Avian

Influenza as an Alternative Concept in Indonesia

Siti Pariani

Pirlina Umiastuti

BACKGROUND

INDONESIA

1. AGENT OF DISEASE :

H5N1 -highly pathogenic avian influenza (HPAI)

- Rapid mutations

- Difficult to detect

2. GEOGRAPHIC AND VECTOR FACTORS:

- Island

- wild bird transsito

- poultry

- butcheriy pig

3. POPULATION: - Mobile - Health behaviour (Knowledge, attitude, Practice)

4. DATA: - Poultries in 23 Provinces H5N1 + - 14 patients H5N1 +

5. CLINICAL & ENVIRONMENT APPROACH: - Pasive approach+ investigation model - Surveillance epidemiology ? - Poultry vaccination? - Culling down chicken?

PROBLEMS:

Prevent and control the avian Influenza

OBJECTIVE:

Epidemiological approach concept to prevent and control avian influenza in Indonesia

SPECIFIC objectives: Data collection

Data management

Data analysis

Data dessimination

CRITICAL APPRAISAL:

1.Available and or reliable data of deseases?

- Number of cases

- Incidence rate

- Case fatality rate

2. Rapid assesssment of host, agent, environment?

Host: -Health behaviours of people

Personal hygienes of poultry breeder, care givers and

sellersand bird market

- direct or indirect contact of vectors and agent

-distribution of diseases by demographic variables of

patients, timing of deseases (dry or rainy season),

mapping place of patients etc

Agent: where, when, how human contact with the agent

Environment: Hygiene Sanitation

3. Disease Management ? 1) Epidemiological method into practice : - Analysis - Evaluation - Communication

- Management and teamwork- Consultation- Presentation skills

2) Public health action :- Collection of pertinent data :

-regular-frequent-timely

- Orderly consolidation, evaluation and description interpretation- Distribution of the finding

WHAT SHOULD WE DO IN INDONESIA

SURVEILLANCE EPIDEMIOLOGY

A. DATA COLLECTION

1. “Active” Surveillance

-timely but simplicity, acceptability and sensitivity

2. “passive” surveillance

Continuesly but simple, acceptable and flexible

3. Sentinel approach,

used provokated avian to detect H5N1

B. QUALITY OF DATA

1. DATA INPUT high quality

Who provided the data

How confirm the data specificitas and sensitivitas

2. MANAGEMEN DATA Clean data

Retrieved and verified

3. DATA ANALYSIS AND DATA OUTPUT

relevant, reliable and acurat

4. DATA ARCHIEVED

C. DISSEMINATION:

interdisipline and intersectoral

INVESTIGATION

THREE ELEMENTS:

(a) Notification of essential people and organization

(b) Identification of materials needed

(c) Travel planning

STEPS:

1. Determine the existence of an avian influenza epidemic

2. Confirm of diagnosis

3. Define and count the cases

4. Orient the data in terms of time, place and person

5. Determine who is at risk of having avian influenza

6. Develop and test an explanatory hypothesis

7. Compare the hypothesis with the proven facts

8. Plan a more systematic study

9. Prepare a written report

10.Propose measures for control and prevention

1. DATA COLLECTIONS:

SIMILAR SYMPTOM counted

LAB SPECIMEN

2. CALCULATION OF DATA COLLECTION

3. EVALUATION OF THE SOURCE of INFECTION

4. ESTABLISHED an INFORMAL ASSOSSIATION:

1) Continuing support

2) An effective continuing education opportunity

3) A mutually supporting and efficient method

Point of Important about data

(6) Providing examples of simple indicators and methods of recording, aggregating, and analyzing data to obtain useful information(7) Providing guidelines on budgeting, cost, analyzing and cost control(8) Providing guidelines on the technical issues, including appropriate ways of controlling the avian influenza

B. Data collection and analysis about :

Population: morbidity, mortality, behaviours, etc

Environment: Hygiene sanitation, poultry & buchery pig environments, etc

Agent:specificity and sensitivity of indikators

Health care system: establishing continuesly system; train providers, etc

C. Research Indikator