6/6/2012

1

1

Indonesia’s National Efforts to Improve Disease Detection and Surveillance: Current Strategies, Initiatives and Challenges

delivered byIsroil Samihardjo, MDefS

2

General Information (1)

An archipelagic country with dry and rainy seasonsTemperature : 20oC to 30oCHumidity : 65% to 90%Large and diverse population – 220 million/population density 113/km2A crossroad of ancient migration – influenced the genetic  background of host and pathogen 

3

General Information (2)

Threats emanating from infectious Diseases

Anthrax Hemorrhagic Fever Smallpox PlaqueTuberculosis MalariaHIV‐AIDS  Avian InfluenzaTyphoid Fever Hantaan & Nipah virusMeningitis  Rickettsiosesetc.

4

General Information (3)Threats emanating from infectious diseasesEpidemological Aspects

Animal diseases

Human diseases(no immunity)

Rapid and prompt responses (surveillance, early detection, etc)

Safe and secure laboratories

6/6/2012

2

5

Fire weapon armament

Chemical & radioactive weapon

Biological weapon

Rapid and prompt responses (surveillance, early detection, etc)

Safe and secure laboratories

General Information (4)

Threat Emanating from infectious DiseasesEvolution of Terrorism

6

Strategies

• Policy• Surveillance• Laboratory• Research• Data Management

7

Strategies (1)POLICY

• Disease detection and surveillance activities on animal health areconducted by 8 regional labs Disease Investigation Center (DIC) andthe Indonesian Research Center for Veterinary Science (IRCVS).Both centers are under the coordination of the Ministry ofAgriculture.

• Reporting mechanism: any results of disease detection andsurveillance will be collected by 8 Regional labs and will be reportedto the persons in charge of this issue within each Ministry (dependon its nature). Should they need any confirmation about the agentof disease, they are requested to send the samples to the IRCVS forfurther research and investigation.

8

Strategies (1)POLICY

DIC Subang• Two stories, total area

45,524 m2

• Completed in March 2009

6/6/2012

3

9

Strategies (1)POLICY

10

Indonesian Research Center for Veterinary Science (IRCVS) in Bogor

11 12

6/6/2012

4

13

15 16

6/6/2012

5

18

19

Strategies (2)POLICY

• Disease detection and surveillance activities on human health are coordinated by the Ministry of Health (Directorate General of Disease Detection and Environmental Health).

• The Government of Indonesia has also included into its priorities: the implementation of capacity building and improvement of the infrastructure of laboratories, in particular regarding the aspects of biosafety and biosecurity.

• Codes of Conduct on Biological Research Practices is being discussed among related government agencies under the coordination of Indonesian Academy of Science.

20

Strategies (3)SURVEILLANCE

• Disease surveillance of animal diseases are conducted by the regional labs (DIC) in a regular basis, including the monitoring activity on the current diseases such as AI, Antrax, Rabies, Brucelosis  and other strategic animal diseases. (Hog Cholera, ND). 

• Occasionally, IRCVS also conducted the surveillance, related to a certain research projects (eg Nipah, AI, HC etc).  

6/6/2012

6

21

Strategies (4)LABORATORY (a)

Does your country haveNational Laboratory Policy YNational Laboratory Plan/Programme YNational Focal Point for Laboratories YNational Advisory Body on Laboratories NNational Laboratory Network YNational Accreditation Body for Laboratories YNational Laboratory Human Resource Plan NRegistration/licensing: Mandatory (M)/ Voluntary (V)/ Nil (N) MNational Regulatory Authority: Stand alone/part of NRA part of

NRA

* Regional Meeting on Lab Networking, Bangkok 15-19 August 2011 22

Describe the laboratories Y/NNumber of laboratories in public sector 10732•BSL3/BSL4 labs 7/0•BSL2 labs 52

•Number of laboratories at central level 9•Number of laboratories at intermediate/provincial level Hosp Lab 33/ PHL 26/ Env

Lab 10

•Number of laboratories at peripheral/district level 218Number of health laboratories in private sector Clin. Lab 792

Number of health/related laboratories in other sectors ?

Do these laboratories have adequate number of trained staff NA

Is there a system that ensures continuous supply of reagents NA

Is there a functioning system for maintenance of equipment Y

Strategies(5)LABORATORY (b)

CAPACITY

23

Does your country have Y/N

National Laboratory Standards Y

National Accreditation Body for Laboratories Y KAN and KALK

Number of laboratories accredited by national body ISO 17025 : 24 lab, ISO 15189 : 28 lab KALK

Number of labs accredited by international organization TB (5), Polio/ Measles (4), Influenza (2)

National Quality Manager ?

National EQAS (specify discipline) Y

Internal audit in all/some/few/none laboratories some

Use of SOP and validation Not all

Follow biosafety practices and proper waste disposal Not all

QUALITY AND BIOSAFETY SYSTEM

Strategies (6)LABORATORY (c)

24

Strategies (7)RESEARCH

• Research for animal health is carried out mainly by central lab (Balitvet). 

•Universities such as Airlangga University, Primata Center, Gadjah Mada University, etc that have veterinary faculties might also conduct  research activities on vet science.

6/6/2012

7

25

Strategies (8)DATA MANAGEMENT

• Data management for all disease information is managed in the Ministry of Agriculture under ”Info Lab” Program.

• This program has been improved to an “Info Lab Plus” Program, in collaboration with Australia.

26

Initiatives (1)NATIONAL REGULATIONS

‐ Law no. 18/2009 on Livestock and Animal Health.‐ Presidential Decree No. 30 year 2011 on Zoonosis ‐ Decree of the Minister of Health No. HK.03.01/Menkes/073/I/2010 on the 

establishment of the Indonesian Commission on the Research and Assessment of Infectious Diseases.

‐ Decree of the Minister of Health No. 1501/Menkes/Per/X/2010 on the communicable diseases which can cause outbreaks included the surveillance systems and  response program in Indonesia.

‐ Decree of the Minister of Health No. 1244/1994 on the Guidelines on the Biosafety in Microbiology and Biomedical Laboratories.

‐ Decree of the Minister  of Trade and Industry No. 254/MPP/Kep/2000 on the Export and  Import of Certain Dangerous Materials, including Chemical & Biological agents.

‐ Presidential Decree Year 1991 on the ratification of Biological Weapons Convention 

27

‐ National Program  on Avian Influenza (AI), Rabies, Brucella and other diseases such as FMD.

‐ Establishing a structure for the AI disease control consists of the CMU (Center Management Unit),  the LDCC (Local Disease Controlling Center), the PDSR (Participatory Disease Search and Response).  

‐ This program is supported by international agencies such as FAO and other international funding bodies. 

Initiatives (2)CASE STUDY

28

Initiatives (1)NATIONAL REGULATIONS

‐ Decree of the Minister of Health no. 1138/Menkes/SK/XI/2009 for the Sulianti Saroso Infectious Disease Hospital as Detection and Surveillance Center for Infectious Disease.

6/6/2012

8

29

Initiatives (1)NATIONAL REGULATIONS

‐ Decree of the Minister of Health no. 1138/Menkes/SK/XI/2009 for the Sulianti Saroso Infectious Disease Hospital as Research, Detection and Surveillance Center for Infectious Disease.

30

• Joint ExerciseUnder the coordination of the Coordinating Ministry of Political and Security, Indonesia has convened a joint exercise in the field of disease detection and surveillance, at the various levels: local, national as well as regional.

• National WorkshopA number of workshops on disease detection and surveillance have been conducted.  The National Workshop on Animal Diseases has been convened by IAARD (Indonesian Agency on Animal R&D), DGLAHS (Directorate General of Livestock and Animal Health Services), and Professional Organization such as Microbiology Association and Indonesian Veterinary Association.  The National Workshop on Human Diseases Detection and Surveillance have been conducted by NIHRD with  WHO and US–CDC. 

Initiatives (3)

31

Managing Public Awareness

Initiatives (4.a)

Given the nature of diseases in Indonesia which are easilytransmittable/communicable due to the climate condition , the public are need to be well-informed on this issue. To this end and considering the large Indonesia’s population, all related ministries/agencies as well as local governments are working together to disseminate information regarding the diseases and others health-related issues.

The raising awareness done by MoH are laboratory technical workshop including biosafety & biosecurity principles for AI networking laboratories since 2005 (44 labs in 20 provinces; and will be 50 labs in 33 provinces by 2012); developed training modules in Indonesian language for handling AI specimen (2008); developing training modules for biosafety & biosecurity principles based on NIH-WHO modules in Indonesian Language at 2009 (1st

ed) and at 2010 (2nd ed).32

Managing Public Awareness

Initiatives (4.b)

It is imperative that all relevant  governmental institutionscontinue their efforts in creating a coordinated approaches in disseminating such issues. At the same time, public awareness issues should also be carefully crafted since it should not create unnecessary panic in the community, in particular during the case of possible bio‐agents outbreak.

6/6/2012

9

33

Initiatives (4.b)

It is imperative that all relevant governmental institutions continue their efforts in creating a coordinated approaches in disseminating such issues. At the same time, public awareness issues should also be carefully crafted since it should not create unnecessary panic in the community, in particular during the case of possible bio‐agents outbreak.

34

Initiatives (5)

Community MobilizationAlert systems for fever disease: EWORSOutbreaks networking systems in MoHAnnual training for PINERE (New Emerging and re‐emerging Infectious Diseases)EQAS lab for TB control programsPromoting programs in MOH for PINEREEstablishing MTA Committee

35

Challenges (1)• Synergy between related Ministries/Agencies• Finalization of the act related to Biological Weapons

Convention, as the legal umbrella of cooperation in the fieldof biosafety and biosecurity issues, including diseasedetection.

• National Implementation of the World Health Organization’sInternational Health Regulations.

• The difficulties of composing national regulation onCoordination among Ministries to control biosafety andbiosecurity among Ministries.

• The lack of international regime on biosafety and biosecurityin particular the absence of the verification mechanism underthe Biological Weapons Convention.

36

Challenges (2)Indonesia’s Responses

• Working on the establishment of a more effectivecommunication and information networks amongministries/agencies dealing with the issue of diseasedetection and surveillance.

• Conducting regular trainings to develop new methods onthe laboratory of biosafety and biosecurity as well as adual‐use laboratory.

• Enhancing capacity building and cooperation programwith a more advance institutions, in particular toimplement the twinning system laboratory.

• Conducting regular training on biosafety and biosecurityprinciples in primary public health laboratories anddeveloping the EQAS (External Quality Assurancessystems).

6/6/2012

10

37

ConclusionAn Effective Disease Detection and Surveillancerequires:

• Domestic policy, effective regulations and adequatehuman resources capacity.

• Coordination and collaboration in raising awareness.• Availability of international regimes to regulate the uses ofbiological materials to ensure for the purpose of peacefuluses.

• Strong collaboration in the field of capacity buildingamong ARF Participants.

38

Recommendation

• Establishment of International Regimes on biosafety andbiosecurity including the establishment of Internationalverification regimes to the BWC.

• Conducting concrete activities such as training fortrainers or table top exercise to improve institutionalcapacity of ARF Participants in the field of diseasedetection and surveillance.

• Conducting cooperation of laboratories in emerginginfectious disease diagnostic and laboratory network.

39