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 H5N patients H5N 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

1.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

CONCLUSION AND RECOMMENDATION : A. Epidemiological approach should : (1) Formulating the health service targets that maybe translated into action (2) Identifying the priority area to which extra resources should be allocated (3) Providing experts in demography and epidemiologist to assist the district staff in analyzing and setting priorities until they have gained the numerical and other skill required to conduct a situational analysis (4) Initiate training programs in planning (5) Providing extra resources from NGOs

(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