1. Technical support provided by: Highly Pathogenic Avian Influenza Control Programme Threats and Problems of Bird Flu Market chain cleaning and disinfection training

2. 2 Avian Influenza (AI) Caused by Influenza A virus Affect birds and mammals (including human) In birds, it is known as Highly Pathogenic AI (HPAI) and Low Pathogenic AI (LPAI) In human, it is known as bird flu with potential of pandemics HPAI outbreak is subtype H5N1

3. Water fowl H1 – H15 N1 – N9 Swine Influenza H1N1, H3N2 H1N2, H4N6 (2000) H5N1 (2004) Human Influenza H1N1 (1933,1979) H5N1 (1997,2003) H2N2( 1957 ) H9N2(1999) H3N2( 1968 ) H1N2( 2002 ) H7N7( 2003 ) Equine Influenza ( H7N7, H3N8 ) Seal Influenza H7N7, H4N5, H3N2 Whale Influenza H3N2, H13N9 Ferret influenza ( H10N4 ) Chicken Influenza H4,5,7,9,10 N1,2,4,7 Pig H1N1, H3N2 Chicken H5N1 Quail H9N2 Duck Birds Human Bovine Influenza H5N1 (2002,2004)

4. LAYERLAYER BROILERBROILER KAMPUNG CHICKENKAMPUNG CHICKEN ARAB CHICKENARAB CHICKEN BANGKOK CHICKENBANGKOK CHICKEN DUCKDUCK GOOSEGOOSE MUSCOVY DUCKMUSCOVY DUCK QUAILQUAIL DOVEDOVE TURTLE DOVETURTLE DOVE KAKATUAKAKATUA SANTHIA-2005

5. HPAI (H5N1) OUTBREAK 1997—Hong Kong, live bird market (6 people died) Outbreaks in poultry were reported in almost 40 countries 318 human fatalities were reported by 15 countries Economic loss in poultry sector Increased problem of public health Influenza pandemic threat Impact on economy, trade and tourism sectors

6. HPAI in Indonesia Endemic in poultry ( 32 out of 33 provinces) 191 confirmed cases with 159 mortalities in human (13 out of 33 provinces)  WHO data in August 2012 Outbreak in Poultry April 2011

7. Virus infecting human and local poultry is probably not caused by local virus infection, but there is a possibility of outside introduction. Production control aspect: -- Vaccination -- Biosecurity -- Monev activity -- Slaughter house/poultry slaughter house Poultry distribution management and control Bird market and collector yard management Integrated poultry supply chain management: for all production system (sector 1-4) and breeds (layers, broilers, kampung chicken, duck) Poultry control and Monitoring from districs

8. CASE DATA BASED ON SEX (source: MoH 2008) 75% workers in poultry sector are men

9. BIRD FLU CASE DATA BASED ON CONTACT, YEAR OF 2005-FEB 2008 (source: MoH 2008)

10. POULTY DENSITY + H5N1 ENDEMIC HUMAN DENSITY INTERACTION BETWEEN HUMAN AND INFECTED BIRDS IS A MEANS WHERE VIRUS, HUMAN, BIRDS AND UNHEALTHY ENVIRONMENT SANITATION ARE PRESENT IN THE SAME TIME CASE TRANSMISSION DEPENDS ON VIRUS NUMBER X HUMAN BODY SUSCEPTIBILITY X EXPOSURE TIME X VIRULENCE X BODY HEALTH

13. AI/FB is an Endemic disease 32 out of 33 Provinces in Indonesia have been AI (poultry) endemic areas, and 13 of them are bird flu (human) endemic areas Mortality Data in Human caused by Bird Flu has reached 82,9%----- high CFR compares to other infectious disease Impact on industry sector (economy and trade) Impact on tourism sector It is concerned to be pandemic

14. Direct Impact Indirect Impact 1.Cost on bird flu prevention in poultry and human (vaccination, biosecurity) 2.Poultry depopulation and compensation fund for poultry owner 3.Hospitalization and treatment cost in human 1, Poultry industry: decreased production, decreased consumption on birds and eggs, vaccination, Bird Flu Response campaign 2. Funding for Healthy and Hygiene Behavior,  household’ income from poultry and egg selling decrease, income from trade and tourism sectors decrease

15. 1. Seasonal flu  strain B influenza virus, spread quickly between human but it’s not fatal. 2. Avian Influenza (Bird Flu)  zoonosis disease caused by H5N1 virus, sporadic spreading, not easy to spread from bird to human  endemic, fatal 3. Influenza Pandemic  spread quickly between human efficiently, continuous fatal, global spread.

16. What is Pandemic ?? Pandemic is influenza epidemic outbreak that infect human globally with method of rapid and continuous transmission between human that causes fatality in a great number.

17. PANDEMIC PERIODE INTERPANDEMIC Phase 1: Only animal; low risk in human Phase 2: Only animal; high risk in human PANDEMIC ALERT Phase 3: There is human case, but transmission between human has not been found Phase 4: Limited transmission between human (small cluster Phase 5: Transmission in bigger cluster PANDEMIC Phase 6: Effective transmission between human Current situatio n

18. Spanish Flu 1918 Brevig Mission (Alaska) – lost 85% of it population in one week in November 1918.

19. 1918 1933 1957 1968 1977 1997 1999 H1N1 H3N2 H5N1 H9N2 H2N2 H1N1 Spanish Flu Asian Flu Hong Kong Flu Russian Flu INFLUENZA – A PANDEMIC Hong Kong, South China, Korea, Japan, Taiwan, Vietnam, Thailand, Indonesia H5N1 2003 2004 H7N7 H5N1 H1N1 Human flu virus was isolated

20. Direct Impact Indirect Impact 1.Cost of pandemic preparedness (simulation, training, coordination meeting, medicine provision, PPE, health equipment, ambulance hospital) 2.Cost of medical response (hospitalization and case treatment ) 3.Cost of non-health response (transportation, telecommunication, personnel and equipment mobility, monitoring at borders, etc) 1, Paralisyng the industry due to high worker’s absence. 2. Burden on public service (transportation, telecommunication, tourism, banking, small-middle enterprise, market/supermarket, etc) 3. Burden on vital supply (fuel, gas) due to production and distribution paralyse). 4. Cost of Healthy and Hygiene Behavior

21. INFLUENZA PANDEMI THREAT IS REAL, BUT WE CAN’T TELL WHEN WILL IT HAPPEN, MORE IMPORTANTLY,  WE MUST STAY ALERT AND HAVE GOOD PREPAREDNESS TO ANTICIPATE AND RESPOND RAPIDLY AND CORRECTLY

22. Transmission Chain BIRD FLU PREPAREDNESS Preparedness In Phase/ Step Phases 5 - 6 Phase 4 Phase 2 Phase 3 Strategic Step Prevent 1 Stop Transmission 2 Rapid Response 3 PreventStopRespond Phase 1

23. Basic Principle Prioritize public health Consider economic factor Integrated Nation’s components Refer to national and international standard agreement Preparedness and Alertness of Influenza Pandemic anticipation must be sustainably maintained.