Task Order 2
Avian Influenza in
Indonesia
Briton Bieze
July 1, 2008
1a
Overview
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•
•
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AI globally
AI in Indonesia
USAID | DELIVER PROJECT activities
Challenges and Lessons Learned
2
Cases of human Avian Influenza Worldwide
• 385 Cases of human AI as of June 29, 2008
– 243 have been fatal
• 135 cases of human AI in Indonesia
– 110 have been fatal
3
So why so much effort into containing AI?
• Human deaths
• Economic loss – poultry deaths, job losses,
production loss from human deaths and illness and
less protein intake, less tourism
• Potential of human pandemic – estimate morbidity
and mortality in the millions
• Potential of economic and societal losses if human
pandemic occurs
4
Worldwide Status of HPAI H5N1
Between Nov 2003 and May 9, 2008
 H5N1 detected in birds in 60 countries
- 6,414 poultry outbreaks reported
- more than 250 million birds have died or been culled
- at least 32 bird and 8 mammalian species affected
- affected countries in Asia, Europe, Near East, Africa
 H5N1 detected in humans in 14 countries
- total of 385 cases and 243 deaths reported
- average of 5-9 new cases per month
- overall fatality rate = 63%
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sources: WHO, OIE, GenBank
Areas reporting confirmed occurrence of H5N1 avian influenza in
poultry and wild birds since 2003, status as of 14.04.2008
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Pandemic Status
•
HPAI-H5N1 already causing a “pandemic” among bird
populations on 3 continents
•
HPAI H5N1 has evolved into 9 different sub-groups between
1996 and 2008; birds still main host
•
H5N1 human infections are still relatively rare; almost all from
bird-to-human transmission
•
Some human-to-human transmission of H5N1 likely but limited
and unsustained in these cases
•
WHO’s current pandemic threat level is 3 (on a scale of 1-6
with 6 being a human pandemic)
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sources: WHO, OIE
Risk Factors Associated with Poultry H5N1 Infections
• Large and dense poultry populations
• Poor biosecurity on farms (especially large, commercial farms)
and in wet markets
• Proximity to or trade with highly-affected areas especially where
there is poor regulation of poultry movement (including ducks
and vaccinated chickens)
• Weak H5N1 surveillance and outbreak investigation capacities
• Slow detection and outbreak response times and incomplete
containment (including limited culling, compensation,
surveillance, movement control)
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Risk Factors Associated with Human H5N1 Infections
• Number/timing of human cases and poultry outbreaks in a
country consistent with bird-to-human transmission of H5N1
– At least 44% of human cases known to have had contact with sick
or dead birds before onset of symptoms
– At least 19% of cases had at least one other family member who
was also a confirmed H5N1 case indicating shared risks and/or
genetic vulnerabilities
– Cases and deaths evenly distributed between males and females
in most countries including Indonesia
•
At least 11 cases of likely but limited and unsustained humanto-human transmission of H5N1 in 4 countries
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Indonesia Country Overview
• Large populations:
– ~1.4 billion poultry
– ~225 million people
• Decentralized systems:
– budgets and decision making
– disease control
• Widespread disease:
– H5N1 circulating in Indonesia between 2003-2008
– H5N1 detected in about 31 of 33 provinces
• Data limitations:
– Limited poultry outbreak and H5N1 sequence data (temporally and
geographically)
– Limited behavioral and treatment data for human cases
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40
37
Sumatra
35
Java
68% of
confirmed H5N1
human infections
in 3 provinces of
Java (Banten,
Jakarta, West
Java)
29
30
24
25
20
15
11
4
5
1
3
2
1
S. Sulawesi
7
6
Bali
10
8
Province
Data from WHO reports through 5/9/08. Indonesia total = 133.
E. Java
C. Java
W. Java
Jakarta
Banten
Lampung
S. Sumatra
W. Sumatra
Riau
0
N. Sumatra
Total Human Cases per Province
Distribution of Confirmed H5N1 Human Cases by Province
(2005-2008)
W. Java has
large poultry and
duck populations
and poultry
outbreaks in
2007
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Indonesia Poultry Production
• Indonesia not a significant exporter of poultry
• Poultry movement within and among islands common
• Mass vaccination of poultry common in commercial sector;
many vaccines available and coverage and dosing not uniform
• Existing poultry surveillance appears to not cover all provinces
or all poultry production sectors
• Reported to be ~13,000 Live Bird Markets in Indonesia
• Co-mingling of poultry, wild birds; poultry slaughter done on
premises
• High-risk factors exist for AI spread among birds and to humans
• Unsold birds sometimes returned to source
• H5N1 detected in some markets
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USAID | DELIVER PROJECT’s Scope of Activities in
Indonesia: 2007 – present
• Personal Protection Equipment (PPE) and
Decontamination Kit pre-positioning
• Support to Komnas FPBI
• Procuring commodities and providing logistics
support for Operational Research poultry vaccination
activity
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PPE and Decontamination Kit Pre-positioning
• 203,350 PPE kits donated to Government of
Indonesia since January 2007
– 55,868 distributed by UNFAO to Ministry of Agriculture for
outbreak investigations
– 31,775 distributed by CBAIC to its partners
– 290 given to Komnas FBPI
– 10,000 on reserve for Komnas FBPI for emergency use
• 997 decontamination kits donated to Government of
Indonesia since January 2007
– 301 decon kits and 501 pails of disinfectant distributed by
UNFAO to Ministry of Agriculture for outbreak investigations
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Support to Komnas FBPI
• National Committee for Avian Influenza Control and
Pandemic Influenza Preparedness
• 10,000 PPE on reserve for emergency
• For PPE stockpile, providing logistics system
guidelines with triggers for emergency use
• Tentative discussions underway to provide Komnas
FBPI with a larger PPE stockpile, more detailed
logistics system, and training on PPE and pandemic
preparedness logistics
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Operational Research Poultry Vaccination Activity
• Operational Research (OR) activity being led by ILRI
in collaboration with UNFAO and USAID | DELIVER
PROJECT and other partners
• Funded by USAID and World Bank
• Main objective to test systems of different
containment strategies
• OR will assess success of 3 different AI control
activities targeting backyard poultry (against control
group, PDSR program) – PDSR program with: AI
mass vaccine; AI with Newcastle Disease (ND) mass
vaccines; full compensation with culling
• Launch date set for July 7
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Partners
• ILRI
– Leading OR
– Research design
– District profiling
• FAO
– Instrumental partner
– On the ground presence and MOA relationship
– Vaccinator trainings, community mobilization
• USAID | DELIVER PROJECT
- Procurement
• CBAIC
– VAICs and community mobilization
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USAID | DELIVER PROJECT and OR
• The project is procuring all commodities
• Supplies include:
– AI and ND vaccine (total of 42.24 million doses)
– Cold chain equipment, including refrigerators for 16 district
storerooms and cold packs, cold boxes and vaccine carriers
for distribution to sub-districts
– Vaccination equipment, including automatic syringes,
injection needles, safe waste disposal boxes, incinerators,
and supplies for vaccinator teams
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Cold Chain
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•
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Assisted UNFAO in conducting cold chain logistics assessment
of district store rooms
Through our sub-contractor, FHI and PATH, developed Quality
Assurance plan for vaccine distribution
Through our sub-contractor, PATH, provided cold chain
logistics management training to provincial and district store
room managers
–
Curriculum: maintaining cold chain for vaccines throughout
distribution, refrigerator maintenance, logistics management
information system, waste management, supportive supervision.
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Challenges - OR
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•
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Animosity between some partners
Need for strong coordination among partners
Lack of clear leadership and roles/responsibilities
Deliver’s relative late arrival in program
Procuring restricted commodities, including those
over $100,000 level – more requirements
• Working through bureaucracy and in decentralized
system
• Lack of cold chain system
• Lack of staff on the ground and in-country support
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Successes - OR
• Partner differences resolved; USAID | DELIVER
PROJECT has strong working relationship with all
partners
• Cold chain system
– Assessed
– Personnel trained
– Commodities procured and being delivered
• All supplies and equipment procured (and being
delivered)
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Lessons Learned
• PPE ordering is a smooth process.
• Preparations for OR activity are succeeding, but have
taken longer and been more complicated than
expected
– Documentation and USAID approval process for purchasing
restricted commodities – vaccines – is extensive
– List of supplies for mass vaccination campaign is extensive
and must be procured globally and locally
– Positive collaboration among partners is imperative
– Clear leadership by USAID and good communication within
USAID and among partners necessary
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Pallet
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Cooler
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TERIMA KASIH!
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