Re: Singapore To Make Tangerang Bird Flu Control Pilot Project
Re: Singapore To Make Tangerang Bird Flu Control Pilot Project
AVIAN INFLUENZA TRANSMISSION DYNAMIC
IN PILOT CONTROL PROJECT, TANGERANG, INDONESIA
By
Kandun I Nyoman1, Erna Tresnaningsih2, Wilfried H Purba3 , Roenizar Roesin4. and Gindo Simanjuntak5
1). Director General, DC&EH, MOH. 2). Director, VBDC, DG of DC&EH, MOH. 3). Head, Sub Directorate of Zoonoses, Dte of VBDC, DG of DC&EH, MOH. 4). APW, DG of DC&EH, MOH, and
5). Secretariat Head, Pilot Project of AI Control and Influenza Pandemic Preparedness, MOH
ABSTRACT
The first case of bird flu or Avian influenza (AI) among poultry in Indonesia was reported in November 2003 while in human was confirmed in July 2005. About two millions of chickens in Indonesia were confirmed positive of influenza A(H5N1) viruses by laboratory examination and another 21 millions were eliminated in order to cut AI transmission.
It was reported also that 31 out of 33 provinces in Indonesia were infected by AI in the poultry, and human AI were found in 12 out of these 31 poultry infected provinces. It was recorded that 95 death out 117 human cases of AI were caused by A(H5N1) viruses.
After West Java and Jakarta provinces, then Banten province is known as the third highest cases and death caused by AI with 20 cases and 17 deaths. Tangerang municipality and Tangerang district in Banten province from 2007 to 2010 were selected where the Pilot Project of AI control and Pandemic Influenza Preparedness is being conducted.
During the first year the project was implemented in Tangerang municipality and followed in Tangerang district in the second year. But when the project is conducted in the first six month the plan was changed and to conduct the project simultaneously in Tangerang district also since the case and death of human AI in Tangerang district increased and become worsen.
In Tangerang municipality, there were five human confirmed AI cases with four deaths.
Two of the cases were males and another three were females. One male was contacted with duck but become recovered, and another one male, car engine mechanic was suspected got infection a week before during his trip to Pandeglang, infected area of AI in poultry, about 200 KM from Tangerang municipality.
One female was infected of AI from the chickens manure that used as fertilizer for her flower plant nursery.
Until now on, it was reported that Tangerang district become the highest number of human AI among all infected districts and municipalities, with 14 cases, and 13 deaths.
Nine out of 14 human AI cases were females and all of them died, while another 5 positives were males with 4 deaths.
By age group, were found that seven cases belong to 6-20 years age groups and five cases belong to 21-50 years age group, and found that all of these cases were died. And the remaining belong to 0-5 years age group with two cases and one death.
Regarding an observation and interview, it was known that 12 out 14 persons of positive AI not own any chicken, and they were never thought that they were ever contacted with death or even live chicken during the last two weeks before they got sick, but they were sure that about 10 to 14 days before they got sick, they knew that there were hundreds of death chickens surrounding with 50 to 200 meters distances from their houses.
From eight out of 14 persons that found positive bird flu were known that they knew later on that during 10 to 14 days before they got sick the specimens were taken from the chickens during outbreaks and were found positive of bird flu.
Mean while, from surrounding areas of 12 out 14 person’s residences that confirmed positive of bird flu where collected specimens were taken from chickens always failed to find the positive of virus A(H5N1) since specimens collection was not in right and proper time, place and target.
Bird flu outbreak events among back yard farms poultry or sector-4 poultry farms were found surrounding of all 12 out 14 AI positive persons, and all chickens there is never been vaccinated against bird flu.
There were four out of 12 bird flu positive persons where sector-2 poultry farms were found and all chickens in this sector-2 farms were vaccinated against AI regularly. Human infection risk of bird flu is higher from the poultry in sector-4
farms.
Key words: bird flu, infection risk, backyard poultry farm…............................………………………
Paper is presented in X International Symposium on Respiratory Viral Infection,
Singapore February 28 – March 2, 2008
- snip -
RESULTS
There were 14 cumulative confirmed AI human cases that recorded in Tangerang district since the first AI human case occurred in July 2005 until December 2007. All these cases were studied respectively. These confirmed human cases in Tangerang district were increased very significantly during the last six month of 2007 compared to Tangerang municipality. Until December 2007, the 14 confirmed AI human cases in Tangerang district, were almost three times higher compared to five cases in Tangerang municipality, while 13 AI human deaths in Tangerang district were found more than three times higher than in Tangerang municipality (four cases in Tangerang municipality). Four out of five death cases with 80% CFR was found in Tangerang municipality (Table-3).
About 13 out of 14 AI death cases with 92.9% CFR was found in Tangerang district. Special cases were found in Serpong Sub-district, Tangerang district where six out of 14 cases were found there and all cases were deaths. There were eight out 36 Sub-districts in Tangerang district where AI human cases were found, and Serpong with six cases had the highest number of human AI and all deaths (Table-4).
There were seven confirmed AI human cases belong to 6 - 20 years old of age group , with six deaths (CFR = 85.71%) in Tangerang district. This is the highest number of AI human case and death and followed by age group of 21 – 50 years old with five cases and deaths (CFR = 100%) and the last was among 0 – 5 years old of age group with two cases and one death. (Table-5).
About 9(64.3%) out of 14 AI human cases in Tangerang district were female and another 5(35.7%) were male. Nine out of 14 AI human cases in Tangerang district were female and all deaths (CFR = 100.0%), while another five cases were male with four deaths (CFR = 80%). These cases and deaths were predominantly by female sex group (Table-6) Environment observation were performed surrounding all of 14 AI human cases housing sites, and interviews were done to all AI cases during they were treated in the hospitals included recovered AI infected person. It was then determined that not a single person out of 14 AI human cases that owned any poultry and also not any one of them have directly contacted with sick or death poultry before they were suffered from AI disease. Twelve out of 14 AI human cases for sure they knew that 1 – 2 weeks before they got sick, there were chickens deaths surrounding their houses belong to their neighbors. The distance of these sick or death poultry is roughly about 200 meters from their housing sites.
The other two persons had never recognized sick or death chickens belong to their neighbor, but one of these two persons had traveled a week before he became sick to Pandegelang town, about 100 KM distance. This town is known as a heavy infected area of AI among poultry, while the other person, a housewife, collected goat and chicken’s manure for fertilizing her flower plant nursery business. Eight out of 12 AI human cases had ever heard that some specimens were collected seven to 10 days before the sick or death chickens and they knew many of these specimens were examined by veterinary laboratories and found positive of bird flu disease. They also informed that hundreds of chickens were killed during
AI outbreaks.
All of these 14 AI human cases during they were suffered from AI infection, never heard about chickens sick or death surrounding their houses which belong to their neighbors (Table-7).
DISCUSSION
About 30% of chickens meat demanded by Jakarta’s 8.5 million population are supplied by Tangerang district and this district is only 25 KM distance from Jakarta. Tangerang municipality population is about 1.6 million, with 320.000 households while Tangerang district popu;ation is about 2.6 million with 520.000 households. Tangerang district population and government incomes mainly from agriculture (rice and poultry), fisheries, and light industrial sectors. Scattered industrial estates can be seen in this district with goods produced for domestic and export market purposes. At least about six sector-1 and 22 sector-2 of big poultry farms can be found in this district with 100.000 up to more than 200.000 chickens capacities in each poultry farm unit.
More than 60% of the village population in Tangerang district own sector-3 and sector-4 backyard poultry farms with average about 20 chickens belong to each household. They breed these chickens for themselves to consume but some they also sell. Chicken’s collector in regular time used to visit by door to door the back yard farm owner and pooled these chickens before the collector brought it by motor cycle or small size truck to traditional live bird market. In traditional live bird market these chickens can be sold alive or taken away by the buyer after it was slaughtered but without cleaning the chickens. Some of these chickens were slaughtered in the live bird market or to the chicken slaughter house belong to the market management and after slaughtering, then sold it at or meat stands after cleaning them. Chicken’s intestine is sold separately. These chicken’s meat is bought by restaurant agencies or housewives, for them to cook and to be prepared for consumption.
If we can consider transmission of AI in the Tangerang setting there are multiple points of possible exposure to infected poultry. The “farm to table” links in the chain include: (1): Chicken’ farmà (2): Collector à (3):Transportation à (4): Market à (5): Slaughter house à (6): Meat stands à(7): Food handler à (8): Consumer / cooked chicken meat food. We do know that well coocked poultry is safe, but the seven preceding links in chain have potential risk for AI transmission.
Seven out of eight segmented chain units are used to be the points of the risk factors where AI transmitted among chickens or may infect somebody. It was indicated in this study that 11 out of 12 infected AI human cases were quiet related to these sector-3 or sector-4 back yard farms or its surrounding farm environment. Only one person, a lady who was infected from the chickens. She had very close contact with the slaughtered unclean chickens which was bought from the live bird market. This lady was infected during she was cleaning the slaughtered chicken in the kitchen and washed it before cooking. Strongly suspected that she was infected since she washed her hands without soap.
The families of the two school ages cases reported that their may have been exposed to infected poultry when passing by nearby illegal poultry slaughter house on their way to school. They reported that they knew that the slaughter house was processing sick chickens about one week before the children developed flu symptoms.
All chickens in the sector-3 and sector-4 poultry farm had never been vaccinated against bird flu. The vaccination was conducted very rarely by the veterinary services after an outbreak of bird flu occurred. By diagnostic laboratory examination it was found that all 14 AI confirmed human cases were infected by A(H5N1) viruses.
Not a single patient been found that infected by mutated A(H5N1) virus. This indicated that no evidence of human to human influenza transmission of related AI A(H5N1) virus.
Chicken “collectors” who visit many house hold and the markets on daily basis are likely contribute to dissemination of AI in poultry. AI outbreak in chickens have been reported in 30 of 36 sub-districts, indicating that the risk of transmission to humans in Tangerang district is substantial. It is highly incriminated that these collectors together with their vehicles play the role as spreading agent of some infectious diseases among the poultry including bird flu.
This have to be considered since there is no active movement of domesticated poultry inter villages except by chicken collectors. For this reason, it has to incriminate that collectors visiting especially with their collected chickens become the risk of AI infection among the poultry and from the poultry to the visited village community. Until now there were 12 out of 36 Sub-districts that AI human cases been found in Tangerang district, but in fact about 30 Sub-district in Tangerang district, where , AI were reported among chickens.
Some ducks were also sold in the live bird market. As we know duck is resistant to bird flu9. Some nasal and pharyngeal swab specimens that collected from ducks during AI field investigation among the human index cases, were found positive of A (H5N1) viruses. Ducks may be important as a reservoir of infection for chickens. The specimens were collected from almost all healthy ducks having no symptom of any disease10,11. Some study said that ducks play a role as a carrier of bird flu disease. Ducks are sold along side of chickens in the live bird markets in Tangerang district and Tangerang municipality.
Ducks are known to be more resisitant to bird flu and may have sub-clinical infection. used to be sold not for their meat to be consumed, but most farmers breed duck in order to collect the eggs to sale freshly cooked or as a “salty eggs”. But we are going to pay more attention since duck can be bought freely and brought to the new owner in new villages. This have to be considered that duck must be vaccinated against bird flu before being sold in the live bird market in order to cut the AI transmission from duck to susceptible animal like chickens, especially to cut AI transmission from duck to human .
CONCLUSION AND SUGGESTION
The first human case of AI in Indonesia was found in Tangerang district in July 2005 and until December 2007 of 14 cases were reported with 13 human deaths in eight out of 36 Sub-district in Tangerang district..
1. The pilot project of Avian Influenza Control and Influenza Pandemic Preparedness was initiated by governmental leaders of United States of America, Republic of Indonesia and Prime Minister of Singapore during APEC meeting in Busan, South Korea in November 12, 2005.
2. The pilot project was developed and implemented in July 2007 in Tangerang municipality and in January 2008 was extended to Tangerang district since AI situation in Tangerang district became worse and worse.
3. Tangerang district supplied about 30% of chicken meat demanded by 8.5 million of Jakarta population and about 30 out of 36 Sub-district were infected by AI among chickens in this district.
4. There were seven chain segments as risk factors of infection among chickens and from chickens to human: farm, collection site, transportation, market, slaughter house, meat stands, and food handlers.
All poultry farm sectors have to be restructured in order to cut AI transmission in the farm among chickens and from chickens to humans.
5. Live bird markets and modern markets must be restructured in order to avoid AI transmission among the poultry and from the poultry to humans, and also must be supervised by government public health veterinarian.
All ducks since they may become AI carrier have to be vaccinated against AI especially before being sold in the market.
6. More intensive surveillance and control of H5NI in poultry in Tangerang are needed, as more human cases can be expected as long as H5N1 remains entrenched in poultry.
Terakhir Diperbaharui ( Monday, 28 July 2008 )
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