Whole-of-society approach for influenza pandemic epicenter Containment exercise in Indonesia

BACKGROUND

Since 2003, 200 cases of bird flu (H5N1) cases have been reported with 168 death (case fatality rate: 84%) in Indonesia. Pandemics are unpredictable, but the threat is imminent. Therefore, pandemic preparedness, which includes full simulation exercises, is a key to reduce this threat. Responding to the challenges, Ministry of Health (MoH) Indonesia adopted WHO pandemic risk management guideline, developed contingency plan and conducted full scale epicenter influenza pandemic simulation.

METHOD

The exercise outlines the Government of Indonesia operational plans for Avian Influenza (AI) control from the detection of AI cases (from poultry to human transmission) and containment of human to human transmission of novel influenza virus in influenza pandemic epicenter at Setu village South Tangerang. The simulation covers multiple locations in community, hospitals, point of entry and live bird market. 25 evaluators and around 800 observers involved in the exercise.

RESULTS

The full scale pandemic epicenter containment exercise has demonstrated Indonesia capacity in whole of society approach pandemic risk management in the overall national emergency response framework, covering command and coordination, animal health response surveillance, medical response, laboratory, risk communication, perimeter control, pharmaceutical interventions, non-pharmaceutical interventions and civil-military interoperability. It is served as a momentum to improve multisector commitment on pandemic preparedness. The outcome of this exercise has contributed to identification of gaps that require further strengthening of IHR core capacities in the country to reduce the threat of the next influenza pandemic.

CONCLUSION

There is also a critical need for more evidence-based strategies and policy formulation to strengthen pandemic preparedness.

Estimated incidence of influenza-associated severe acute respiratory infections in Indonesia, 2013-2016

Background

Indonesia's hospital‐based Severe Acute Respiratory Infection (SARI) surveillance system, Surveilans Infeksi Saluran Pernafasan Akut Berat Indonesia (SIBI), was established in 2013. While respiratory illnesses such as SARI pose a significant problem, there are limited incidence‐based data on influenza disease burden in Indonesia. This study aimed to estimate the incidence of influenza‐associated SARI in Indonesia during 2013‐2016 at three existing SIBI surveillance sites.

Methods

From May 2013 to April 2016, inpatients from sentinel hospitals in three districts of Indonesia (Gunung Kidul, Balikpapan, Deli Serdang) were screened for SARI. Respiratory specimens were collected from eligible inpatients and screened for influenza viruses. Annual incidence rates were calculated using these SIBI‐enrolled influenza‐positive SARI cases as a numerator, with a denominator catchment population defined through hospital admission survey (HAS) to identify respiratory‐coded admissions by age to hospitals in the sentinel site districts.

Results

From May 2013 to April 2016, there were 1527 SARI cases enrolled, of whom 1392 (91%) had specimens tested and 199 (14%) were influenza‐positive. The overall estimated annual incidence of influenza‐associated SARI ranged from 13 to 19 per 100 000 population. Incidence was highest in children aged 0‐4 years (82‐114 per 100 000 population), followed by children 5‐14 years (22‐36 per 100 000 population).

Conclusions

Incidence rates of influenza‐associated SARI in these districts indicate a substantial burden of influenza hospitalizations in young children in Indonesia. Further studies are needed to examine the influenza burden in other potential risk groups such as pregnant women and the elderly.