Download emerging infectious disease challenges

One Health Approach to Deal with
Avian Influenza in DKI Jakarta
1 November 2011
Borobudur Hotel, Jakarta, Indonesia
Prof Wiku Adisasmito, DVM, MSc, PhD
Faculty of Public Health
Universitas Indonesia
Outline
Emerging Infectious Disease Challenges
Avian Influenza and other EID Threat
Human-Animal-Environmental Interface
One Health Approach
EID – One Health Approach for Jakarta
EMERGING INFECTIOUS DISEASE
CHALLENGES
Source : Emerging & Re-Emerging Infectious Disease Challenges. Nature 430: 242-49 (Morenz. DM et al, 2004)
EID Threats
Locus of human disease in
geographic hot spots
Pathogens often started as
zoonoses
•Many long-standing
diseases in humans caused
by microbes originally
from animals
•In last 70 years, many new
diseases have “jumped”
from animals to humans
•Nearly three-quarters of
new zoonotic diseases
were caused by pathogens
originating in wildlife
•New diseases tend to
emerge in geographic “hot
spots”
•“Drivers” for emergence
are closely linked to factors
that intensify animalhuman interactions
– Climate changes
– Food security
– Economic growth
– Population pressures
– Behaviors
•The rate of pathogen
emergence is projected to
increase 5 fold over
between 2000 - 2030 as
animal-human interactions
intensify
Human and economic
Impact can be enormous
Adapted from Carroll, D. (2011). Building a One Health Future in Asia : The Special Role of Universities.
Paper presented at the One Health University Network in SEA Deans' Meeting.
World Population
Major area,
region, country
or area
World
Total population in
2010 (thousand)
China
1,341,335
India
1,224,614
Indonesia
239,871
Japan
126,536
Republic of
Korea
Singapore
48,184
6,895,889
5,086
Source : United Nations, Department of
Economic and Social Affairs, Population
Division (2011). World Population
Prospects: The 2010 Revision, CD-ROM
Edition.
In thousand
Most Populous Cities in The World
(November 2010)
35000
30000
25000
20000
15000
10000
5000
0
Rosenberg, Matt (2011). Largest Cities in the World – List One.
www.geography.about.com
Top 10 Most Populous Cities
(November 2010)
No.
Cities
Population (in thousand)
1
2
3
4
5
6
7
8
9
10
Tokyo-Yokohama, JPN
New York, US
Sao Paulo, Brazil
Seoul-Incheon, South Korea
Mexico City, Mexico
Osaka-Kobe-Kyoto, JPN
Manila, Philippines
Mumbai, IND
Jakarta, INA
Lagos, Nigeria
33,200
17,800
17,700
17,500
17,400
16,425
14,750
14,350
14,250
13400
Rosenberg, Matt (2011). Largest Cities in the World – List One.
www.geography.about.com
Global Potential Water Scarcity
AVIAN INFLUENZA AND
OTHER EID THREAT
* Updated on 20 September 2011
(CDC-EH MoH Indonesia)
Cases : 179
Deaths : 147
Cumulative Number of Laboratory Confirmed AI Human
Cases in Indonesia by Province (20 September 2011)
North Sumatra
8
South Sumatra
1
West Sumatra
4
South Sulawesi
1
Riau
9
Lampung
3
East Java
9
Central Java
13
West Java
46
Jakarta
50
Banten
31
Yogyakarta
2
Bali
2
0
10
20
30
40
50
Aditama, Tjandra Yoga. (2011). Policy and Strategy of Avian Influenza & H1N1 Control in
Indonesia. Paper presented in Scientific Conference in Batam 26-28 September 2011.
60
AI in Indonesia - Update
A 1-year old baby from West Jakarta, DKI Jakarta
8 August 2011
• Developed
symptoms
and was
treated at a
health care
15 August 2011
• Hospitalized
in private
hospital
25 August 2011
• Died
AI in Indonesia - Update
10-year old boy and 5-year old girl, siblings from Bangli, Bali
30
September
2011
• Developed
symptoms
and was
treated at
primary
health care
6 October
2011
• Hospitalized
in RSUD
Bangli
7 October
2011
• Hospitalized
in RSUD
Sanglah
9 &10
October
2011
• 5 yo died in
9 Oktober
• 10 yo died in
10 Oktober
HPAI Active Cases in Poultry
Per Month - 2010
400
362
Jumlah Kasus Positif
284
300
200
159
109
100
79
53
64
77
84
85
96
50
De
s
No
v
Ok
t
Se
pt
Ju
n10
Ju
l-1
0
Au
g10
M
ay
-1
0
0
Ap
r-1
Fe
b10
M
ar
-1
0
Ja
n1
0
0
Azhar, M. (2011). Overview Surveillance and Control of HPAI in Poultry in Indonesia. Paper
presented at Workshop on Human and Animal Interface toward WHO-CC
HPAI Active Cases in Poultry per
Province, 2010
Azhar, M. (2011). Overview Surveillance and Control of HPAI in Poultry in Indonesia. Paper
presented at Workshop on Human and Animal Interface toward WHO-CC
H5N1 Influenza
• Birds are principal
reservoir for emergence
and spread
• Closely linked to recent
surge in food production
• Inadequate livestock
“biosecurity” facilitates
uncontrolled spread
• Poor hygiene practices
increase risk of human
exposure and infection
Emergence
Characteristics
• Highly virulent
• Efficient transmission
among poultry
• Very limited transmission
between humans
• Continues to “evolve”
• A coordinated “One
Health” - multi-sectoral
response spanning
animal and human health
is critical
• Highly dynamic changes
in disease patterns
requires programmatic
flexibility
Response
Adapted from Carroll, D. (2011). Building a One Health Future in Asia : The Special Role of
Universities. Paper presented at the One Health University Network in SEA Deans'
Meeting.
Other EID Challenges
First challenge
• Outbreaks of H5N1
since 2003 to date
have caused 501
cases with 297
fatalities in 15
countries. Five Asian
countries (Indonesia,
Thailand, Vietnam,
China, Cambodia)
contribute 72% case
in the world.
Second challenge
• H1N1 Influenza
pandemic, as of 1
August 2010, there
have been 214
countries reported
laboratory-confirmed
cases including over
18,449 deaths
worldwide.
SEARO
(1992)
EURO (at
least
4879)
AFRO
(168)
EMRO
(1019)
AMRO (at
least
8533)
•
WPRO
(1858)
The reported number of fatal cases is an under representation of the actual number
as many deaths are never tested or recognized as influenza related
Source : World Health Organization, 2010
No
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Province
DKI Jakarta
East Java
Banten
West Java
Bali
Central Java
Lampung
South Kalimantan
Yogyakarta
Riau
North Sumatera
South Sulawesi
East Kalimantan
West Kalimantan
North Sulawesi
Papua
Riau Island
Aceh
Central Kalimantan
NTB
Central Sulawesi
South Sumatera
Jambi
NTT
West Sumatera
Total
Cases
(%)
322
198
149
98
58
41
39
37
32
29
20
15
11
10
8
7
6
4
3
3
3
2
1
1
1
1097
29,4
18
13,6
8,9
5,5
3,7
3,6
3,4
2,9
2,6
1,8
1,4
1,0
0,9
0,7
0,6
0,5
0,4
0,3
0,3
0,3
0,2
0,1
0,1
0,1
100
Source : Ministry of Health Indonesia, 2010
HUMAN-ANIMAL-ENVIRONMENTAL
INTERFACE
Key risk factors for important EIDs
•
•
•
•
Human
Animal
Environment
Their interactions
Human
Environment
Animal
Epidemiology
Environment
distribution and determinants of events
in specified populations
Pfeiffer, D. (2011). Introduction to Zoonotic Diseases. Paper presented at the Emerging Zoonotic
Diseases: Integrative Research, Training and Practice Short Course.
Cross-sectoral Development Platforms
Health
•
•
•
•
Maternal and child health programming
Infectious diseases control
Disease surveillance
Communications/behavior change
Education
•
•
•
University linkages
Curriculum development
Education reform
Environment
•
•
•
•
Wildlife resources
Forestry
Conservation
Climate change
Agriculture
•
•
•
Food security
Natural resource management
Livestock/animal husbandry programs
Public Private
Partnership
•
•
•
Vaccines and immunization
Global food security
Pharmaceuticals
Adapted from Carroll, D. (2011). Building a One Health
Future in Asia : The Special Role of Universities. Paper
presented at the One Health University Network in SEA
Deans' Meeting.
ONE HEALTH APPROACH
“One World One Health” was first
launched at The IUCN World
Conservation Congress in Bangkok on
11-25 November 2004
Conceptual Framework to evaluate Resilience of Health System
(Atun & Coker, 2010)
Health System Components (Horizontal Level)
Health System Components
(Vertical Level)
External Context
Stewardship and
Organizational
Arrangements
Financing resource
Generation and
Allocation
Health Care
Provision
External Context
Political
Economic
Epidemiologic
Legislative
Demographic
Socio-cultural
Stewardship and
Organizational
Arrangements
Organizational system and
laboratory and drug networks
Financing resource
Generation and
Allocation
Finances and resources
Health Care Provision
Disease control, Service delivery,
Care pattorn or provision and
utilization, Human resources
Information System(s)
Intrastructure: information
Use information for decision
making
Routine datasets, disease
surveillance
Information
System(s)
Source : Preparing for Highly Pathogenic Avian Influenza - V. Martin, A. Forman, J. Lubroth
Animal Production and Health Division FAO, Rome, Italy
Risk of
introduction
by migrating
birds
Risk of
spread from
infected
poultry
Risk of
introduction
and
dissemination
of Avian
Influenza
Risk of
importation
i
EID – ONE HEALTH APPROACH FOR
JAKARTA
JAKARTA
Jakarta Health Care Services
105 73 49
36 18 0
301
45
43
337
761
1491
154
Public Hospital
Mental Hospital
Maternity Hospital
Specialized Hospital
Primary Health Care (with inpatient)
Primary Health Care
Mobile Primary Health Care
Maternity Home
Clinic
Physician - in group
Physician
Traditional Practice
Pharmacy
Drug Store
7928
Profil Kesehatan DKI Jakarta Tahun 2009 – Dinas Kesehatan Provinsi DKI Jakarta
Drug Traditional Industry
Resource Distribution in DKI Jakarta
The AsiaFluCap Project
Evaluating health system capacity to respond to pandemic influenza in Thailand, Lao PDR,
Cambodia, Indonesia, Taiwan, Viet Nam
Source : The Asia FluCap Project – UI & LSHTM
Cakung
RPU Kartika
Eka Darma
(milik swasta)
Pulogadung
Rawa Kepiting
Petukangan
Utara
5 Poultry
Slaughterhouse
Location in 2010
Surat Keputusan Gubernur
DKI Jakarta No.1909/2009
dalam “April 2010,
Pemotongan Unggas Hanya
Boleh di Lima Lokasi”
(2010)
Cilincing
Tanjung
Priok
Kalideres
Cakung
Pasar
Cengkareng
Pulogadung
Pasar Senen
Rawa Kepiting
Lampiri
Cakung
Petukangan
Utara
Pintu Air
Kramat Jati
Ciracas
13 Poultry
Slaughterhouse
Location in 2011
“Pemprov DKI Jakarta
Bangun 8 Rumah
Pemotongan Unggas”
(2011)
Early Detection
• Wild bird
surveillance
• Domestic poultry
surveillance
AI
Control
AI Control Strategies
Rapid Response
• Culling
• Financial Support
• Vaccination
• Disease surveillance
• Planning for AI
control
Source : Preparing for Highly Pathogenic Avian Influenza - V. Martin, A. Forman, J. Lubroth
Animal Production and Health Division FAO, Rome, Italy
Response
Coordination
Avian
Influenza –
One
Health
Awareness
Surveillance
One Health Institutional Partner and Role
Partner
Ministries &
Provincial
Health Office
Educational
institutions
Description
Example activities
• Partnering with ministries of health,
agriculture and “wildlife”, and provincial
health office to address structural and
operational capacities for coordinated
action
•
•
•
Strengthen animal and human disease surveillance capacities,
Build and link laboratory networks, and
Enhance response capacities – for disease outbreaks, including
those “public health emergencies of international concern”
(IHRs)
• Pairing schools of public health,
veterinary medicine, nursing, and
wildlife management with counterpart
schools and institutions in hot-spot
countries
•
Co-develop pre-service and in-service curricula tailored to the
emerging disease, epidemiology and outbreak response needs of
each country and program.
Strengthen faculty teaching abilities and methodologies through
targeted professional development programs.
Build cadres of trained professionals to lead “the way forward”
•
•
in public-private and community •
Private Sector • Investing
partnerships
• Identify/mitigate practices that contribute •
to the risk of new emergent diseases
Community
•
Supporting the technical and
operational capacities of provincial and
district responders
•
•
Partner with the “extractive industry” to
characterize “risky practices”
Formulate appropriate interventions to reduce “risk”
Characterize “highest risk” areas for focused
operations
Partner with provincial and district authorities from
MOH/MOA/MOE to build local outbreak response
capacities
Adapted from Carroll, D. (2011). Building a One Health Future in Asia : The Special Role of
Universities. Paper presented at the One Health University Network in SEA Deans'
Meeting.
Coordination, Command, and Control
of Public Health Emergency and Pandemic
President
Menko Kesra
National level
Steering
component
Multi sector Planning
Executing
component
Governor
Province
Senior Official
Steering
component
Leadership
Standby
resources
Executing
component
Regent/Mayor
Senior Official
DISTRICT/MUNICIPALITY
Steering
component
Incident Command System/
Executing
component
Agustiono, E. (2011). Human Animal Interface dalam Menghadapi Pandemi Influenza.
Paper presented in Scientific Conference in Batam 26-28 September 2011.
Wilcox, B. A., & Colwell, R. R. (2005). Emerging and Reemerging Infectious Diseases:
Biocomplexity as an Interdisciplinary Paradigm. EcoHealth, 2(4), 244-257.
One Health for Jakarta
Multi-discipline
Multi-sectoral
Various methods
One Health
Emergence
Preparedness
THANK YOU