Sign Beginning of Bird Flu Like Influenza

27 November 2008

The beginning of this season of year rain in Central Java was marked by an incident that was not expected, that is the existence of casualties to die resulting from the infection of the bird flu virus on November 07 2008 in Medoho, Gayamsari, Semarang. The epidemic of the bird flu infection in humankind was begun during 2005, where 20 cases happening, 13 among them died. The number of cases and casualties died reached his peak during 2006, where being obtained by 55 cases, 45 among them died. All the efforts were mobilised to prevent the occurrence of new cases, so as in the following year his incident figure began to descend, but the new case that happened in Indonesia was still highest in the world was compared country-nagara other that also was attacked by the epidemic of bird flu. (saw the Table) the Table 1. The Cumulative number the Case Avian A/ influenza (H5N1) Humankind that was reported To WHO Up To September 10 2008

The infection Flu Burung Kejadian the bird flu illness to humankind, happened because of the entry of the virus of kind bird flu H5N1 to humankind through the respiratory tract. The virus H5N1 in fact was the kind of the influenza virus that attacked the poultry, but immediately infected humankind. This virus personally was the kind that was really unstable, had the variation many and was easy having a mutation. The infection of the influenza virus was also known as an illness that really was easy to spread. The spread especially through droplet (cipratan) mucus and direct contact were with the sufferer's mucus infected. The variation of the influenza virus was based on the variation from 2 surface antigens, that is H antigens (Hyaluronidase, has been known by 9 sub-types) and N antigens (Neuraminidase, has been known 15 sub the type). (saw the picture). The sub-type variation of this influenza virus also caused the emergence of various variations of the species kind that were sensitive to this virus infection. The influenza virus could attack the poultry, the pig, the whale et cetera, including also humankind. But the attack is generally limited in the certain species kind to individually the sub-type of the virus.

For example to humankind that up till now was known as the seasonal influenza illness, only was caused by the virus infuenza the B type, A type influenza the sub-type H1N1, and A type influenza the sub-type H3N2. Diagnosis humans that was infected by the bird flu virus did not have the typical clinical sign. The sign of the illness in the beginning stage like the common influenza illness, that is the existence of the headache and the cough of the fever. In the development of the illness, hot did not descend and that was typical was the fast breathless emergence got serious. The picture of the blood inspection is also not typical, like the virus attack generally that is the existence of the decline in the number of white blood cells (lekopeni) and the fall trombosit (trombositopeni) so as the possibility if only was based on this data the doctor will diagnose as dengue fever dengue fever or the fever tifoid.

Anamnesa about the story of the existence of the possibility of the sufferer's contact with the poultry was very important in diagnosing bird flu before the laboratory inspection could be carried out. In order to give the guide for people and the health power, then Department of Health RI grouped the case of AI H5N1 to humankind was classified in 3 kinds, in accordance with the development of the diagnosis, that is the case suspek AI, the case probable and the case of confirmation.

1. The Suspek whenever suspicion someone suffered the hot fever 38 C levels were accompanied with one or more the sign along with, the cough, was sick the throat, pilek, breathless (the short breath) was increased with one or more the situation below this:

a. Once contact with the poultry was sick/died suddenly that was not yet known by his cause as well as his raw product (the egg, the bowel) including the waste for the last 7 days before emerging the sign above. That was meant by contact to be treated, cleaned the pen, processed, killed, buried/throw away/membawa

b. Had lived in the location that was gotten by the death of the abnormal poultry for the last 7 days before emerging the sign above. The area of the location was determined with the mobilisation of the poultry that died

c. Once contact with the sufferer AI confirmation for the last 7 days before emerging the sign in atas

d. Once contact with the specimen of AI H5N1 for the last 7 days before emerging the sign in atas

e. Found by the existence lekopenia (not all that 5000/µl) F. Found by the existence of antibodies against H5 with the Hemaglutinase Inhibition inspection (HI) test used eritrosit the horse.

Someone who suffered Acute Respiratory Distress Syndrome (ARDS) with one or more the situation below this:

A. Leukopenia (not all that 5000) or limfositopenia

B. The photograph toraks depicted pneumonia atipikal or infiltrat just on the other hand the lungs that increasingly spread in serial foto 2.

Probable case

It was the case that filled the criterion suspek with one or more the situation below this:

a. Found by the existence of the rise titer antibodies 4 times against H5 with the HI test inspection used eritrosit the horse or the ELISA test

b. Results of the limited laboratory for influenza H5 (terdeteksi him specific antibodies H5 in the single serum specimen) used neutralisasi test.

3. Confirmed case

It was the case suspek or the possibility was attacked with one or more the situation below this:

a. Culture (the culture) the influenza virus of A/H5N1 positif

b. PCR Influenza A/H5N1 positif

c. To Imunofluorescence (IFA) test was found positive antibodies by using antigens monoklonal influenza A/H5N1

d. The rise titer specific antibodies Influenza/H5N1 in the phase konvalesen totalling 4 times or more compared with the acute phase with microneutralization test.

So in this case, the assurance of the cause diagnosis of this infection could be just carried out was based on the laboratory inspection that could prove the existence of the virus infection in the sufferer, that is with the existence of this virus directly or by checking the existence of antibodies anti the bird flu virus to the sufferer. The antibodies inspection was the inspection that fast results at a cost of that was cheap and technically was easy to be done by using the sample took the form of the serum of the sufferer's blood. Antibodies were one of the very specific immunity systems, that was formed by humankind as the response when having the foreign object (the virus) entered the body. Because only was the infection response, then antibodies were just detected in blood after approximately 1 week being sick. Moreover antibodies that were formed could remain several months or even several years to the sufferer's blood. So as the antibodies inspection could be just made by the foundation the infection diagnosis when most was not carried out twice the inspection with the distance 1 - 2 weeks.

In this inspection antibodies could be made infection proof when in the second inspection (the phase konvalesen or recuperation) was obtained by the increase titer minimal 4 times or more were compared by results titer the first inspection that was taken in the acute phase the infection. This was based on consideration of this sufferer still in the active process of forming antibodies as the response to the infection incident that just happened. If results far were not different between the first and second inspection, then indicated that the infection has happened in several months, or the year beforehand. So the antibodies inspection for the bird flu diagnosis, although in fact was specific enough, but could not help in the handling of the sufferer and the epidemiological handling (prevented the spreading of the illness). Because in the day to 14 sufferers has been in the recuperation phase or even has died.