Indo: Warring Against Bird Flu by CA Nidom #H5N1 #birdflu

Author: CA Nidom Chairman AIRC-Airlangga University, Surabaya
January 31, 2012

Bird flu in Indonesia asked the victim again. Beginning in 2012, uncle and nephew who live at home infected. This first cluster of cases in Indonesia this year. Until January 24, 2012, victim of bird flu in Indonesia reached 184 people and 152 died (32 percent and 44 percent of victims of the world), the highest in the world, followed by Egypt and Vietnam. In Thailand and Turkey, stopping human cases since 2007. Of the 33 provinces in Indonesia, 32 are endemic areas of bird flu in poultry and other animals.

Control measures have not been visible progress, let alone educating the public, was like eight years ago. In fact, human cases will be exhausted if the case in animals as well stop. There is no synergy between the authorities. After disbanding the National Commission on Bird Flu, people waiting for Disease Control National Zoonoses gait is expected to play more, no longer as "a cowboy without a gun". The interaction of host and viral Since 1997, the agent / bird flu virus interacts specifically with the host (the host). When this virus infects chickens, morbidity and mortality is very high, can be 100 percent. In ducks, high morbidity, but mortality rate is low. In other avian species are sporadic. In other animals, pigs, cats, dogs and other mammals, the pattern of transmission has not been clearly known. When the virus jumps to humans, the number of cases is very low compared to the population, but mortality (case fatality rate / CFR) is very high, 60-80 percent, depending on the handling of patients.

Lately the pattern of interaction of host (human) with virus-specific look and need to be observed by all parties. Especially the last three cases in Bali, Jakarta and Tangerang. Cases in Bali, the end of 2011, the victim of three people: two children and mothers who live at home. When her children were hospitalized, the mother was still healthy. Mother ill and died several days after her two children died. Preliminary information, the mother is not infected with bird flu, but ultimately positive.

From the field, it is difficult to find a relationship with a factor of transmission from animals. In Jakarta, the nephew died after his uncle died and also lived at home. Nephew was declared not infected with bird flu, but then tested positive. No H5N1 virus found in pigeons in their home. The last case, in Tangerang, has announced infected with pandemic flu virus (H1N1-p), but the action in the RS Tangerang like handling victims of bird flu. Based on family information, the victim did not contact with ducks in the house. Fatwa autopsy Based on the study of victims in other countries, the H5N1 virus not only infects the respiratory tract, but also the whole organ. The victim died of bird flu not only because of the very rapid cytokine storm damage respiratory tissue, but also infection in multiple organs (multiorgan failure). Something similar appears on the animal. Actually human bird flu virus from Indonesia at least produce cytokines compared to other countries of bird flu virus and H1N1 virus-p. However, because the victim showed the opposite picture, autopsy of each victim's needs. Autopsy and analysis of virus in organs will help get the information the course of disease (pathogenesis) that are essential to prevent further casualties. It is not easy to do this because there are social factors, culture, and religion. We need a fatwa or religious regulation so victims of bird flu or other contagious diseases and can turn off the autopsied. The autopsy and the assessment requires hospitals and specialized laboratories. As a country with the highest casualties, the government must set up this facility so soon be able to cope with bird flu.

We could follow the example of Turkey, who since 2007 no human casualties, by addressing the patient to the maximum. liveliness highly dependent Handling victims sufferers. During this flu in Indonesia is considered a disease that is not harmful. Therefore, the readiness of medical personnel need to anticipate the bird flu disease, and final readiness referral hospitals. If this circuit is missed, the case will not be listed as bird flu. Thus, the amount so far only a small portion and an iceberg phenomenon.

Steps that can be done is bird flu vaccination in people at risk, especially those living in the triangle of bird flu, namely Jakarta, West Java, and Jakarta. Another option, sell the antiviral drugs flu-free (osiltamivir) at the drugstore, since the drug is only effective 48 hours after infection. In order for the early diagnosis of right, takes a quick test (rapid test) is available at the clinic. Symptoms of bird flu similar to other flu, often confused with other diseases, like dengue fever or typhoid. While confirmation by lab test (PCR) takes time.

Coalition virus influenza virus, including bird flu and H1N1-p, has the same structure: 8 genes are mutually separated. This virus mutates very easily, either in the gene (drift) and between genes (shift). Mutation drift is usually triggered by extreme conditions, such as weather changes, that is not appropriate vaccinations, and host factors. The vaccine can not cause the virus to jump right into another host, particularly a human, so be careful using bird flu vaccines in animals. Moreover, the current world flu pandemic struck by a new virus, H1N1-p, which is so rapidly spreading. In fact, bird flu has not been successfully controlled. So, this time in Indonesia spread of seasonal influenza viruses (H3N2, H1N1), H1N1-p, and bird flu (H5N1) animals and humans. We "let" them to live freely in Indonesia, a coalition (recombination) antarjenis flu virus, swap genes with one another, giving rise to various characters of the virus. Not surprisingly, the world concerned with Indonesia. We do not other countries willing to take advantage of Indonesia bird flu virus, but we also do not do anything. We need to get to know, how the character of the bird flu virus from patients with past and how the possibility of transmission between humans. Although some experts argue the bird flu virus can not be transmitted between humans, simulations with various models of the virus in lab-enabled high-level security (at least BSL-3) need to be carried out. The researchers at-zoonotic Avian Influenza Research Center, University Press (AIRC-Unair) have examined the patterns of influenza virus in the field and in laboratories. In 2006, carried a mutation "artificial" in the H5N1 virus from poultry in Indonesia without a coalition. It turned out that the H5N1 avian virus H3N2 is more virulent allies. During this time the experts think H5N1 avian virus will adapt to mammals, including humans, if there is a mutation in the PB2 protein amino acids, numbered 627 and 701. However, the experts were surprised the structure of p-H1N1 virus is able to adapt without the mutation 627.

Could there be a similar mutation in bird flu that infected animals or humans? AIRC-Unair joint team of Tokyo University-p track the H1N1 virus and the H5N1 virus in animals in 2011. Of the 1607 samples of healthy chickens found eight positive chickens carrying the virus H5N1. Healthy chickens positive for bird flu but are located in Riau, Central Java, East Kalimantan, West Kalimantan and South Kalimantan. The overall structure of the virus that was isolated in 2011 closer to the duck virus from Yogyakarta, 2007. Chicken H5N1 virus in Indonesia is very varied. This effect on the success of the vaccine used. Ministry of Agriculture has set a master seed vaccine to be used from 2012. From serosurvei antibodies (immune substances) Indonesian children aged 10-11 years against the H1N1 virus-p, 66.9 percent had antibodies without any history of illness. This means that Indonesian children are naturally infected with H1N1 virus-p with no symptoms of illness and most capable of causing antibody. This is different from the rest of children in Japan, 75.6 percent had antibodies to influenza symptoms clear. Transmission antarmamalia Is really the bird flu virus is not transmitted between humans? If the bird flu virus stand alone without a coalition, an opinion can be justified. However, if there is a coalition (shift mutation), transmission antarmamalia (humans) could occur. More recently two influenza research centers, a group of University of Wisconsin (USA) and Erasmus Medical Center (Netherlands), mengoalisikan H5N1 bird flu virus with the H1N1 virus- p. The result is similar: the H5N1 bird flu virus potentially infectious antarmamalia coalition in ferrets. It is very important for Indonesia to confront the pandemic, given our region an ideal place of the coalition. All strains are available, while structuring the environment of animals and humans remains unclear.