Indonesia opens major exercise to prepare for possible bird flu pandemic

The Jakarta Post (AP), Bali | Fri, 04/25/2008 12:04 PM

Indonesia launched a major bird flu drill Friday that will test the ability of the nation hardest hit by the virus to respond to a possible pandemic. Thousands were taking part, from local residents to government officials.

The three-day simulation started with the isolation of a village on the resort island of Bali, where a field hospital was being set up to treat people with flu-like symptoms. At Sunday's closing, officials will try to prevent "infected" travelers from leaving the international airport and spreading the virus to other countries.

"This is a very important event from the perspective of public health," said Subhash Salunke, of the World Health Organization. "It will certainly help better equip Indonesia in the event of a pandemic. But other countries struggling to contain bird flu outbreaks can and will learn from this exercise as well."

Indonesia has been worst affected by bird flu since it started ravaging Asian poultry stocks in late 2003, with its 107 human deaths accounting for nearly half the 240 recorded fatalities worldwide. The government has come under fire for failing to slow the spread of the virus, which is not endemic in poultry in all but two of the countries' 33 provinces.

Others, like Vietnam, have succeeded thanks largely to strong political will, mass culling of all chickens in infected areas and aggressive vaccination campaigns. But Indonesia says there are limits to what its cash-strapped government can do.

The virus remains hard for people to catch, but scientists worry it could mutate into a form that spreads more easily between humans, with the potential to kill millions worldwide. Indonesia is seen as a potential hot spot for that to happen.

That makes the drill on Bali especially relevant, said Nyoman Kandun, a senior health ministry official. More than 5,000 people were taking part, from government officials and law enforcement officers to doctors and villagers.

"We want to show the world that we are prepared, that we are ready to contain and stop this virus in the event of a pandemic," he said.

Indonesia, US discuss cooperation in bird flu management

Jakarta (ANTARA News) - Visiting US Health and Human Service Minister Michael O Leavitt and his Indonesian counterpart Siti Fadilah Supari met at the presidential office here on Monday to discuss the continuation of bilateral cooperation in bird flu management.

"We meet to follow up on talks on bird flu management that we held in Geneva ten days ago," Siti Fadilah Supari said after the meeting.

She said the follow-up talks with the US health and human services minister were held to find a solution to the Materal Transfer Agreement (MTA) on the shipment of bird flu virus samples to the United States.

According to the Indonesian health affairs minister, almost all of Indonesia`s proposals on MTA were approved at the Geneva meeting although their formats were simplified.

The minister said developing countries including Indonesia wanted MTA to ensure transparency in the use of bird flu virus specimens, transfer of technology to produce bird flu vaccine, and equality in the right to access vaccines.

US Health and Human Service Minister Michael Leavitt was on a two-day visit in Indonesia starting Monday (April 14) to strengthen bilateral cooperation in health affairs, a US Embassy Embassy staffer Kresna Soegio said.

He said there was close cooperation between Indonesia and the United States in health affairs, especially in bird flu management.

According to US Embassy data, the US was through the USAID implementing a program to support Indonesia`s national strategy to control and promote preparedness to deal with the bird flu pandemic for the 2006-2008 period. The strategy provides for enlightenment campaigns for the public and private sectors in every sub district in Java, Bali, West Sumatra and Lampung.

Since 2005, the United States had provided Indonesia with US$42.85 million to fund bird flu control and prevention programs.

Indonesia experiencing slow development in HIV/AIDS treatment

Erwida Maulia, The Jakarta Post, Jakarta | Sat, 04/12/2008 11:17 AM

With shortages of imported medicines and a general lack of knowledge among the affected, only about 10 percent of the 200,000 Indonesians living with HIV/AIDS receive the recommended anti-retroviral (ARV) therapy, an official said Friday.

Chairman of the Association of Indonesian Physicians Concerned about HIV/AIDS and coordinator of the HIV/AIDS clinic at the Cipto Mangunkusumo General Hospital (RSCM), Samsuridjal Djauzi, said in Jakarta on Friday only some 15,000 people with HIV/AIDS in Indonesia were currently receiving ARV therapy.

"Most of these people don't even know of their status (as people living with HIV/AIDS), while others live too far from hospitals to receive treatment," he told reporters on the sidelines of the two-day "2008 Clinical Research Meeting on HIV/AIDS".

The meeting, which started Friday at RSCM in Central Jakarta, is being attended by experts and physicians from hospitals, community health centers and penitentiaries providing HIV/AIDS treatment across the country.

A lack of certain drugs, especially imported ones, has further hampered treatment, according to speakers.

Samsuridjal said most of the 15,000 people being treated were receiving the first-line ARV course, which has been funded by the government for the last few years. The course consists of AZT, d4T, 3TC, Nevirapine and Efavirenz, which is the only drug of the four that is imported.

He said while the number of those treated had steadily increased, funds allocated by the government had not kept up with demand, resulting in a lack of supply of the imported Efavirenz in Jakarta's hospitals over the last month.

He said such restrictions would result in the ARV therapy being discontinued, which could prompt HIV resistance to first-line drugs.

"If the HIV becomes resistant, then we have to shift to the second-line ARV therapy, which is far more expensive and has more severe side-effects," he said, adding that, currently, only 5 percent of Indonesians living with HIV/AIDS were treated with the second-line option, which is typically supplied and funded by donor institutions.

He said the percentage use of second-line ARV therapies would rise yearly following a global increase in HIV resistance to the first-line treatment, and that adherence to the directions for ARV drug usage was crucial, describing it as "the key to the success of HIV/AIDS therapy".

"How can we tell patients to adhere to the drugs' directions if we can't always make the drugs available to them?" he said.

Robert Kosasih, a doctor at Dharmais Cancer Hospital, said among the factors influencing patients' commitment to the rules of anti-retroviral drug courses were the convenience of taking the drugs, the drugs' side-effects, patient background knowledge of the disease and medicine, and the implementation of a reminder policy during therapy sessions.

Artisto Adi Yussac of RSCM said the mortality rate among those using a combination of ARV drugs within two years of starting anti-retroviral therapy was 4.9 percent, based on a recent study involving 367 people treated at the hospital.

China confirms human-to-human bird flu transmission

The Jakarta Post

The Associated Press, London | Tue, 04/08/2008 11:48 AM 

Chinese health officials have confirmed that a father caught bird flu from his son in December, according to a report released Tuesday. 

Human-to-human transmission of bird flu has happened about a dozen times in the past, in countries including Cambodia, Thailand, Vietnam and Indonesia. In nearly every case, transmission has occurred among blood relatives who have been in close contact, and the virus has not spread into the wider community. 

In the case in China, a 52-year-old man and his 24-year-old son in Jiangsu province were diagnosed with H5N1 bird flu within a week of each other in December. At the time, officials from the World Health Organization said they could not rule out the possibility of human-to-human transmission. 

After the son died, his father was treated with antivirls and participated in an H5N1 vaccine trial. He survived. 

The son's only exposure to bird flu was at a poultrymarket, while the father apparently had no direct exposure to sick birds. His only known exposure to bird flu was close contact with his ill son. 

The H5N1 viruses from the father and son were almost genetically identical. 

Experts also tested 91 friends, colleagues, and family members of the father an son -- all of whom tested negative for H5N1, proving that the virus is not casually transmitted. 

"Limited, non-sustained person to person transmission of H5N1 virus probably occurred in this family cluster," wrote researchers at Beijing's Chinese Centre for Disease Control and Prevention in the medical jurnal, The Lancet. 

"There is no indication from this data that we are any nearer to a pandemic," said Ian Jones, a professor of virology at the University of Reading. Bird flu remains difficult for humans to catch, and experts think most cases are linked to close contact with infected birds. 

Health officials monitor every potential case of human to human transmission with particular concern to see if the virus might have mutated into a form that is more easily spread. So far, that has not happened. 

"An air of tension still surrounds this disease," wrote Dr. Jeremy Farrar of the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, and colleagues. 

"Given that the species barrier can be breached, the intriguing question is why the transmissibility of H5N1 among people remains so low?" 

Many flu experts worry that H5N1 will spark a pandemic, potentially killing millions worldwide. But despite circulating widely in Asia and beyond since late 2003, the virus only rarely infects humans. As of April 3, WHO reported 378 cases and 238 deaths worldwide. 

Last week, the agency confirmed another instance of human-to- human transmission in Pakistan from last December.