Anggota Panel Ahli Komnas FBPI, Dr. IGN Mahardika untuk Jakarta Post, 23 April 2008
The nature of avian influenza A (H5N1) virus -- popularly known as bird flu -- itself brings difficulties in its control. Curbing its infection and spread needs to be well organized and concerted, nation-wide. Like a concert, there must be a single conductor.
The intrinsic nature of the virus makes it difficult to be fully controlled. The vaccine should be adjusted to the most current strains. Antiviral agents might lose their effectiveness quickly.
Moreover, a genetic makeup of that kind leads to a complex virus ecology. Considering evolution, the influenza virus is strictly species related. Avian influenza is limited to avian species only, while swine influenza to pig, equine influenza to horse, and human influenza to people.
As proven, however, the bird flu virus is capable of infecting a variety of species. It has expanded its host range from domesticated birds to wild birds and mammals, such as dogs, cats, pigs and even tigers.
Within this situation, the virus will continue to be disseminated by sick and healthy animals. It does not recognize any boundary. The risk in Aceh might be as high as in Java and Papua. It might happen in Indonesia, China, as well as in the United States. The risk level might differ in one area, depending primarily on animal and people densities. Wild bird and international travelers contribute to the globalization of the bugs.
Nowadays, the control of bird flu in Indonesia is disorganized. There is a conductor in every related ministry. Down to provincial and district level, there are other conductors. In the name of autonomy, every province or district has its own strategy to control the bug.
If we go deeper, the bird flu control does not find fertile ground within the community, private industry and government agencies. A part of the community is still unwilling to report any suspected case. People are afraid to be exposed by the media and their birds could be culled thereafter.
So far, bird flu control initiative can not penetrate giant poultry industries. Top officers in this country have said, on various occasions, the state has no access to major poultry industries, known as sector 1 and 2.
This kind of indifference is also supported by local governments. Officers try hard to keep any suspected case silent. The reasons vary. It might be for community stability, poultry industry existence, or tourism safety issues.
We are dealing with a bug that could infect anyone in the planet, rich or poor. If it would happen, there will be no mantra to stop the industry people, their workers and families from becoming infected. The magic of tourism will also lose its sorcery.
International agencies seem to work without coordination as well. Some projects sound very donor driven. Its sustainability is arguable. Some are carried out without the government and society's willingness to adopt them.
The result, not surprisingly, is disharmony. We understand a lot of things have been done and a bulk of funds have been disbursed for bird flu control. Notwithstanding effort, animal and human cases happen out of control. Outbreaks are continuously reported. The up and down pattern expresses merely that the disease is endemic with very little human intervention.
We should find a concerted action to handle this. It must be a single national task force. The National Committee on Bird Flu and Influenza Pandemic Preparedness (Komnas FBPI) was established to coordinate actions to control bird flu. Unfortunately, ego, funding, and autonomy issues have hampered its action.
To be effective, the Komnas should be led by the president or vice president. The head of executive secretary should be a ministry level. This problem of the strata of officers, known as 'eselon', will be diminished.
Komnas must be a task force that works at all level of activities, including research and surveillance, community awareness, communication, and legal and enforcement. It must work based on the best scientific evidence. All stakeholders, such as research institutes, universities, private industries, non-government organizations, lawmakers and enforcers, mass media, etc, must support the task force. All segments must work accordingly.
Available funding should go to it. International donors should work under the Komnas umbrella.
In this regard, international scientist collaboration is a must. The task force will be a port de'entre for international experts to work hand-in-hand with local counterparts.
Nothing is at stake. Neither the livelihood nor poultry industry is. Neither the tourism industry nor national dignity is. We simply save life.
The writer is a virologist at School of Veterinary Medicine, Udayana University, Denpasar, Bali. He can be reached at gnmahardika@indosat.net.id.
Indonesia Luncurkan Kesiapsiagaan dan Respon dalam menghadapi Pandemi Influenza
Jakarta, April 18, 2008 – Pemerintah Indonesia meluncurkan Pedoman Nasional Kesiapsiapsiagaan dan Respon dalam Menghadapi Pandemi Influenza (National Pandemic Preparedness and Response Plan/NPPRP) untuk mengantisipasi kejadian terburuk terjadinya penularan flu burung antar manusia.
Peluncuran dokumen NPPRP tersebut diikuti dengan pengumuman rencana pelaksanaan simulasi penanggulangan episenter pandemi influenza pada 25 hingga 27 April 2008 di Bali. Simulasi tersebut ditujukan untuk menguji pelaksanaan dokumen NPPRP.
“Indonesia mengambil langkah proaktif.” kata Menteri Koordinator Kesejahteraan Rakyat (Menko Kesra) Aburizal Bakrie, yang juga menjabat sebagai Ketua Komite National Pengendalian Flu Burung dan Kesiapsiagaan Menghadapi Pandemi Influenza (KOMNAS FBPI), yang melalui Peraturan Presiden No. 7 tahun 2006 bertugas membantu peningkatan kesiapsiagaan dan tanggap darurat menghadapi kemungkinan pandemi flu burung sebagai akibat mutasi virus H5N1.
Dokumen NPPRP tersebut disusun KOMNAS FBPI melalui diskusi panjang dengan para pakar kesehatan nasional dan internasional, perwakilan pemerintah, dan Perserikatan Bangsa-Bangsa (PBB).
Merujuk pada data PBB, hanya beberapa negara di dunia yang berhasil menyusun dokumen rencana kesiapsiagaan pandemi dan hanya sebagian kecil saja yang kemudian melakukan pengujian melalui simulasi.
“NPPRP ini merupakan dokumen hidup, dalam arti akan terus disempurnakan dengan berjalannya waktu,” ujar Bayu Krisnamurthi, Ketua Pelaksana Harian KOMNAS FBPI.
Untuk menguji dokumen NPPRP tersebut, pemerintah akan menyelenggarakan Simulasi Penanggulangan Episenter Pandemi Influenza di Bali, 25-27 April 2008.
Skenario kondisi pandemi yang dipakai sebagai acuan dapat dilihat dari tabel dibawah ini:
Tertular secara klinis | 66 juta jiwa (30% x populasi RI) |
Perawatan pasien rawat jalan | 33 juta (50% x populasi yang terinfeksi secara klinis) |
Dirawat di rumah sakit*) | 633.600 jiwa (1.92% x pasien rawat jalan) |
Membutuhkan perawatan di ICU*) | 95.040 jiwa (15% x pasien yang dirawat di RS) |
Membutuhkan dukungan Ventilator*) | 47.520 jiwa (50% x pasien yang dirawat di ICU) |
Meninggal*) | 153.120 jiwa (0.232% x populasi yang terinfeksi secara klinis) |
Skenario tersebut mengacu pada perhitungan tingkat keparahan yang meninggal serupa dengan “Flu Asia atau Flu Hongkong” tahun 1968.
”
Simulasi Penanggulangan Episenter Pandemi Influenza Digelar di Jembrana
Sampai saat ini belum terjadi penularan virus flu burung antar manusia. Namun, untuk mengantisipasi dan mencegah meluasnya penularan apabila terjadi episenter pandemi influenza, pemerintah akan laksanakan Simulasi Penanggulangan Episenter Influenza di Desa Dangin Tukadaya, Kab. Jembrana Bali dari tanggal 25-27 April 2008.
Kegiatan itu akan melibatkan kurang lebih 1000 orang yang mewakili pemerintah dan non-pemerintah, TNI dan POLRI. Dalam simulasi tersebut akan diujicobakan tujuh dari delapan pilar kesiapsiagaan menghadapi pandemi influenza, yaitu; komando pengendalian, surveilans dan dukungan laboratorium, respons medis dan kesehatan masyarakat, karantina dan pengawasan mobilitas orang dan barang, pembatasan kegiatan sosial, pemulihan dan rehabilitasi, dan komunikasi risiko.
Desa Dangin Tukadaya disimulasikan sebagai tempat Episenter Pandemi Influenza yaitu lokasi pertama kali ditemukannya kasus penularan flu burung antar manusia. Lokasi lainnya sebagai tempat simulasi adalah Puskesmas Kec. Jembrana, rumah sakit Negara Kab. Jembrana, RS Tabanan Kab. Tabanan dan RS Sanglah Denpasar (dua rumah sakit ini merupakan rumah sakit rujukan flu burung) di Provinsi
Menkes menambahkan, selain Puskesmas dan rumah sakit, Bandara Internasional Ngurah Rai juga digunakan sebagai lokasi simulasi dalam rangka karantina dan pengawasan lalu lintas orang dan barang yang pernah mengunjungi/berasal dari lokasi episenter.
Menurut Menkes, tujuan simulasi adalah mempersiapkan masyarakat, tokoh masyarakat, tokoh adat, tokoh agama, LSM, media
Bertindak sebagai penanggung jawab Simulasi adalah Dr. I Nyoman Kandun, MPH, Dirjen Pengendalian Penyakit dan Penyehatan Lingkungan. Sedangkan sebagai Kepala Pusat Komando dr. Tjandra Yoga Aditama, Sp.P (K). MARS, Direktur Pengendalian Penyakit Menular Langsung Depkes.
Kepala Pusat Komando, dibantu 4 deputi yaitu Deputi Lapangan/Desa, Deputi Komunikasi, Deputi Kabupaten dan KKP serta Deputi Tabanan. Dalam melaksanakan tugasnya, Kepala Pusat Komando dibantu 3 orang Koordinator yaitu Koordinator Wasdal, Pemantau dan Komentator. Selain itu, bertindak sebagai Ketua Penyelenggara adalah dr. Marwan T. Nusri, MPH, Sekretaris Ditjen P2PL Depkes., ujar Menkes.
Pada kegiatan simulasi akan ada pengamat baik dari dalam dan luar negeri. Mereka itu adalah wakil dari badan internasional, tamu negara asing, organisasi profesi, pejabat pusat (lintas sektor), RS Rujukan Flu Burung, UPT Depkes (KKP, BTKL-PPM, dan RS Penyakit Infeksi Dr. Sulianti Saroso) serta Dinas Kesehatan Provinsi, kata dr. Siti Fadilah.
Saat ini virus H5N1 sudah menyebar di Asia, Eropa dan Afrika yaitu : Azerbaijan, Kamboja, China, Djibouti, Mesir, Indonesia, Irak, Laos, Myanmar, Nigeria, Pakistan, Thailand, Turki dan Vietnam dengan angka kematian yang tinggi.
Influenza merupakan virus yang dapat bermutasi dan dapat menular ke manusia. Oleh karena itu virus ini juga mengancam kesehatan manusia dan berpotensi terjadi mutasi atau reasortment sehingga mudah terjadi penularan antar manusia. Karena itu Simulasi ini penting untuk meningkatkan kewaspadaan dan kecepatan bertindak untuk menanggulanginya, papar Menkes.
Flu Burung adalah penyakit mematikan namun dapat dicegah dengan cara yang sederhana, yaitu:
- Cuci tangan pakai sabun sebelum dan sesudah makan. Cuci pula dengan sabun, tangan dan peralatan masak sebelum dan setelah memasak serta saat menyajikan masakan. Masak ayam dan telur ayam sampai matang sebelum dikonsumsi.
- Jangan sentuh unggas yang sakit atau mati. Jika terlanjur, cepat-cepat cuci tangan pakai sabun. Segeralah melapor pada ketua RT/RW atau kepala desa.
- Kandangkan unggas dan pisahkan dari pemukiman. Pisahkan unggas baru dengan ungas lama selama 2 minggu. Bersihkan kandang unggas secara rutin minimal 1 minggu sekali.
- Periksakan diri ke dokter, Puskesmas atau rumah sakit jika mengalami gejala flu dan demam, terutama setelah berdekatan dengan unggas. Pengobatan dan penanganan pasien akan efektif jika penderita mendapat perawatan sesegera mungkin, dan tidak lebih dari 2 hari setelah gejala muncul.
Untuk informasi lebih lanjut, silakan menghubungi:
Bidang Komunikasi KOMNAS FBPI
Telp: 021 385 4227
Email: komunikasi.fbpi@gmail.com
Pusat Komunikasi Publik Departemen Kesehatan
Telp: 021 522 3002
Email: puskom.publik@yahoo.com
New Strategies Against Bird Flu
ScienceDaily (Apr. 17, 2008) — Multiple lethal pathogens such as H5N1 avian flu trigger acute lung injury with a high death rate. Scares of an epidemic have led to an increasing interest in understanding the molecular mechanisms that lead to this condition. Scientists have now identified oxidative stress and innate immunity as a common pathway that controls the severity of ARDS.
The Spanish flu outbreak of 1918 killed between 30 and 50 million people. In the infected patients, the ultimate cause of death was acute respiratory distress syndrome (ARDS). This fatal condition is a massive reaction of the body during which the lung becomes severely damaged. ARDS can be induced by various bacterial and viral infections, but also by chemical agents. These could be toxic gases that are inhaled or gastric acid when aspirated. Once ARDS has developed, survival rates drop dramatically. Among patients infected with H5N1 bird flu, about 50 percent die of ARDS.
An international team of scientists has been addressing the underlying disease mechanisms for the past five years. The team involved researchers from leading institutions in Vienna, Stockholm, Cologne, Beijing, Hongkong, and Toronto as well as the US-army at Fort Detrick. The international effort was coordinated by Josef Penninger and Yumiko Imai of the Institute of Molecular Biotechnology (IMBA) of the Austrian Academy of Sciences.
A first breakthrough came in 2005 when IMBA-scientists identified ACE2 as the essential receptor for SARS virus infections and showed that ACE2 can protect from acute lung failure in disease models (Imai et al. Nature 2005; Kuba et al. Nature Medicine 2005). Based on these data, ACE2 is now under therapeutic development.
In a paper recently published by Cell, the authors describe an essential key injury pathway that is operational in multiple lung injuries and directly links oxidative stress to innate immunity. They also report for the first time a common molecular disease pathway explaining how diverse non-infectious and infectious agents such as anthrax, lung plague, SARS, and H5N1 avian influenza may cause severe and often lethal lung failure with similar pathologies.
To identify these pathways, the researchers studied numerous tissue samples from deceased humans and animals. Victims of bird flu and SARS were examined in Hongkong, and the US-army provided samples from animals infected with Anthrax and lung plague. Common to all ARDS samples was the massive amount of oxidation products found within the cells. Based on these findings, the scientists showed that oxidative stress is the common trigger that ultimately leads to lung failure.
To elucidate the entire pathway, Yumiko Imai of IMBA developed several mouse models. She was now able to show that a molecule called TLR4 (Toll-like receptor 4) is responsible for initiating the critical signalling pathway. TLR4 is displayed at the surface of certain lung cells called macrophages, important players of the body's immune system. Once activated, TLR4 initiates an entire chain reaction which ends with the fatal failure of the lungs. Surprisingly, mice challenged with inactivated H5N1 avian influenza virus also dveloped the full reaction. On the other hand, mutant mice in which the function of TLR4 was genetically impaired were protected from lung failure in repsonse to the inactivated virus.
Based on these findings, the researchers can now outline a common molecular disease pathway: Microbial or chemical lung pathogens trigger the oxidative stress machinery. Oxidation products are intrepreted as danger-signals by the receptor TLR4. Subsequently, the body's innate immune system is activated. This defense machinery in turn leads to a chain of reactions with severe and often fatal lung damage as a consequence.
For Yumiko Imai, a Postdoc in Josef Penninger's team and pediatrician by training, these results are highly satisfying. Her motivation to study ARDS is based on personal experience in over 10 years at a pediatric intensive care unit. "I have seen so many children die from acute lung failure and felt utterly helpless", Imai says. "Since we found a common injury pathway, our hopes are high that we may be able to develop a new and innovative strategy for tackling severe lung infections."
The paper "Identification of oxidative stress and Toll like receptor 4 signalling as a key pathway of acute lung injury" by Imai et al. will be published on April 18 in Cell, Vol. 133(2).
Adapted from materials provided by Research Institute of Molecular Pathology, via EurekAlert!, a service of AAAS.
Indonesia Progress on Pandemic Preparedness
Indonesia formulates the plan to cope with the situation should one day avian influenza mutate into a form that is easily transmitted between humans and spark global flu pandemic.
During the launch, the government also announces a plan to hold a pandemic influenza epicenter containment simulation in
“
Based on the Presidential Decree No.7, 2006, KOMNAS FBPI is tasked to develop the country’s preparedness and response capacity in coping with possible flu pandemic.
After going through series of debates and discussions among
“This (NPPRP) is a living document. It opens for further revisions to adopt the latest development,” said Bayu Krisnamurthi, KOMNAS FBPI's chief executive.
To put the plan into test and review the government's capacity in coping with possible flu pandemic, the government will hold a Flu Epicenter Containment Simulation in
“
Jembrana Distrct Will Host Pandemic Influenza Simulation
Although at present, bird flu has yet mutated into a form that is easily transmitted between humans, to anticipate the spread of a possible deadly flu pandemic, the Government of Indonesia will review its capacity in containing the spread of deadly flu, right at its epicenter.
The drill will involve about 1,000 people, dozens of government and private institutions, the police and military, and therefore would be the largest pandemic simulation ever conducted in the world.
The simulation will put into test seven pillars of pandemic preparedness: command and control, surveillance, medical response and public health response, quarantine and people and goods movement control, social distancing, recovery and rehabilitation, and risk communication.
Health Minister Siti Fadilah Supari said in the simulation, Dangin Tukadaya village would be the epicenter of the pandemic, meaning that it would be the first place where human-to-human flu infection is found. Simulation will also be held in
Siti added that besides Puskesmas and hospitals, the
The minister said the purpose of the drill is to prepare the community and its leaders, non-government organizations, mass media, private sector and government officials to be able to rapidly working together in containing the spread of a deadly flu spread.
The drill will be attended by hundreds of international and domestic observers, representing various United Nations agencies, international organizations, diplomats, professional organizations, senior officials from various ministries, directors of bird flu referral hospitals across
This simulation is vital to increase our awareness and rapid respond capacity to contain deadly flu spread, said the health minister.
Bird flu is a deadly disease, but there are simple steps that every one can take to reduce the risk of contracting the bird flu virus:
- Do not touch sick or dying birds; if you do, immediately wash your hands and report to local authorities.
- Wash your hands and utensils with soap and water before you eat or cook. Cook all poultry and eggs well.
- Separate your birds and separate all new flocks for two weeks.
- Go immediately to a health clinic if you have a fever with flu-like symptoms and have had contact with bird
For more information please contact:
Bidang Komunikasi KOMNAS FBPI
Telp: 021 385 4227
Email: komunikasi.fbpi@gmail.com
Pusat Komunikasi Publik Departemen Kesehatan
Email: puskom.publik@yahoo.com
First Successful Libraries Of Avian Flu Virus Antibodies Created
Dikutip dari http://www.sciencedaily.com/releases/2008/04/080414174851.htm
ScienceDaily (2008-04-14) -- Scientists have created the first comprehensive monoclonal antibody libraries against avian influenza using samples from survivors of the 2005/2006 "bird flu" outbreak in Turkey. These antibody libraries hold the promise for developing a therapy that could stop a pandemic in its tracks and provide treatment to those infected, as well as potentially pointing the way towards the development of a universal flu vaccine.
ScienceDaily (2008-04-14) -- Scientists have created the first comprehensive monoclonal antibody libraries against avian influenza using samples from survivors of the 2005/2006 "bird flu" outbreak in Turkey. These antibody libraries hold the promise for developing a therapy that could stop a pandemic in its tracks and provide treatment to those infected, as well as potentially pointing the way towards the development of a universal flu vaccine.
The expanded treatment and containment options offered by Sea Lane's antibody libraries could help provide healthcare officials, researchers, and governments with unprecedented resources to combat this serious global health threat.
"Three global influenza pandemics have occurred within the past 100 years, each with devastating consequences," said Richard A. Lerner, the Lita Annenberg Hazen Professor of Immunochemistry at, and President of, the Scripps Research Institute (La Jolla, CA) who collaborated with Sea Lane on the study. "Our study holds out the hope that a new outbreak could potentially be stopped at an early stage, and that effective treatment could be available to those infected."
Libraries Have Yielded More Than 300 Antibodies Active Against Avian Influenza
So far, the new antibody libraries reported in the study have yielded more than 300 unique monoclonal antibodies that are active against H5N1 antigens--foreign substances that produce an immune system response. From this group, the authors identified several broadly neutralizing antibodies that were effective against a number of contemporary subtypes of H5 (avian) flu.
Moving Towards A Universal Influenza Vaccine
The new research reported here suggests that the antibodies recovered from the avian flu survivors may point to an exploitable weak spot in the virus, offering the tantalizing possibility that a "universal" vaccine against all strains might be made.
Remarkably, three of the more than 300 antibodies catalogued have been found to neutralize both the H1 (common seasonal flu) and H5 (avian) subtypes. "The antibodies we have isolated have the potential to be used directly as therapeutic agents against multiple influenza subtypes, permitting the resolution of infection upon administration to an infected individual," said Peter Palese, the Horace W. Goldsmith Professor & Chairman of Microbiology at The Mount Sinai School of Medicine (New York, NY), another collaborator on the project.
"Perhaps most importantly, these antibodies may be used to identify cross-reactive epitopes on the hemagglutinin protein of an influenza virus. Identification of such epitopes may allow the rational design of vaccines with cross-subtype neutralizing activity. Such vaccines would constitute a major advance on current technology, and would be a first step towards the design of a universal influenza vaccine," noted Palese.
Preventing The Worst-Case Scenario -- Another Global Influenza Pandemic
Human infection with the avian flu virus H5N1 was first reported in 1997. Since 2003, according to the World Health Organization, more than 370 confirmed cases of human infection have been reported in 14 countries.
While overwhelmingly confined to bird populations in Asia and Europe, the H5N1 avian flu virus has shown its ability to infect humans and has killed more than 230 people around the world. Epidemiologists remain concerned that the virus will one day mutate and be able to spread more readily between people, sparking a global pandemic. The 1918-1920 Spanish flu, which shows evidence of originating in birds, killed somewhere between 40 and 100 million people.
The antibodies recovered from these H5N1 survivor libraries, described in the report, provide opportunities for passive immunization with monoclonal antibodies that could help future individuals infected with H5N1 successfully overcome infection. Monoclonal antibody therapy is known as passive immunotherapy because patients are treated with antibodies that were made outside of their own immune systems instead of those actively made internally.
The potential for passive immunization against influenza has been evident since the Spanish influenza pandemic nearly a century ago, where the benefits of transfused blood reduced the risk of mortality by more than 50 percent. Additionally, the benefits of treatment with convalescent plasma have begun to be reported in instances of H5N1, while passive immunization with human and mouse monoclonal antibodies have been shown to protect animals from death, even when given after H5N1 infection.
Offers Additional Therapeutic Potential
"The antibodies we recovered from Turkey have important and broad potential," said Michael Horowitz, Chief Operating Officer for Sea Lane. "They could lead the way to providing significant protection against a broad reach of influenza--perhaps as protection to first responders and those at immediate risk, and then as treatment for those infected."
According to Ramesh Bhatt, Vice President for Research at Sea Lane, "The combination of the team's innovative antibody library techniques and tremendous scientific rigor enabled the recovery of this extensive collection of antibodies from the avian flu survivors. Because of the large number of antibodies obtained, we were able to perform a detailed immunochemical analysis of these survivors' antibody solutions against avian influenza virus during an actual outbreak."
The resulting antibody libraries--collections of genetic antibody material--were not dependent on whether an important antibody was being produced by the body at the time of the sample collection. Instead, the scientists were able to obtain the entire immunologic history of an individual's response, which offered a clearer picture of the relationships between antibodies and their relative effectiveness. These insights may help scientists determine prescient strategies for therapies as the virus mutates in the future.
"Our libraries create a roadmap for improving the efficacy and/or specificity of therapeutic influenza antibodies," Arun Kashyap, Director of Influenza and Antibody Libraries for Sea Lane said. "As a result, we might be able to engineer the best features of different antibodies into a single antibody that may not only treat contemporary strains of influenza, but also future influenza strains which normally would escape through simple mutations."
Innovative Research Driven by International Effort
"None of this research could have been accomplished without the participation of the Turkish scientists who were responsible for the processes for collection of the bone marrow and their shipment to the laboratories in the United States preserved in a way that made recovery of the antibodies possible. This shows the value of international cooperation in basic scientific research," said Lawrence Horowitz, CEO of Sea Lane. "Infectious diseases know no national boundaries and treatments will only be developed if the pooled efforts of all scientists are harnessed, regardless of where they happen to reside."
The study is being published in the Early Edition of the journal Proceedings of the National Academy of Sciences.
Other authors of the study, Combinatorial Antibody Libraries from Survivors of the Turkish H5N1 Avian Influenza Outbreak Reveal Virus Neutralization Strategies, include Michael A. Dillon, Ryann E. Swale, Katherine M. Wall, Kimberly J. Perry, and Aleksandr Faynboym of Sea Lane Biotechnologies; John Steel of The Mount Sinai School of Medicine; and Mahmut Ilhan and Ahmet F. Oner of Yuzuncu Yil University.
The study was supported by Sea Lane Biotechnologies, LLC. Partial support to Peter Palese was also provided by NIH grants.
Adapted from materials provided by Scripps Research Institute, via EurekAlert!, a service of AAAS.
31 Maret 2008 - 01 April 2008, Lokakarya Komunikasi Pemberdayaan KKR – Komda II, Hotel Salak, Bogor
Lokakarya ini merupakan lanjutan dari lokakarya yang diadakan sebelumnya tanggal 24 - 25 Maret 2008. Peserta kali ini merupakan perwakilan Dinas Kesehatan dan Dinas Pertanian/Peternakan Propinsi, Balai Penelitian Veteriner, dan Kelompok Kerja Regional Komnas FBPI wilayah Indonesia bagian barat.
24 Maret 2008, Konferensi Pers, Hotel Borobudur, Jakarta
Jumpa pers yang dilaksanakan dalam rangka "Rapat Koordinasi Konsolidasi Intensifikasi rogram Penanganan Flu Burung di Jabodetabek" ini menghasilkan beberapa kesimpulan, yaitu:
1.Flu burung TELAH menimbulkan korban manusia. Di Indonesia 105 korban flu burung meninggal, 10 korban diantaranya meninggal di tahun 2008.
2.Flu burung juga TELAH menimbulkan kerugian ekonomi. Sejak 2004 flu burung telah menimbulkan kerugian dalam bentuk ayam yang musnah atau dimusnahkan, berkurangnya permintaan ayam dan telur, berkurangnya konsumsi ayam dan telur di restoran, tambahan biaya yang harus dikeluarkan peternak dan pemerintah dalam penanganan flu burung, serta dampak terhadap sektor-sektor lain (terutama pariwisata). Nilai kerugian sejak 2004 hingga 2007 (4 tahun) diperkirakan telah mencapai Rp. 4,1 trilyun. Nilai tersebut belum termasuk hilangnya kesempatan kerja dan kerugian akibat berkurangnya konsumsi protein masyarakat.
3.Flu burung DAPAT menyebabkan korban lebih besar, apabila memasuki tahap Pra-PANDEMI (Stage 4 & 5) dan PANDEMI (Stage 6). Tidak ada yang tahu kapan dan dimana dimulai. Tidak ada yang bisa memperkirakan dengan tepat berapa korban, melihat pengalaman masa lalu namun dengan kemajuan ilmu pengetahuan, teknologi dan kemampuan masyarakat saat ini. Simulasi untuk menghitung dampak Pandemi Influenza menunjukkan bahwa jika terjadi Pandemi saat ini diperkirakan dapat terjadi situasi dimana 66 juta orang yang akan sakit dan dapat terjadi 150.000 orang meninggal.
4.Kondisi Pandemi juga dapat menyebabkan kerugian ekonomi jauh lebih besar. Dalam situasi Pandemi, kerugian akan disebabkan oleh tidak berfungsinya kegiatan ekonomi (bank, transportasi, pariwisata, industri, investasi, dll) karena orang sakit dan kekhawatiran akan tertular sakit. Simulasi ekonomi (dengan basis data 2006) menunjukkan bahwa apabila terjadi Pandemi, maka kerugian langsung jangka pendek akan mencapai antara Rp 14 trilyun – Rp 48 triyun. Kerugian jangka panjang akan jauh lebih besar.
5.Penanganan flu burung di Indonesia, telah menunjukkan kemajuan, baik secara kuantitatif (lihat Tabel) maupun kualitatif dalam bidang komunikasi, surveilan, penanganan pada unggas dan manusia, serta persiapan pandemi. Namun pekerjaan belum selesai.
6.Perlu pula dicermati perkembangan flu burung di negara-negara lain:
1.Flu burung TELAH menimbulkan korban manusia. Di Indonesia 105 korban flu burung meninggal, 10 korban diantaranya meninggal di tahun 2008.
2.Flu burung juga TELAH menimbulkan kerugian ekonomi. Sejak 2004 flu burung telah menimbulkan kerugian dalam bentuk ayam yang musnah atau dimusnahkan, berkurangnya permintaan ayam dan telur, berkurangnya konsumsi ayam dan telur di restoran, tambahan biaya yang harus dikeluarkan peternak dan pemerintah dalam penanganan flu burung, serta dampak terhadap sektor-sektor lain (terutama pariwisata). Nilai kerugian sejak 2004 hingga 2007 (4 tahun) diperkirakan telah mencapai Rp. 4,1 trilyun. Nilai tersebut belum termasuk hilangnya kesempatan kerja dan kerugian akibat berkurangnya konsumsi protein masyarakat.
3.Flu burung DAPAT menyebabkan korban lebih besar, apabila memasuki tahap Pra-PANDEMI (Stage 4 & 5) dan PANDEMI (Stage 6). Tidak ada yang tahu kapan dan dimana dimulai. Tidak ada yang bisa memperkirakan dengan tepat berapa korban, melihat pengalaman masa lalu namun dengan kemajuan ilmu pengetahuan, teknologi dan kemampuan masyarakat saat ini. Simulasi untuk menghitung dampak Pandemi Influenza menunjukkan bahwa jika terjadi Pandemi saat ini diperkirakan dapat terjadi situasi dimana 66 juta orang yang akan sakit dan dapat terjadi 150.000 orang meninggal.
4.Kondisi Pandemi juga dapat menyebabkan kerugian ekonomi jauh lebih besar. Dalam situasi Pandemi, kerugian akan disebabkan oleh tidak berfungsinya kegiatan ekonomi (bank, transportasi, pariwisata, industri, investasi, dll) karena orang sakit dan kekhawatiran akan tertular sakit. Simulasi ekonomi (dengan basis data 2006) menunjukkan bahwa apabila terjadi Pandemi, maka kerugian langsung jangka pendek akan mencapai antara Rp 14 trilyun – Rp 48 triyun. Kerugian jangka panjang akan jauh lebih besar.
5.Penanganan flu burung di Indonesia, telah menunjukkan kemajuan, baik secara kuantitatif (lihat Tabel) maupun kualitatif dalam bidang komunikasi, surveilan, penanganan pada unggas dan manusia, serta persiapan pandemi. Namun pekerjaan belum selesai.
6.Perlu pula dicermati perkembangan flu burung di negara-negara lain:
- Hong Kong, Maret 2008: Terjadi kekhawatiran yang serius akan kemungkinan outbreak “flu like illness” / “influenza like illness” khususnya pada penderita anak-anak.
- Vietnam, Maret 2008: Flu burung telah timbul lagi dan wilayah yang cukup luas.
- India, Maret 2008: Flu burung merebak di daerah miskin dan padat penduduk yang menimbulkan kekhawatiran masyarakat.
- Beberapa negara Afrika, Maret 2008: Flu burung dinyatakan telah menambah banyak ancaman kesehatan hewan, kesehatan manusia, dan kesehatan lingkungan pada kelompok masyarakat miskin dan lingkungan bersanitasi buruk.
- kepadatan virus yang tinggi, sudah diketahui sejak 2006 (a.l. studi IPB di Tangerang dan daerah lain).
- dapat terjadi –tetapi belum terbukti– adanya “reassortment” (campuran, gabungan) antara virus AI (unggas) dengan virus influenza manusia.
- virus unggas dapat bermutasi, dan sudah diketahui adanya beberapa “kelompok genetik”– semuanya masih virus unggas:
“Kelompok A”. Menyebar di Jawa, Bali, dan Sulawesi
“Kelompok B”. Menyebar di Jawa, Bali, NTB, dan NTT
“Kelompok C”. Menyebar di Jawa, Bali, dan Sumatera
“Kelompok B”. Menyebar di Jawa, Bali, NTB, dan NTT
“Kelompok C”. Menyebar di Jawa, Bali, dan Sumatera
- Ketiga kelompok virus berasal dari satu “clade” (cabang kluster virus). Virus unggas yang menular ke manusia umumnya “kelompok A”, kecuali di Karo dari “kelompok C”.
- Kemungkinan adanya kelompok lain (D, E, dan F) juga telah terdeteksi (a.l. oleh penelitian IPB dan penelitian Deptan), termasuk kemungkinan dari “clade” lain; tetapi belum diketahui persebarannya dan masih dalam penelitian lebih lanjut.
- 70% kasus kematian manusia akibat FB terjadi di Jawa Barat, Jakarta, dan Banten.
- 54% kasus terjadi di Jabodetabek.
- 63% kasus yang berulang (di wilayah yang sama dalam waktu singkat) terjadi di Jakarta dan Tangerang.
- Pemerintah Daerah akan sungguh-sungguh menangani flu burung, terutama dalam merestrukturisasi bisnis unggas. Penanganan di unggas dan manusia akan lebih terkoordinasi.
- Melakukan pembersihan pasar unggas hidup, dan membersihkan bagian penjualan unggas hidup di pasar. Akan diusahakan ada satu hari dalam seminggu atau 10 hari yang tidak ada penjualan agar bisa dibersihkan.
- Melakukan pengaturan transportasi unggas hidup. Transportasi unggas hidup secara terbuka akan diminimumkan.
- Mengusahakan dan menetapkan jadwal pelaksanaan penjualan ayam hanya dalam bentuk daging ayam (karkas), dan tidak lagi dalam bentuk ayam hidup. Ayam produk peternakan disembelih/dibersihkan pada Tempat Pemotongan Ayam (TPA) yang memenuhi standar yang telah ditetapkan.
- Melanjutkan program bersihkan wilayah pemukiman padat dari ayam yang berkeliaran, dan pengandangan ayam.
- Membuka peluang pemanfaatan program-program penanggulangan kemiskinan (seperti PNPM) untuk penanganan masalah kesehatan termasuk flu burung.
- Melakukan pelatihan tentang flu burung untuk dokter dan perawat terutama di klinik 24 jam, dokter umum, dan rumah sakit swasta. Telah diawali dengan pelatihan 100 dokter di Tangerang dan Bekasi minggu ini dan minggu depan.
- Melanjutkan kegiatan sosialisasi dan pendidikan masyarakat, terutama untuk anak sekolah dan ibu rumah tangga. Peningkatan komunikasi lewat radio dan media lain, dengan panduan sosialisasi yang sudah tersedia.
- Melakukan persiapan dan simulasi menghadapi pandemi. Rencana, sistem penanganan dan panduan telah dikoordinasikan oleh Tim Pandemi Komnas FBPI bekerja sama dengan Depkes dan stakeholder terkait.
- Melaksanakan riset lebih lanjut: (a) analisa lebih lanjut virus FB unggas dan manusia; (b) monitoring dan analisa atas hasil vaksinasi terutama di Sektor 1 dan 2.
24 - 25 Maret 2008, Lokakarya Pemberdayaan Komunikasi Kelompok Kerja Regional (KKR) Komnas FBPI dan Komite Daerah (KOMDA), Hotel Santika, Surabaya
Tujuan dari lokakarya ini adalah:
1.Membangun kapasitas anggota KKR/Komda dalam merencanakan kegiatan komunikasi strategis dan komunikasi perubahan perilaku. Hal ini sangat penting bagi KKR/Komda dalam mengembangkan dan merancang kegiatan komunikasi di tingkat Kabupaten, yang pada akhirnya akan memberikan manfaat di tingkat desa dan masyarakat.
2.Meningkatkan pengetahuan peserta mengenai komunikasi perubahan perilaku dan kemampuan dalam mengembangkan rencana komunikasi strategis di wilayah kerja masing-masing, serta cara menyampaikan pesan – pesan utama pencegahan flu burung nasional ke masyarakat.
3.Memperkuat jejaring antara Komnas FBPI, KKR, Komda, RMU dan masyarakat dalam pengendalian flu burung pada hewan dan manusia.
4.Mengembangkan wawasan peserta dengan strategi pengendalian flu burung terbaru dari perspektif hewan, manusia dan masyarakat.
Dalam lokakarya ini, materi yang diberikan kepada peserta mencakup:
1.Materi komunikasi perubahan perilaku, meliputi gambaran umum mengenai program komunikasi dan komunikasi perubahan perilaku dan gambaran akan prinsip dasar dan komponen kunci dalam perencanaan program/strategi komunikasi.
2.Materi pengembangan jejaring (networking), meliputi identifikasi potensi, peran dan tanggung jawab instansi pemerintah, swasta, masyarakat dan stakeholder lainnya dalam lingkup kedaerahan khususnya pada tingkat provinsi.
3.Materi lesson-learns kegiatan komunikasi, informasi, edukasi dan pemberdayaan masyarakat yang telah dilaksanakan.
4.Materi diskusi pengembangan rencana kegiatan komunikasi, informasi, dan edukasi dan pelaksanaannya.
Lokakarya dua hari ini diikuti perwakilan dari Dinas Pertanian/Peternakan dan Dinas Kesehatan Provinsi, Balai - balai Penelitian Veteriner dan Kelompok Kerja Regional Komnas FBPI untuk wilayah timur Indonesia.
Dalam lokakarya ini, peserta berhasil mengembangkan rencana tindak lanjut kegiatan - kegiatan komunikasi, informasi, dan edukasi untuk dapat diimplementasikan di wilayah kerjanya masing - masing.
19 Maret 2008, Presentasi dan Sosialisasi untuk Wahana Visi Indonesia
Wahana Visi Indonesia adalah sebuah organisasi kemanusiaan yang memiliki fokus pelayanan pada anak - anak. Bekerja sama dengan World Vision Indonesia berbagai program telah dikembangkan, diantaranya adalah program pendidikan dan kesehatan untuk anak - anak.
Salah satu program kesehatan yang telah dikembangkan adalah peningkatan kesadaran anak - anak dalam penerapan perilaku hidup bersih dan sehat untuk mencegah penularan flu burung melalui pengembangan berbagai media komunikasi yang sesuai untuk kelompok umur tersebut.
Pada pertemuan "Pembelajaran Penggunaan Media Komunikasi untuk Anak - Anak dalam Rangka Pencegahan Flu Burung melalui Penerapan Perilaku Hidup Bersih dan Sehat," Komnas FBPI berkesempatan memberikan materi dan presentasi mengenai Strategi Komunikasi Nasional Pengendalian Flu Burung dan Kesiapsiagaan Menghadapi Pandemi Influenza.
Tujuan pertemuan tersebut adalah untuk berbagi pelajaran dalam implementasi kegiatan komunikasi, informasi, dan edukasi oleh pemerintah maupun organisasi lainnya. Selain itu pada pertemuan tersebut, para peserta saling berbagi informasi dan kegiatan apa saja yang sudah dan akan dilakukan oleh masing - masing organisasi dalam hubungan dengan masalah flu burung.
Sebagai informasi, Wahana Visi Indonesia beralamat di Jl. Wahid Hasyim No. 31 Jakarta 10340, Telp. (021) 390 7818, Fax. (021) 310 514, Email. visi@wvi.org.
10 - 13 Maret 2008, Pelatihan Spokeperson Deptan – FAO, Hotel Grand Kemang, Jakarta
Kegiatan ini bertujuan untuk mengembangkan kemampuan komunikasi pimpinan dan staf Dinas Pertanian/Peternakan dan Balai Penelitian Veteriner seluruh Indonesia dalam menghadapi masyarakat dan media dalam penyampaian pesan - pesan dan informasi mengenai flu burung.
Komnas FBPI diberi kesempatan untuk memberikan materi dengan tema "Analisis Media dan Pemberitaan Flu Burung." Materi - materi yang diberikan pada pelatihan ini antara lain:
Komnas FBPI diberi kesempatan untuk memberikan materi dengan tema "Analisis Media dan Pemberitaan Flu Burung." Materi - materi yang diberikan pada pelatihan ini antara lain:
- Implementasi kebijakan pengendalian fluburung disektor Kesehatan.
- Implementasi lebijakan pengendalian penyakit AI pada sektor keswan.
- Wawasan media secara umum.
- Analisis media dan pemberitaan fluburung.
- Pengantar hubungan media.
- Komunikasi dan mobilisasi masyarakat menghadapi pandemi.
- Metode pendekatan sosial dalam komunikasi partisipatif.
- KAP (Knowladge, Attitude and Practical) Survey dan pesan utama AI.Humas: Menghadapi media.
- Menulis rilis pers.
- Menyelenggarakan konferensi pers.
ScienceDaily: New Approach May Lead To Effective H5N1 Influenza A Virus Vaccine
(Mar. 28, 2008) — Manipulating a previously identified protein may be the key to developing an effective H5N1 influenza A virus vaccine say researchers from the University of Wisconsin-Madison and the University of Tokyo.
Since its emergence in 1997, the highly pathogenic avian influenza virus (H5N1) has affected wild birds and poultry in more than 10 Asian countries as well as Europe and
The influenza A virus M2 protein consists of three structural domains, one of which is a 54-amino acid cytoplasmic tail domain. In a previous study the researchers demonstrated that deleting the M2 cytoplasmic tail caused a growth defect in the H1N1 influenza virus, indicating that the M2 cytoplasmic tail plays a vital role in virus replication. In the current study they created an M2 tail mutant H5N1 virus, vaccinated mice with it and challenged the mice with a lethal dose of influenza virus. Results showed that the mice were protected from death suggesting that the virus could not replicate and could therefore be used as a vaccine.
"Here, we demonstrate that an M2 cytoplasmic tail deletion mutant protects mice from lethal challenge with a highly pathogenic H5N1 virus, suggesting the potential of M2 tail mutants as live attenuated vaccines against H5N1 influenza virus infection," say the researchers.
Journal reference: T. Watanabe, S. Watanabe, J. Hyun Kim, M. Hatta, Y. Kawaoka. 2008. Novel approach to the development of effective H5N1 influenza A virus vaccines: use of M2 cytoplasmic tail mutants. Journal of Virology, 82. 5: 2486-2492.
Adapted from materials provided by American Society for Microbiology.
http://www.sciencedaily.com/releases/2008/03/080326181733.htm#Jakarta Post : "RI bird flu virus, Let's keep in scientific loop", Dr. IGN Mahardika, Anggota Panel Ahli Komnas FBPI
I Gusti Ngurah Mahardika, Denpasar, Sat, 03/29/2008
The Indonesian bird flu virus might not become a pandemic vaccine seed and thus it is a far-flung idea to make it into a biological weapon.
In an influenza pandemic horror vision, world health politicians and experts agree on one point, a vaccine will be the most powerful medical intervention to reduce the morbidity and mortality caused by an influenza pandemic strain.
However, if "an Indonesian" thinks the Indonesian bird flu virus will be used as a pandemic vaccine seed, the geographical and serological data show it might not be the case.
Moreover, although Indonesian bird flu cases end mostly in the death of victims, the virus has no potential to be developed into a biological weapon.
It is true that the latest bird flu virus, a popular name for avian influenza virus of H5N1 subtype, cases in Indonesia are increasing a pandemic worry.
The sheer number of human cases and fatalities is steadily increasing. In 2005, 13 out of 20 (65 percent) cases were fatal. The rate has become 82, 88 and 83 percent in 2006, 2007 and until February 2008, respectively. The figure is the highest in the world. The overall fatality of world bird flu cases is only 63 percent.
Although the Indonesian virus seems to be "super" pathogenic, it does not automatically mean that the Indonesian virus is the most harmful in the world. It might simply be a matter of victims being late to seek medical help.
Moreover, pathogenecity is not the most important criteria in selecting a pandemic vaccine seed. The selection is especially based on the geographical distribution, epidemiology and genetic and antigenic character of a virus candidate.
The Global Influenza Program of World Health Organization (WHO) is continuously evaluating all influenza viruses -- not only H5N1 -- and selecting appropriate vaccine seed candidates as a part of pandemic preparation plan.
Based on the state of knowledge at this time, experts do not know whether the next pandemic will be caused by an H5N1 virus or other subtype. They mostly agree that the pandemic is a matter of when, not if.
The H5N1 virus is indeed a strong candidate. Therefore, international communities via the WHO need to analyze the dynamics of the bug. Selected vaccine candidates will be changed as needed.
In 2006, the WHO selected three viruses as candidates. They were A/Indonesia/5/2005-like, A/Bar headed goose/Qinghai/1A/2005-like, and A/Anhui/1/2005-like viruses. In 2006, the number became eight strains.
Given current geographical distribution and genetic characteristics, the Indonesian bird flu virus -- so-called Clade 2.1 -- will find its best use in
However, in case the pandemic epicenter is somewhere in
The steady increasing number of human cases in
Carrier fowl continuously contaminate the environment. Available data throughout
These animals can be clinically healthy due to vaccination or naturally resistant. Water fowl -- such as ducks and geese -- have long been known to be resistant to any influenza virus infection.
They can carry the virus without being sick. They act as a reservoir of the virus and continuously transmit it to other animals and humans. Village chickens seem to act the same role, to a somewhat lesser extent.
The ecology of the virus can be more complex than the current idea that the source of infection is mainly fowl. The role of human beings and other animals as silent disseminators can not be ignored.
In the case of silent infection, a human being and other animals such as dogs and cats can be infected and carry the bug in a tiny number before it will find a genetically susceptible human host. The level of infection is so low that it can not produce disease, nor an antibody response, in the carrying person or animal.
An environment of that kind is a paradise for the emergence of pandemic strain. The bug can reproduce and replicate continuously, which gives it the chance to mutate into what it will.
The answer to the question, can an Indonesian H5N1 virus be a pandemic vaccine, is "maybe yes or maybe no". It will definitely be yes if the pandemic is caused by H5N1 virus and starts here.
Although the virus is very fatal -- killing most sick people -- it absolutely can not be used as a biologic weapon.
It would be laughable if one put an effort into developing a biological weapon based on the bird flu virus.
The bug has the biggest potential to disseminate globally. There will not be any country in the world out of the line of its fire, including the country that some thought is developing this virus into a weapon.
At this pre-pandemic stage, it is global task to prepare for a potential pandemic caused by bird flu virus. Any development of the bug should be studied intensively to detect a pandemic at the earliest moment. This effort will save millions of human lives.
In strictly contained facilities -- known as bio-safety level 3 or higher laboratories -- every virus will be propagated before its molecular, antigenic and biological characteristics are unfolded. In case it shows its adaptability to mammals and humans, the influenza alert system will be rung. If the virus does not match antigenically with standard viruses, a new vaccine seed will be developed thereafter.
To my knowledge, there is no plausible reason not to send any Indonesian human viruses to a WHO network laboratory. Such state-of-the-art facilities are not available in
If the benefit-sharing issues are the main reason to keep the virus, such a facility here should be accelerated. Based on global interest, we can not rely on global vaccine manufacturers in stockpiling pandemic vaccine to be used in
Upgrading influenza vaccine manufacturers for fowls into human influenza vaccine producers is one short-cut alternative to be considered.
Human resources are available. We could propagate the resources if we need them. Trust to national resources should be given.
The writer is a virologist and staff member of the
Langganan:
Postingan (Atom)