Conference organized by:

Center for Biosecurity of UPMC

World Health Organization Communicable Disease Surveillance and Response Office

Conference sponsored by:

The Nuclear Threat Initiative

Avian Influenza: The Indonesian Experience
Presenter: Amin Soebandrio, M.D.

slide thumbnails     slide show

Dr. Soebandrio reviewed the H5N1 Highly Pathogenic Avian Influenza (AI) outbreak which started in Indonesia in August 2003 and outlined how it was controlled. Originally discovered in 2 areas of Java, it spread quickly, so that by September it was in 98 areas of 15 provinces. As a result, between August 2003 and November 2004, 8,894,124 birds were reportedly killed. Of 829 persons with a history of contact with infected birds, none contracted the disease.

Soebandrio reviewed Indonesia's control strategy, detailing the following:

1. Improve biosecurity: Prevent susceptible birds from having contact with the AI virus and stop replication of AI virus in infected birds by controlling bird traffic (birds, bird-products, farm workers, and vehicles), cleaning and decontaminating coops and cages, isolating infected flocks, burning and burying dead birds.
2. Vaccinate poultry populations: Although larger farms, particularly breeding and commercial layer farms, vaccinated their flocks, only 30% of commercial broiler farms complied. Seven different vaccines from different countries were used.
3. Depopulate poultry flocks: The depopulation procedure, which entailed large scale destruction of poultry flocks, was complicated and had to be followed by careful disposal to prevent the carcasses from becoming a source of infection. Small farmers were compensated for their loss.
4. Conduct surveillance and tracing of new outbreaks.
5. Restock farms: After infected flocks were destroyed, farms were restocked with new poultry, but farmers had to wait until 30 days after disposal of dead birds and had to disinfect equipment and/or utilities.
6. Stamp-out new outbreaks: When a new outbreak occurred, infected birds and all birds within a 1 km radius were destroyed.
7. Increase public awareness: A multi-media approach to educate the public and to increase awareness of threat of AI was adopted.
8. Monitor and evaluate: Regional meetings and coordination between agencies was employed to monitor AI outbreaks and response.

Finally, Soebandrio compared the effects of the avian influenza outbreak to other challenges faced by Indonesia recently, noting that AI has resulted in the destruction of 8 million birds, with no human deaths; dengue fever infected 60,000 people in 2004, killing 800; and the recent tsunami, a national tragedy that killed 166,000 people and left 100,000 missing.

- Summary by Eric Toner, M.D.

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