An observational prospective cohort study of the #epidemiology of hospitalized patients with acute #febrile #illness in #Indonesia (PLOS Negl Trop Dis., abstract)

[Source: PLOS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia

Muhammad Hussein Gasem , Herman Kosasih , Emiliana Tjitra, Bachti Alisjahbana, Muhammad Karyana, Dewi Lokida, Aaron Neal, Jason Liang, Abu Tholib Aman, Mansyur Arif, Pratiwi Sudarmono, Suharto, Tuti Parwati Merati,  [ … ], for INA-RESPOND

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Published: January 10, 2020 / DOI: https://doi.org/10.1371/journal.pntd.0007927 / This is an uncorrected proof.

 

Abstract

Background

The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied.

Methodology/Principal gindings

This prospective observational study enrolled febrile patients (temperature ≥38°C) aged ≥1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standard-of-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14–28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7%), gastrointestinal (497, 33.0%), respiratory (114, 7.7%), constitutional (62, 4.2%), skin and soft-tissue (24, 1.6%), central nervous system (17, 1.1%), or genitourinary (4, 0.3%) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5%) participants, of which 351/1,003 (35.0%) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6%), Salmonella spp. (103, 10.3%), and Rickettsia spp. (103, 10.3%). The overall mortality was 89 (5.9%).

Conclusions/Significance

Febrile illness in Indonesia has various microbiologic etiologies and substantial overall mortality. Diagnostic limitations and lack of epidemiologic data resulted in potentially treatable, and at times fatal, diseases being missed.

 

Author summary

In tropical countries like Indonesia, fever due to infectious disease is the most common reason for hospitalization. However, diagnoses are mostly unconfirmed, as diagnostic tests are not available or are not performed due to budget constraints. Consequently, many patients are only treated based on clinical syndromes. To gain a better understanding of the epidemiology of acute fever in Indonesia, we conducted a study at eight hospitals in the seven largest cities from 2013–2016. We enrolled 1,486 subjects aged ≥1 year with acute fever ≥38°C. Blood cultures were mandatory for all subjects, while cultures of other biological specimens, microscopic examinations, and rapid tests for specific pathogens were based on clinical judgment and availability. Retrospectively, we performed molecular and serological testing for a panel of bacterial and viral pathogens for systemic, respiratory, and diarrheal diseases. We found six pathogens to be the most prevalent: dengue virus (47%), Salmonella Typhi/Paratyphi (10%), Rickettsia typhi (10%), influenza virus (7%), Leptospira spp. (5%), and chikungunya virus (4%). Rickettsia typhi, influenza, and chikungunya had not been considered in the differential diagnosis of any subject at the hospitals. Thus, multiple pathogens were associated with acute febrile illnesses, and a subset of treatable cases were missed. This may have resulted in increased overall mortality.

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Citation: Gasem MH, Kosasih H, Tjitra E, Alisjahbana B, Karyana M, Lokida D, et al. (2020) An observational prospective cohort study of the epidemiology of hospitalized patients with acute febrile illness in Indonesia. PLoS Negl Trop Dis 14(1): e0007927. https://doi.org/10.1371/journal.pntd.0007927

Editor: Florian Marks, International Vaccine Institute, REPUBLIC OF KOREA

Received: December 5, 2018; Accepted: November 14, 2019; Published: January 10, 2020

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contract Nos. HHSN261200800001E and HHSN261201500003I. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Infectious Diseases; Indonesia.

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The #PB2 #Polymerase Host Adaptation Substitutions Prime #Avian #Indonesia Sub Clade 2.1 #H5N1 Viruses for Infecting #Humans (Viruses, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Viruses. 2019 Mar 22;11(3). pii: E292. doi: 10.3390/v11030292.

The PB2 Polymerase Host Adaptation Substitutions Prime Avian Indonesia Sub Clade 2.1 H5N1 Viruses for Infecting Humans.

Wang P1, Song W2,3, Mok BW4, Zheng M5, Lau SY6, Liu S7, Chen P8, Huang X9, Liu H10, Cremin CJ11, Chen H12.

Author information: 1 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. puiwang@hku.hk. 2 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. wjsong@hku.hk. 3 State Key Laboratory of Respiratory Disease, Institute of Integration of Traditional and Western Medicine, Guangzhou Medical University, Guangzhou 510180, China. wjsong@hku.hk. 4 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. bobomok@hku.hk. 5 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. min.zheng@stjude.org. 6 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. sylau926@hku.hk. 7 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. siwen531@CONNECT.HKU.HK. 8 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. u3508816@connect.hku.hk. 9 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. stevehxf@connect.hku.hk. 10 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. lhlotus@connect.hku.hk. 11 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. conor93@connect.hku.hk. 12 State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, and the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong SAR, China. hlchen@hku.hk.

 

Abstract

Significantly higher numbers of human infections with H5N1 virus have occurred in Indonesia and Egypt, compared with other affected areas, and it is speculated that there are specific viral factors for human infection with avian H5N1 viruses in these locations. We previously showed PB2-K526R is present in 80% of Indonesian H5N1 human isolates, which lack the more common PB2-E627K substitution. Testing the hypothesis that this mutation may prime avian H5N1 virus for human infection, we showed that: (1) K526R is rarely found in avian influenza viruses but was identified in H5N1 viruses 2⁻3 years after the virus emerged in Indonesia, coincident with the emergence of H5N1 human infections in Indonesia; (2) K526R is required for efficient replication of Indonesia H5N1 virus in mammalian cells in vitro and in vivo and reverse substitution to 526K in human isolates abolishes this ability; (3) Indonesian H5N1 virus, which contains K526R-PB2, is stable and does not further acquire E627K following replication in infected mice; and (4) virus containing K526R-PB2 shows no fitness deficit in avian species. These findings illustrate an important mechanism in which a host adaptive mutation that predisposes avian H5N1 virus towards infecting humans has arisen with the virus becoming prevalent in avian species prior to human infections occurring. A similar mechanism is observed in the Qinghai-lineage H5N1 viruses that have caused many human cases in Egypt; here, E627K predisposes towards human infections. Surveillance should focus on the detection of adaptation markers in avian strains that prime for human infection.

KEYWORDS: H5N1; Influenza virus; PB2; RNP; cross species transmission; host adaptation

PMID: 30909490 PMCID: PMC6480796 DOI: 10.3390/v11030292 [Indexed for MEDLINE] Free PMC Article

Keywords: Avian Influenza; H5N1; Human; Poultry; Indonesia, Animal models.

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#Disappearance of the last #tropical #glaciers in the Western Pacific Warm Pool (#Papua, #Indonesia) appears imminent (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Disappearance of the last tropical glaciers in the Western Pacific Warm Pool (Papua, Indonesia) appears imminent

Donaldi S. Permana, Lonnie G. Thompson, Ellen Mosley-Thompson, Mary E. Davis, Ping-Nan Lin, Julien P. Nicolas, John F. Bolzan, Broxton W. Bird, Vladimir N. Mikhalenko, Paolo Gabrielli, Victor Zagorodnov, Keith R. Mountain, Ulrich Schotterer, Wido Hanggoro, Muhammad N. Habibie, Yohanes Kaize, Dodo Gunawan, Gesang Setyadi, Raden D. Susanto, Alfonso Fernández, and Bryan G. Mark

PNAS first published December 9, 2019 / DOI: https://doi.org/10.1073/pnas.1822037116

Edited by Michael L. Bender, Princeton University, Princeton, NJ, and approved November 5, 2019 (received for review December 27, 2018)

 

Significance

The glaciers near Puncak Jaya, Papua, Indonesia, the last tropical glaciers in the Western Pacific Warm Pool, have recently undergone a rapid pace of loss of ice cover and a 5.4-fold increase in the rate of thinning, augmented by the strong 2015–2016 El Niño. Ice cores recovered in 2010 record approximately the past half-century of tropical Pacific climate variability and reveal the effects of El Niño–Southern Oscillation (ENSO). It appears that the regional warming has passed a threshold such that the next very strong ENSO event, which typically exacerbates the rising freezing levels and associated feedbacks such as reduced snow cover, could lead to the demise of the only remaining tropical glaciers between the Himalayas and the Andes.

 

Abstract

The glaciers near Puncak Jaya in Papua, Indonesia, the highest peak between the Himalayas and the Andes, are the last remaining tropical glaciers in the West Pacific Warm Pool (WPWP). Here, we report the recent, rapid retreat of the glaciers near Puncak Jaya by quantifying the loss of ice coverage and reduction of ice thickness over the last 8 y. Photographs and measurements of a 30-m accumulation stake anchored to bedrock on the summit of one of these glaciers document a rapid pace in the loss of ice cover and a ∼5.4-fold increase in the thinning rate, which was augmented by the strong 2015–2016 El Niño. At the current rate of ice loss, these glaciers will likely disappear within the next decade. To further understand the mechanisms driving the observed retreat of these glaciers, 2 ∼32-m-long ice cores to bedrock recovered in mid-2010 are used to reconstruct the tropical Pacific climate variability over approximately the past half-century on a quasi-interannual timescale. The ice core oxygen isotopic ratios show a significant positive linear trend since 1964 CE (0.018 ± 0.008‰ per year; P < 0.03) and also suggest that the glaciers’ retreat is augmented by El Niño–Southern Oscillation processes, such as convection and warming of the atmosphere and sea surface. These Papua glaciers provide the only tropical records of ice core-derived climate variability for the WPWP.

glacier retreat – tropical ice cores – Papua Indonesia – climate change – ENSO

 

Footnotes

1 To whom correspondence may be addressed. Email: donaldi.permana@bmkg.go.id or thompson.3@osu.edu.

Author contributions: L.G.T., E.M.-T., and R.D.S. designed research; D.S.P., L.G.T., E.M.-T., M.E.D., P.-N.L., B.W.B., V.N.M., P.G., V.Z., K.R.M., W.H., M.N.H., Y.K., D.G., G.S., and R.D.S. performed research; D.S.P., L.G.T., M.E.D., P.-N.L., J.P.N., J.F.B., U.S., A.F., and B.G.M. analyzed data; D.S.P., L.G.T., E.M.-T., and M.E.D. wrote the paper; D.S.P., L.G.T., V.N.M., P.G., V.Z., K.R.M., W.H., Y.K., D.G., G.S., and R.D.S. supported the ice core drilling project and collected ice core samples; D.S.P., L.G.T., K.R.M., W.H., M.N.H., Y.K., and G.S. measured the stake accumulation; M.E.D., and P.-N.L. conducted the ice core stable isotope, dust, and chemical analyses; and U.S. conducted the ice core tritium analysis.

The authors declare no competing interest.

This article is a PNAS Direct Submission.

Data deposition: The data reported in this paper have been archived at the National Center for Environmental Information (NCEI) National Oceanic and Atmospheric Administration (NOAA) World Data Center for Paleoclimatology: https://www.ncdc.noaa.gov/data-access/paleoclimatology-data/datasets/ice-core; https://www.ncdc.noaa.gov/paleo/study/24351.

This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.1822037116/-/DCSupplemental.

Published under the PNAS license.

.

Keywords: Climate Change; Global Warmings; Indonesia.

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#Streptococcus suis–Associated #Meningitis, #Bali, #Indonesia, 2014–2017 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 12—December 2019 / CME ACTIVITY – Research

Streptococcus suis–Associated Meningitis, Bali, Indonesia, 2014–2017

Ni Made Susilawathi, Ni Made Adi Tarini, Ni Nengah Dwi Fatmawati, Putu I.B. Mayura, Anak Agung Ayu Suryapraba, Made Subrata, Anak Agung Raka Sudewi, and Gusti Ngurah Mahardika

Author affiliations: Udayana University, Denpasar, Bali, Indonesia

 

Abstract

Streptococcus suis is an emerging agent of zoonotic bacterial meningitis in Asia. We describe the epidemiology of S. suis cases and clinical signs and microbiological findings in persons with meningitis in Bali, Indonesia, using patient data and bacterial cultures of cerebrospinal fluid collected during 2014–2017. We conducted microbiological assays using the fully automatic VITEK 2 COMPACT system. We amplified and sequenced gene fragments of glutamate dehydrogenase and recombination/repair protein and conducted PCR serotyping to confirm some serotypes. Of 71 cases, 44 were confirmed as S. suis; 29 isolates were serotype 2. The average patient age was 48.1 years, and 89% of patients were male. Seventy-seven percent of patients with confirmed cases recovered without complications; 11% recovered with septic shock, 7% with deafness, and 2% with deafness and arthritis. The case-fatality rate was 11%. Awareness of S. suis infection risk must be increased in health promotion activities in Bali.

Keywords: Streptococcus suis; Meningitis; Indonesia.

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High- #Risk #International #Clones of #Carbapenem-Nonsusceptible #Pseudomonas aeruginosa Endemic to #Indonesian #ICUs: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level (MBio, abstract)

[Source: MBio, full page: (LINK). Abstract, edited.]

High-Risk International Clones of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Endemic to Indonesian Intensive Care Units: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level

Andreu Coello Pelegrin, Yulia Rosa Saharman, Aurélien Griffon, Mattia Palmieri, Caroline Mirande, Anis Karuniawati, Rudyanto Sedono, Dita Aditianingsih, Wil H. F. Goessens, Alex van Belkum, Henri A. Verbrugh, Corné H. W. Klaassen, Juliëtte A. Severin

Peter Gilligan, Editor

DOI: 10.1128/mBio.02384-19

 

ABSTRACT

Infection control effectiveness evaluations require detailed epidemiological and microbiological data. We analyzed the genomic profiles of carbapenem-nonsusceptible Pseudomonas aeruginosa (CNPA) strains collected from two intensive care units (ICUs) in the national referral hospital in Jakarta, Indonesia, where a multifaceted infection control intervention was applied. We used clinical data combined with whole-genome sequencing (WGS) of systematically collected CNPA to infer the transmission dynamics of CNPA strains and to characterize their resistome. We found that the number of CNPA transmissions and acquisitions by patients was highly variable over time but that, overall, the rates were not significantly reduced by the intervention. Environmental sources were involved in these transmissions and acquisitions. Four high-risk international CNPA clones (ST235, ST823, ST375, and ST446) dominated, but the distribution of these clones changed significantly after the intervention was implemented. Using resistome analysis, carbapenem resistance was explained by the presence of various carbapenemase-encoding genes (blaGES-5, blaVIM-2-8, and blaIMP-1-7-43) and by mutations within the porin OprD. Our results reveal for the first time the dynamics of P. aeruginosa antimicrobial resistance (AMR) profiles in Indonesia and additionally show the utility of WGS in combination with clinical data to evaluate the impact of an infection control intervention. (This study has been registered at www.trialregister.nl under registration no. NTR5541).

 

IMPORTANCE

In low-to-middle-income countries such as Indonesia, work in intensive care units (ICUs) can be hampered by lack of resources. Conducting large epidemiological studies in such settings using genomic tools is rather challenging. Still, we were able to systematically study the transmissions of carbapenem-nonsusceptible strains of P. aeruginosa (CNPA) within and between ICUs, before and after an infection control intervention. Our data show the importance of the broad dissemination of the internationally recognized CNPA clones, the relevance of environmental reservoirs, and the mixed effects of the implemented intervention; it led to a profound change in the clonal make-up of CNPA, but it did not reduce the patients’ risk of CNPA acquisitions. Thus, CNPA epidemiology in Indonesian ICUs is part of a global expansion of multiple CNPA clones that remains difficult to control by infection prevention measures.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Pseudomonas aeruginosa; ICU; Nosocomial outbreaks; Indonesia.

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The #Threat of Emerging and Re-emerging #Infections in #Indonesia (Acta Med Indones., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Acta Med Indones. 2019 Jul;51(3):195-196.

The Threat of Emerging and Re-emerging Infections in Indonesia.

Nelwan EJ1.

Author information: 1 Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia. erni.juwita@ui.ac.id.

 

Abstract

Human immunodeficiency virus (HIV) is one example of an emerging infection with total of 386 district of all province in Indonesia reported having such infection; with cumulative number of HIV infected patient from the year 1987 to 2014 is 150,296 while AIDS is 55,799 patients. The access to care only available for 153,887 patients among all HIV/AIDS patients of whom 70% are eligible for anti-retroviral (ARV) treatment and of these only half adhered to ARV treatment. In addition to that, there is an increased risk of other emerging diseases such as Zika virus, Monkey pox or Hanta pulmonary syndrome since a sporadic cases were reported around the region.

Beside new diseases, tuberculosis, dengue virus, malaria and diphteria are continuously reported in Indonesia and classified as re-emerging illnesses. On this edition data on diphteria epidemiology in Indonesia will be shown by Karyanti et al.6 A recent outbreak of diphteria in Indonesia which involved almost all province in the country has led to a response named ORI (outbreak response of Immunization). Regardless of immunization, proper treatment including the distribution of anti-toxin and antibiotics are needed to stop the spread of this particular bacteria, further decreasing the mortality rate. In conclusion, the author of this paper mentioned that immunization gap needs to be handle systematically. Immunization data released on 2017 showed that complete immunization was given only to 20% of targeted group, while almost 75% were either unvaccinated or unknown. During the outbreak of diphteria in Indonesia, the WHO also reported several countries with similar problem such as Bangladesh, Haiti and Yamen. It was shown that a coordination between doctors in clinic/hospital with public health officer to conduct an epidemiological investigation, in conjunction with giving prophylaxis and assuring the logistics of anti-diphteria toxin and antibiotics were accessible were  the key of success in eliminating diphteria like it was in Bangladesh.

Adherence to treatment are multifactorial for all illnesses. First, is the duration of treatment and the potential adverse event due to the medication. The Ministry of Health of the Republic of Indonesia has support the early diagnosis of HIV and delivering treatment as soon as possible, in order to avoid transmission of the disease. Second, looking at another side of the story for HIV infected patients, receiving ARV treatment as a long life treatment could possibly cause an adverse event somewhere along the line. Budiman et.al reported factors that might contribute to liver injury. His study shows that measuring baseline liver function test AST routinely might minimize the toxicity of ARV to patients particularly with a low body mass index. Last, despite the adherence to treatment and procedures in minimizing the risk of adverse event to medication, we are now facing the primary resistance virus that transmitted in the community as mentioned by Megasari et al.8 on her report regarding the transmission of drug resistance HIV virus to naïve patients in Bali.

The Indonesian government through the Indonesian Ministry of Health has established a collaboration and one health approaches to tackle the threat of diseases in the country, particularly in infectious diseases.

KEYWORDS: AIDS; HIV; Infection; Virus

PMID: 31699941

Keywords: Indonesia; Public Health; Diphtheria; HIV/AIDS.

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Seasonal #Influenza and #Avian Influenza A(#H5N1) Virus #Surveillance among Inpatients and Outpatients, East #Jakarta, #Indonesia, 2011–2014 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 11—November 2019 / Research

Seasonal Influenza and Avian Influenza A(H5N1) Virus Surveillance among Inpatients and Outpatients, East Jakarta, Indonesia, 2011–2014

Kathryn E. Lafond1  , Catharina Y. Praptiningsih1, Amalya Mangiri, Misriyah Syarif, Romadona Triada, Ester Mulyadi, Chita Septiawati, Vivi Setiawaty, Gina Samaan, Aaron D. Storms, Timothy M. Uyeki, and A. Danielle Iuliano

Author affiliations: University of Tampere, Tampere, Finland (K.E. Lafond); US Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K.E. Lafond, A.D. Storms, T.M. Uyeki, A.D. Iuliano); US Centers for Disease Control and Prevention, Jakarta, Indonesia (C.Y. Praptiningsih, A. Mangiri, E. Mulyadi); Ministry of Health, Jakarta (M. Syarif, R. Triada, C. Septiawati, V. Setiawaty); Australian National University, Canberra, Capital Territory, Australia (G. Samaan)

 

Abstract

During October 2011–September 2014, we screened respiratory specimens for seasonal and avian influenza A(H5N1) virus infections among outpatients with influenza-like illness and inpatients with severe acute respiratory infection (SARI) in East Jakarta, an Indonesia district with high incidence of H5N1 virus infection among poultry. In total, 31% (1,875/6,008) of influenza-like illness case-patients and 15% (571/3,811) of SARI case-patients tested positive for influenza virus. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B virus infections were detected in all 3 years, and the epidemic season extended from November through May. Although 28% (2,810/10,135) of case-patients reported exposure to poultry, only 1 SARI case-patient with an H5N1 virus infection was detected. Therefore, targeted screening among case-patients with high-risk poultry exposures (e.g., a recent visit to a live bird market or close proximity to sick or dead poultry) may be a more efficient routine surveillance strategy for H5N1 virus in these types of settings.

Keywords: Seasonal Influenza; Avian Influenza; H1N1pdm09; H3N2; H5N1; SARI; Indonesia.

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