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Task Order 2 Avian Influenza in Indonesia. Briton Bieze. July 1, 2008. Overview. AI globally AI in Indonesia USAID | DELIVER PROJECT activities Challenges and Lessons Learned. Cases of human Avian Influenza Worldwide. 385 Cases of human AI as of June 29, 2008 243 have been fatal

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AI globally

AI in Indonesia


Challenges and Lessons Learned

cases of human avian influenza worldwide
Cases of human Avian Influenza Worldwide
  • 385 Cases of human AI as of June 29, 2008
    • 243 have been fatal
  • 135 cases of human AI in Indonesia
    • 110 have been fatal
so why so much effort into containing ai
So why so much effort into containing AI?
  • Human deaths
  • Economic loss – poultry deaths, job losses, production loss from human deaths and illness and less protein intake, less tourism
  • Potential of human pandemic – estimate morbidity and mortality in the millions
  • Potential of economic and societal losses if human pandemic occurs
worldwide status of hpai h5n1
Worldwide Status of HPAI H5N1

Between Nov 2003 and May 9, 2008 H5N1 detected in birds in 60 countries - 6,414 poultry outbreaks reported

- more than 250 million birds have died or been culled

- at least 32 bird and 8 mammalian speciesaffected

- affected countries in Asia, Europe, Near East, Africa H5N1 detected in humans in 14 countries

- total of 385 cases and 243 deaths reported

- average of 5-9 new cases per month

- overall fatality rate = 63%

sources: WHO, OIE, GenBank

Areas reporting confirmed occurrence of H5N1 avian influenza in poultry and wild birds since 2003, status as of 14.04.2008
pandemic status
Pandemic Status
  • HPAI-H5N1 already causing a “pandemic” among bird populations on 3 continents
  • HPAI H5N1 has evolved into 9 different sub-groups between 1996 and 2008; birds still main host
  • H5N1 human infections are still relatively rare; almost all from bird-to-human transmission
  • Some human-to-human transmission of H5N1 likely but limited and unsustained in these cases
  • WHO’s current pandemic threat level is 3 (on a scale of 1-6 with 6 being a human pandemic)

sources: WHO, OIE

risk factors associated with poultry h5n1 infections
Risk Factors Associated with Poultry H5N1 Infections
  • Large and dense poultry populations
  • Poor biosecurity on farms (especially large, commercial farms) and in wet markets
  • Proximity to or trade with highly-affected areas especially where there is poor regulation of poultry movement (including ducks and vaccinated chickens)
  • Weak H5N1 surveillance and outbreak investigation capacities
  • Slow detection and outbreak response times and incomplete containment (including limited culling, compensation, surveillance, movement control)
risk factors associated with human h5n1 infections
Risk Factors Associated with Human H5N1 Infections
  • Number/timing of human cases and poultry outbreaks in a country consistent with bird-to-human transmission of H5N1
    • At least 44% of human cases known to have had contact with sick or dead birds before onset of symptoms
    • At least 19% of cases had at least one other family member who was also a confirmed H5N1 case indicating shared risks and/or genetic vulnerabilities
    • Cases and deaths evenly distributed between males and females in most countries including Indonesia
  • At least 11 cases of likely but limited and unsustained human-to-human transmission of H5N1 in 4 countries
indonesia country overview
Indonesia Country Overview
  • Large populations:
    • ~1.4 billion poultry
    • ~225 million people
  • Decentralized systems:
    • budgets and decision making
    • disease control
  • Widespread disease:
    • H5N1 circulating in Indonesia between 2003-2008
    • H5N1 detected in about 31 of 33 provinces
  • Data limitations:
    • Limited poultry outbreak and H5N1 sequence data (temporally and geographically)
    • Limited behavioral and treatment data for human cases

Distribution of Confirmed H5N1 Human Cases by Province




68% of confirmed H5N1 human infections in 3 provinces of Java (Banten, Jakarta, West Java)

W. Java has large poultry and duck populations and poultry outbreaks in 2007

Total Human Cases per Province


Data from WHO reports through 5/9/08. Indonesia total = 133.

indonesia poultry production
Indonesia Poultry Production
  • Indonesia not a significant exporter of poultry
  • Poultry movement within and among islands common
  • Mass vaccination of poultry common in commercial sector; many vaccines available and coverage and dosing not uniform
  • Existing poultry surveillance appears to not cover all provinces or all poultry production sectors
  • Reported to be ~13,000 Live Bird Markets in Indonesia
  • Co-mingling of poultry, wild birds; poultry slaughter done on


  • High-risk factors exist for AI spread among birds and to humans
  • Unsold birds sometimes returned to source
  • H5N1 detected in some markets
usaid deliver project s scope of activities in indonesia 2007 present
USAID | DELIVER PROJECT’s Scope of Activities in Indonesia: 2007 – present
  • Personal Protection Equipment (PPE) and Decontamination Kit pre-positioning
  • Support to Komnas FPBI
  • Procuring commodities and providing logistics support for Operational Research poultry vaccination activity
ppe and decontamination kit pre positioning
PPE and Decontamination Kit Pre-positioning
  • 203,350 PPE kits donated to Government of Indonesia since January 2007
    • 55,868 distributed by UNFAO to Ministry of Agriculture for outbreak investigations
    • 31,775 distributed by CBAIC to its partners
    • 290 given to Komnas FBPI
    • 10,000 on reserve for Komnas FBPI for emergency use
  • 997 decontamination kits donated to Government of Indonesia since January 2007
    • 301 decon kits and 501 pails of disinfectant distributed by UNFAO to Ministry of Agriculture for outbreak investigations
support to komnas fbpi
Support to Komnas FBPI
  • National Committee for Avian Influenza Control and Pandemic Influenza Preparedness
  • 10,000 PPE on reserve for emergency
  • For PPE stockpile, providing logistics system guidelines with triggers for emergency use
  • Tentative discussions underway to provide Komnas FBPI with a larger PPE stockpile, more detailed logistics system, and training on PPE and pandemic preparedness logistics
operational research poultry vaccination activity
Operational Research Poultry Vaccination Activity
  • Operational Research (OR) activity being led by ILRI in collaboration with UNFAO and USAID | DELIVER PROJECT and other partners
  • Funded by USAID and World Bank
  • Main objective to test systems of different containment strategies
  • OR will assess success of 3 different AI control activities targeting backyard poultry (against control group, PDSR program) – PDSR program with: AI mass vaccine; AI with Newcastle Disease (ND) mass vaccines; full compensation with culling
  • Launch date set for July 7
  • ILRI
    • Leading OR
    • Research design
    • District profiling
  • FAO
    • Instrumental partner
    • On the ground presence and MOA relationship
    • Vaccinator trainings, community mobilization

- Procurement

    • VAICs and community mobilization
usaid deliver project and or
  • The project is procuring all commodities
  • Supplies include:
    • AI and ND vaccine (total of 42.24 million doses)
    • Cold chain equipment, including refrigerators for 16 district storerooms and cold packs, cold boxes and vaccine carriers for distribution to sub-districts
    • Vaccination equipment, including automatic syringes, injection needles, safe waste disposal boxes, incinerators, and supplies for vaccinator teams
cold chain
Cold Chain
  • Assisted UNFAO in conducting cold chain logistics assessment of district store rooms
  • Through our sub-contractor, FHI and PATH, developed Quality Assurance plan for vaccine distribution
  • Through our sub-contractor, PATH, provided cold chain logistics management training to provincial and district store room managers
    • Curriculum: maintaining cold chain for vaccines throughout distribution, refrigerator maintenance, logistics management information system, waste management, supportive supervision.
challenges or
Challenges - OR
  • Animosity between some partners
  • Need for strong coordination among partners
  • Lack of clear leadership and roles/responsibilities
  • Deliver’s relative late arrival in program
  • Procuring restricted commodities, including those over $100,000 level – more requirements
  • Working through bureaucracy and in decentralized system
  • Lack of cold chain system
  • Lack of staff on the ground and in-country support
successes or
Successes - OR
  • Partner differences resolved; USAID | DELIVER PROJECT has strong working relationship with all partners
  • Cold chain system
    • Assessed
    • Personnel trained
    • Commodities procured and being delivered
  • All supplies and equipment procured (and being delivered)
lessons learned
Lessons Learned
  • PPE ordering is a smooth process.
  • Preparations for OR activity are succeeding, but have taken longer and been more complicated than expected
    • Documentation and USAID approval process for purchasing restricted commodities – vaccines – is extensive
    • List of supplies for mass vaccination campaign is extensive and must be procured globally and locally
    • Positive collaboration among partners is imperative
    • Clear leadership by USAID and good communication within USAID and among partners necessary