Review of the DoD-GEIS Influenza Programs Strengthening Global Surveillance and Response (2008) / Chapter Skim
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3 Naval Medical Research Unit 2 Indonesia Avian and Pandemic Influenza Activities
3 Naval Medical Research Unit 2 Indonesia Avian and Pandemic Influenza Activities
Pages 55-80
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From page 55... ...
Avian influenza highlights the issues of regional disease spread and also the significant role that NAMRU-2 plays in conducting disease surveillance, case and outbreak investigation, and diagnostic support. NAMRU-2 either identified or shared in the confirmation of all recent human cases of H5N1 infection in Indonesia, where the laboratory is recognized as one of two H5N1 reference laboratories by the Ministry of Health (MoH)
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From page 56... ...
3-1 and 4-1 INFLUENZA IN INDONESIA Indonesia, home to 224 million people and 1.3 billion poultry, including 920 million chickens and 48 million ducks, reported its first human case of H5N1 avian influenza in July 2005 (Naipospos, 2007; WHO, 2007a)
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From page 57... ...
All department heads have significant involvement in programs other than DoD-GEIS and avian influenza/pandemic influenza (AI/PI) activities, including Military Infectious Diseases Research Program (MIDRP)
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From page 58... ...
. Conclusions The site visit team was told that single-year funds received at the end of a fiscal year are very difficult to use effectively.
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From page 59... ...
. Using the 2006 AI/PI supplemental funding, NAMRU-2's avian and pandemic influenza surveillance program was expanded to incorporate both animal and human surveillance, including surveillance of influenza viruses in migratory birds in Java; a passive surveillance network to detect influenza viruses in humans with influenza-like illness alone or with diarrhea and acute respiratory symptoms in Indonesia; and development of new human surveillance projects and diagnostic capabilities in Laos and Cambodia (NAMRU-2, 2007b)
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From page 60... ...
In some fatal cases of avian influenza reported in Vietnam and Thailand, diarrhea occurred without any respiratory symptoms, and laboratory testing has found that highly pathogenic avian influenza H5N1 is present in the stool of infected patients (de Jong, et al. 2005 and Wiwanitkit, 2005)
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From page 61... ...
. NAMRU-2 expects this study to yield information about influenza in Laos, to enhance Laos's capacity to identify potential pandemic influenza viruses and other highly pathogenic and virulent respiratory pathogens, and to provide the CDC with a broader net to identify highly pathogenic influenza viruses.
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From page 62... ...
This program has three main objectives: to develop and conduct surveillance of avian influenza viruses in migratory and wild birds; to train Indonesian government scientists in field and laboratory techniques for collecting and testing for virus; and to use remote sensing to determine environmental correlates for transmission (NAMRU-2, 2007b)
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From page 63... ...
In addition, the committee concluded that NAMRU-2's work with novel findings will greatly contribute to knowledge of the H5N1 influenza virus.
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From page 64... ...
At present, presumptive H5 antibody in animal and human sera is detected at NAMRU-2 by the hemagglutination inhibition method; until a BSL-3 is available, microneutralization tests cannot be performed. The site visit team drew attention to the complexity of detecting antibodies to avian influenza viruses in mammalian sera.
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From page 65... ...
Also included in the laboratory is a DNA/RNA extractor paid for by DoD-GEIS influenza surveillance supplemental funds. NAMRU-2 Laboratory in Laos The site visit team did not visit Vientiane but was informed that NAMRU-2 has been working in Laos for eight years, with influenza-specific work being done in the past year and a half.
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From page 66... ...
While the site visit team was impressed with the expanded capabilities this technology adds to all of the laboratories, its members did have concerns about the sustainability of this sort of advanced diagnostic system due to its high cost of operation. RESPONSE CAPACITY Outbreak Response NAMRU-2 has a tradition of supporting the ministries of health in the region in investigating and responding to significant disease threats, such as severe acute respiratory syndrome (SARS)
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From page 67... ...
The Jakarta laboratory would be able to increase specimen testing to 3,400 specimens per week (2,000 using real-time RT-PCR and an additional 1,400 using the Luminex technology) ; the Phnom Penh laboratory would be able to test 1,000 specimens per week (500 using real-time RT-PCR and an additional 500 using the Luminex technology)
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From page 68... ...
68 TABLE 3-1 Summary of Surge Capability at NAMRU-2 Indonesia Cambodia Laos Total (# specimens/week) (# specimens/week)
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From page 69... ...
; the Phnom Penh laboratory would be able to test 1,200 specimens per week (700 using real-time RT-PCR and an additional 500 using the Luminex technology) ; and the Laos laboratory, if requested to do testing for a suspected outbreak, could test 500 specimens per week.
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From page 70... ...
An ABI 3300 gene sequencer has been added to the new molecular virology laboratory, and, in addition, funds provided for this project have supported the purchase of reagents and the hiring of two technicians to oversee activities. NAMRU-2 has provided the laboratory in Phnom Penh, Cambodia, with significant support in the form of equipment, supplies, and personnel with which to conduct avian influenza projects in the country.
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From page 71... ...
The IOM site visit team learned that the large items of equipment purchased with supplemental influenza surveillance monies, including the multiplex PCR apparatus installed in Cambodia and Laos, represent Department of the Navy equipment that would not be left behind should the influenza surveillance budget be severely curtailed. IOM site visitors were informed that this lack of transfer of ownership of the equipment to host country institutions was clearly explained to host country collaborators.
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From page 72... ...
The other issue related to another CDC standard operating procedure, which was to make viral isolates available upon request to manufacturers of influenza vaccines for humans and to make the sequences publicly available to everyone in Genbank. This was in accordance with the rules of the WHO International Influenza Reference Laboratories, but the Indonesian government was unhappy with the way its viruses and sequences were being handled, and it argued that a lack of respect was being shown for the needs of Indonesia as a sovereign government.
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From page 73... ...
An important clarification was provided to the site visit team when it visited with the WHO country representative in Jakarta. He indicated that at the highest levels of WHO there was involvement and discussions with the Minister of Health of Indonesia and with her associates over the issues of sending virus isolates to a WHO influenza reference laboratory and sharing strains and sequence data.
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From page 74... ...
During the IOM team's visit, its members met with officials from the WHO, who confirmed that NAMRU-2 is well coordinated with and closely linked with WHO activities. As mentioned previously, specimens positive for H5N1 and other influenza viruses are shipped immediately to the CDC for confirmation and genetic analysis, if applicable.
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From page 75... ...
NAMRU-2 also works closely with relevant government agencies on influenza surveillance activities in Cambodia and Laos. The site visit team felt that NAMRU-2 was working well in all of its locations, even in the face of serious challenges to coordination.
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From page 76... ...
2007b. Avian influenza outbreaks in South-East Asia.
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From page 77... ...
2, Phnom Penh, Cambodia Thomas Wierzba, Phnom Penh Laboratory, Naval Medical Research Unit No. 2, Phnom Penh, Cambodia Bill Brady, Avian Influenza Country Coordination, National Institute of Public Health, Phnom Penh, Cambodia Ung Sam Un, National Institute of Public Health, Phnom Penh, Cambodia
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From page 78... ...
Embassy Avian Influenza Working Group 1230-1400 Lunch 1400- Rumah Sakit Pneyakit Infeksi Sulianti Saroso Hospital for Influenza site visit
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From page 79... ...
1430-1600 Visited family farm south of Phnom Penh 1900- Dinner Friday, March 9, 2007 0830-1600 Fly to Bangkok, Thailand Saturday, March 10, 2007 1000-1640 Departure
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