Efforts by Indonesia to combat H5N1 avian flu outbreaks in the human population are being hampered by the difficulty in detecting and stamping out the disease in poultry, says an epidemiologist at the World Health Organization.
The disease has claimed at least 37 lives in the vast archipelago, which has a population of 220 million people. Most cases represent the sentinel case for an outbreak in poultry, said Steven Bjorge, an epidemiologist with WHO in Jakarta.
“When a human case is reported, field investigations find that birds have been dying [in the area] for days or weeks before. The problem is the virus is now deeply entrenched in the backyard farms where poultry is kept for personal use,” he said.
When the bird flu outbreak first hit Indonesia two and a half years ago, it decimated industrially reared chicken flocks, but large poultry farms have introduced better biosecurity to protect their business. “There is no such thing as biosecurity in backyard farms. The chickens run everywhere. Only when we slow the transmission in animals will we see a reduction in cases on human side,” said Dr Bjorge.
One important obstacle to the fight against bird flu is the decentralised nature of the Indonesian government, whereby each of the country’s 441 district governments decides its own priorities. Indonesia’s Ministry of Health has staff down to local district level, making it easier to implement nationally decided policy. The Ministry of Agriculture does not, however, leaving the decisions about whether or not to combat outbreaks in poultry to local government.
“Each of the 441 districts has to decide to take action,” said Dr Bjorge. The high level of decentralisation also contrasts sharply with Thailand and Vietnam, where efforts to bring bird flu under control have been far more effective.
A recent cluster of eight cases of bird flu, seven of whom died, in one family in northern Sumatra once again raised the spectre of the emergence of a pandemic strain with higher human to human transmissibility, but so far none of the contacts of the family have shown signs of infection. “We are still waiting to get through another week or so before we declare that outbreak over, but we have been watching 54 close contacts of the last fatal case and so far no one has shown any health problems,” said Dick Thompson, WHO’s spokesman in Geneva. “However, there still continues to be a steady drip of new cases and they are not all from one place,” he added.
It is too early to assess the possible impact of the recent earthquake in central Java and Yogyakarta on the effort to combat bird flu, said Mr Thompson. “Given what we know now it shouldn’t have any impact but this is an evolving outbreak. Over the last couple of years Indonesia has been hammered with a series of [health crises]—the tsunami in 2004, a polio outbreak, a threatening volcano eruption, and now an earthquake. The government and the Indonesian people themselves have responded very well and we have a remarkable degree of collaboration with the Indonesian government,” he said.
