Avian Influenza Preparation Advice

click here to download full version pdf document from UN Medical Directors ( September 2006 )

Avian Influenza Situation Update
WHO, INDONESIA
( 27 Sept 2005 )

Current avian influenza in Indonesia

On 23 September 2005, the Ministry of Health in Indonesia confirmed a further human case of highly pathogenic H5N1 avian influenza. The case, in an 8-year-old boy, was confirmed as positive for H5N1 infection by a WHO reference laboratory in Hong Kong. The boy has fully recovered but remains in hospital for observation and follow up. Current investigations in Indonesia have produced no evidence that the H5N1 virus is spreading easily from person to person.

As of 23 September 2005, there are three laboratory-confirmed cases of avian influenza in Indonesia. There are also two suspected cases who were identified during the family cluster in July but who could not be confirmed by laboratory testing.

Background on avian influenza in Indonesia

Since mid-2003, Indonesia has experienced outbreaks of avian influenza in its poultry population. Prior to the new case announced today, two human cases of H5N1 infection have been laboratory confirmed in Indonesia, one in July and another in September. All three cases have been investigated by the Indonesia health authorities, with WHO support, and have included searches for further cases.

As investigations have produced no evidence that the H5N1 is spreading easily from person to person, WHO has not raised its current level of pandemic alert. WHO will, however, continue to monitor the situation closely. Given the experience of other H5N1 affected countries in Asia, the detection of further human cases in Indonesia or elsewhere would not be surprising.

Laboratory confirmation of cases in Indonesia has led to heightened public concern, intensified surveillance for further cases, and strengthened government commitment to contain the disease. As a result, several patients with respiratory symptoms and a history of possible exposure to the avian virus are being evaluated as part of ongoing surveillance efforts. Samples from these patients have also been sent for analysis by the WHO reference laboratory in Hong Kong.

Overall assessment

In all affected countries, most human cases of H5N1 infection have been linked to contact with poultry. In a few instances, limited human-to-human transmission of the virus may have occurred following close contact with a patient during the acute phase of illness. In all known instances, such transmission has been limited and has not led to larger outbreaks in the general community, indicating that the virus does not spread easily among people at this time.

Prevention of Avian Influenza Infection

Consumer of chicken and chicken products:

• Chicken meats and eggs in the market are safe but they must be thoroughly cooked. All food should be thoroughly cooked to an internal temperature of 70°C or above.
• Do not eat half cooked meat (chicken, duck etc).
• Don’t eat raw eggs or soft-boiled eggs.

Commercial food handler and people who prepare food for household consumption:

• Don’t buy chicken meat that has dark, bruised or hemorrhagic spots.
• Don’t buy eggs that have cracked shells or have dirt, feces or feathers on them. Wash eggs thoroughly before cooking.
• Don’t use dirty hand to touch the nose, eyes, or mouth. Wash hands frequently, especially after handling chicken meat, duck meat, offal and eggs.
• Use separate chopping boards for meats, vegetable, cooked and raw food.

Management of pets:
• Watch out for any animal deaths.
• Avoid contact with dead poultry/birds and their feces. If contact is really necessary, use gloves, mask and personal protective gears.
• When burying dead birds or their feces, avoid generating dust. Spraying or sprinkle water to dampen the area first. Bury bird carcass and feces at a depth of at least 1 metre.
• When the dead birds and their feces have been properly disposed, clean cages and other contaminated areas very well with detergent and water. Influenza viruses are relatively susceptible to a variety of detergents and disinfectants.
Living in bird flu affected area:
• If you find sick or dying birds (of any species) in your neighborhood, report it to the Provincial Agriculture department (Dinas Peternakan). Wear gloves and put a cloth over your mouth if you have to touch these birds. Wash your hands with soap and water for at least 10 seconds after touching the birds.
• Avoid entering farms or wet markets where live birds/poultry are kept.
• After walking around areas that may be contaminated (such as farms, markets or backyards with poultry), clean your shoes as carefully as possible with soap and water.
• When cleaning shoes, make sure that you do not flick any particles into your face or on your clothes. Wear a plastic bag over your hands and or gloves.


Influenza-like symptoms (eg fever >38°C, cough, sore throat, runny nose and muscle aches):
• Cover your nose and mouth when coughing or sneezing. Use a tissue and throw it away once used. Teach children to do this as well.
• Always wash your hands with soap and water after any contact with secretions from nose or mouth as these can carry the virus.
• Children are especially prone to touching their face, eyes and mouth with unwashed hands. Teach children the importance of hand washing after coughing and sneezing.
• If you go to the doctor, wear a surgical mask or cover your nose and mouth with a cloth.
• If you have fever and breathing difficulties, go to the health centre and ask them if you have influenza.


Human Influenza Vaccine

A number of UN staff and their dependents have indicated interest in obtaining the human seasonal influenza vaccine.
The human influenza vaccine will not protect against avian influenza or a pandemic strain but it will protect against seasonal human influenza. Using the human influenza vaccine is cost-effective in reducing lost work time and minimizing utilization of limited healthcare facilities.

The vaccine will be available in Indonesia in the upcoming days. The cost of the vaccine is IDR 137,000 and is reimbursable through the UN Medical Insurance cover.

The Human Resources section of your organization will inform you as soon as the vaccine is available and where it can be obtained.

12.06.2008. 14:28

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