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  • Indonesians hold major drill for bird flu pandemic

    Indonesians hold major drill for bird flu pandemic

    By ZAKKI HAKIM – 27 minutes ago

    BALI, Indonesia (AP) — Indonesia launched a major bird flu drill Friday that will test the ability of the nation hardest hit by the virus to respond to a possible pandemic. Thousands were taking part, from local residents to government officials.

    The three-day simulation started with the isolation of a village on the resort island of Bali, where a field hospital was being set up to treat people with flu-like symptoms. Before the drill ends Sunday, officials will try to prevent "infected" travelers from leaving the international airport and spreading the virus to other countries.

    "This is a very important event from the perspective of public health," said Subhash Salunke, of the World Health Organization. "It will certainly help better equip Indonesia in the event of a pandemic. But other countries struggling to contain bird flu outbreaks can and will learn from this exercise as well."

    Indonesia has been worst affected by bird flu since it started ravaging Asian poultry stocks in late 2003, with its 107 human deaths accounting for nearly half the 240 recorded fatalities worldwide. The government has come under fire for failing to slow the spread of the virus, which is now endemic in poultry in all but two of the countries' 33 provinces.
    Others, like Vietnam, have succeeded thanks largely to strong political will, mass culling of all chickens in infected areas and aggressive vaccination campaigns. But Indonesia says there are limits to what its cash-strapped government can do.

    The virus remains hard for people to catch, but scientists worry it could mutate into a form that spreads more easily between humans, with the potential to kill millions worldwide. Indonesia is seen as a potential hotspot for that to happen.

    That makes the drill on Bali especially relevant, said Nyoman Kandun, a senior health ministry official. More than 5,000 people were taking part, from government officials and law enforcement officers to doctors and villagers.

    "We want to show the world that we are prepared, that we are ready to contain and stop this virus in the event of a pandemic," he said.


  • #2
    Re: Indonesians hold major drill for bird flu pandemic

    Foreign observers to witness bird flu-handling exercise in Indonesia

    JAKARTA, April 23 (Xinhua) -- At least 42 representatives of international agencies and foreign governments are to witness a bird flu handling exercise in Bali on April 25-27, sources close to the event's organizers said on Wednesday. "They will be able to see from close quarters the seriousness with which the Indonesian government, including the Bali provincial administration, is handling bird flu," Antara news agency Wednesday quoted the sources as saying in Denpasar, capital of Bali province.

    The simulation would involve related agencies and ordinary people and be staged in three districts and one municipality in Bali. It would also take place at Tabanan district's general hospital, Ngurah Rai airport and Sanglah General Hospital in Denpasar.

    Observers would also come from professional organizations, various central government agencies, referral hospitals and public health offices in all other Indonesian provinces,
    Indonesian Health Minister Siti Fadilah Supari is slated to open the demonstration in Jembrana District on April 25


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    • #3
      Re: Indonesians hold major drill for bird flu pandemic

      Drills to test pandemic preparedness

      Emmy Fitri, The Jakarta Post, Jembrana

      Jembrana regency in Bali is hosting a three-day avian influenza pandemic simulation involving nearly 1,000 people to try out the newly completed National Pandemic Preparedness Plan.

      Jembrana Regent I Gede Winasa said it was an honor to host the international event, which started Friday. The simulation is a response to fears avian influenza virus H5N1 could evolve and turn into a pandemic strain through human to human transmission.

      "Jembrana will never stop innovating. Hopefully, with this simulation, we can contribute something to the world. We hope a pandemic will not really strike," said Winasa.

      Home to 260,000 people, Jembrana is a two hour drive west of Denpasar. The village hosting the simulation, Dangin Tukad Daya, reported two fatalities from bird flu last year.

      First reported in Hong Kong in 1997, bird flu has claimed 137 lives worldwide, 107 in Indonesia. Indonesia has culled millions of chickens in at least 30 provinces, severely affecting the country's poultry industry.

      Kicking off the first day of the simulation Friday, the Health Ministry's director general for communicable disease control, I Nyoman Kandun, said Indonesia had taken fundamental steps to control the spread of avian influenza in the country since its first reported human infection in 2005.

      The steps, he said, included disease control in animals, protection for high-risk groups, epidemiology surveillance for humans and animals, restructuring the poultry industry, risk communication and research.

      Kandun said bird flu should not merely be the concern of the health sector, but must be addressed across the board with concerted efforts.

      "It's high time for us to test our preparedness by involving all sectors and the public so we can all learn. With this simulation, we can show the world we mean what we say -- we're prepared," Kandun said.

      "In an old Indonesian saying, we're sedia payung sebelum hujan (putting up our umbrellas before it rains)," he said.

      The three-day simulation costs US$500,000 and is funded by Atlanta-based Centers for Disease Control and Prevention.

      The pandemic simulation began with a villager visiting a community health center complaining of a prolonged cold and respiratory problems. Several residents were reported to have similar symptoms. An investigation team from the local health agency was deployed to detect the possible spread of the virus by checking residents' temperatures.

      The village was then sealed off to prevent the virus from spreading. Police and military officers were deployed to bar people from entering or leaving the village. In the meantime, the local administration set up a makeshift hospital on a soccer field to treat patients with anti-viral prophylaxis or oseltamivir, effective in tempering the early onset of avian influenza.

      In Saturday's simulation, people will be referred to Tabanan Hospital in Tabanan and later Sanglah Hospital in Denpasar for further treatment.

      On the last day, staff at the airport will simulate thermal scans on all people entering and leaving the airport and will spray their vehicles with disinfectant

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      • #4
        Re: Indonesians hold major drill for bird flu pandemic



        Fitri on the end of the Indonesian flu drill

        Via The Jakarta Post, Emmy Fitri posts a fascinating account: Bali airport in 'chaos' as flu pandemic drill ends. Excerpt:

        It was not business as usual at Ngurah Rai International Airport in Denpasar, Bali, on Sunday morning.

        Security was heightened throughout the airport, but this time it had nothing to do with terrorism, but was part of a simulation to test the country's response to an avian influenza pandemic.

        With surgical masks and radios, airport security, police officers and local administration officials stopped vehicles outside the airport and asked drivers and passengers for IDs.

        All were asked if they were residents of Dangin Tukadaya in Jembrana or if they had visited the village in the last two days. Vehicles coming from the village were sprayed with disinfectant and all passengers and drivers were told to report to a nearby tent for health checks.

        Further checks were done inside the airport, including at the departure terminal where two thermal scanners were placed to screen all passengers.

        Anyone with a temperature of 38 degrees Celsius or above and who showed symptoms of influenza or respiratory problems would not be allowed to leave, being sent instead to a field hospital for further examination.

        There were sporadic commotions as people refused to comply with officials' orders to report to a nearby office where they would be questioned about their time in Bali -- checking if they had been to Dangin Tukadaya village or had contact with villagers there.

        Complaints were mostly about fear of missing flights.

        Japanese national Etsuko Fukuoka and her daughter Amari Fukuoka and Etsuko's friend Reiko Yamamoto said they were not allowed to enter the departure terminal because they were returning from Dangin Tukadaya village.

        This "unusual business" was part of an avian influenza pandemic simulation, which previously took place at Dangin Tukadaya village, about a two-hour drive west of Denpasar.

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        • #5
          Re: Indonesians hold major drill for bird flu pandemic

          My source at the CDC confirms that, in fact, funds from the CDC, as well as WHO, were used to support the pandemic flu exercise sponsored by the Indonesian Ministry of Health. Funds were provided by the CDC through a cooperative agreement with the Directorate for Disease Control and Environmental Health within the Ministry.

          S.

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          • #6
            Re: Indonesians hold major drill for bird flu pandemic

            CBN Report: Indonesia Conducts 3-Day Drill of Pandemic Influenza National Response Plan
            By Luciana Borio, MD, May 1, 2008
            A small rural village in Bali spent months preparing to participate in what the Jakarta Post described as Indonesia?s first massive pandemic influenza exercise, held this past weekend.<sup>1</sup> Indonesia has good reason to drill on a large scale: 107 people have died from H5N1 avian influenza avian flu there, a number that represents close to 50% of the world's total human deaths from H5N1, and the virus is endemic in bird populations in most of the country.<sup>2</sup>
            Indonesia?s scripted exercise, which cost $500,000 and was funded by the U.S. Centers for Disease Control and Prevention (CDC), began the morning of Friday, April 25, and ran through Sunday, April 27.<sup>3</sup> With 1,000 participants, this drill involved local village residents, 20 institutions?ranging from the armed forces, to healthcare organizations, to foreign and trade ministries?and more than 50 foreigners, including many diplomats; it was covered by more than 50 local and international journalists.<sup>4,5</sup> The purpose was to test the Indonesian government?s readiness and response to a pandemic, as outlined in its National Strategic Plan for Avian Influenza Control and Pandemic Influenza Preparedness.<sup>1,6</sup> The Jakarta Post reported that at least 2 other much smaller drills were held earlier this year, and that Singapore and South Korea have conducted computer-simulated drills, but this was the first in the region that involved real-life conditions. The paper also reported that 8 more simulations will be conducted throughout the year.<sup>6</sup>
            The drill began in Dangin Tukadaya village, on the resort island of Bali, when a man presented himself to a clinic with symptoms of avian influenza. Health workers, who initially assumed he had been in contact with infected chickens, soon learned that the man had no such contact, and they realized that he had contracted the illness from another villager, indicating that the H5N1 virus was being spread from person to person.<sup>5</sup>
            In response, access to the village was shut down, chickens were slaughtered, and health officials raced to identify and isolate other ill people and quarantine their houses and families.<sup>3</sup> Local officials distributed supplies to those under quarantine. Antiviral prophylaxis was dispensed to prevent disease spread. Schools were closed. Healthcare workers donned full body protective suits and ?moved like ghostly astronauts around the field hospital tents set up outside the main building.?<sup>4</sup> Travelers at the Bali airport were screened with thermal scanners to detect fever prior to leaving or entering. Vehicles from the village arriving at the airport were sprayed with disinfectant, and passengers underwent ?health checks.? Those who had visited the affected village underwent additional screens.<sup>7</sup>

            This drill was fully scripted and limited to a small rural community. While analysis and final reports on the drill will take some time, first impressions suggest that some of the public health actions that were taken in the drill, such as imposition of quarantine, are difficult to implement and sustain and are of limited value in a pandemic situation. News reports did not cover hospital response, so it is not possible to learn how the main hospital managed to deliver care to the ill patients.

            Two commendable features of the exercise were the involvement of the full range of sectors (health, safety, transportation, etc.) and the extent to which local villagers participated in this exercise. Pandemic influenza drills typically test formal response institutions, casting the population at-large as mere bystanders to the crisis. In contrast, rural villagers played key roles in this exercise, learning first hand the challenges of disease containment as well as the difficulties of cross-sector coordination.
            The comments of one villager suggest the value of incorporating citizens into preparedness activities. Villager I Wayan Nerken, 51, whose role in the drill was to report the sudden "death" of one of his chickens, said the exercise was "very useful . . . So far the information that we've got about bird flu has been limited to what we've seen on television. We don't really understand [how to act] when an infection happens," he told the press. "Before this I didn't know that we're not supposed to handle the carcasses when chickens die suddenly."<sup>5 </sup>Monica Schoch-Spana, PhD, contributed to this article.
            References
            1. Fitri E. Bird flu drill gives residents golden lessons. Jakarta Post April 27, 2008. http://www.thejakartapost.com/news/2...en-lesson.html. Accessed April 30, 2008.
            2. World Health Organization. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO. http://www.who.int/csr/disease/avian.../en/index.html. Updated April 2, 2008. Accessed April 30, 2008.
            3. Fitri E. Drills to test pandemic preparedness. Jakarta Post April 26, 2008. http://www.thejakartapost.com/node/167307. Accessed April 30, 2008.
            4. Williamson L. Bird flu: Indonesia's trial run. BBC News April 29, 2008. http://news.bbc.co.uk/go/pr/fr/-/2/h...ic/7371658.stm. Accessed April 30, 2008.
            5. Indonesia runs massive bird flu drill. Agence France-Presse April 25, 2008. http://afp.google.com/article/ALeqM5...3Mp8r6SIEdUjAQ. Accessed April 30, 2008.
            6. Fitri E. Why bird flu? Why a pandemic simulation? Jakarta Post April 27, 2008. http://www.thejakartapost.com/news/2...imulation.html. Accessed April 30, 2008.
            7. Friti E. Bali airport in ?chaos? as flu pandemic drill ends. Jakarta Post April 28, 2008. http://www.thejakartapost.com/news/2...rill-ends.html. Accessed April 30, 2008.
            See Also
            1. Schoch-Spana M, Franco C, Nuzzo JB, Usenza C; on behalf of the Working Group on Community Engagement in Health Emergency Planning. Community engagement: leadership tool for catastrophic health events. Biosec Bioterror 2007;5:8-25.
            2. Wray RJ, Becker SM, Henderson N, et al. Communicating with the public about emerging health threats: lessons from the Pre-Event Message Development Project. Am J Public Health 2008 Apr 1 [Epub ahead of print] http://www.ajph.org/cgi/content/abst....2006.107102v1. Accessed April 30, 2008.
            http://www.upmc-cbn.org/

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