6/6/2012. General Information (3)

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1 Indonesia s National Efforts to Improve Disease Detection and Surveillance: Current Strategies, Initiatives and Challenges delivered by Isroil Samihardjo, MDefS General Information (1) An archipelagic country with dry and rainy seasons Temperature : 20 o C to 30 o C Humidity : 65% to 90% Large and diverse population 220 million/population density 113/km2 A crossroad of ancient migration influenced the genetic background of host and pathogen 1 2 General Information (2) Threats emanating from infectious Diseases Anthrax Hemorrhagic Fever Smallpox Plaque Tuberculosis Malaria HIV AIDS Avian Influenza Typhoid Fever Hantaan & Nipah virus Meningitis Rickettsioses etc. General Information (3) Threats emanating from infectious diseases Epidemological Aspects Animal diseases Human diseases (no immunity) Rapid and prompt responses (surveillance, early detection, etc) Safe and secure laboratories 3 4 1

2 General Information (4) Threat Emanating from infectious Diseases Evolution of Terrorism Fire weapon armament Chemical & radioactive weapon Biological weapon Policy Surveillance Laboratory Research Data Management Strategies Rapid and prompt responses (surveillance, early detection, etc) Safe and secure laboratories 5 6 Strategies (1) POLIC Disease detection and surveillance activities on animal health are conducted by 8 regional labs Disease Investigation Center (DIC) and the Indonesian Research Center for Veterinary Science (IRCVS). Both centers are under the coordination of the Ministry of Agriculture. Reporting mechanism: any results of disease detection and surveillance will be collected by 8 Regional labs and will be reported to the persons in charge of this issue within each Ministry (depend on its nature). Should they need any confirmation about the agent of disease, they are requested to send the samples to the IRCVS for further research and investigation. Strategies (1) POLIC DIC Subang Two stories, total area 45,524 m 2 Completed in March

3 Strategies (1) POLIC Indonesian Research Center for Veterinary Science (IRCVS) in Bogor

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5 18 Strategies (2) POLIC Disease detection and surveillance activities on human health are coordinated by the Ministry of Health (Directorate General of Disease Detection and Environmental Health). The Government of Indonesia has also included into its priorities: the implementation of capacity building and improvement of the infrastructure of laboratories, in particular regarding the aspects of biosafety and biosecurity. Codes of Conduct on Biological Research Practices is being discussed among related government agencies under the coordination of Indonesian Academy of Science. Strategies (3) SURVEILLANCE Disease surveillance of animal diseases are conducted by the regional labs (DIC) in a regular basis, including the monitoring activity on the current diseases such as AI, Antrax, Rabies, Brucelosis and other strategic animal diseases. (Hog Cholera, ND). Occasionally, IRCVS also conducted the surveillance, related to a certain research projects (eg Nipah, AI, HC etc)

6 Strategies (4) LABORATOR (a) Does your country have National Laboratory Policy National Laboratory Plan/Programme National Focal Point for Laboratories National Advisory Body on Laboratories National Laboratory Network National Accreditation Body for Laboratories National Laboratory Human Resource Plan Registration/licensing: Mandatory (M)/ Voluntary (V)/ Nil (N) National Regulatory Authority: Stand alone/part of NRA N N M part of NRA CAPACIT Strategies(5) LABORATOR (b) Describe the laboratories /N Number of laboratories in public sector BSL3/BSL4 labs 7/0 BSL2 labs 52 Number of laboratories at central level 9 Number of laboratories at intermediate/provincial level Hosp Lab 33/ PHL 26/ Env Lab 10 Number of laboratories at peripheral/district level 218 Number of health laboratories in private sector Clin. Lab 792 Number of health/related laboratories in other sectors? Do these laboratories have adequate number of trained staff NA Is there a system that ensures continuous supply of reagents NA Is there a functioning system for maintenance of equipment * Regional Meeting on Lab Networking, Bangkok August Strategies (6) LABORATOR (c) QUALIT AND BIOSAFET SSTEM Does your country have National Laboratory Standards National Accreditation Body for Laboratories Number of laboratories accredited by national body /N KAN and KALK ISO : 24 lab, ISO : 28 lab KALK Number of labs accredited by international organization TB (5), Polio/ Measles (4), Influenza (2) National Quality Manager? National EQAS (specify discipline) Internal audit in all/some/few/none laboratories some Use of SOP and validation Not all Follow biosafety practices and proper waste disposal Not all Strategies (7) RESEARCH Research for animal health is carried out mainly by central lab (Balitvet). Universities such as Airlangga University, Primata Center, Gadjah Mada University, etc that have veterinary faculties might also conduct research activities on vet science

7 Strategies (8) DATA MANAGEMENT Data management for all disease information is managed in the Ministry of Agriculture under Info Lab Program. This program has been improved to an Info Lab Plus Program, in collaboration with Australia. Initiatives (1) NATIONAL REGULATIONS Law no. 18/2009 on Livestock and Animal Health. Presidential Decree No. 30 year 2011 on Zoonosis Decree of the Minister of Health No. HK.03.01/Menkes/073/I/2010 on the establishment of the Indonesian Commission on the Research and Assessment of Infectious Diseases. Decree of the Minister of Health No. 1501/Menkes/Per/X/2010 on the communicable diseases which can cause outbreaks included the surveillance systems and response program in Indonesia. Decree of the Minister of Health No. 1244/1994 on the Guidelines on the Biosafety in Microbiology and Biomedical Laboratories. Decree of the Minister of Trade and Industry No. 254/MPP/Kep/2000 on the Export and Import of Certain Dangerous Materials, including Chemical & Biological agents. Presidential Decree ear 1991 on the ratification of Biological Weapons Convention Initiatives (2) CASE STUD National Program on Avian Influenza (AI), Rabies, Brucella and other diseases such as FMD. Establishing a structure for the AI disease control consists of the CMU (Center Management Unit), the LDCC (Local Disease Controlling Center), the PDSR (Participatory Disease Search and Response). This program is supported by international agencies such as FAO and other international funding bodies. Initiatives (1) NATIONAL REGULATIONS Decree of the Minister of Health no. 1138/Menkes/SK/XI/2009 for the Sulianti Saroso Infectious Disease Hospital as Detection and Surveillance Center for Infectious Disease

8 Initiatives (1) NATIONAL REGULATIONS Decree of the Minister of Health no. 1138/Menkes/SK/XI/2009 for the Sulianti Saroso Infectious Disease Hospital as Research, Detection and Surveillance Center for Infectious Disease. Initiatives (3) Joint Exercise Under the coordination of the Coordinating Ministry of Political and Security, Indonesia has convened a joint exercise in the field of disease detection and surveillance, at the various levels: local, national as well as regional. National Workshop A number of workshops on disease detection and surveillance have been conducted. The National Workshop on Animal Diseases has been convened by IAARD (Indonesian Agency on Animal R&D), DGLAHS (Directorate General of Livestock and Animal Health Services), and Professional Organization such as Microbiology Association and Indonesian Veterinary Association. The National Workshop on Human Diseases Detection and Surveillance have been conducted by NIHRD with WHO and US CDC Initiatives (4.a) Managing Public Awareness Given the nature of diseases in Indonesia which are easily transmittable/communicable due to the climate condition, the public are need to be well-informed on this issue. To this end and considering the large Indonesia s population, all related ministries/agencies as well as local governments are working together to disseminate information regarding the diseases and others health-related issues. The raising awareness done by MoH are laboratory technical workshop including biosafety & biosecurity principles for AI networking laboratories since 2005 (44 labs in 20 provinces; and will be 50 labs in 33 provinces by 2012); developed training modules in Indonesian language for handling AI specimen (2008); developing training modules for biosafety & biosecurity principles based on NIH-WHO modules in Indonesian Language at 2009 (1 st ed) and at 2010 (2 nd ed). 31 Initiatives (4.b) Managing Public Awareness It is imperative that all relevant governmental institutions continue their efforts in creating a coordinated approaches in disseminating such issues. At the same time, public awareness issues should also be carefully crafted since it should not create unnecessary panic in the community, in particular during the case of possible bio agents outbreak. 32 8

9 Initiatives (4.b) It is imperative that all relevant governmental institutions continue their efforts in creating a coordinated approaches in disseminating such issues. At the same time, public awareness issues should also be carefully crafted since it should not create unnecessary panic in the community, in particular during the case of possible bio agents outbreak. Initiatives (5) Community Mobilization Alert systems for fever disease: EWORS Outbreaks networking systems in MoH Annual training for PINERE (New Emerging and reemerging Infectious Diseases) EQAS lab for TB control programs Promoting programs in MOH for PINERE Establishing MTA Committee Challenges (1) Synergy between related Ministries/Agencies Finalization of the act related to Biological Weapons Convention, as the legal umbrella of cooperation in the field of biosafety and biosecurity issues, including disease detection. National Implementation of the World Health Organization s International Health Regulations. The difficulties of composing national regulation on Coordination among Ministries to control biosafety and biosecurity among Ministries. The lack of international regime on biosafety and biosecurity in particular the absence of the verification mechanism under the Biological Weapons Convention. 35 Challenges (2) Indonesia s Responses Working on the establishment of a more effective communication and information networks among ministries/agencies dealing with the issue of disease detection and surveillance. Conducting regular trainings to develop new methods on the laboratory of biosafety and biosecurity as well as a dual use laboratory. Enhancing capacity building and cooperation program with a more advance institutions, in particular to implement the twinning system laboratory. Conducting regular training on biosafety and biosecurity principles in primary public health laboratories and developing the EQAS (External Quality Assurances systems). 36 9

10 Conclusion An Effective Disease Detection and Surveillance requires: Domestic policy, effective regulations and adequate human resources capacity. Coordination and collaboration in raising awareness. Availability of international regimes to regulate the uses of biological materials to ensure for the purpose of peaceful uses. Strong collaboration in the field of capacity building among ARF Participants. Recommendation Establishment of International Regimes on biosafety and biosecurity including the establishment of International verification regimes to the BWC. Conducting concrete activities such as training for trainers or table top exercise to improve institutional capacity of ARF Participants in the field of disease detection and surveillance. Conducting cooperation of laboratories in emerging infectious disease diagnostic and laboratory network