Transcript INDONESIA_ARF_BTR_100609

NATIONAL EFFORTS TO MITIGATE
BIOLOGICAL THREATS – INDONESIA’S
EXPERIENCE
Herawati Sudoyo
Eijkman Institute for Molecular Biology
Jl Diponegoro 68
Jakarta 10430, Indonesia
Indonesia’s Experience
 Bioterrorism prevention measures
Risk assessments
Biosafety laboratories infrastructures for
dangerous pathogens
 Systems to detect, diagnose and track
outbreaks of highly infectious diseases
 Systems to track the origin of the outbreak
of highly infectious diseases
 Emergency response systems for control
and containment of infectious disease
events
Indonesia – A Rapidly Developing Country with
Serious Problems in Infectious Disease
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West to east 4,500 km; North to South 2,000 km
Dry land 1.8 million sq.km. (Borneo 0.7, Sumatra 0.4, Java 0.1)
More than 17,000 islands – 3,000 inhabited
Population 220,000,000 - > 500 ethnic groups
Indonesia – A Rapidly Developing Country with
Serious Problems in Infectious Disease
Malaria:
– 15 million malaria cases and 42,000 deaths every year (2005)
– Highest case number and fatality rate in the world
Tuberculosis:
– ranked third in TB burden following India and China
– TB is third of major causes of mortality in Indonesia
– WHO estimate, Indonesia has 269 TB cases/100,000 populations
Dengue:
– Most important viral borne disease in Indonesia
– Outbreak in 2004: 78,690 cases with 954 deaths (CFR- 1.2%)
– In 2007: 123,174 cases with 1,251 deaths
Hepatitis B:
– 10% (3.4-20.3%) of population are HBV carriers
– Moderate-to-high endemic (WHO)
Avian Influenza:
– June 2005-June 2009: 262 positive cases; 115 deaths, CFR: 80%
– Highest case number and fatality rate in the world
World : Affected areas with confirmed cases of H5N1
avian influenza since 2003 Status as of 06.05.2009
World Indonesia
Confimed cases
433
262
Death
141
115
National Actions to Strengthen
Biological Security
 Building a safe, secure and sustainability capacity
 Best practices on biological safety and security
 Building capacity to detect, diagnose and track
outbreaks of highly infectious diseases
 Enhancing cooperation
Jakarta
EIJKMAN
NIHRD
UI
Surabaya
TDC-UNAIR
Bogor
BALITVET
Institutions working on Avian Influenza and BSL3 facilities
I. Building a Safe, Secure and
Sustainability Capacity - Pressure
• Urgent need for Avian Influenza genomic risk assessment
(MOH policy)
• No BSL3 was on the horizon in Indonesia at the time
• Awareness of international community watching
Funds allocated by Indonesian government with support
from parliament
Why Need a BSL3 Facility?
 Research is an essential component of response to
emerging infectious diseases
 Role in national response to Emerging Infectious Disease
• To provide scientific and technological support to the
national diagnostic laboratory network, including
capacity building
• As the leading research laboratory, in particular in
genomic research (viral as well as host) and pathology
• As the major back up diagnostic facility in emergency
situation, such as in pandemic response
 Current infectious disease research activity – e.g. culture of
tuberculosis (airborne) bacteria
 Prepare for future emerging infectious disease threat e.g
recent experience of NOT being able to respond
scientifically to threat of SARS
Building a BSL3 Facility at Eijkman
• A new wing entirely for the BSL3 attached to the current building
• Total space available: 150 sq m (15 x 10 m)
• For handling pathogenic bacteria and viruses - No animal work
II. Best Practices on Biological Safety and
Security - Challenges
·……The human element is the crucial part of the chain for many aspects of
biosafety and biosecurity, good facilities and procedures are not sufficient if
personnel are not adequately trained and do not clearly understand their
roles and responsibilities…………………..
 Laboratory biosecurity training, complementary to
biosafety training is provided - protection, assurance
and continuity of operations
 Should not be a one-time event – offered regularly
and taken currently. To refresh memories and to learn
about new developments and advances in different
areas
Most importantly, strengthening the spirits!
Management System
 No history of running containment facilities
 Management system had to be started from basics
– Policies
– Biosafety manual
– SOPs
– Risk assessments
– Etc.
 New personnel
– Laboratory manager
– Staff
– Maintenance
 Some documentation supplied from other institutes and
support to get program started
 Need own system which fits individual institute and culture
Regional Need to Promote and Implement
Biosafety and Biosecurity Management
More than 70 representatives from 17 countries
Contributions by the WHO, APBSA and academia.
 Need to enhance capabilities in addressing
challenges such as emerging and reemerging diseases
 Capabilities must be adapted to local needs complexities involved in setting up new
laboratories, many challenges associated
with construction, on-going maintenance and
running costs
 Increased co-operation between countries –
make a use of existing capabilities and
resources
Summary of Regional Seminar on Promoting and Implementing
Biosafety and Biosecurity Management, Jakarta, Juni 2008
 Adequate systems to address
biosafety and biosecurity are critical in
overcoming these challenges - involve
physical structures, strong commitment
by senior management, development
of safety and security procedures and
training
 It was affirmed that countries in the
region should learn from each other’s
experiences
Experience from the Eijkman Institute
is of particular relevance
Indonesia and Norway will co-host “International Seminar on the
Biological weapons Convention Supporting Global Health: Reducing
Biological Risk buy Building Capacity in Health Security – Oslo, 18-19
June 2009
Building infrastructure to combat emerging infectious
diseases – more facilities built in the country –
ABSL-3 @ Airlangga University, Surabaya
15 m
14 m
 Total space available 210 m2
 Four animal handling rooms for mice, ferret, chicken and monkey
 Dedicated for handling animal work
Manpower and Capacity Building Through
Training, Specific Workshops and Conferences
• Laboratory Biosecurity and Biosafety for BSL3 Laboratories,
Bogor, 2006
• APBA Biosafety Management Course, Singapore, July 2006
• Lab for the 21st Century, High performance, Low Energy Design
Course, Scottsdale, USA, April 2007
• Safe BSL3 Work Practices and Procedures, Scottsdale, 2007
• ABSA 50th Biological Safety Conference, October, 2007
• 3rd APBA Conference, Bangkok, 2008
• 3rd Annual Conference SEA Influenza Clinical Research Network,
Bali, 2008
• Regional Seminar on Promoting and Implementing Biosafety and
Biosecurity Management, Jakarta, June, 2008
• Laboratory Biorisk Management System Workshop, Jakarta,
August 2008
• Advanced Topics in Managing BSL3 Laboratories, CDC Atlanta,
January, 2009
• BSL3 Science and Safety Training Course, Emory, Atlanta,
March, 2009
• 4th APB A Conference, Manila, April 2009
Laboratory Capacity and Capability Building to
Overcome Deficiencies in Management System
Funding by the Norwegian Ministry of
Foreign Affairs
 Establishing an effective, best practice
management system, incorporating safety
and security management process and
associated procedures
 Devising necessary document templates
 Developing the training programs and
material
 Developing a generic model of the system
which can be applied in other Institutes in
Indonesia and elsewhere
 Enhancing communication around biorisk
management and capacity building at all
levels within SEA and beyond
 Concept and practices based on CWA
15793: 2008 Laboratory Biorisk
Management Standard
III. Building capacity to detect, diagnose and
track outbreaks of highly infectious diseases
 Development of diagnostic tests
 Diagnosed by virus isolation – hemaglutinating
activity indicates the presence of influenza virus
 Reverse Transcriptation-PCR assay for molecular
identification
 Positive test by RT-PCR should be confirmed by the
second Institution
 RT-PCR and antigen testing carried out in BSL2
 Tracking outbreaks
 BSL3 laboratory conditions are required for HPAI
viruses culture - detection of viral sequence
changes (infection with other subtypes have been
associated with outbreaks in other species)
Preparedness for a New Emerging Infectious Diseases
June 8, 2009: 73 countries, 25.288 cases, 139 death
 From bench to bedsite - Eijkman Institute has designed
primers for A/H1N1 on HA and NA genes and PB2 genes
(based on 133 sequences deposited at GISAID)
 CDC Detection protocol
 SEARN –Oxford Detection protocol
Diagnostic Laboratory Network for Avian Flu
Central
Laboratory
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Eijkman Institute
NIHRD-MOH
MOH lab
Surabaya
Micro
FKUI
Micro
MOH lab
Bandung
FKUSU
Micro
UNHAS
Micro
FKUNDIP
Micro
MOH lab
Palembang
FK UNUD
Front line
Laboratories:
 BTKL
 Hospital Laboratory
 District Laboratory
44 Reference laboratories for emerging infectious diseases were
developed to increase national capacity
III. Building capacity to detect, diagnose and
track outbreaks of highly infectious diseases
Risk Assessments
 Epidemiology:
• Grouping of H5N1:Virological clades or
subclades - H5N1 of Indonesian isolates
clustered together – no new strain
• Surveilance - tracing sources of infection
 Characteristics of Virus
• Alteration of interaction with host receptors
- Pandemic need changing in specificity of
avian type receptor ( 2,3) into human-type
(2,6) - showed the presence of avian-type
receptor
• Change of virulence
• Drug resistance –no sign
IV. Enhancing Cooperation
 Risk asessments need huge amount of materials of
the virus which has to be cultured in a certified BSL3
equipped with bio-safety SOP and well trained staff
 Active participation in the region is necessary not
only in the field of biosafety and biosecurity but also in
infectious diseases research and surveillance APSBA, ABSA, SEA Network of Influenza,
 Active participation in Meeting of Experts of the BWC
Conclusion - National Efforts to
Mitigate Biological Threats
 Raising awareness of biologically threats globally –
BWC, BTR
 Strengthening laboratory biosafety and biosecurity to
protect laboratory capacity and safely combat
infectious diseases – Training, SOP
 Expanding the use of safe and modern diagnostics –
National Capacity Building
 Participation in infectious disease surveillance
networks – SEA Influenza Clinical Research Network,
 Developing emergency response, recovery and
mitigation plans for biological events – National
Committee on Avian Flu Control and Pandemic Influenze
Preparedness, MOH Expert Committee on Avain flu,
Thank you and greetings from Indonesia