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Professor drh. Wiku Adisasmito, MSc, PhD.
1 2 3 4 1 2 5
Nyoman Sri Budayanti1, Wiku Adisasmito2, James W. Rudge3, Gavin J. Smith4, Made Prashinta1, Dewi Nur Aisyah2, Ketut Subrata5, Nyoman Sutedja5, Richard Coker3
1Faculty of Medicine, Udayana University, Bali, Indonesia; 2Faculty of Public Health, University of Indonesia; 3Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Bangkok, Thailand; 4Duke‐NUS Graduate Medical School, Singapore; 5Bali Provincial Health Office, Indonesia.
Bali is the most popular tourist destination in Indonesia which is with high densities of humans poultries and pigs These conditions make the island a potential hotspot for mixing humans, poultries and pigs. These conditions make the island a potential hotspot for mixing of influenza viruses. Moreover, while Indonesia continues to report the majority of avian influenza outbreaks worldwide, research on the molecular ecology and evolution of influenza in the country has been severely limited
The Molecular Epidemiology of Influenza A in Bali project (“BaliMEI” ) aims to conduct five years of active surveillance for influenza A in among patients presenting with influenza‐
like illness at health facilities across Bali.
Study Site Selection
Health Facility Selection
Permission
Hospital and Health Centre Representation of Area
Denpasar incidence
manageability RS Health
Centre (HC)
Central Government
Local Government
Buleleng Jembrana
Tabanan
Bangli
Klungkung Patient Recruitment feasibility
( ) Government
Provincial government
Badung
Karangasem Buleleng
Flu A Flu B PCR
Epidemiology Investigation Form Novel H1
+ve
‐ve Flu B
PCR Novel H1
‐ve H1 H5
H3 ‐ve
+ve N1
Seasonal H1 H3 H5
+ve
‐ve
N2
Resistance Markers on N1
Flu A 10.1% Flu B
4.8%Flu A and Flu B 0.4%
Negative 84.7%
PROPORTION OF FLU A AND FLU B
5 6 7 8 9
imens
Incidence of influenza (July 2010‐July 2011)
Flu A Flu B Flu A and Flu B
Positive for Influenza A
Positive for Influenza B ILI
patients
No. of samples (%)
No. of samples (%)
All patients 456 46 (10.1) 22 (4.8)
Sex:
Female 207 19 (9.2) 13 (6.3)
Male 249 27 (10.9) 9 (3.6)
0 1 2 3 Speci4
pH1pN1 31%
sH1sN1 2%
sH3N2 9%
pH1Nx 4%
sH3Nx 2%
HxNx 52%
SUBTYPING of INFLUENZA A
Mean age (yrs) 19.0 19.8 ‐ 21.96 ‐
Age range (yrs) 0.75‐79.0 1.0‐54.9 ‐ 3.9‐59.0 ‐ Age group (yrs):
<5 99 6 (6.1) 3 (3.0)
5 to 15 145 14 (9.7) 7 (4.8)
16 to 44 167 23 (13.9) 9 (5.4)
45 to 65 37 3 (8.3) 3 (8.3)
>65 5 0 (0.0) 0 (0.0)
Primary health centres are more successful than hospitals as ILI surveillance sites. Of 456 ILI cases tested to date, 46 (10.1%) and 22 (4.8%) tested positive for Influenza A and B, respectively.
The findings suggest different temporal patterns in circulation of Flu A and B in Bali: Flu B dominated from Jul‐Nov 2010, while Flu A dominated from Jan‐Jul 2011. Of the Flu A samples successfully subtyped, the majority were pH1N1, followed by sH3N2. However, more than half of the subtyping tests gave negative results using the existing primers. Re‐optimisation of the subtyping assay is ongoing.
65 5 0 (0 0) 0 (0 0)
Health Facility Type:
Primary Health
Centre 351 37 (10.6) 18 (5.2)
Hospital 105 9 (8.6) 4 (3.8)
This work was supported by Hoffman‐La Roche
Presented : The 4thESWI Influenza Conference, Malta, 11‐14 September 2011
