The East Jakarta Project: surveillance for highly pathogenic avian influenza A(H5N1) and seasonal influenza viruses in patients seeking care for respiratory disease, Jakarta, Indonesia, October 2011-September 2012.

Indonesia has reported the most human infections with highly pathogenic avian influenza (HPAI) A(H5N1) virus worldwide. We implemented enhanced surveillance in four outpatient clinics and six hospitals for HPAI H5N1 and seasonal influenza viruses in East Jakarta district to assess the public health impact of influenza in Indonesia. Epidemiological and clinical data were collected from outpatients with influenza-like illness (ILI) and hospitalized patients with severe acute respiratory infection (SARI); respiratory specimens were obtained for influenza testing by real-time reverse transcription-polymerase chain reaction. During October 2011-September 2012, 1131/3278 specimens from ILI cases (34·5%) and 276/1787 specimens from SARI cases (15·4%) tested positive for seasonal influenza viruses. The prevalence of influenza virus infections was highest during December-May and the proportion testing positive was 76% for ILI and 36% for SARI during their respective weeks of peak activity. No HPAI H5N1 virus infections were identified, including hundreds of ILI and SARI patients with recent poultry exposures, whereas seasonal influenza was an important contributor to acute respiratory disease in East Jakarta. Overall, 668 (47%) of influenza viruses were influenza B, 384 (27%) were A(H1N1)pdm09, and 359 (25%) were H3. While additional data over multiple years are needed, our findings suggest that seasonal influenza prevention efforts, including influenza vaccination, should target the months preceding the rainy season.

Avian Influenza A(H5N1) Virus Outbreak Investigation: Application of the FAO-OIE-WHO Four-way Linking Framework in Indonesia.

WHO, FAO and OIE developed a 'four-way linking' framework to enhance the cross-sectoral sharing of epidemiological and virological information in responding to zoonotic disease outbreaks. In Indonesia, outbreak response challenges include completeness of data shared between human and animal health authorities. The four-way linking framework (human health laboratory/epidemiology and animal health laboratory/epidemiology) was applied in the investigation of the 193 rd human case of avian influenza A(H5N1) virus infection. As recommended by the framework, outbreak investigation and risk assessment findings were shared. On 18 June 2013, a hospital in West Java Province reported a suspect H5N1 case in a 2-year-old male. The case was laboratory-confirmed that evening, and the information was immediately shared with the Ministry of Agriculture. The human health epidemiology/laboratory team investigated the outbreak and conducted an initial risk assessment on 19 June. The likelihood of secondary cases was deemed low as none of the case contacts were sick. By 3 July, no secondary cases associated with the outbreak were identified. The animal health epidemiology/laboratory investigation was conducted on 19-25 June and found that a live bird market visited by the case was positive for H5N1 virus. Once both human and market virus isolates were sequenced, a second risk assessment was conducted jointly by the human health and animal health epidemiology/laboratory teams. This assessment concluded that the likelihood of additional human cases associated with this outbreak was low but that future sporadic human infections could not be ruled out because of challenges in controlling H5N1 virus contamination in markets. Findings from the outbreak investigation and risk assessments were shared with stakeholders at both Ministries. The four-way linking framework clarified the type of data to be shared. Both human health and animal health teams made ample data available, and there was cooperation to achieve risk assessment objectives.

Chicken faeces garden fertilizer: possible source of human avian influenza H5N1 infection.

Avian influenza H5N1 infection in humans is typically associated with close contact with infected poultry or other infected avian species. We report on human cases of H5N1 infection in Indonesia where exposure to H5N1-infected animals could not be established, but where the investigation found chicken faeces contaminated with viable H5N1 virus in the garden fertilizer. Human cases of avian influenza H5N1 warrant extensive investigations to determine likely sources of illness and to minimize risk to others. Authorities should regulate the sale and transportation of chicken faeces as fertilizer from areas where H5N1 outbreaks are reported.

Determination of cortisol and associated glucocorticoids in serum and urine by an automated liquid chromatographic assay.

We describe a method for the determination of urinary free cortisol and glucocorticoids in plasma, used in the diagnosis of adrenal disorders, based on automated reverse-phase high-performance liquid chromatography (HPLC). The within-day and day-to-day CVs were less than 5.5 and 8.0%, respectively. The calibration curves for cortisol and 11-deoxycortisol were linear up to 2000 nmol/L. Cortisol concentrations as low as 3.5 nmol/L in 1 mL of plasma or urine can be measured. Correlation of HPLC results for 40 plasma specimens with those by radioimmunoassay showed r = 0.965. This method is sensitive and free from the interference habitually encountered in immunoassays, and can thus be proposed for research and as a potential reference method.

Semi-automated fluorometric assay for urinary total and B N-acetyl-beta-D-glucosaminidase: analytical investigation.

Total N-acetyl-beta-D-glucosaminidase (NAG) and NAG-B isoenzyme determination are determined in order to investigate renal tubular function. Here, we propose a semi-automated adaptation of Sandman's manual method for the Monarch centrifugal analyzer. Fluorescence of the released 4-methylumbelliferone is automatically read and results are directly expressed in nanokatal/l. Mean (1 SD) values expressed in nanokatal/millimole creatinine in urine from healthy female (n = 30) and male (n = 30) subjects were 8.2 (4.0) and 7.8 (2.9) for total NAG and 1.9 (1.4) and 1.5 (0.7) for the NAG-B isoenzyme activity. The assay of six patients with various renal disorders shows definite increase in total NAG and NAG-B isoenzyme activities.