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Globalization High Mobility of Human Globalization of infectious disease outbreaks Lessons from Pandemic (H1N1) 2009 Concern of next pandemic due to H5N1 Need to quickly identify information of outbreaks Required rapid response (the ability to detect, react and sharing appropriate information)

 To share know-how for pandemic influenza surveillance  Exchange of knowledge and information regarding influenza surveillance  Improve and strengthen the surveillance system  To build a system for sharing information on pandemic influenza outbreaks in member cities

Cluster surveillance of ILI patients Rapid testing Information sharing Western Region Sub District PHC Kalideres Sub District PHC Cengkareng Southern Region Sub District PHC Pesanggrahan Sub District PHC Kebayoran Lama

July – 14 Sept Sept Nov 2012 Preparation Site selection Training for Public health center - Using rapid test - Surveillance method PHC Internal socialization Implementation Implementation of the results of the rapid test collection since October 2012 to October 2013 October 2013

Registration Clinics Laboratory Surveillance officer Reporting to Health Dept. Epidemiologic investigation Operational Team (at PHC) 1 General practitioner 1 nurse from GP / pediatric clinic 1-2 laboratory analyst 1 surveillance officer Supervisor : Provincial Health Department Jakarta Municipal Health Department of South Jakarta and West Jakarta

PHCNegPos APos BTotal Samples Cengkareng1147 (6%)-121 Kalideres417 (14%)2 (4%)50 Kebayoran lama22-- Pesanggrahan543 (5%)2 (3%)59 Total23117 (7%)4 (2%)252 Samples Tested per- Public Health Center Since week 39 / 2012 until recent Number of cluster identified : 2 cluster

C : Cengkareng PHC K : Kalideres PHC P : Pesanggrahan PHC L : Kebayoran Lama PHC

Positive Symptoms % of positive symptoms Fever252100% Cough23794% Runny nose17770% Sore throat14056%

Patients age group # o f patients tested # of positive result Proportion of positive result  10 y.o % 11 – 20 y.o % 21 – 30 y.o16425 % 31 – 40 y.o180- > 41 y.o % Total % Days tested after onset # o f patients tested # of positive result Proportion of positive result Same day % 1 day % 2 days % 3 days2222 % 4 days511 % > 4 days1200 %

Possible reasons of low cluster identification : Habits of patients to take anti fever drug before seeing a doctor makes not all ILI symptoms appear Different onset of illness among cluster member Higher percentage of positive test result if test is conducted soon after disease onset In order to detect cluster influenza patients,doctor must conduct a careful history, especially to explore the history of contact with a patient's likelihood of transmitting source Only patients live within PHC working area can be followed up and check for other suspected cluster member

Necessary to increase public awareness before flu season Healthy hygiene behavior avoid contact with the patient, alert in the flu season, and the use of personal protective equipment (PPE), and perhaps vaccination influenza

 Approximately 7 % of the results showed the influenza type A, the same subtype with avian influenza virus (H5N1 and H7N9). Therefore, caution against potential pandemic influenza and important to find strategy for early detection of potential pandemic.  The surveillance system through the discovery of clusters of influenza in a population setting is not easy, considering influenza as a disease is considered "regular", customs of the people to self-medicate with fever reliever, doctor visit, the spectrum of disease, etc.  Involvement in ANMC21 a positive impact, both to improve the knowledge and capacity of human resources and an opportunity to benchmark with country / city

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