SARS PREVENTION EVALUATION IN INDONESIA

SARS DISEASE - SARS PREVENTION EVALUATION IN INDONESIA
Indonesia is not a country / region affected by SARS and safe for everyone to come and go from Indonesia. This explanation is a progress report and the Government of Indonesia Health generally ranks in the response to SARS in Indonesia that is still being established in all regions of Indonesia. This explanation given by the Minister of Health of the Republic of Indonesia on behalf of the Government of the Republic of Indonesia, at the press conference on June 17, 2003 at the Building Department. Health of the Republic of Indonesia with the theme of Penang gulangan SARS efforts in Indonesia.



Cases of SARS (Severe Acute Respiratory Syndrome) or Serious Acute Respiratory Syndrome was first identified in Guangdong province (China) in November 2003. The existence of an outbreak in Guangdong was new was reported by the WHO four months later in mid-February 2003. At the time referred to as Atypical Pneumonia or inflammation of atypical Patu. WHO information is the basis for the MOH to early in the month of February 2003 instructed all Port Health Office (KKP) in Indonesia, which oversees 155 airports, seaports and land border crossing to raise awareness and take steps necessary deterrence.

On March 11, 2003, WHO announced a new disease that rapidly spread in Hong Kong, Singapore and Vietnam, called SARS. On March 15, 2003 the Director General of WHO declared that SARS is a global threat or a Global Threat. Given that statement, the Ministry of Health of the Republic of Indonesia on March 16, 2003 date in coordination with WHO and immediately inform all the Provincial Health Office, Provincial Hospital, the CTF in Indonesia and across all sectors concerned to take necessary measures for the prevention of transmission and prevention of the spread of SARS on March 17, 2003. At that time not yet known whether the disease is similar to Atypicak Pneumonia outbreak in Guangdong. in April 2003 before Atypical Pneumonia WHO to ensure that SARS in Guangdong is

Consideration of the WHO declared SARS a global threat of SARS is a new disease of unknown cause, SARS meneybar quickly via interstate conveyances and SARS primarily affects health workers in hospitals. SARS outbreak has prompted a variety of health experts in the world to work together to find the cause of SARS and to understand the mode of transmission of SARS. In cooperation with experts from 13 laboratories in the world April 16, 2003 confirmed that the cause of SARS is Corona Virus or coronavirus.

Department of Health and the early start of the pandemic since SARS in March of 2003 implementing SARS Response with the aim of preventing the occurrence of illness and death from SARS and prevent the spread of SARS in the community (community transmission) in Indonesia Strategies implemented to achieve this goal are: public awareness efforts through advocacy and dissemination, monitoring or epidemiological surveillance of cases based on public information, hospital information and CTF information, prepare a good hospital facilities and infrastructure as well as the knowledge and skills of officers. All of them supported by developing the skills examination in the laboratory and research to know the disease. To support the implementation of SARS on 3 April 2003 set out the decision

No Minister of Health. 424 of 2003 on SARS as a disease that can cause outbreaks. With this designation the fourth Act 1984 on Communicable Disease Outbreaks can be applied in the response to SARS. Follow-up steps to execute that strategy requires resources (personnel, facilities, and financing as well as guidelines for the health and the general public), namely by:
To give knowledge of public awareness and vigilance on SARS to the public, including to the health sector, outside the Department of Health and local government and NGOs, the Association of Professionals and others established the Dissemination and Advocacy for Advocacy and socialization has prepared a series of guidelines consisting of 7 Fruit Manual are:
Universal Precautions Guidelines for Community
Guidelines for Universal Precautions in public places.
Universal Precautions guidelines for health workers.
Examination Guidelines for SARS at airports, ports and across the border.
Guidelines for Surveillance Epidemiology of SARS
Case Management Guidelines.
Specimen collection and examination guidelines.

In addition to the published Poster, Booklet, leaflet and flyer (both for the health districts / cities and specifically to the workers). A number of companies / private parties are very helpful in the procurement of these materials. Socialization to the public through the mass media and through sites that SARS can be seen in http://www.infeksi.com; http://www.penyakitmenular.info and http://.www.asean-disease-surveilance . net and other information channels such as the Hotline Service RSPI Prof. Dr. Sulianti Saroso Jakarta (021) - 6506568, Command Post Phone Service Anticipation SARS outbreak. (021) -4265974, 021-640141 or call directly to the Department of Public Relations of Ministry of Health with No. Phone 021-5223002 and control centers MOH Health Problems 021-5265043.

READINESS 34 HOSPITAL Hospital Setting a SARS referral hospitals based on the following criteria:
In the entrance area of ​​sea / air from abroad
Territory workers pockets who just returned from abroad.
Of the 34 hospitals are designated as 6 homes Salit main referral hospital, which is H.Adam Malik Hospital Medan, Batam Hospital Authority, Dr Dr. Kariadi Semarang, Hospital Dr. Sutomo Surabaya, Denpasar Sanglah Hospital and Dr. Dr. Wahidin Sudirohusodo Makassar. Each of the main referral hospital were given Rp. 100. Million dollars for preparation and isolation room triage. In space there is minimal isoalsi 2 beds (TT) to TT and 4 probable cases for suspected cases. Moreover given the tools to protect individual and universal Precaution tools and medical equipment.

For Infectious Diseases Hospital Prof. Dr. Sulianti Saroso as the National Referral Hospital for SARS patients prepared 20 TT and 50 TT for the treatment of post cured but still infectious, 3 special SARS ambulance, medical equipment and personal protective equipment. currently being made EWORS (Early Warning Outbreak Recognition System) at 34 referral hospitals to surveillance aspects hospotal base. Each referral hospital SARS Response Team was formed in hospitals, training of nurses for the knowledge of universal Precaution, workshops and training on Strict Barrier Nursing Care and Hospital with funding assistance from WHO, among others, amounting to Rp. 485 724 300, -.

Training in each of the hospitals (inservice training) for all officers involved in the handling of SARS (This activity is still ongoing). Management of SARS cases in hospitals based on guidelines prepared by the Ministry of Health in collaboration with Indonesia Lung Association of Physician Specialists (PDPI).

SURVEILLANCE In Indonesia there are 45 CTF which oversees 155 airports, seaports and overland postal scattered throughout Indonesia. In addition there are 24 CTF which oversees the airport / sea port of transit transport means (air peasawat and ships) coming from countries affected by SARS. CTF has done for officer training and the provision of barrier nursing personnel protection.

For the addition of SARS prevention preparedness of health workers at these locations Soekarno-Hatta Airport (terminal 2 and terminal 3) as many as 41 doctors (21 doctors from the brigade Disaster Preparedness / BSB Jakarta) and 12 nurses from the health department Jakarta Province who served in Terminal 3 at Soekarno-Hatta. Prof. RS Infectious Diseases. Dr. Sulianti Saroso as many as 13 doctors from the Directorate General of PPM and PL. Port of Tanjung Priok sebanya four doctors from the Directorate General of PPM and PL. CTF Batam as many as 56 doctors with details; 29 doctors from BSB Bandung, 17 doctors from BSB DI Yogyakarta and Semarang 10 doctors from BSB.

Health Department also received reports of cases of SARS from the community including those contained in the mass media. against all of the information alleged to be checked for SARS is confirmed by the Expert Group and the verification team. Suspected and probable cases should be reported by each house saki and health facilities to the Department of Health. The clinical data of each case are reported to be verified by the verification team and the Expert Group. The cases that do not meet the criteria will be excluded from the list as the case is not SARS. If necessary telephone connections are also used to discuss the cases reported by doctors who handled the case. More than 80,000 migrants work abroad (in the regions affected by SARS). Most of them work as domestic servants and are very likely to have close contact (close contact). Therefore, special attention is given to the workers by way of a medical examination (including measurement of temperature) in the terminal 3. If they show symptoms of illness immediately referred to the hospital. They also provided counseling on the prevention of SARS and was given a mask to use when showing symptoms of diseases such as flu, is also advised to not leave the house (home isolation) for 10 days since his arrival. Health officials in the area of ​​workers is obliged to supervise them.

SARS epidemiology surveillance efforts in Indonesia include checking passengers at the airport upon arrival (arrival screening) and the time of departure (pres-departure screening), examination of workers who come from areas affected by SARS, SARS surveillance in hospitals and health facilities, surveillance of SARS and pneumonia in the community, investigation and contact tracing. Premises the way that SARS will be detected as early as possible. To support surveillance activities and the success of SARS will be placed some 20 thermo scanners at airports and some seaports and a digital thermo (ear).

EXAMINATION LABORATORY One of the initial response to SARS laboratory tests conducted in collaboration with the U.S. NAMRU-2 Jakarta in taking specimens from suspect and probable cases and then sent to CDC Atlanta. To support this Department of Health has prepared guidelines for the collection and shipment of specimens based on the WHO and CDC guidelines. Laboratory workers from provincial hospitals have been trained to use the guidelines.

Three laboratories designated as SARS reference laboratory is Litbangkes Department of Health, the UI Microbiology and Bio Medical Laboratory Mataram. Batch 4 specimens taken from 24 SARS patients have been sent to CDC Atlanta with negative results for both RT-PCR examination and serology tests. In addition to the laboratory in Medan and Makassar are included to develop a SARS laboratory

In the response to SARS, Indonesia also received help from within and abroad, among others, of the United States Government in the form of masks 5000, the Japanese form of government protective equipment and laboratory equipment worth 30 million yen or about U.S. $ 250,000, the Singapore government will contribute a thermo scanner pieces, PT. Johnson Home Hygiene Products in the form of a mask.

Number of patients with SARS in the world in the period November 2003 - May 2003 to increase from time to time. But in June 2003 new cases of SARS disunia started meurun. On June 13, 2003 the cumulative number of reported probable SARS patients amounted to 8554, the number of new people with 10 people, the number of 792 people who died and the number of people who recover 6.793. There are 32 countries / regions that have reported cases of probable SARS.

On that date the number of countries / territories of the most widely reported probable cases of SARS is PRC 5327, 1755 Hong Kong, Taiwan 693, Singapore 206, Canada 242 and Vietanam 63 people. In Indonesia, up to June 16, 2003 found seven suspected cases and two cases of probable number of people seeking treatment in Indonesia for fear that he was suffering from SARS or suspected SARS as many as 112 people. After review, there are 103 of these people certainly are not suffering from SARS.

7 suspected SARS cases consisted of 3 women and 4 men aged between 20-57 years. A total of 5 of them had been to Singapore and the two men had been to the PRC. They live in Jakarta, Depok, Tangerang. While the two probable cases of SARS consists of 2 men each aged 47 years (WNA) is domiciled in Tangerang and has returned to Hong Kong and aged 65 years (WNI) is domiciled in Medan, both recently returned from Singapore while suffering from SARS. As many as six suspected cases of SARS were treated in RSPI - SS Jakarta and 1 case in the department of Adam Malik.

2 probable cases of SARS were treated in a RSPI Prof. Dr. Sulianti Saroso and one treated at the department of Adam Malik Medan. All suspect cases of SARS and SARS Probable Cases, blood samples and throat swabs sent and examined at CDC Atlanta and all showed negative results for the Corona virus. For the case of suspected and probable SARS and suspected SARS cases that a particular investigation or an investigation and contact tracing of contact tracing is found as many as 103 people suspected of contact. The whole contact is made in the form of contact management counseling and surveillance. Investigation, tracking and contact management carried out in cooperation between DG and PL PPM, Provincial Health Office, District Health Office / City and the health center, family and coworkers.

SARS has a negative impact on the country's economy particularly in aviation, tourism and labor. The existence of countries / regions affected by SARS led to a reduced number of flights and number of passengers by destination country / region. For example, among others, the impact on the airline magazine that was published in the Business News on April 4, 2003 which reported the number of passengers GIA from Singapore fell to 20%, travel agencies also reported a decline in passengers between 50-70%, Kompas Daily Bertia dated 5 April 2003 the occupancy rate hotel in Batam decreased to 10%.

The existence of countries / regions affected by SARS regional ASEAN region is also spill over to the decline in tourist visits to Indonesia. In addition, because too many Indonesian workers who work in countries / regions affected by SARS is sending workers to countries / regions affected by SARS for a while delayed.

To cope with the impact of SARS on regional economies ASEAN Special Summit Plus 1 (PRC) and the ASEAN Health Ministers Meeting Plus 3 (PRC, Japan and Korea) in Kuala Lumpur, ASEAN plus 3 flights Forum in the Philippines and the ASEAN Regional meeting on SARS in Siem Riep , Cambodia and Thailand in Bangkok. APEC Health Ministers Meeting on SARS to be held in Bangkok on June 28, 2003.

Based on reports from hospitals throughout Indonesia, the Department of Health and Port Health Offices throughout Indonesia are monitored every day from the date of May 14, 2003 until today June 17, 2003 No New Suspected Case and New Probable Cases in Indonesia. Similarly, however people still need to be vigilant because there are areas outside of Indonesia are still indicate the presence of local transmission in the region by June 13, 2003 which include Canada (Toronto), China (Beijing, Hong Kong and Taiwan). Therefore, the observation of disease SARS through SARS surveillance activities will continue to be maintained and enhanced for example pre departure screning still be enforced as well as filling in the form of Arrival Screening Health Alert Card.

Similarly, surveillance of pneumococcal disease in adults at home, the hospital will be implemented as AFP surveillance. Therefore I (Minister of Health) advised the public, print / electronic, health workers to continuously improve public oversight of SARS and SARS alert but not panicked.

FACT-SHEET
DEVELOPMENT OF SARS (GLOBAL AND IN INDONESIA)

Brief history of the spread of SARS and the Health Ministry in efforts to anticipate the soon spread in Indonesia: 1 November 2002:
for the first time the discovery of disease Atypical Pneumonia in Guangdong Province PRC then diyaikini sloh WHO as SARS.

February 11, 2003:
SARS in Guangdong reported officially by WHO through the website: http://www.who.int.


End of February 2003 (two weeks before WHO declared SARS a global threat)
MOH has taken steps to counter early instructed all Port Health Office (KKP) in Indonesia to meningkatkna vigilant and take steps as may be necessary (in Indonesia there are 45 pieces of the CTF is responsible for overseeing and implementing deterrence and prevention of entry of quarantine diseases and illnesses certain infectious to Indonesia through airports, seaports and land border crossing)

March 10, 2003:
SARS spread beyond Guangdong, namely the Hong Kong and Hanoi (Vietnam).
The first deployment in Hong Kong occurred among hospital staff, and thereafter spread to other countries through the people who are infected and do cross-country trip.

March 15, 2003:
WHO officially declared that SARS is a global threat (Global Treat) with consideration of:
(1) SARS a new disease of unknown cause
(2) Transmission occurs mainly among healthcare workers through health facilities
(3) SARS spread across the country through the people who travel across the country.

March 16, 2003:
Consolidation and coordination meetings were held between MOH and WHO with the results:
(1) Removing the circular from the Director General of P2M and PL to all Provincial Chief Medical Officer, Chief of the CTF, the Director of the Provincial Hospital to take steps to prevent the spread of SARS in Indonesia (sent by facsimile dated March 16, 2003 late afternoon)
(2) Establish a Task Force on SARS and PL DG P2M
(3) Open POSKO SARS in P2M DG and PL (No. Tel. 021-42655974)
(4) Implement a daily picket of SARS in the DG and PL P2M and Center for Health Problems (PPMK) with No. Tel. 021-5265043

March 17, 2003:
Press Conference by Minister of Health

3 April 2003:
Minister of Health establish a potential SARS outbreak as the disease

4 April 2003:
Government of Indonesia issued a Travel Advisory, which recommends that Indonesian citizens who will travel to countries / regions affected by SARS to delay first. But if for some reason had to be visited should consider:
(1) Not to bring the elderly or children under five
(2) Preparing for the prevention of SARS
(3) Taking into account local health instruction on the prevention of SARS.

16 April 2003:
WHO announced the official stated that the corona virus as the cause of SARS (in cooperation with 13 research institutions around the world)

25 April 2003:
Meeting of Health Ministers of ASEAN + 3 (Korea, Japan, PRC) and Hong Kong.

29 April 2003:
ASEAN + 1 (RRC), among others, agreed:
(1) Increased cooperation in the response to SARS
(2) Examination of passengers arriving and departing from the ASEAN + 1 to prevent the spread of SARS.

12? May 16, 2003:
The Indonesian delegation explained to the member states dlaam WHO World Health Assembly (WHA) in Geneva through the booklets were distributed, entitled
? Indonesia is not a SARS affected country?


15? May 16, 2003:
Held the ASEAN + 3 Aviation Forum in Pampanga, the Philippines, which established the opportunity of checking passengers on arrival and departure at the airport.

2 Criteria for suspected SARS patients in Indonesia:
Observations of SARS cases:
If the data of patients still need to be equipped

Suspect case:
If clinical data show the suspect according to WHO criteria (body temperature> 38 Der C, cough, shortness of breath / difficulty breathing, there is a history of traveling from infected areas or direct contact with patients)

Probable:
If clinical data show the suspect cases + X-ray picture of the lungs showed pneumonia, or if the patient has died in an autopsy examination showed unexplained pneumonia or RDS show (Repiratory Disstress Syndrome).

Not a case of SARS
When complete clinical data, but it has nothing to do with SARS.

3. Global Data and Indonesia
(1) Global (May 29, 2003)

10 Provinces in the PRC have contracted SARS, ie:
Beijing, Guangdong, Hubei, Hebei, Inner Mongolia, Jiangshu, Jilin, Shanxi, Shaanxi and Tianjin.

In addition to the PRC, the country / region on the list as an infected country: Canada, (Toronto), Hong Kong, Singapore and Taiwan)

Number of countries have reported / had reported cases of SARS Probable there are 31 countries / regions with a number of cases of 8295 (17 new cases, 750 cases of death, 4994 cases have been cured)

(2) Indonesia
The number of probable cases: 2 (1 WNA, a citizen)
The number of suspect cases: 7 (1 WNI, 6 WNI)

(3) Data up to June 13, 2003
Of the 10 Provinces only three provinces in the PRC, namely: Beijing, Hongkong, Taiwan
Country / region there are local transmission: Canada (Toronto), China (Beijing, Hongkong, Taiwan)