NATIONAL EFFORTS TO MITIGATE BIOLOGICAL THREATS – INDONESIAS EXPERIENCE Herawati Sudoyo Eijkman Institute for Molecular Biology Jl Diponegoro 68 Jakarta.

NATIONAL EFFORTS TO MITIGATE BIOLOGICAL THREATS – INDONESIA’S

EXPERIENCE

Herawati SudoyoEijkman Institute for Molecular Biology

Jl Diponegoro 68Jakarta 10430, Indonesia

Indonesia’s Experience

Bioterrorism prevention measuresRisk assessmentsBiosafety 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

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

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

WorlWorldd

IndonesiIndonesiaa

Confimed Confimed casescases

433 262262

DeathDeath 141 115115

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

JakartaEIJKMAN

NIHRDUI

BogorBALITVET

SurabayaTDC-UNAIR

Institutions working on Avian Influenza and BSL3 facilities

• 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

I. Building a Safe, Secure and Sustainability Capacity - Pressure

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

More than 70 representatives from 17 countriesContributions by the WHO, APBSA and academia.

Need to enhance capabilities in addressing challenges such as emerging and re-emerging 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

Regional Need to Promote and Implement Biosafety and Biosecurity Management

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

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

Summary of Regional Seminar on Promoting and Implementing Biosafety and Biosecurity Management, Jakarta, Juni 2008

Experience from the Eijkman Institute is of particular relevance

Building infrastructure to combat emerging infectious diseases – more facilities built in the country – ABSL-3 @ Airlangga University, Surabaya

Total space available 210 m2 Four animal handling rooms for mice, ferret, chicken and monkey Dedicated for handling animal work

14 m

15 m

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

Establishing an effective, best practice management system, incorporating safety and security management process and associated procedures Devising necessary document templatesDeveloping the training programs and materialDeveloping a generic model of the system which can be applied in other Institutes in Indonesia and elsewhereEnhancing communication around biorisk management and capacity building at all levels within SEA and beyondConcept and practices based on CWA 15793: 2008 Laboratory Biorisk Management Standard

Funding by the Norwegian Ministry of Foreign Affairs

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 virusReverse Transcriptation-PCR assay for molecular identificationPositive 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

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

s

June 8, 2009: 73 countries, 25.288 cases, 139 death

Central Laboratory

MicroFKUI

MicroFKUSU

MicroUNHAS

MicroFKUNDIP

MicroFK UNUD

MOH labPalembang

MOH lab Bandung

MOH lab Surabaya

Front line Laboratories: BTKL Hospital Laboratory District Laboratory

• Eijkman Institute• NIHRD-MOH

Diagnostic Laboratory Network for Avian Flu

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 AssessmentsEpidemiology:

• Grouping of H5N1:Virological clades or subclades - H5N1 of Indonesian isolates clustered together – no new strain

• Surveilance - tracing sources of infectionCharacteristics 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

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