JAKARTA, KOMPAS — The spread of the bird flu virus is growing at the global level. Even so, transmission to humans is still relatively low. Vigilance must still be increased by ensuring the readiness of health facilities in handling cases.
Chairperson of the Indonesian Association of Lung Doctors’ Infection Working Group (PDPI) Erlina Burhan in an online seminar entitled “Awareness of H5N1 Avian Flu”, in Jakarta, Friday (3/3/2023), said that extraordinary cases of bird flu reported in animals in Indonesia are still under control. Transmission of the bird flu virus from animals to humans is actually not easy.
“However, because the situation is very dynamic, we still need to be vigilant. Prevention efforts must continue to be improved. Apart from that, it is hoped that health workers will be able to improve preparedness in the management of bird flu in the community,” he said.
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Referring to the Guidelines for Control of Avian Flu issued by the Ministry of Health, a person is declared confirmed with H5N1 bird flu if the H5 PCR results show a positive result. From the examination results, the patient will usually experience a more than four-fold increase in the neutralizing antibody titer for H5N1. The titer of H5N1 microneutralized antibody in serum specimens taken on day 14 or after the onset of symptoms reached more than 1/80.
The clinical symptoms that arise due to the transmission of H5N1 bird flu to humans include fever over 38 degrees Celsius, weakness, cough, sore throat, muscle aches, abdominal pain, chest pain, and diarrhea. In worse conditions, patients can experience severe pneumonia and acute respiratory distress syndrome. If it continues until respiratory failure, the patient will need breathing assistance via a mechanical ventilator.
“The symptoms of bird flu are similar to Covid-19. However, one of the characteristics of H5N1 is a history of exposure to dead birds, sick birds, birds that have been confirmed positive for H5N1, or to people who have also been confirmed. So it is necessary to ask the history of people with suspicion of bird flu, “said Erlina.
However, because the situation is very dynamic we still need to be vigilant. Prevention efforts must continue to be improved. Health workers are also expected to be able to improve preparedness in the management of bird flu in the community.
Erlina conveyed that the diagnosis of H5N1 bird flu patients could be made through a physical examination and supporting examinations. On physical examination, health workers can assess the patient’s vital signs, such as fever, pulse rate, and respiratory rate. In addition, other findings on physical examination may include bluish (cyanosis) of the lips, reddish rash, red and watery eyes, and reddish throat mucosa.
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While on supporting examinations, the diagnosis can be made by carrying out one of the RT PCR examinations (real time polymerase chain reaction), viral culture, or H5-specific antibody testing. Specimens for examination can be obtained through nasopharyngeal swab tests, blood serum, rectal swab tests in cases of children, or stool in patients with diarrhea. Another supporting examination that can also be done is through a chest photo examination.
“If the diagnosis has been established, bird flu management can be given immediately. Management of bird flu can be done by administering antivirals, such as oseltamivir or zanavir or peramivir, oxygen therapy if there is shortness of breath, and administering symptomatic drugs to treat symptoms. A mechanical ventilator can be used if the patient has respiratory failure,” said Erlina who is also a teaching staff at the Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia-Persahabatan Hospital.
Erlina said that the community is expected not to panic over the risk of bird flu transmission. Vigilance can be done by ensuring that prevention efforts have been implemented properly. Be sure to prevent direct contact with sick or suddenly dead birds. When cleaning the poultry cage you should also wear gloves and a mask.
Efforts to prevent the transmission of Covid-19 through 3M must be properly implemented again, namely washing hands, using masks, and keeping a distance from sick people or animals. It is also hoped that the public will not have to worry about consuming chicken and eggs. Transmission of bird flu can be prevented by ensuring that the food consumed is thoroughly cooked.
“When having symptoms of ILI (influenza-like-illness) after contact with infected poultry in the last 10 days, consult a doctor or the nearest health service facility and immediately self-isolate until it is proven that you are not infected with bird flu,” said Erlina.
Prof. However, vigilance is still required.
“Don’t be careless because it might be bad for public health. The next pandemic could happen but we don’t know when and where and what the disease will be. However, it is predicted that the possibility of a pandemic caused by zoonoses, disease X, and influenza. That’s why we have to be wary of H5N1,” he said.
Separately, Director of Prevention and Control of Infectious Diseases of the Ministry of Health, Imran Pambudi, in socializing preparedness for the management of H5N1 bird flu in hospitals, said that the government had prepared a number of efforts as a strategy for bird flu prevention and control. The strategy will be based on the One Health approach.
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The strategy includes prevention, surveillance, case management, health promotion and preparedness. Case handling consists of management of cases of suspected bird flu, meeting the need for antiviral drugs, setting up a bird flu referral hospital, setting up a bird flu referral laboratory, and increasing the capacity of health workers.
“In handling bird flu, we need to emphasize the five pillars, viz prevention, surveillance, treatment, therapeutic, promotion, and management. We also need to strengthen governance so that handling can be better,” said Imran.