The United States Naval Medical Research Unit #2 (NAMRU-2), has worked with the Indonesian National Institute of Health Research and Development (LITBANGKES) under the Indonesian Ministry of Health (DEPKES), since about 1970 on a variety of projects, including Avian Influenza. Since 1999, NAMRU-2, DEPKES, and the US CDC have maintained a hospital-based influenza surveillance network at sites across the Indonesian archipelago. NAMRU-2 analyzes about 700 influenza samples a month and about 100 samples a month strictly for avian influenza. NAMRU-2 has tested every human AI case in Indonesia since human cases first appeared.

From January to December 2005, NAMRU-2 has identified 18 cases of H5N1 in Indonesia, all of which were confirmed internationally. A number of family clusters were observed in Indonesia and the possibility of human to human transmission could not be excluded in at least two of these clusters. Small clusters with possible limited human to human transmission is a worrying development, as is the fact that many of the human H5N1 isolates have been obtained from cases without a clear exposure.

Molecular analysis of the H5N1 isolates has shown that human viruses are clustering and most have a distinct genetic difference from the poultry viruses. The number of cases is accelerating with 45 deaths in 2006 as compared to 13 deaths in 2005. The seriousness of the Indonesian situation, and recently publicized failures in national contingency planning for an AI outbreak highlight the need for oil and gas industry to engage in detailed contingency planning arrangements.

This paper will review the NAMRU-2’s sampling and analysis program drawing some broad conclusions from the results as well as highlighting the need for ongoing influenza surveillance in Indonesia and improvements in national crisis management and contingency planning.

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