The Challenge & Opportunity of One Health Approach to Indonesia’s Laboratory on Identification and Early Detection of Zoonotic Emerging Infectious Diseases

Prof. Wiku Adisasmito, DVM, M.Sc, PhD Adjunct Professor, Infectious Disease and Global Health, Tufts University, USA

Affiliate Professor, Environmental Health Sciences, UMN, USA Professor – Health Policy

Faculty of Public Health, Universitas Indonesia INDOHUN Coordinator

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2 Outline

• Background

• Laboratory in Indonesia

• Sectoral laboratory network in Indonesia

• Laboratory Roles

• Capacity assessment in 12 MoH, MoA, and University laboratory

• Biorisk spectrum

• One Health Laboratory Network Platform

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3 Global and National Challenges

Land Use Change Global Mobilization

Disaster

Terrorism (Bioterror)

Infectious Diseases

D

I

R

E

C

T

T

H

R

E

A

T

S

Climate Change

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Source : Emerging & Re-Emerging Infectious Disease Challenges. Nature 430: 242-49 (Morenz. DM et al, 2004)

Source : Emerging & Re-Emerging Infectious Disease Challenges. Nature 430: 242-49 (Morenz. DM et al, 2004)

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Source : Emerging & Re-Emerging Infectious Disease Challenges. Nature 430: 242-49 (Morenz. DM et al, 2004)

Life Science Laboratory in Indonesia

* This data is for discussion only

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Source : Emerging & Re-Emerging Infectious Disease Challenges. Nature 430: 242-49 (Morenz. DM et al, 2004)

Life Science Laboratory in Indonesia

LIFE SIENCE Laboratory

19.648 This has not been included thousands of individual clinical laboratory, food industrial,

and private animal health laboratory

Total

Laboratorium

590

* This data is for discussion only

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Source : Emerging & Re-Emerging Infectious Disease Challenges. Nature 430: 242-49 (Morenz. DM et al, 2004)

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Sectoral Laboratory Network in Indonesia

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9 Laboratory Network in Indonesia

Ministry of Health Laboratory Network based on Diseases (focus on referral system)

Improved and Migrated

MoH In the process of Establishing Public Health Laboratory Network (PHLN)

Public Health Laboratory Network

(PHLN)

The PHLN platform scope of work will be:

- Lab-based surveillance and referral system for 23

notifiable diseases, food-borne diseases, and NCD

(eg. Congenital disorder etc.)

- Screening (including neonatal)

- Environmental health (toxin, metal, soil etc.)

- Testing for outbreak investigation

The PHLN member will be 10 BBTKL PP and 4 BBLK

*Supported by ministerial regulation

Leptospira Lab Network

*Polio Lab Network

AI Lab Network

*Measles & Rubella Lab Network

ILI Lab Network

Diphtheria Lab Network

*HIV Diagnostic Lab Network *National

Referral TB Lab

Other Clinical Laboratory for diagnostic (non

network)

Infectious Disease Lab-Based Surveillance

Network

The MoH will also establish Infectious Diseases Lab-based Surveillance Network involving

PHLN member, hospital labs, clinical private labs, and university/research labs

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13 Laboratory Network in Indonesia

Ministry of Agriculture Animal Health Laboratory Networks (referral and targeted diseases surveillace system) based on Kepmentan 668/2002 concerning National Animal Quarantine, Coordinating Committee

Ditjen PKH

Badan Karantina Pertanian

Badan LITBANG Pertanian

Lab Veteriner Provinsi

Balai Besar Pengujian Mutu dan Sertifikasi

Obat Hewan

Balai Veteriner

(5)

Pusat Veteriner

Farma

Balai Besar Veteriner

(3)

Balai Pengujian Mutu dan Sertifikasi

Pakan

Balai Pengujian Mutu dan Sertifikasi

Produk Hewan

Balai Besar

Penelitian Veteriner

Lab. Veteriner Provinsi

Balai Besar/ Balai/Stasiun

Karantina Pertanian

Balai Besar Uji Standar Karantina Pertanian

Balai Uji Terap Teknik

& Metode Karantina Pertanian

It is not include in Kepmentan 668/2002

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Microbiology Laboratory and Parasitology Laboratory, FM, Universitas Indonesia

Microbiology and Parasitology Laboratory FM, Padjadjaran University Microbiology Laboratory, FM Hasanuddin University

Veterinary Microbiology Laboratory, FVM, Bogor Agriculture University

Microbiology and Parasitology Laboratory, FM and FVM, Gadjah Mada University

Microbiology and Veterinary Microbiology Laboratory, FM and FVM, Airlangga University

Parasitology Laboratory, FM, Sam Ratulangi University

8 Microbiology, 3 Parasitology, 1 Microbiology & parasitology

One Health Laboratory Network Current University Laboratory Member

8 Human Health Laboratory

4 Animal Health Laboratory

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17 Life Science Laboratory Roles

2. Early Detection and Referral System

1. Developing New Vaccine and Drugs

3. Training and Education

BIOSAFETY & BIOSECURITY

ANTI-MICROBIAL RESISTANCE

BIOTERROR

BIOTECH NOLOGY

INFECTIOUS DISEASE

(EID, Zoonotic, NTD)

Utilization Aspects National Security and

Defense Aspects

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18 Laboratory Assessment Tool

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19 Laboratory Capacity in 3 Ministries

3

1

6

4

3

1

5

1

2

9

4

1

4

7

5

6

4

6

1

1

4

5

2

3

5

4

6

5

8

6

4

4

8

4

5

6

7

8

10

7

10

13

2

7

6

3

5

9

3

11

4

12

7

7

5

8

9

3

2

3

5

1

2

5

1

10

1

1

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Laboratory collaboration

National lab networking

Communication means

Staff Security/Health

Biosafety/Biosecurity

Quality Assurance

Training

Available technology

Sample accession

Staff skills + availability

Reagent supply

Equipment

Infrastructure

Organization

Basic supply

Laboratory Budget

Geographic location

Var

iab

les

20 Laboratory Capacity from Ministry of Health, Ministry of Agriculture, and University Capacity Based on FAO LMT

0 - 20 21 - 40 41 - 60 61 - 80 81 - 100

Mapped based on FAO LMT, 2017

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20 Laboratory Bio-risk Spectrum

Outbreak Epidemic Pandemic

Laboratory Infections Containment Failure

Behavior

Sabotage DURC

Bio-crime Bioterrorism

Natural Accident Deliberate

BIOSAFETY BIOSECURITY

EID: 2019-nCoV

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1. Anthrax 2. Rabies 3. Salmonellosis 4. Brucellosis (Brucella abortus) 5. Avian Influenza (AI) 6. Porcine Reproductive and Respiratory Syndrome (PRRS) 7. Helminthiasis 8. Septicaemia Epizootica (SE) 9. Nipah 10. Infectious Bovine Rhinotracheitis (IBR) 11. Bovine tuberculosis 12. Leptospirosis 13. Brucellosis (Brucella suis) 14. Jembrana 15. Surra 16. Paratuberculosis 17. Toxoplasmosis 18. Classical Swine Fever (CSF)/ Hog Cholera 19. Swine Influenza 20. Campylobacteriosis 21. Cysticercosis 22. Q Fever 23. Penyakit Mulut dan Kuku (PMK) 24. Bovine Spongiform Encephalopathy (BSE) 25. Rift Valley Fever (RVF)

Infectious Disease Priority between MoA and MoH

1. Acute Diare 2. Malaria Konfirmasi 3. Tersangka Demam Dengue 4. Pneumonia 5. Diare Berdarah 6. Tersangka Demam Tifoid 7. Jaundice Akut 8. Tersangka Chikungunya 9. Tersangka Flu Burung pada Manusia 10. Tersangka Campak 11. Tersangka Difteri 12. Tersangka Pertussis 13. AFP (Lumpuh Layuh Mendadak) 14. Kasus Gigitan Hewan Penular Rabies 15. Tersangka Anthrax 16. Tersangka Leptospirosis 17. Tersangka Kolera 18. Kluster Penyakit yg tdk lazim 19. Tersangka Meningitis/Encephalitis 20. Tersangka Tetanus Neaonatorum 21. Tersangka Tetanus 22. Influenza like-illness (ILI) 23. Hand, foot, and mouth diseases (HFMD)

Ministry of Agriculture Based on Kepmentan 4 0 2 6/2013 con c e rn ing S t r a teg ic I n f ec t ious D i sease s

Ministry of Health Based on P e rmenkes 1 5 0 1/2010 Con c enring I n fect ious d i s eases t h at po t entia l ly c au s e ou t b r eak

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What should be done to better identify and detect the Emerging Infectious Disease (EID)?

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23 Establishing One Health Laboratory Network

Strengthening Collaboration and Laboratory Capacity to Identify, Detect the Emerging Infectious Diseases (EID) and Zoonosis

Collaboration

Linking Related Government Laboratories to Combat EID and Zoonosis

Advocacy

Promotion and Advocacy on the Implementation and Development of OHLN and Biorisk Management national

policy

Support

Strengthening Laboratory Capacity

Mission

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24 Technical Core Function of One Health Laboratory Network

1. One Health related infectious disease identification and early detection (diagnostic testing)

2. One Health related infectious disease surveillance

3. Reference and specialized testing (eg. outbreak test)

4. One Health related infectious disease research

5. Data integration management

6. Capacity building (training and education)

7. One Health preparedness and emergency operation

OHLN is focusing on combating national and international priority EID and zoonosis by promoting:

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25 Current Function of Human and Animal Health Laboratory

Human Clinical Labs (GoI & Private) Public Health Labs (GoI) Animal Health Lab

(GoI)

Human and Animal University Lab

(GoI and Private)

• Diagnostic testing • Some reference testing • Medical management • Data sharing (potential) • Focus Individual health

• Some diagnostic testing • Some reference testing • Surveillance and monitoring • Data sharing (potential) • Focus Public health

• Some diagnostic testing • Reference testing • Surveillance and monitoring • Data Sharing (potential) • Research • Focus Animal health

• Research • Some diagnostic testing • Some Reference testing • Data sharing (potential) • Focus Both human and

animal health

Ministry o f Hea lth MoA Ministry RHE

Aquatic Animal Lab (GoI)

• Some diagnostic testing • Reference testing • Research • Data sharing (potential) • Focus Aquatic animal health

Marine Affairs

One Health Laboratory Network Establishing Integrated diagnostic, referral, surveillance, epidemiology and clinical data sharing,

and research system for Emerging Infectious Diseases and Zoonosis

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Thank You CONTACT:

Kampus Baru Universitas Indonesia Depok, Faculty of Public Health, G Building, 3rd Floor,

Room G316 Universitas Indonesia, Depok, West Jawa, Indonesia

+62 2129302084 nco@indohun.org indohun.org