Indonesia: Ministry admits government can do little about Zika virus

Hans Nicholas Jong and Ina Parlina, The Jakarta Post 3 Feb 16;

The government was unable to do much to anticipate the spread of the Zika virus, Health Ministry secretary-general Untung Suseno Sutarjo acknowledged on Tuesday, as the virus was hard to detect and its symptoms similar to those of other mosquito-borne viruses.

Responding to the WHO declaration of a global emergency over the explosive spread of Zika in Geneva a day earlier, Untung advised Indonesians to be cautious regarding the disease, including by refraining from visiting Zika-affected areas.

“We are telling people to be cautious as a preventive measure. What else can we do? After all, there is no medicine available,” Untung said.

He added that it was also hard to detect people who had been infected by the virus.

“We don’t know whether people are sick with the virus, because the symptoms are usually mild,” the official said.

Citing the ministry data, Untung said of five Indonesians known to have contracted the virus, only one of them had fallen sick with a fever, with the other four showing no symptoms whatsoever.

As with efforts to prevent dengue fever, Untung advised people to use mosquito nets while sleeping and to apply mosquito repellent.

“If someone goes to a region [where the virus has spread], that person must report if they fall sick after returning home,” he said.

Indonesia has a history of Zika infections dating back to 1981. According to several studies, Zika was found in Indonesia in 1981 and in 2005, Untung said.

The Eijkman Institute for Molecular Biology warned in a recent report that the virus had been spreading for some time. A Zika infection was found among 103 dengue specimens that the institute took during an outbreak in Jambi between December 2014 and April 2015.

The fast-spreading Zika virus is likely being under-diagnosed in Southeast Asia, infectious disease experts have warned in several reports, including one regarding an Australian who was infected after being bitten by a monkey in Bali.

A report last year into the case of a 27-year-old Australian man proposed that a monkey bite he had received at the Ubud Monkey Forest could have been to blame for his subsequent Zika infection.
The man was diagnosed with acute Zika virus after arriving at the Royal Darwin Hospital with a fever and a rash seven days after the bite, the report stated. He had also been bitten by mosquitoes while holidaying in Bali.

The authors of the report, including doctors from the hospital and academics from the Victorian Diseases Reference Laboratory and the Menzies School of Health Research, wrote that while mosquito-borne transmission was possible, the monkey was also a plausible route of transmission.

Commenting on the report, Untung said that he had never heard of it. “Where did that story come from? That’s nonsense. Who is spreading this fraudulent conjecture? The carrier [of the virus] is mosquitoes, not monkey bites,” he said.

Meanwhile, President Joko “Jokowi” Widodo has instructed Health Minister Nila Moeloek to pay attention to and be cautious of the Zika virus.

“Although it has yet to occur here, it needs to be kept an eye on,” presidential spokesman Johan Budi said on Tuesday.

Government intensifies research on Zika virus
Hans Nicholas Jong, The Jakarta Post 2 Feb 16;

The government is stepping up its research on the Zika virus, which has been suspected of causing a rare birth defect, in light of its possible spread in Indonesia.

The Health Ministry’s research and development agency said on Monday that it would trace back all samples of the virus, which produces symptoms similar to dengue fever, following its discovery in Jambi last year.

“We will try to check again because this has become an international concern,” Pretty Multihartina, head of the biomedical and technology department at the research and development agency, told The Jakarta Post.

The Zika virus was detected in Jambi during a dengue fever outbreak that hit the province from December 2014 to April 2015, said Eijkman Biological Molecular Institute deputy director Herawati Sudoyo.

After taking blood samples from patients, the institute noticed that many of the samples were not positive for dengue fever, and carried out further research. It was subsequently found that one of the samples was infected with the Zika virus.

The sample came from a 27-year-old man who sought treatment at the Jambi city hospital two days after being struck with a sudden high fever, headache, elbow and knee arthralgia, myalgia and malaise.

However, the patient recovered without any complications, two days after receiving treatment.

The institute also found that the man had never traveled abroad.

“The isolation and characterization of ZIKV [Zika virus] from a resident with no travel history confirm that the virus is circulating in Indonesia and that, by mimicking a mild dengue infection, this infection is likely contributing to the large number of undiagnosed cases of acute febrile illness,” a report from the institute, published in the Emerging Infectious Diseases Journal, said.

The report suspected the incidences of the Zika virus in Indonesia had been underestimated.

“Although reported human cases of ZIKV infection have been rare in Southeast Asia, confusion with dengue and difficulty in obtaining a laboratory diagnosis are likely causing its incidence to be underestimated,” the report said.

“Surveillance must be implemented to evaluate and monitor the distribution of ZIKV and the potential public health problems it may cause in Indonesia.”

Four out of five people with the Zika virus have no symptoms, according to the WHO. Those who do become ill typically have mild symptoms, such as a low fever, rash, joint pain, pink eye and headaches.

These characteristics have prompted senior health experts to predict the Zika virus could become a bigger threat than the Ebola epidemic, which killed more than 11,000 people in Africa. They described it as a silent infection in a group of highly vulnerable individuals — pregnant women — that can be associated with a horrible outcome for their babies.

Pretty said the ministry had not been able to answer how the man in Jambi was infected with the virus when he had never traveled abroad.

“There are many possibilities,” she said. “There’s a possibility that we already had Zika [for a long time] but it hasn’t caused any deaths and thus is underestimated.”

Pretty added that the virus might also come from foreigners traveling to Indonesia. “Foreign tourists like to venture into remote areas [in Indonesia],” she said.

Herawati said the Eijkman institute had not found any other cases of Zika as of Monday.

“But we will dig deeper [into the case in Jambi]. We will examine [the sample] again,” she told the Post on Monday. If there’s another dengue fever outbreak, then we might get another sample [of Zika].”

The Zika virus was first discovered in Uganda in 1947, but until last year, when it was found in Brazil, it had never been a threat in the western hemisphere.

An emergency WHO committee met on Monday to advise on the response to the Zika virus, as the number of infected people continues to soar.

The committee will decide whether to designate the mosquito-borne virus — which has been linked to serious birth defects — a global emergency meriting immediate coordinated international action, amid criticism that it has been too slow to act.


Govt ready and able to deal with Zika
Ina Parlina and Nurul Fitri Ramadhani, The Jakarta Post 4 Feb 16;

Although there have been no recent cases of the Zika virus in the country following the recent WHO emergency status alert over the dengue-like Zika virus, President Joko “Jokowi” Widodo instructed on Wednesday relevant officials to prepare joint efforts to prevent the virus from spreading in the country.

Jokowi summoned a number of relevant ministers for a limited Cabinet meeting on Wednesday, during which he ordered them to take a number of measures, including early detection steps, public campaigns to raise awareness on the importance on eliminating mosquito breeding grounds and quick response once the virus was detected in the country.

“We should alert our citizens who plan on visiting countries where the Zika virus has been detected; [we need] to also monitor the entry points [across the country],” Jokowi said.

Following the meeting, Coordinating Human Development and Culture Minister Puan Maharani issued a statement saying that the government was prepared to deal with the spread of the virus, dismissing an earlier claim made by a Health Ministry official that the government was unable to take anticipatory measures since Zika was difficult to detect and had similar symptoms to those of other mosquito-borne viruses.

“[We] also urge people to not panic and, at the same time, maintain hygiene and sanitation, and to take measures to prevent potential areas, [for example] puddles, sewers and toilets, from becoming the breeding grounds of the mosquito,” Puan said, adding that the government would also call on all schools to partake in the campaign.

“We indeed hope for participation from all elements of the public,” she said.

Health Minister Nila Moeloek said the government would impose a travel advisory for Indonesian citizens who wanted to visit South American countries and other Zika-endemic areas.

“They should be careful, particularly women who are pregnant in their first trimester,” she said.

According to Nila, one suspected case in Jambi last year had been declared under control.

The Eijkman Institute for Molecular Biology warned in a recent report that the virus had been spreading for some time. A Zika infection was found among 103 dengue specimens that the institute took during an outbreak in Jambi between December 2014 and April 2015.

Indonesia has a history of Zika infections dating back to 1981. According to several studies, Zika was found in Indonesia in 1981 and in 2005, said the Health Ministry recently.

The travel advisory would contain prevention guidelines in the countries prone to the virus, said Oscar Primadi, head of the Health Ministry’s communications and public services division.

Earlier, WHO urged countries in Southeast Asia to strengthen surveillance and take preventive measures against the Zika virus, which is strongly suspected to have a causal relation with clusters of microcephaly and other neurological abnormalities.

“The Aedes aegypti mosquito, responsible for its spread, is found in many areas and there is no evidence of immunity to the Zika virus in many populations of the region,” WHO Southeast Asia regional director Poonam Khetrapal Singhs said in a statement.

The WHO has recommended that countries build capacity in their laboratories to detect the virus and strengthen surveillance of fevers and rashes, neurological syndromes and birth defects.

Countries should intensify their vector control program and prepare health services for managing the Zika virus.

Public should not worry about Zika virus: Expert
Antara 4 Feb 16;

Yogyakarta (ANTARA News) - The public are advised not to worry about Zika virus but should remain vigilant, according to Tri Wibawa, chairman of the Microbiology Department at Gajah Mada Universitys Faculty of Medicine in Yogyakarta.

"In Indonesia, the identification of the Zika virus that has spread in the Latin American community is not yet clear. It should be examined first whether the Zika virus in Indonesia is the same as or is different from that in Latin America," Wibawa noted on Wednesday.

In addition, he remarked that it should be reconfirmed whether the incidence of microcephaly in Colombia was really caused by the Zika virus.

"The Zika virus found in Indonesia could be different from that in Latin America, and therefore, the people need not worry about the virus. Besides this, the clinical manifestations due to the Zika virus attack are not as severe as dengue fever, which can lead to death," he pointed out.

Wibawa added that from an earlier report about the Zika virus attacks, it did not cause death, but the symptoms were characterized by fever, headache, joint pain, sometimes accompanied by a rash, red rash, and inflammation of the eye.

Nonetheless, he suggested that the people should still remain alert to the presence of the Zika virus since Indonesia is a country where the virus has a potential to spread.

In the meantime, Indonesias Agency for the Assessment and Application of Technology (BPPT) claimed in Jakarta on Tuesday that the Zika virus infection was yet to be identified clearly in the archipelago.

According to the agencys deputy head of the agroindustrial technology and biotechnology division, Eng Eniya Listiana Dewi, the most common symptoms of the Zika virus infection are similar to those of malaria and the aedes aegypti-caused dengue fever.

"We still affirm that the symptoms of the Zika virus infection are similar to those of malaria and the aedes aegypti-caused dengue fever. Therefore, the identification of this virus remains unclear. For Indonesia, malaria remains harmful," she noted.

In coping with the threat of the Zika virus infection, the Health Ministry has warned related parties and society members to implement the 3M guidelines, which stand for burying, draining, and covering, as well as the campaign to eradicate mosquito breeding grounds.(*)


Indonesia facing two serious health issues
Otniel Tamindael Antara 3 Feb 16;

Jakarta (ANTARA News) - In the fight against the dengue fever outbreak that has spread alarmingly to several regions, Indonesia should also implement early preventive measures in preparation for the possible occurrence of the deadlier Zika virus.

Zika virus is also transmitted by the Aedes aegypti mosquito, which is known to spread dengue fever and the chikungunya virus that produce flu-like symptoms including low-grade fever, headaches, joint pain, and rashes.

According to the Eijkman Institute for Molecular Biology, a 27-year-old man living in Jambi province on Sumatra Island who had never traveled overseas was found to be infected with the Zika virus.

Therefore, Deputy Director of the Eijkman Molecular Biology Institution Herawati Sudoyo emphasized that Indonesia should implement early preventive measures in line with the World Health Organizations (WHOs) announcement.

Eijkman is the first institution to have isolated the Zika virus in Indonesia and has found a Zika case in Jambi, Sumatra, after the outbreak of the dengue disease in the province.

Zika has opened a new front in Indonesia, and therefore, preventive actions should be taken immediately against both the dengue and Zika viruses, Herawati affirmed.

Head of the Communications Bureau of the Public Health Care of the Health Ministry Oscar Primadi noted that the ministry had alerted all regional health offices against the outbreak of the Zika virus.

The WHO has announced that the Zika virus in Latin America poses a global public health emergency, necessitating a united response.

Margaret Chan, the WHO director general, called Zika an "extraordinary event" that needed a coordinated response.

"I am now declaring that the recent cluster of microcephaly and other neurological abnormalities reported in Latin America following a similar cluster in French Polynesia in 2014 constitutes a public health emergency of international concern," Chan remarked.

She affirmed that the priorities were to protect pregnant women and their infants from harm and to control the mosquitoes that are spreading the virus.

Presidential Special Staff of Communication Johan Budi Sapto Pribowo had noted that the Zika virus should be taken seriously before it is too late, despite it not having become an epidemic in Indonesia.

Speaking to reporters at the Presidential Palace complex here on Wednesday, Budi stated that President Joko Widodo will soon call Health Minister Nila Djuwita Anfasa Moeloek to formulate precautionary and preventive measures in the fight against the Zika virus.

"The government wants to obtain comprehensive data from the Ministry of Health on the Zika virus," Budi noted, adding that news on the discovery of the Zika virus in Bengkulu in 2015 was not valid.

He affirmed that the president would not take a decision without hearing and reading information provided by the Ministry of Health on the Zika virus, which has raised global concerns following its rapid spread.

Tri Wibawa, chairman of the Microbiology Department at the Gajah Mada Universitys Faculty of Medicine, noted in Yogyakarta on Tuesday that the public should not worry about the Zika virus but should remain vigilant.

"In Indonesia, the identification of the Zika virus that has spread in the Latin American community is not yet clear. It should be examined first whether the Zika virus in Indonesia is the same as or is different from that in Latin America," Wibawa noted.

In addition, he remarked that it should be reconfirmed whether the incidence of microcephaly in Colombia was really caused by the Zika virus.

"The Zika virus found in Indonesia could be different from that in Latin America, and therefore, the people need not worry about the virus. Besides this, the clinical manifestations due to the Zika virus attack are not as severe as dengue fever, which can lead to death," he pointed out.

Wibawa added that from an earlier report about the Zika virus attacks, it did not cause death, but the symptoms were characterized by fever, headache, joint pain, sometimes accompanied by a rash, red rash, and inflammation of the eye.

Nonetheless, he suggested that the people should still remain alert to the presence of the Zika virus since Indonesia is a country where the virus has a potential to spread.

In the meantime, Indonesias Agency for the Assessment and Application of Technology (BPPT) claimed here on Tuesday that the Zika virus infection was yet to be identified clearly in the archipelago.

According to the agencys deputy head of the agroindustrial technology and biotechnology division, Eng Eniya Listiana Dewi, the most common symptoms of the Zika virus infection are similar to those of malaria and the aedes aegypti-caused dengue fever.

"We still affirm that the symptoms of the Zika virus infection are similar to those of malaria and the aedes aegypti-caused dengue fever. Therefore, the identification of this virus remains unclear. For Indonesia, malaria remains harmful," she informed journalists on the sidelines of a meeting of the Joint Coordinating Committee (JCC) for the SATREPS Project by Utilizing Diversity of Indonesia Bio-resources (SLeCAMA) here.

In coping with the threat of the Zika virus infection, the Health Ministry has warned related parties and society members to implement the 3M guidelines, which stand for burying, draining, and covering, as well as the campaign to eradicate mosquito breeding grounds.
(Uu.O001/INE/KR-BSR/A014)