Stengthening surveillance key to keeping Ebola from Indonesia

Stengthening surveillance key to keeping Ebola from Indonesia Tommy Dharmawan  ;   A medical doctor who lives in Jakarta

JAKARTA POST, 23 Agustus 2014

                                                

Ebola is still a threat to Indonesia despite the location of the current outbreak being in west Africa. Unlike swine flu (H1N1) and the severe acute respiratory syndrome (SARS) epidemics that directly affected Indonesia or the latest MERS (Middle East Respiratory Syndrome) CoVirus outbreak, which it is feared may affect many Indonesians on pilgrimage to Saudi Arabia, Ebola has yet to affect Indonesians and only a few Indonesians visit west Africa. Nevertheless preventive measures are still urgently required to prevent Ebola entering Indonesia – the virus has reportedly reached nearby Vietnam. The World Health Organization (WHO) has stated that more than 1,000 people have died in the Ebola outbreak in west Africa. The Ebola virus is spread to people by contact with the skin or bodily fluids, such as sweat, saliva and blood, of a patient afflicted with Ebola. The first symptoms will be similar to flu but later can directly affect other human organs. There is still no vaccine and no clinically proven treatment. The WHO has declared the outbreak “a public health emergency of international concern”. In human history viruses like the flu have caused global pandemics. In 1918 the flu infected 500 million people across the world and killed 50 million of them. Ebola has a higher fatality rate, at 90 percent. This means that of 10 people affected by Ebola, nine are likely to die, so the WHO should work hard to prevent Ebola outbreaks from becoming a worldwide pandemic. Viral diseases, including Ebola, SARS and swine flu, pose a serious threat when the virus transmits from human to human. The WHO recommends countries take preventive measures, such as strengthening surveillance at airports and issuing travel advisories. Therefore, the Ministry of Health should reinforce inspections especially at arrival points such as airports or harbors for people returning from Africa, for instance, or pilgrims returning from the Middle East, where many other pilgrims also come from Africa. If Ebola develops into a major outbreak in the Middle East, the Indonesian government should announce a travel warning as soon as possible, including for haj and umrah, or minor haj, pilgrims. There should be thermal detectors at every airport and seaport to detect flu symptoms in those coming from affected countries. Health officials in those areas should be aware of every person with flu symptoms. If a foreigner is found to be infected with Ebola, he or she should not be allowed to enter Indonesia and immediately deported to their country. If Indonesians come back from affected countries with Ebola symptoms, they should be hospitalized to specific referral hospitals that have quarantine wards for highly contagious infectious diseases. The government should continue to increase awareness of Ebola, including among all health workers. Ebola is transmitted through close contact. There have been cases of virus transmission in healthcare facilities in several West African countries, particularly from patients to healthcare providers. Health Minister Nafsiah Mboi has stated the government has alerted its embassies in affected countries to be cautious when issuing visas. Immigration offices have said that visa issuance will be tightened and potential visitors will be required to go through health checks. This is a good policy to counter and prevent Ebola from entering this country. Given the difficulty of detecting patients with Ebola in the early phases without lab tests, it is important for health workers to apply universal precautions to suspected patients although universal precautions are the standard nowadays in hospitals all across Indonesia. Contact precautions should be added to standard procedures when providing care to patients with flu symptoms coming from countries reporting incidences of Ebola. Of course self-awareness is important. Indonesians returning from African countries or pilgrimages should tell health officials if they are suffering from symptoms of flu. The Health Ministry should advise travelers who develop flu symptoms after their return from African or Middle East countries to minimize their contact with others to prevent virus transmission. Suspected Ebola cases will pose a threat to other people if they do not go to hospital; thus increasing the transmission rate. The cooperation between the Indonesia government and the WHO should be strengthened, to gather information and resources on management and prevention of this illness, as in the case of the viral-sharing agreement in H1N1 cases. At that time, Indonesia wanted a mutual-sharing agreement between developing countries and developed countries regarding the virus and its treatment research. Indonesia as a developing country would have an equal share of information on treatment of H1N1 in the event of a worldwide outbreak. In the case of Ebola, developing countries like Indonesia should have the same access to the virus treatment if necessary. We can achieve that if we have strong cooperation and diplomacy with the WHO. No vaccine or specific treatment is currently available for Ebola. Several drugs that have been produced are limited and only boost the immune system. The WHO has said that the basic prevention of Ebola transmission is finding and isolating Ebola patients, those who have been in contact with the patient and the performance of strict hospital infection control. Strengthening surveillance at harbors and airports is the best way to prevent Ebola from entering Indonesia. ●