12. tropis 11 2012 (flu-burung)
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Flu Burung(Avian Infuenza)
Prof. Dr. Mochammad Hatta, PhD, SpMK (K)
Laboratorium Molekuler Biologi dan munologi,
!akulta" Kedokteran,
#ni$er"ita" Ha"anuddin
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Infuenza virusAda 3 tipe virus infuenza: A, B, dan C
Hanya tipe B dan C telah diisolasi dari
manusia.
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Karakteristik Infuenza
Virusrthomy!ovirus
"leomorphi#
$in%le&stranded '(A viruses
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)ia%nosis Infuenza virus*ase akut penyakit, virus infuenza dapatse%era diisolasi dari spesimen saluranpernapasan, seperti s+a naso*arin% danten%%orokan.
Keanyakan strain tumuh di primary monkeykidney #ell, dan dapat dideteksi olehhemadsorption atau hema%lutinasi.
'apid dia%nosis)ire#t immunofuores#en#e
)eteksi immunoenzymati#
)ia%nosis serolo%i
Pada sel epitel/sekret
saluran pernapasan
-. Virus isolasi: kultur virus memun%kinkanuntuk analisis %enetik dan anti%enik
. )eteksi protein virus: satu /am tes
memantu dalam pemilihan a%en antivirus
3. )eteksi asam nukleat virus 0'(A1 diikutiden%an "C' 0metode yan% san%at sensiti*1
2. $erolo%is dia%nosis: 2&kali lipatpenin%katan kadar antiodi spesik leihdari min%%u
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4atar Belakan% "enyakit menular masih men/adi masalah
prioritas dalam peman%unan kesehatanmasyarakat di Indonesia.
)alam $istem "elayanan 5inimal 0$"51 yan%terdapat dalam $urat Keputusan 5enteriKesehatan 'I (omor -2678993 tentan%"enan%%ulan%an "enyakit 5enular +a/i
diselen%%arakan )aerah, ke#uali teruktimasalah terseut tidak ada 8 ditemukan.
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4an/utan $alah satu "enyakit 5enular yan% san%at
men%%emparkan saat ini yaitu ;lu Burun%0Avian Infuensa1 yan% termasuk salah satupenyakit %olon%an
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"en%ertian dan $e/arah
;lu Burun% ;lu urun% 0avian infuenza1 merupakan in*eksi
virus infuenza A sutipe H6(-0H=hema%%lutinin>(=neuraminidase1 yan% pada
umumnya menyeran% un%%as, urun%, ayam danai yan% kemudian dapat menyeran% manusia
)ikonrmasikan telah ter/adi di 'epulik Korea,Vietnam, ?epan%, @hailand, Kamo/a, @ai+an,
4aos, China, Indonesia dan "akistan. $umer virus didu%a erasal dari mi%rasi urun%
dan transportasi un%%as yan% terin*eksi.
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)alam perkeman%annya ,Kasus ;lu Burun% ukanmenyeran% pada un%%as sa/a, tetapi /u%a menyeran%
manusia
"ada th -7 ;lu urun% pertama kali mele+atihalan%an spesies dari un%%as ke manusia. "ertamakali mun#ul di Hon%kon% den%an -D oran% dira+at dirumah sakit dan enam oran% diantaranya menin%%al
dunia, kemudian menyear ke Vietnam dan Korea.
)i Indonesia pada ulan ?anuari 992 di laporkanadanya kasus kematian ayam ternak yan% luar iasa0terutama di Bali, Botaek, ?a+a @imur, ?a+a @en%ah,Kalimantan Barat dan ?a+a Barat1
4an/utan..
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4an/utan.."ada ulan ?uli 996, penyakit fu urun%
telah meren%%ut ti%a oran% nya+a +ar%a@an%eran% Banten.
Hal ini didasarkan pada hasil pemeriksaanlaoratorium Badan "enelitian dan"en%eman%an )epkes ?akarta danlaoratorium ru/ukan EH di Hon%kon%.
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1918-9: Spanish lu!"#1$1% Se&ere19'(-8: )sian lu! "#2$2% Se&ere
19*8-9: #on+ ,on+ lu! "#3$2%oderate
19(1: S.ine inluena! "#1$1% ild
%e"ulting from& Small chan+es in an animal &irus
ar+e chan+es rom miin+ o animal andhuman inluena &iruses
Influenza A PandemicsInfluenza A Pandemics
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How do Pandemics Get
Started?At human&to&human level, depends on
Fase o* transmission
'apidity to death or deilitatin% symptomsIn*e#tious period
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Infuenza virus in*e#ts throu%h respiratory tra#t
Inhaled virus droplets tar%etrespiratory epithelial #ells. @hese#ells produ#e lar%e amount o* virus+hi#h #an then in*e#t alveolar
ma#ropha%e. Alveolar ma#ropha%e+ill die predominantly y apoptosismean+hile epithelial #ells under%one#roti# death.
tracheitis
ronchitis
ronchiolitis
oncho!neumonia
human avian infuenza virus atta#ks lo+er respiratory tra#t
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Cell ne#rosis8apoptosis tri%%erimmune response and produ#e#ytokines 0@(; alpha, I4&-1 and#hemokines 05C"&-, 5I"
-alpha8eta, I"&-9, I4&D1
Infuenza virus in*e#ts throu%hrespiratory tra#t
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$tarted
At population level, depends at least on
5oility o* in*e#tious people
'an%e o* travel o* in*e#tious people
Human networksmochammad hatta@2013
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'hailand (*++)& -+//*/0
ndone"ia (*+)& 1+//0*/
2ambodia (*) & // +//0
3ietnam (+*4-)& 0 +//*/02hina (1*/)& 1/ +//0*/
'urke5 (*+)& -- +//
ra6 (*) // +//
Human Bird Flu, WorldwideHuman Bird Flu, Worldwide
As of 6 February 2006
( countries
88 deaths o 1*' conirmed
'3 case atalit4 rate
5anuar4 200* cases reported rom
ndone"ia6 7ra6 urke4
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99 "andemi# "hases
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"enyea fu urun% adalah virus infuenzatipe A. Virus infuenza termasuk *amilirthomy!oviridae.
Virus infuenza tipe A dapat eruah&uahentuk 0)ri*t, $hi*t1, dan dapatmenyeakan epidemi dan pandemi.
Virus infuenza tipe A terdiri dari
Hema%lutinin 0H1 dan (euramidase 0(1,kedua huru* ini di%unakan sea%aiidentikasi kode sutipe fu urun% yan%anyak /enisnya.
Pen"ea
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H6(- Infuenza inHumans'ran"mi""ion& per"on7to7per"on
ar+e droplets: cou+hin+6 sneein+Possile ecal ; inhalation#i+hl4 conta+ious
#and h4+iene is important
ncubation period& 7 - da5"
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2ommon S5mptom" #i+h e&er ">38 ? =%
and/or
od4 aches
Ar4 cou+h Sore throat #eadache
H!" Influenza in HumansH!" Influenza in Humans
2our"e, if ho"pitali8ed
Bapidl4 de&elop pneumonia echanical &entilation ulti-or+an ailure
da4s
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%apid influen8a diagno"tic te"t"
Besults otained .ithin 30 min $ot particularl4 sensiti&e6 ails to detect a&ian &iruses
#ia$nosis#ia$nosis
Detection of H09 $iru"&
)mpliication o speciic &irus +enes "B-P=B% Besults in * hours6 &er4 sensiti&e
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Ge#ala dan tanda
DeEala lu urun+ dapat diedakan pada un++as dan
manusia DeEala pada un++as5en++er er.arna iru
orok dikaki
,ematian mendadak DeEala pada manusia Aemam "suhu adan diatas 38o =%
atuk dan n4eri ten++orokan
Badan+ saluran pernapasan atas
Pneumonia
neksi mata
$4eri otot
Aiare atau +an++uan saluran cerna
atiue "lemas%mochammad hatta@2013
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4an/utan..
Ma"a nkuba"i
Pada un++as : 1 min++u Pada manusia : 1-3 hari6masa ineksi 1 hari
seelum sampai 3-' hari sesudah timul
+eEala6pada anak sampai 21 hariF
2ara Penularan
lu urun+ menular dari un++as ke un++as
dan dari un++as ke manusia melalui udara
4an+ tercemar &irus #'$1 4an+ erasal darikotoran atau sekreta un++as 4an+ menderita
lu urun+
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$e%nisi &asus
,asus lu urun+ ditetapkan dalam C
Eenis1F Seseoran+ dalam pen4elidikan 4aitu
seseoran+ atau sekelompok oran+ 4an+
diputuskan oleh peEaat kesehatan 4an+
er.enan+ untuk dilakukan pen4elidikanepidemiolo+i tehadap kemun+kinan
terineksi #'$1F
2F ,asus Suspek
3F ,asus Proael
CF ,asus ,onirmasi
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'reatmentSupporti$e
)ssist reathin+ and lood circulation reat an4 secondar4 inections
%reatment%reatment
:nti$iral"&amilu - =G$=HB$ #'$1 resistanceI
3accine"&; 7n earl4 clinical trialsJ
- $ot completel4 protecti&e
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Pencegahan
1FPada Kn++as:
aF Pemusnahan un++as/urun+ 4an+
terineksi lu urun+F
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Human Animal $urveillan#e7s #'$1 adaptin+ to humansI
Lhere is #'$1 causin+ diseaseI
#as #'$1 mutated to cause epidemicsI
7s #'$1 transmittin+ human-to-humanI
;utbreak Detection;utbreak Detection
n$e"tigation Supportn$e"tigation Support
&es'ondin$ to Pandemic %(reat&es'ondin$ to Pandemic %(reat
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7ntensi&e sur&eillance o human inluena Hpansion o participatin+ hospitals
ocus on areas .ith poultr4 inection
Poultr4 processin+/sellin+
#ospitals .here seriousl4 ill patients report
ook or #'$1 inection in hi+h risk persons "eF+F6 li&e poultr4market .orkers%
7nter-species assessment or transmission to other specieseF+F6 pi+s6 chickens6 .ild-irds
onitor or respirator4 disease outreaks
onitor +enetic chan+es in the &irus;
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H6(- in IndonesiaJpdate
As of 6 Feb 2006
2C conirmed cases
1* deathsJ =B *(
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Ehere is $urveillan#eCondu#ted
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Ehere Are Cases
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>
>
> >. 'angerang
?ul5
. Bintaro
Sept
. Lampung
;ct
3. 'angerang
9o$
@*! *! -@*M
-1*! 4*M
+*M *M
4*! @*M
9;
Human )lusters in IndonesiaHuman )lusters in Indonesia
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$ummary
1F #'$1 has circulated in 7ndonesia since 2003 an4 species: poultr46 uail6 .ild ducks and s.ine
2F )&ian #'$1 endemic throu+hout 5a&a (0 o all poultr4 are produced on 5a&a
Present in ree-ran+in+ ack4ard irds
3F Possile limited human-to-human inection
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'esour#es
#'$1 Kpdateshttp://...F.hoFint/csr/disease/a&ianMinluena/en/
http://...FcdcF+o&/lu/a&ian/
http://...FstateF+o&/+/oes/a&ianlu/
http://...FaoFor+/a+/a+aino/suEects/en/health/dis
eases-cards/specialMa&ianFhtml
KS State in 7ndonesia ; #'$1 updateshttp://...Fusemass4EakartaFor+/
http://www.state.gov/g/oes/avianflu/http://www.state.gov/g/oes/avianflu/