Surveillance for Severe Acute Respiratory Infection As One Approach to Enhance Global Health Security in Indonesia

Latar Belakang: Sistem surveilans nasional untuk infeksi saluran pernafasan akut berat (SARI) dapat memberikan informasi penting tentang sirkulasi virus influenza, menyediakan sistem untuk mengendalikan kejadian luar biasa yang mengancam keamanan dan keselamatan masyarakat serta menyediakan data untuk sistem surveilans influenza global (GISRS). Kemampuan Indonesia untuk mendeteksi dan mengendalikan penyakit menular penting untuk keamanan kesehatan dunia. Penelitian ini bertujuan untuk menilai sistem surveilans ISPA berat Indonesia (SIBI) dan pemanfaatan untuk memantau patogen prioritas lainnya sebagai upaya meningkatkan keamanan kesehatan global. Metode: penilaian atribut surveilans melalui review laporan, analisis data dan interview staff yang terlibat dalam sistem surveilans. Semua kasus yang memenuhi kriteria SARI pada bulan Mei 2013 – April 2015 ikut serta dalam penelitian. Data epidemiologi dan virologi dianalisis. Kelengkapan dan kemudahan sistem untuk mencapai tujuan surveilans influenza dan mendukung surveilans penyakit infeksi baru (emerging) dikaji. Hasil: Sebanyak 1,806 kasus SARI dan 1,697 (94%) spesimen dilakukan pemeriksaan virus influenza. Sebanyak 200 (12%) positif influenza, terdiri dari 46% influenza A(H3N2), 18% A(H1N1)pdm09 dan 37% influenza B. Hasil penilaian terhadap sistem surveilans didapatkan kesesuaian pelaksanaan untuk semua atribut surveilans melebihi target >80%, kelengkapan laporan online 95%, kesesuaian kasus terhadap definisi kasus 100%, kasus yang diambil spesimen 94% dan hasil laboratorium diinput ke database secara online 100%. Sistem surveilans untuk dengue dan infeksi arbovirus lainnya sudah terlaksana di unit rawat jalan dan gawat darurat di sentinel SARI surveilans. Kesimpulan: SIBI dapat disesuaikan untuk menggabungkan surveilans penyakit lain yang menunjukkan kegunaan dan fleksibilitas dalam mendukung keamanan kesehatan global. Kata kunci: keamanan kesehatan global, surveilans, influenza, Indonesia Abstract Background: The existing national surveillance system for severe acute respiratory infection (SARI) provides critical information on influenza virus circulation, provides a system to control influenza outbreaks that threaten the safety and security of the population and feeds data into the global influenza surveillance and response system (GISRS). Indonesia’s ability to detect and control communicable diseases is critical for global health security. The aim of this study was to assess the SARI surveillance system and utility for monitoring other priority pathogens as an effort to enhance global health security. Methods: Surveillance attributes were assessed by reviewing records, data analysis and through interviewed with staffs involved in the surveillance system. All patients at six sentinel hospitals who meet the SARI case definition during May 2013 – April 2015 were enrolled. Epidemiological and virological data were analyzed. The surveillance system utility for its influenza surveillance objectives and flexibility to support surveillance of emerging infectious diseases were assessed. Resuts: A total of 1,806 SARI cases were reported of which 1,697 (94%) had specimens tested for influenza viruses. Of those tested, 200 (12%) were positive, of which 46% were influenza A(H3N2), 18% A(H1N1)pdm09 and 37% influenza B viruses. The system exceeded the targets of >80% adherence for most attributes: 95% for completeness of online reporting, 100% for cases adhering to the case definition, 94% for cases with specimens collected and 100% of laboratory results uploaded to the online database. A surveillance system for dengue and other arbovirus infections was established in the outpatient/emergency units at the SARI surveillance sentinel. Conclusion: SIBI was adjusted to incorporate surveillance for other priority diseases indicating its utility and flexibility to support global health security Keywords: Global Health Security, surveillance, influenza, Indonesia