Physician's knowledge, attitudes, and practices regarding seasonal influenza, pandemic influenza, and highly pathogenic avian influenza A (H5N1) virus infections of humans in Indonesia.

Amalya Mangiri,Nugroho Soeharno,Gina Samaan,Timothy M Uyeki,Aaron D Storms,Yunita Wahyuningrum,Iwan Ariawan,Kathryn E Lafond,Jennifer M Kreslake,Catharina Y Praptiningsih,J Douglas Storey,A Danielle Iuliano

doi:10.1111/irv.12428

Abstract

Indonesia has reported highest number of fatal human cases of highly pathogenic avian influenza (HPAI) A (H5N1) virus infection worldwide since 2005. There are limited data available on seasonal and pandemic influenza in Indonesia. During 2012, we conducted a survey of clinicians in two districts in western Java, Indonesia, to assess knowledge, attitudes, and practices (KAP) of clinical diagnosis, testing, and treatment of patients with seasonal influenza, pandemic influenza, or HPAI H5N1 virus infections. Overall, a very low percentage of physician participants reported ever diagnosing hospitalized patients with seasonal, pandemic, or HPAI H5N1 influenza. Use of influenza testing was low in outpatients and hospitalized patients, and use of antiviral treatment was very low for clinically diagnosed influenza patients. Further research is needed to explore health system barriers for influenza diagnostic testing and availability of antivirals for treatment of influenza in Indonesia.

Highlights

Indonesia is considered an endemic country for highly pathogenic avian influenza (HPAI) A (H5N1) virus among poultry and reported the highest number of fatal human cases of HPAI H5N1 virus infection worldwide (199 cases and 84% mortality) during 2005 to 2015.1,2 Most human cases of HPAI H5N1 in Indonesia have occurred in the western part of the main island of Java
Clinicians were asked about a series of clinical signs and symptoms that are commonly associated with influenza to see whether they thought a particular sign or symptom was related to seasonal influenza, pandemic influenza during the 2009 H1N1 pandemic (2009–2010), or HPAI H5N1 virus infection in hospitalized patients or outpatients
Among outpatient-based physicians, over 90% reported ever making a clinical diagnosis of seasonal influenza, but only 2% reported having diagnosed pandemic influenza, and 4% reported having diagnosed a case of suspected HPAI H5N1 (Table 3)

Summary

| BACKGROUND

Indonesia is considered an endemic country for highly pathogenic avian influenza (HPAI) A (H5N1) virus among poultry and reported the highest number of fatal human cases of HPAI H5N1 virus infection worldwide (199 cases and 84% mortality) during 2005 to 2015.1,2 Most human cases of HPAI H5N1 in Indonesia have occurred in the western part of the main island of Java. The suspect case definition for HPAI H5N1 in Indonesia includes acute lower respiratory tract illness with fever and recent exposure to poultry or suspected human cases within 7 days of illness onset and is based upon the World Health Organization (WHO) suspect H5N1 case definition.[16,17] Clinicians were asked about a series of clinical signs and symptoms that are commonly associated with influenza to see whether they thought a particular sign or symptom was related to seasonal influenza, pandemic influenza during the 2009 H1N1 pandemic (2009–2010), or HPAI H5N1 virus infection in hospitalized patients or outpatients. Knowledge, attitudes, and practices (KAP) of physicians about clinical diagnosis, testing, and treatment of patients with seasonal influenza, pandemic influenza, or HPAI H5N1 virus infections. In both of these districts, human cases of HPAI H5N1 virus infection had been identified as recently as 2009 prior to implementation of the survey. We summarize the findings of the KAP survey

| MATERIALS AND METHODS

| DISCUSSION

Findings

| CONCLUSIONS