Avian influenza.

Avian influenza, or “bird flu”, is a contagious disease of animals which crossed the species barrier to infect humans and gave a quite impact on public health in the world since 2004, especially due to the threat of pandemic situation. Until 1st March 2006, laboratory-confirmed human cases have been reported in seven countries: Cambodia, Indonesia, Thailand, Viet Nam, China, Iraq and Turkey with a total of 174 cases and 94 dead (54.02%). Indonesia has 27 cases, 20 were dead (74.07%). AI cases in Indonesia are more in male (62.5%) and all have a symptom of fever. An influenza pandemic is a rare but recurrent event. An influenza pandemic happens when a new subtype emerges that has not previously circulated in humans. For this reason, avian H5N1 is a strain with pandemic potential, since it might ultimately adapt into a strain that is contagious among humans. Impact of the pandemic could include high rates of illness and worker absenteeism are expected, and these will contribute to social and economic disruption. Historically, the number of deaths during a pandemic has varied greatly. Death rates are largely determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations, and the effectiveness of preventive measures. Accurate predictions of mortality cannot be made before the pandemic virus emerges and begins to spread.

SARS – infectious disease of 21st century.

Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. According to the World Health Organization, a suspected case of SARS is defined as documented fever (temperature >38°C), lower respiratory tract symptoms, and contact with a person believed to have had SARS or history of travel to an area of documented transmission. A probable case is a suspected case with chest radiographic findings of pneumonia, acute respiratory distress syndrome (ARDS), or an unexplained respiratory illness resulting in death, with autopsy findings of ARDS without identifiable cause. In this article some SARS epidemiological data in Indonesia will also presented. There are 7 SARS suspected cases and 2 probable cases were registered in Indonesia on the period of 1 March to 9 July 2003, and no more cases were reported after that time. How will be SARS progression in the future will be a subject of discussion among scientist, and we will have to wait and be prepared for any development might occur.

Fixed Dose Combination for TB treatment.

According to the World Health Organization, a third of the world’s population is infected with tuberculosis. The disease is responsible for nearly 2 million deaths each year and over 8 million were developing active diseases. Moreover, according to WHO (2000), tuberculosis deaths are estimated to increase to 35 million between 2000-2020. The majority of tuberculosis patients worldwide are still treated with single drugs, or with 2-drug fixed-dose combinations (FDCs). To improve tuberculosis treatment, 2- and 3-drug FDCs were recommended by the World Health Organization (WHO) as part of the DOTS strategy. Since 1999 a 4-drug FDC was included on the WHO Model List of Essential Drugs. Today, FDCs are important tools to further improve the quality of care for people with TB, and accelerate DOTS expansion to reach the global TB control targets. Fixed dose combination TB drugs could simplifies both treatment and management of drug supply, and may prevent the emergence of drug resistance .Prevention of drug resistance is just one of the potential benefits of the use of FDCs. FDCs simplify administration of drugs by reducing the number of pills a patient takes each day and decreasing the risk of incorrect prescriptions. Most tuberculosis patients need only take 3–4 FDCs tablets per day during the intensive phase of treatment, instead of the 15–16 tablets per day that is common with single-drug formulations It is much simpler to explain to patients that they need to take four tablets of the same type and colour, rather than a mixture of tablets of different shapes, colours and sizes. Also, the chance of taking an incomplete combination of drugs is eliminated, since the four essential drugs are combined into one tablet. FDCs are also simpler for care-givers as they minimize the risk of confusion. Finally, drug procurement, in all its components (stock management, shipping, distribution), is simplified by FDCs. Adverse reactions to drugs are not more common if FDCs are used. Nevertheless, whenever side-effects to one or more components in a FDC are suspected, there will be a need to switch to single-drug formulations. Quality, safety and efficacy of FDC drugs are determined by the manufacturing process i.e. by compliance of the manufacturer with the requirements of good manufacturing practices (GMP) and pharmacopoeial specifications. National TB programmes must establish a QA system WHO established a laboratory network that tests the quality of FDCs in the marketplace and registers products upon request from the pharmaceutical industry.

TB & Tobacco.

One third of the world population is infected with tuberculosis, and over 8 millions people were developing each year. On the other hand tobacco is responsible for 3 millions death in the world. For Indonesia, our country has the third biggest TB cases in the world. Whereas Indonesia is ranked as having the fourth largest number of smokers in the world. A relationship between smoking and TB has been suspected for a long time, even though the epidemiological evidence has not been convincing so far, as well as the pathophysiology and the biomolecullar changes. At present time there are more and more epidemiological data to suggest relationship between TB and tobacco. Further research should be done to get more indepth relationship as well as avoiding the confounder factor. To be able to perform TB control as well as tobacco control successfully there should be emphasize on synergistic public health approaches. Tuberculosis –which Indonesia got 3rd rank in the world- as well as smoking problem –which Indonesia got 4th rank in the world- are two important public health problem for the country. If there are relationship between tobacco and tuberculosis, health problem faced by Indonesian even become bigger. Knowledge about tuberculosis as well as tobacco among Indonesian population is very essential to improve the public health situation. Tuberculosis control programme as well as smoking control programme are essential tools for the well being of Indonesian people.

Tuberculosis of the Future.

Beginning and during the 20th century there were several milestones in TB control, including the development of vaccine and chemotherapy. But, as we enter the 21th century, TB continue be a global public health problem and if there is no improvement in TB control, the number of new TB cases is projected to rise to 11 million by 2020. Problems faced include inability to deliver / assure chemotherapy, deficient case finding, inadequate vaccine, rising level of drug resistance, failure to employ preventive chemotherapy and migration, HIV epidemics and nosocomial transmission. As far as recent advances in TB diagnostics, there is a need to find a tool for identification of latent infection, detection of diseases in migrant and other high risk populations, replace or facilitate AFB microscopy, improve the diagnosis of AFB smear-negative cases, and simple tools for determining drugs susceptibility. New diagnostic technologies includes nucleic acid probes, amplification tests, high performances liquid chromatography (HPLC), gas / liquid chromatography (GLC), and automated system for radiometric and non radiometric detection and molecular fingerprinting approach. In the coming years new drugs are needed, especially to shorten the duration of TB treatment or otherwise simplify its completion, improve the treatment of latent TB infection and to be eliminate. MDR-TB. There are some problems in pursue tuberculosis research because of the high investment required to bring a product to market and lack of likely commercial returns. Some new drugs and molecules with promising antimycobacterial activity include Fluoroquinolone, Oxazolidinones, Nitroimidazole, Thiolactomycine, Nitroimidazopyran and Isocitrate lyase inhibitor. To deliver good case finding and treatment, effective TB control program should be implemented in the country, as well as globally. The integration of TB control program with tobacco control program and chronic respiratory diseases control program could be one of the alternative.

Sick building syndrome.

Sick building syndrome describes a number of mostly unspesific complaints of some occupants of the building. The exact pathophysiological mechanism remains elusive. It is a multi factorial event which may include physical, chemical, biological as well as psycological factors. In many cases it is due to insufficient maintenance of the HVAC (heating, ventilation, air conditioning) system in the building. Sign and symptoms can be uncomfortable and even disabling, which may include mucus membrane irritation, neurotoxic symptoms, asthma like symptoms, skin complaints, gastrointestinal symptoms and other related symptoms. There are various investigation methods to diagnose sick building syndrome, and on site assessment of the building is extremely useful. Prevention through a proactive air quality monitoring program is far more desirable than dealing with an actual sick building. Indoor air and the sick building symdrome serves as a paradigm of modern occupational and environmental medicine.

Smoking problem in Indonesia.

Smoking is an important public health probLem in Indonesia. Up to 60% of male adult population as well as about 4% of female adult population are smokers. In fact, some of Indonesian kretek cigarettes have quite high tar and nicotine content. Besides health effect, smoking habit also influence economic status of the individuals as well as the family. In health point of view, even though reliable nation wide morbidity and mortality data are scarce, report from various cities showed smoking related diseases, such as Lung cancer, COPD, effect of pregnancy, etc. Other problem is a fact that smoking habit start quite in early age in Indonesia. This article also describe factors complicate smoking control program as well as several things to be done to strengthen smoking control program in Indonesia.