Highly pathogenic avian influenza a(H5n1) outbreaks in West Java Indonesia 2015–2016: Clinical manifestation and associated risk factors

Karo-Karo, Desniwaty; Diyantoro; Pribadi, Eko Sugeng; Sudirman, Fransiscus Xaverius; Kurniasih, Sussi Widi; Sukirman; Indasari, Iin; Muljono, David Handojo; Koch, Guus; Stegeman, Jan Arend


Knowledge of outbreaks and associated risk factors is helpful to improve control of the Highly Pathogenic Avian Influenza A(H5N1) virus (HPAI) in Indonesia. This study was conducted to detect outbreaks of HPAI H5N1 in endemically infected regions by enhanced passive surveillance, to describe the clinical manifestation of these outbreaks and identify associated risk factors. From November 2015 to November 2016, HPAI outbreak investigations were conducted in seven districts of West Java. In total 64 outbreaks were confirmed out of 75 reported suspicions and outbreak characteristics were recorded. The highest mortality was reported in backyard chickens (average 59%, CI95%: 49–69%). Dermal apoptosis and lesions (64%, CI95%: 52–76%) and respiratory signs (39%, CI95%: 27–51%) were the clinical signs observed overall most frequently, while neurological signs were most frequently observed in ducks (68%, CI95%: 47–90%). In comparison with 60 non-infected control farms, the rate of visitor contacts onto a farm was associated with the odds of HPAI infection. Moreover, duck farms had higher odds of being infected than backyard farms, and larger farms had lower odds than small farms. Results indicate that better external biosecurity is needed to reduce transmission of HPAI A(H5N1) in Indonesia.