Polio eradication in Indonesia - Surveillance, immunization and community support
Right after the 1988 World Health Assembly passed a resolution to eradicate polio, the Global Polio Eradication Initiative was launched. This initiative drove WHO to support countries, including Indonesia, to further develop their polio control capacity in any necessary aspects, from laboratory reagents to a national campaign.
The country moved from clinically based to laboratory based confirmation of polio cases in 1991. In 1995, Indonesia collaborated with WHO in advancing its surveillance system for acute flaccid paralysis (AFP).
From over 800 cases in 1984, surveillance and immunization in Indonesia succeeded in bringing the number of cases down to 24 in 1994, and just 1 case in 1995. The last case of indigenous wild poliovirus was found on 23 June 1995 in Probolinggo District, East Java.
Indonesia also introduced National Immunization Week - Pekan Imunisasi Nasional (PIN). PIN was conducted in 1995, 1996 and 1997. To secure the goal of polio eradication, PIN was again conducted in 2002.
Overcoming polio importation in a country of over 17 000 islands
A decade later, in April 2005, Indonesia’s polio eradication programme suffered a setback when the National Polio Laboratory in Bandung confirmed a wild poliovirus type 1 isolated from the stool specimens of an AFP case from Sukabumi District, West Java. The first case was a 20 month-old boy from Sukabumi District, West Java. The laboratory tests showed that the virus was originally from West Africa and had travelled via the Middle East. Global travel had returned polio to Indonesia.
The Ministry of Health, joined by WHO, immediately conducted a field investigation followed by a mass immunization. To further prevent transmission, 2 rounds of an immunization campaign were conducted for all children up to 5 years old in May and June of 2005. This focused on 6 million children in West Java and the nearby provinces of Banten and Jakarta.
More cases were identified in the islands of Sumatera and Java. The ad hoc Immunization Coordinating Committee recommended PIN (National Immunization Programme) and targeted 24.4 million children under the age of 5. Three rounds of PIN were conducted in 2005 and 2 more conducted the next year.
In consultation with WHO, another mass immunization was conducted in high risk areas in August 2006. This covered 39 districts in the provinces of Aceh, North Sumatera and East Java. This mass immunization expanded to 8 provinces in the island of Sumatera and the island province of Nusa Tenggara Timur.
The last case of polio found in Indonesia was on February 2006. By that time, 305 polio cases had been identified in 10 provinces of Sumatera and Java.
Community support for polio eradication
A special nationwide immunization campaign is a massive undertaking in Indonesia. The 4th largest world population contains geographical challenges within its 17 000 islands covering the span of 3 400 kilometres. Still, Indonesia has managed to free its children from polio.
”This couldn’t have been possible without strong community support and clear government strategy” said Dr Nyoman Kandun, former Director General of Communicable Disease Control and Environmental Health. “The central and local government, army and police, cadres, religious groups, professional organizations, private sectors, and even celebrities played a part. The community came together to support PIN. Indonesia also received the strong support from international organizations like WHO, UNICEF, Rotary, and donor countries which enabled the country to develop the necessary infrastructure to fight polio.”
Indonesia’s women volunteers are part of the PKK (community family welfare) movement supported by the government and are best known for their health promotion activities. The role of women volunteers in managing and operating Integrated Health Posts called Posyandu was vital in Indonesia’s battle against polio and the wider immunization programme.
“Indonesia needs sustainable immunization financing to maintain these gains.” says Dr Julitasari Sundoro, member of the Indonesian Technical Advisory Group on Immunization.
WHO Representative to Indonesia, Dr Khanchit Limpakarnjanarat, added that a strong immunization programme at the national and local levels, along with a strong surveillance system are key to protecting children from polio.
WHO’s South-East Asia Region, which includes Indonesia, is expected to be certified polio free in March 2014.