• Dr. Agung Dwi Wahyu Widodo, dr, M.

Si
• Departemen Mikrobiologi Kedokteran/ Klinik
• Fakultas Kedokteran FK Unair/ RSUD Dr
Soetomo Surabaya
Curriculum Vitae
• Training :
• Infection and Immunity, Osaka Univ, Japan
(2009)
• Tropical Infection and Molecular Biology,
Gottingen Univ, Germany (2010)
• Infection and Immunity, The Univ of Tokyo,
Japan (2010)
• Infection and Immunity, Osaka Univ, Japan
(2012)
• Molecular Biology of Infection, RSPTI Unair-
The Univ of Tokyo (2012)
• Antimicrobial Resistance, Siriraj Hosp, Mahidol
Univ, Bangkok (2013)
• Research Fellow on Molecular Viral Infection
and Immunity, RIMD, Osaka Univ Japan (2013)
• Emerging and Re-Emerging Infectious Disease,
Mahidol Univ, Bangkok (2014)

• Current Position: IPCO Dr Soetomo Hospital

and Lecturer Faculty of Medicine
Emerging and Reemerging Disease:
Prevention and control

Agung Dwi Wahyu Widodo

Departemen Mikrobiologi Klinik
Fakultas Kedokteran Universitas Airlangga
RSUD Dr Soetomo Surabaya
Talaro and Chess, 2015
Ebola Hemorrhagic Fever-2014
SARS CoV-2003
Avian Influenza 2005
H1N1 Swine Flu-2009
H7N9 Influenza-2013
MERS-CoV 2012-2014
Spanish flu – Pandemic 1918
 Influenza Virus
• Family Orthomyxoviridae
• Three main types
– Type A
• Multiple species
– Type B
• Humans
– Type C
• Humans and swine
Hayden, www.nejm.org, 2006
Distribusi Subtipe Virus Influenza
 The difference in receptor-binding specificity
between human and avian influenza A viruses.

Kawaoka and Shinya, 2008

Influenza virus receptor distribution in
human airways.

Nature, 440, 435–436. 2006

 Which one More Virulence, Swine or Avian ?
Paramater H5N1 Avian H1N1 Swine-o
Mortality 61% (2003-2007) 2% ( till 5 Mei 2009)

Spread 12 country in 5 21 country in 2

years weeks
Transmission Probable Possible
among Human
Receptor 2,3 SA 2,6 SA
spesific Avian Share with Human
type
Pandemic Emerging Re-Emerging
Defense Mechanisms induced by Influenza virus
(Tamura & Kurata, 2004)
 MERS-CoV
Agung Dwi Wahyu Widodo
Infection Prevention and Control
Dr Soetomo Hospital Surabaya
 Korea Selatan
20 Mei – 29 Juni

Kasus 182
Karantina 2562
Mati 33
Mortalitas 18,2%
 Spreading MERS Cases
Countries in the Arabian Countries with Travel-
Peninsula with Cases associated Cases
• Saudi Arabia • United Kingdom (UK)
• United Arab Emirates • France
(UAE) • Tunisia
• Qatar • Italy
• Oman • Malaysia
• Jordan • United States of
• Kuwait America (USA)
MERS-CoV First Case in Human
 Abnormalities on Chest Imaging

The Day on Admission 2 day later

Identification of MERS-CoV
Merah: Infeksi pada Human
Abu-Abu: Cluster MERS-CoV
MERS-CoV 2012
Sign and Symptoms MERS-CoV
Gunakan Masker
Gunakan masker
Standard, Contact, and Airborne Precautions
Recommended for Prevention of MERS-CoV
Transmission in Hospitals
 Case Definitions
• Patient Under Investigation (PUI)
• A patient under investigation (PUI) is a person with the following characteristics:
• fever (≥38°C, 100.4°F) and pneumonia or acute respiratory distress syndrome
(based on clinical or radiological evidence);
AND EITHER
• history of travel from countries in or near the Arabian Peninsula within 14 days
before symptom onset;
OR
• close contact with a symptomatic traveler who developed fever and acute
respiratory illness (not necessarily pneumonia) within 14 days after traveling from
countries in or near the Arabian Peninsula;
OR
• is a member of a cluster of patients with severe acute respiratory illness (e.g. fever
and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV
is being evaluated, in consultation with state and local health departments.
 Case Definitions
• Confirmed Case
• A confirmed case is a person with laboratory
confirmation of MERS-CoV infection.
• Probable Case
• A probable case is a PUI with absent or
inconclusive laboratory results for MERS-CoV
infection who is a close contact of a
laboratory-confirmed MERS-CoV case.
 Case Definitions
• Countries considered in or near the Arabian Peninsula: Bahrain, Iraq,
Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories,
Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.
• Close contact is defined as a) any person who provided care for the
patient, including a healthcare worker or family member, or had
similarly close physical contact; or b) any person who stayed at the
same place (e.g. lived with, visited) as the patient while the patient was
ill.
• Confirmatory laboratory testing requires a positive PCR on at least two
specific genomic targets or a single positive target with sequencing on a
second.
• Examples of laboratory results that may be considered inconclusive
include a positive test on a single PCR target, a positive test with an
assay that has limited performance data available, or a negative test on
an inadequate specimen.
 CDC Guideline for MERS CoV Infection
Komponen Rekomendasi
Patient placement Airborne Infection Isolation Room
(AIIR)
Personal Protective Equipment Gloves
(PPE) for Healthcare personnel Gowns
(HCP) Eye protection (goggles or face shield)
Respiratory protection that is at least
as protective as a fit-tested NIOSH-
certified disposable N95 filtering
facepiece respirator.
Environmental Infection Control Follow standard procedures, per
hospital policy and manufacturers’
instructions, for cleaning and/or
disinfection of:
Environmental surfaces and equipment
Textiles and laundry
Food utensils and dishware
 Zika Virus Infection:
An Update

Agung Dwi Wahyu Widodo

Departemen Mikrobiologi Klinik, FK Unair / RSUD Dr Soetomo Surabaya
Program Studi Imunologi, Sekolah Pascasarjana Unair Surabaya
Timeline zikv infection
 Causes
• Zika virus is transmitted to people through the
bite of an infected mosquito from the Aedes
genus, mainly Aedes aegypti in tropical regions.
• This is the same mosquito that transmits dengue,
chikungunya and yellow fever.

• Key messages
• Zika virus disease is caused by a virus transmitted
by Aedes mosquitoes.
• The virus is known to circulate in Africa, the
Americas, Asia and the Pacific.
Aedes – Tiger Mosquito
 Symptoms
• The incubation period (the time from exposure to
symptoms) of Zika virus disease is not clear, but is likely
to be a few days.
• The symptoms are similar to other arbovirus infections
such as dengue, and include fever, skin rashes,
conjunctivitis, muscle and joint pain, malaise, and
headache.
• These symptoms are usually mild and last for 2-7 days.
• Key messages
• People with Zika virus disease usually have a mild
fever, skin rash (exanthema) and conjunctivitis. These
symptoms normally last for 2-7 days.
 Health Effects & Risks
• What we know
• Zika infection during pregnancy can cause serious
birth defects and is associated with other
pregnancy problems.
• Several countries that have experienced Zika
outbreaks recently have reported increases in
people who have Guillain-Barré syndrome (GBS).
• Current CDC research suggests that GBS is
strongly associated with Zika; however, only a
small proportion of people with recent Zika virus
infection get GBS.
ZIKV Infection
ZIKV infection in fetus
 Diagnosis
• Zika virus is diagnosed through PCR
(polymerase chain reaction) and virus
isolation from blood samples.
• Diagnosis by serology can be difficult as the
virus can cross-react with other flaviviruses
such as dengue, West Nile and yellow fever.
 Treatment
• Zika virus disease is usually relatively mild and
requires no specific treatment.
• People sick with Zika virus should get plenty of
rest, drink enough fluids, and treat pain and fever
with common medicines. If symptoms worsen,
they should seek medical care and advice.
• There is currently no vaccine available.
• Key messages
• There is no specific treatment or vaccine
currently available.
 Prevention and Control- Vector
• Mosquitoes and their breeding sites pose a significant risk factor for
Zika virus infection.
• Prevention and control relies on reducing mosquitoes through
source reduction (removal and modification of breeding sites) and
reducing contact between mosquitoes and people.
• This can be done by using insect repellent; wearing clothes
(preferably light-coloured) that cover as much of the body as
possible; using physical barriers such as screens, closed doors and
windows; and sleeping under mosquito nets.
• It is also important to empty, clean or cover containers that can
hold water such as buckets, flower pots or tyres, so that places
where mosquitoes can breed are removed.
• Special attention and help should be given to those who may not be
able to protect themselves adequately, such as young children, the
sick or elderly.
 Prevention and Control- Vector
• During outbreaks, health authorities may advise
that spraying of insecticides be carried out.
• Insecticides recommended by the WHO Pesticide
Evaluation Scheme may also be used as larvicides
to treat relatively large water containers.
• Travellers should take the basic precautions
described above to protect themselves from
mosquito bites.
• Key messages
• The best form of prevention is protection against
mosquito bites.
Arigato Gozaimasu