Risk factors of poultry outbreaks and human cases of H5N1 avian influenza virus infection in West Java Province, Indonesia

Background: The purpose of this study was to determine the association of potential risk factors to the spread and maintenance of the highly pathogenic avian influenza (HPAI) H5N1 virus in poultry and humans at the district level in West Java Province, Indonesia. Methods: The association of demography and environmental risk factors including poultry density, human density, road density, percentage of paddy field, and percentage of swamp, dyke and pond with both HPAI human cases and HPAI outbreaks in poultry were assessed using a descriptive epidemiological design. We also assessed the association of HPAI outbreaks in poultry with HPAI human cases. Poisson regression (generalized linear modeling and generalized estimating equations) was used to analyze the data corrected for over-dispersion. Results: There were 794 HPAI outbreaks in poultry covering 24 of the 25 districts in our study during 2003-2008 and 34 HPAI human cases involving 12 districts during 2005-2008. We found that two risk factors - poultry density and road density - had a statistically significant correlation with the number of HPAI outbreaks in poultry. The number of poultry outbreaks had a negative association with poultry density (29% effect) and a positive association with road density (67% effect). The number of human cases was significantly associated with the number of poultry outbreaks (34% effect), but with none of the other risk factors considered. Conclusions: We conclude that the most effective way to prevent human HPAI cases is to intervene directly in the poultry sector. Our study further suggests that implementing preventive measures in backyard chicken farming and limiting transport of live poultry and their products are promising options to this end. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.