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Since 2006 Indonesia has developed a laboratory-based influenza surveillance system. Confirmation of influenza-like illness (ILI) cases is conducted by PCR examination in regional laboratories and followed by virus isolation on positive PCR samples. The long process ILI samples shipping that in the chain can affect the viability of the virus in the sample to be recovered. The study was aimed to evaluate the initial cold chain application monitoring on ILI specimen shipment and to identify the influencing factors. This cross-sectional study found that in 2014 there were 232 sample shipments from 25 provinces. There were 54% shipment from health centers and only 12% shipment from regional laboratories with temperatures meet 2-8oC delivery standard that contributed to the low number of virus isolates. It also found that some samples were damaged, missing, broken thermometer, poor timeliness, however, the recording forms were not filled properly. The application of cold chain principles to ILI sample shipment in influenza surveillance has various challenges from a less thorough officer such as in incomplete cases or improper packaging and shipping methods. It is necessary to increase understanding of the principles of cold chain application in surveillance shipment to reduce human error and to increase timeliness.

The Challenge of Laboratory-Based Influenza Surveillance in Indonesia: Cold Chain Application