urgent topics in infectious disease

8/6/2019 Urgent Topics in Infectious Disease

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Urgent Topics in Infectious Disease

In Indonesia

DR.Dr.Zinatul Hayati M.Kes Sp.MK

Haris Munirwan

Gottigen University, Germany, March 02 ,2009


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Subject Matter Introduction

Profile of Indonesia

Urgent Topics in Infectious Disease in Indonesia

1. Malaria

2. Pulmonary Tuberculosis3. Dengue Haemorrhagic Fever (DHF)

4. Diarrhea

5. Avian Influenza

6. Acute Respiratory Infection (ARI)7. HIV/AIDS

8. Chikungunya


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Introduction

Indonesia:

is the largest archipelago in the world

a country that have 222.05 million total

populated that have nearly 17000 islands.

have population below national poverty line at

17% of population


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Indonesia major

health problems

Infectious diseases

exacerbated by

malnutritionparticularly

TB & malaria

Under-nutrition

inchildren

remians high

Non communicable

diseases areemerging as

a major threat


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Ten Most Diseases of Inpatient in Hospital 2005

In Indonesia

Source: Depkes RI

No. Disease

1 Diarrhea and gastroenteritis caused by certain

infection (Colitis Infection)

2 Typhoid and paratyphoid fever

3 Dengue Haemorrhagic Fever (DHF)

4 Other complications of pregnancy and delivery

5 Intracranial injury

6 Transportation accident

7 Fever or unknown origin

8 Other specified, unsoecified and multiple injuries

9 Malaria (includes all malaria)

10 Pneumonia


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Filariasis

Chikungunya

A ian Influenza

IV/AIDS

Acute

Respiratory

Infection

(ARI)

Dengue

aemorrhagicFe er (D F)

ulmonary

Tuberculosis

alaria

Diarrhea

Urgent Topics

inInfectious

Disease

in Indonesia


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1.Malaria

Malaria as one of transmitted disease which is still bea community health problem, has effect in humanresource quality decreasing that can cause all

economy, social problem, even national safety anddefense.

This is despite the fact that malaria is an easilypreventable and cureable disease.

Situation of malaria morbidity rate in Indonesiaduring 2001 2007 relatively tended to decrease.


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MORBIDITY SITUATION OF MALARIA 2001 2007 in IN INDONESIA

Source: Ditjen PPPL,Depkes RI 2008

Malaria morbidity rate . per ,000 population in 2000

had decreased to . per ,000 population in 200 .

51,6

4540

3025

22,520

17,5

0

10

20

30

40

50

60

2000 2001 2002 2003 2004 2005 2006 2007

Malaria

MALARIA

MORBIDITY

SITUATION

PER1000

PEOPLE


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MORTALITY SITUATION OF MALARIA 2001 2007

Source: Ditjen PPPL,Depkes RI 2008

Situation of malaria mortality rate during 2000 200 relati ely fluctuated, it

was 2. % in 2000 increased to . % in 200 and then back to decrease to

0. % in 200 ; this alue was lower comparing to the indicator target that must

be reached (target 0. % in 200 ),

2,69

1,4

2,7

4,9

1,68

0,92

0,45 0,56

0

0,5

1

1,52

2,5

3

3,5

44,5

5

20002001200220032004200520062007

East

% CFR of

Malaria


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Prevention in Indonesia

Rapid diagnosis affirmation

(Active Case Detection by malaria village

worker to find the people with clinical malariasign )

Eliminate malaria with kelambu

Disease vector investigation Massive treatment

Malaria Counselling.


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2. Pulmonary Tuberculosis

Indonesia is a tropic country that recognize

among 22 high burden TB countries as

decribe by the WHO

The Incident case of TB per 100.000 resident

in Indonesia show tendency of degradation

during year range of time 2000-2006


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INSIDENCE RATE OF NEW CASES OF AFB+ PER 100,000

POPULATION IN INDONESIA

In the year 2000 Number Incident equal to 2 per 00.000 people, this

number continue to go down till reach le el 0 per 00.000 resident in the

year 200

126122

118 115110 107 104

0

20

40

60

80

100

120

140

2000 2001 2002 2003 2004 2005 2006

East

INSIDENCE

RATEOF

NEW CASES

OF AFB+PER

100,000

POPULATION

Source: Ditjen L, Depkes RI 2008


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PROPORTION OF TB CASES BY TYPE

2007


AFBPositif

AFBNegatif

Relaps

Extra Lung


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Pulmonary TB Control

Prevention and elimination Pulmonary TB areconducted by DOTS (Directly Observed TreatmentShortcource Chemotherapy) method or Pulmonary

TB treatment with directly observing by Drugs IntakeSupervisor.

These programs cover case detection by sputumexamination on health providers followed-up bytreatment package.

This program succed for decreasing prevalence of TBat 126/100.000 people at 2000 to 104/100.000people at 2006


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3. Dengue Haemorrhagic Fever (DHF)

Dengue Hemmorage Fever is starting to infect

indonesia since year 1968.

Dengue Hemorrhagic Fever (DHF) has spread to all

provincial areas and the number of infected districtsup to 2007 is 330 districts/municipalities (75% of

district/municipality).

DHF often emerges as an outbreak with relatively

high morbidity and mortality rates.


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INCIDENCEOF DHF, 2003 2007

23,87

37, 3, 2

52, 8

71,78

010

20

30

40

50

60

70

80

2003 2004 2005 2006 2007

E st

(PER 100,000

POPULATION)


In the year 200 Number Incident equal to 2 ,8 per 00.000 people, this

number is increasing unttill reach le el , 8 per 00.000 resident in the year200


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CFR(%)OF DHF, 2003 2007

,

,2

,3

,0 ,0

0

0,2

0,

0,0,

,2

,

,

2003 200 200 200 2007

Eas

CFR(%)OF

DHF


In the year 200 CFR equal to , %, this number is decreasing untill reach

le el ,0 % in the year 200


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DHF Control

1) Disease and vektor surveilance

2) Rapid diagnosis affirmation and treatment

3) Vector eradication


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4. Diarrhea

Diarrhea is the most disease of Inpatient on

hospital in Indonesia.

Diarrhea is the third death cause in Indonesia. In 2007, CFR caused by diarrhea was 1.3%

with 46 deaths from 3661 cases.


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16

3.314

12

5.051

16

10.980

8

3.661

0

2000

4000

6000

8000

10000

12000

2004 2005 2006 2007

Outbreak

ProvinceTotal Case

Data of diarrhea 2000 2007

In the year 200 , the outbreak pro ince at pro ince, and total case at . ,

but the case relati ely fluctuated. the outbreak pro ince at 8 pro ince, and totalcase at . at 200



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53

1,6

127

2,51

277

2,52

46

1,30

50

100

150

200

250

300

2004 2005 2006 2007

Death Case

CFR (%)


Data of diarrhea 2000 2007

In 200 , the death case of diarrhea at case and CFR at , %. but the case

relati ely fluctuated. the death case of diarrhea at case and CFR at , % in

200


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5. Avian Influenza

Avian Influenza is a disease caused by A typeinfluenza virus, includes in familyOrthomyxoviridae

In Indonesia, the type of avian influenza virusthat very virulent strain that is subtype of AH5N1

Avian influenza (AI) first case was reported onJune 2005 in Tangerang, Banten


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SPREADING OF AVIAN INFLUENZA IN INDONESIA

2005-2007



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65

81,8 88,1

0

10

20

30

40

50

60

70

8090

2005 2006 2007

CaseDeath Case

CFR %

AVIAN INFLUENZA CONFIRMED DEATH CASE

AND CFR IN INDONESIA 2005-2007

During 200 , AI confirmed case on human was

reported in Indonesia, which was 20 cases with people dead



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AI CONFIRMED CASE BY SEX

2005-2007

WOMEN

9%

MEN

%



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6. Acute Respiratory Infection (ARI)

ARI is the first death cause disease for infant

In Indonesia (22,30% of all infant death case)

ARI is the 8

th

death cause disease In Indonesia morbidity (2/1000) and mortality (4%)


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REPORT COMPLETENESS OF UNDERFIVE PNEUMONIA

DETECTION

IN 2002 2006

29

549.035

24

502.275

23

625.611

31

600.720

33

641.136

0

100000

200000

300000

400000

500000

600000

700000

2002 2003 2004 2005 2006

ReportedProvi ce

DetectedP tient



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COVERAGE OF UNDERFIVE PNEUMONIA DETECTION

BY PROVINCE IN 2006


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7. HIV/AIDS

This reported case is still increase in Indonesia

every year.

Nationally, AIDS cumulative rate per 100,000population was 2.65

From 1997-2007, the AIDS case is increasing

more than 40 times.

Papua is a highest prevalence of HIV/AIDS in

Indonesia


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NUMBEROF NEW CASES AND CUMULATIVEOF

HIV PATIENTS DETECTED

FROM SOME HEALTH SERVICES

200 2007


2 2

.90

8

2 2

8

2.720

8

. 88

87

.2

998

.2

8

.0 8

0

000

2000

000

000

000

000

7000

200 200 200 2007

New C e

C ve

C e


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PROPORTION OF CUMULATIVE AIDS PATIENTS

BY TRANSSMISION UP TO 2007

Source: Ditjen L, Depkes RI, 2008

Unknown


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PROPORTION OF CUMULATIVE AIDS PATIENTS

BY AGE GROUP UP TO 2007


roducti e age and

sexual acti ity

acti e


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CASE RATE OF CUMULATIVE AIDS CASES PER 100,000 POPULATION

BY PROVINCE, 2007



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8. Chikungunya

Chikungunya fever is a communicable disease

that caused by chikungunya virus with Aedes

aegyptias a vector.

This disease have symptom; sudden fever,

pain in joint especially knee joint, bangle,

hand, backbone and accompanied by rash at

skin.


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SPREADING OF CHIKUNGUNYA

2004 2007

At 200 there is 2. 8 case of chikungunya without

death case.


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9. Filariasis

Filariasis has been still be the health problem for

people in Indonesia and based on result of mapping

up to 2006

The cases of Filariasis had spread in 33 provinces in377 districts/municipalities with case number

reached 10,427 chronic cases

In Indonesia 3 species of filarial worm i.e.

Wucherecia bancrofti, Brugia malayiand Brugia

timoriwere found


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DISTRIBUTION OF CHRONIC CASE OF FILARIASIS

2002-2007

6.2 76.63 6.430

0.2390.427.473

0

2.000

4.000

6.000

.000

0.000

2.000

2002 2003 2004 200 2006 2007

To a ase


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Elimination Program of Filariasis

in Indonesia

1. Mass medication to all people in endemic

districts of Filariasis use DEC 6mg/kgBW

combination with Albendazol 400 mg once per

year during 5 years to cut off infection cycle.

2. Manual/guidelines of Filariasis clinic cases are

to prevent and to minimize deformity/physical

defect.


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