Epidemiology Dengue Hemorrhagic Fever (DHF) in Indonesia

DHF commonly found in tropical and sub-tropical. Data from around the world showed Asia ranks first in number of patients with DHF each year. Meanwhile, since 1968 until 2009, 0rganization World Health Organization (WHO) recorded the state of Indonesia as a country with the highest cases of DHF in Southeast Asia. DHF disease remains one of the major public health problems in Indonesia.

The number of patients and the distribution area increases with increasing mobility and population density. Dengue Fever in Indonesia were the first time found in the Surabaya city during 1968, where as many as 58 people were infected and 24 of them died (mortality rate : 41.3%). And since that time, the disease was spread throughout Indonesia.

The disease is caused by Dengue virus of the genus Flavivirus, family Flaviviridae. Dengue is transmitted to humans through the bite of an infected Aedes mosquito dengue virus. Dengue virus causes dengue fever (DD), Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) is included in group B Arthropod Virus (Arbovirosis) is now known as the genus Flavivirus, family Flaviviride, and have four types of serotypes, namely: Den -1, Den-2, Den-3, Den-4.

In Indonesia, DHF has become a public health problem for 41 years. Since 1968 there has been increased spread of the number of provinces and districts / cities of endemic dengue, from 2 provinces and 2 cities, became 32 (97%) and 382 (77%) districts/cities in 2009. Maluku Province, from 2002 until 2009 there were no reports of dengue cases. In addition there is also an increasing number of dengue cases, in 1968 only 58 cases to 158 912 cases in 2009.

The increase and spread of dengue cases are probably caused by high population mobility, urban development, climate change, changes in population density and distribution and other epidemiological factors that still require further study.

 

Incidence Rate (IR)

According to Mc Michael (2006), climate change is causing changes in rainfall, temperature, humidity, air direction so that the effect on terrestrial and marine ecosystems and the effect on health, especially against the proliferation of disease vectors such as Aedes mosquito, malaria and others. In addition, behavioral factors and community participation is still lacking in the activities of mosquito eradication nest (PSN) and the factor of population growth and increased mobility of population factors in line with the improved means of transportation led to the spread of dengue virus more easily and more widely.

In 2009 the province of Jakarta was a province with the highest incidence rate DHF (313 cases per 100,000 population), whereas the NTT province with the lowest incidence rate DHF (8 cases per 100,000 population). There are 11 (33%) provinces, including in high-risk areas (AI> 55 cases per 100,000 population), the last five years (2005-2009) five provinces with the highest IR. Jakarta and East Kalimantan province always has been in five provinces with the highest IR. Jakarta always has the highest IR each year.

This happened because of the influence of population density, high population mobility and a better transportation facilities than other areas, so the spread of the virus becomes more easily and more widely. In contrast to East Kalimantan not too densely populated, according to SUPAS 2005 East Kalimantan population densities of only 12 people/km2 (DKI Jakarta 13,344 people/km2). Factors that influenced the height of the DHF incident in East Kalimantan, the possibility was because of the high rainfall year round and the existence of the biological environment that caused mosquitoes to breed more easily.

Dengue cases per group age of the year 1993 - 2009 there was a shift. From 1993 to 1998 greatest old group of dengue cases was the age group <15 years, in 1999 to 2009 the largest age group of DHF cases tend to be in the age group> = 15 years. When seen, the distribution of cases by sex in 2008, the percentage of male patients and female nearly equal. Number of patients with male sex was 10 463 persons (53.78%) and women amounted to 8991 people (46.23%). This illustrates that the risk of DHF for men and women was almost the same, did not depend gender.

Climate change may extend the transmission of vector borne diseases and the changing geographic area, with possible spread to areas of low population immunity or the public health infrastructure is lacking. In addition to climate change, risk factors that may affect the transmission of dengue is environmental factors, urbanization, population mobility, population density and transportation. Rainfall Index (RI) that is multiplication of the rainfall and the day rain divided with the number of days in the month. RI not directly affects the breeding of mosquitoes, but the effect on the ideal rainfall. The ideal rainfall meaning that rain water not to cause flooding and stagnant water in a container / media into the breeding places of mosquitoes that are safe and relatively clean (for example basins in bamboo fences, trees, tin cans, old tires, roof or gutters home ). Availability of water in the media will cause mosquito eggs to hatch and after 10-12 days will turn into a mosquito. When the man was bitten by a mosquito with dengue virus then in 4-7 days and then will be symptoms of dengue fever. So if only attention to risk factors of rainfall, the time required from start to the rainy season until the occurrence of dengue incidence is about 3 weeks.

Sumber : Kemenkes, 2010, demam berdarah dengue, Buletin  jendela epidemiologi, vol 2, 1-15