Beruflich Dokumente
Kultur Dokumente
in Indonesia
Tatty E. Setiatia, Jiri F.P. Wagenaarb, Martijn D. de Kruifb, Albert T.A. Mairuhub,
Eric C.M. van Gorpb and Augustinus Soemantria
a
b
Pediatric Department, Dr. Kariadi Hospita, JL Dr. Sutomo 16, Semarang, Indonesia
Abstract
Dengue fever (DF)/dengue haemorrhagic fever (DHF) is a growing public health problem in the subtropics.
Dengue was first reported in Indonesia in 1968 and since then the number of reports in the literature
and the number of dengue virus (DENV)-infected cases reported by the Indonesian health authorities
have increased. This review addresses the changing epidemiology of dengue in Indonesia by means of
a chronological overview. Over time, the morbidity and mortality of dengue disease have increased and
DHF epidemics occur throughout all the 29 provinces. The outbreak trend of DHF in the country has
become irregular, with a high inter-epidemic background. All dengue serotypes are circulating, although
severe disease is predominantly attributed to DENV-3. The case-fatality rate is dropping over time,
probably reflecting increased awareness and improved treatment protocols. An increasing percentage
of adolescents and adults develop DHF relatively earlier in the course of the disease, compared with the
days when DHF was considered a primarily paediatric illness. Many inter-related factors such as
environmental, biological and demographic issues influence dengue epidemiology and transmission.
Keywords: Dengue, dengue virus, outbreak, epidemiology, Indonesia.
Introduction
Dengue fever (DF)/dengue haemorrhagic fever
(DHF) is a growing public health problem in
the subtropics.[1] In South-East Asia, with a total
population of 1.5 billion, approximately 1.3
billion people live at risk of acquiring DF or
DHF. Currently, DHF is the leading cause of
hospital admissions and death among children
in this region.[2]
Major dengue epidemics date back to the
late 17 th century. However, the start of
epidemics of severe dengue began in the
South-East Asia region following World War II,
jfpwagenaar@hotmail.com
Methods
Literature search and data sources
A systematic review was performed to identify
eligible articles. The MEDLINE database from
1966 through 2005 was searched by two
reviewers (JFPW and MDK). This was done,
by combining the Medical Subject Headings
(MeSH terms) and text words dengue, dengue
virus, outbreak, epidemiology and Indonesia.
In addition, the Indonesian Ministry of Health,
WHO and experts in the field were contacted
for data on epidemics occurring from 1966
through 2005. This exercise was undertaken
by two different reviewers (TES and AS).
Results
The computer search yielded 116 references.
Forty-four articles were excluded after we had
read the title and the abstract that did not
address the topic under investigation (a list of
these excluded articles is available with the
authors). For the remaining 72 potentially
relevant references, we read the full report to
decide whether to select the study for this
review. Several articles reported on the same
study and results; therefore, in order to avoid
inclusion of duplicate reports, the most detailed
version of each was selected. Some articles
reported on the same study, although different
results were presented. All these papers were
therefore included. One study investigated the
total incidence rates in Indonesia from 1968
to 1985,[6] and these data were combined with
the data derived from WHO and the Ministry
of Health.
The Table summarizes some of the
characteristics of the selected studies, with
clinical outcome and data on virology if
available. The majority of the studies describe
the results of outbreaks with an in-depth survey
of a selected group of patients. The number
of cases enrolled ranged from 72 to more than
2000.
Epidemiological overview
The first cases of DENV infection in Indonesia
were reported in 1968 in the cities of Jakarta
(West Java) and Surabaya (East Java).[6,8-10] These
The solid line represents the total number of DHF cases officially reported during the years 19682005. The
dashed line represents the total number of deaths from DHF per year during the years 1968 till 2005.
(Source: WHO, Sumarmo 1987)
Figure 2: The incidence rate and case-fatality rate of DHF in Indonesia in 2005
This figure shows: (A) the number of DHF cases among 100 000 civilians [the incidence rate (IR)] throughout the
29 Indonesian provinces in 2005 and (B) the percentage of deaths among reported DHF cases [case-fatality rate
(CFR)] throughout the 29 Indonesian provinces in 2005.
(Source: Ministry of Health, Indonesia, 2006)
Virology
In the 1960s, the clinical diagnosis of DHF was
based on the existence of fever of unknown
origin accompanied by a haemorrhagic
tendency with or without symptoms of shock.
This diagnosis could be supported by a positive
haemagglutination inhibition test. No virus
isolations were made at that time. The first
isolations of dengue virus took place during the
1970s in Jakarta, Medan (North Sumatra) and
Semarang.[11,16,26-28] Limited data suggest that
DENV-2 was the predominant virus in that
time,[29] and indeed DENV-2 was isolated most
frequently from the Semarang epidemic in
1973.[16] The 1974 Manado outbreak showed
that, of the 125 serological identifications of
the etiological agent, DENV-1 was the
predominant virus in both non-shock and shock
cases.[14] Virological surveillance using the
Dengue Bulletin Volume 30, 2006
Conclusion
Epidemics of DF and DHF have become an
important public health problem throughout the
Indonesian archipelago since it was first
recognized in 1968. The epidemiology of DHF
in the country is changing alarmingly given the
increasing number of infections reported from
all provinces. The outbreak trends of dengue,
in general characterized as a cyclic pattern,
have become somewhat irregular, with a high
endemic background. A higher percentage of
adolescents and adults seem to develop DHF.[5]
The median age of DHF patients from Jakarta
was 4 years and 11 months during the period
19791984.[6] Recent data from the Ministry
of Health show an increasing number of DHF
in children aged 15 years and older
(unpublished data, Ministry of Health). Other
reports also show this trend.[5,21] Furthermore,
Dengue Bulletin Volume 30, 2006
The case-fatality rates (%) are denoted on the Y axis in percentages during the years 1968-2005.
(Source: WHO, Sumarmo 1987)
References
[1] Guzman MG, Kouri G. Dengue: an update.
Lancet Infect Dis 2002 Jan;2(1):33-42.
[2] World Health Organization. Dengue
haemorrhagic fever: diagnosis, treatment and
control. Geneva; 1998.
[3] Gubler DJ. Dengue and dengue hemorrhagic
fever. Clin Microbiol Rev 1998 Jul;11(3):48096.
[4] Rigau-Perez JG, Clark GG, Gubler DJ, Reiter P,
Sanders EJ, Vorndam AV. Dengue and dengue
haemorrhagic fever. Lancet 1998 Sep
19;352(9132):971-7.
[5] Suwandono A, Kosasih H, Nurhayati,
Kusriastuti R, Harun S, Maroef C, Wuryadi S,
Herianto B, Yuwono D, Porter KR, Beckett
CG, Blair PJ. Four dengue virus serotypes
found circulating during an outbreak of
dengue fever and dengue haemorrhagic
fever in Jakarta, Indonesia, during 2004. Trans
R Soc Trop Med Hyg 2006 Sep;100(9):85562.
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