PBL 2

Recently, the news stated that hundreds of

resients of Kulonprogo both adults and children
suffer from typical symptoms including fever, ple
face, bitter taste, dryness in the oral cavity. Some
people died so that the status of the incident
became the outbreak. Several villages in the
district are endemic to certain infectious disease.
Oral examination of the oral cavity found that
there were oral candidiasis on the tongue, cheek,
palate mucosa and bad breath. Blood test shows
erythrocyte, leukocyte, and platelet abnormalitis
and positively found plasmodium parasites.

CLARIFYING THE TERM

1. Outbreak disease
 Sudden increase in occurences of a
disease in a particular time n place
excessively (WHO)
 And may last for few days or even years
(WHO)
 
2. Parasites
 Small living organism that give negative
impact to the host

3. Endemic
 Existence of disease that persist in a
population or certain region (pengantar
epidemiologi peyakit menular)
 Occurence of disease which is bound due
to a certain territory w/o time limitation

4. Infectious
 Communicable disease is ilnness caused
by virus or bacteria that spread from one
to another thru contact with
contaminated surfaces, body fluid, blood
products, insect bite or thru air
(Communicable disease and outbreak
control)

5. Plasmodium
  Protozoa that infects the RBC.
 It duplicates and cause malaria to the host
 They are obligate parasite of vertebrate
and insects
6. Epidemic
Rapid spread of infectious disease to a
large nuber of ppl in a given poppulation
within a short period of time usually 2 weeks
or less. Ex: meniococcal infection and tract
rate in excess of 15 cases per 100.000 ppl
(principle of epidemiology 2012 and Green et
al 2002)
Mass occurence of infectious disease in
mutual epidemiological connection taking
place in a limited territory for a certain
ammount of time.
7. Plague
 Disease that affects human and other
mammals. Cause by Yersinia pestis
(bacteria). Human get plague after being
bitten by a rodent flea that carry the
plague bacteria. Without prompt
 treatment it will cause serious disease or
death.
 Bubonic plague: the most common and
usually rsults from the inocculation of
yersinia pestis
 pneumonic plague: occurs after inhalation
of bacteria. The secondary pneumonic
plague: from ppl that has been infected
by bubonic. The transmission is thru
blood.
 septichemic plague: occur without
obvious involvement of the lymph node
or as the results of disemination of the
other 2 forms. Happen when the bact
enters the blodd stream directly and
multiply them. (healthline editorial team
that reviewed by prof daniel mumel)
8. pandemic
Mass occurence of infectious disease affecting
the whole continent without territorial limits
9. sporadic:
 isolated case of disease w/o obvious
epidemiological connection

SETTING THE PROBLEMS

1. the continuous disease (mechanism)
Definition of communicable disease and
examples and special endemic disease in
indonesia
2. Definition of endemic disease with the
examples. And
3. What is an outbreak (the outbreak)
4. Criteria of outbreak
5. Kinds of disease that can be an outbreak
6. Outbreak classificaton
7. Factors that affects an outbreak
8. The main aspects of infectious disease from 1
person to another
9. How to investigate outbreak
10. Purpose of outbreak investigation
11. How to control an outbreak
12. How to prevent an outbreak
ANALYZING THE PROBLEMS
1. Definition of communicable disease and
examples and
 Illness caused by viruse and bacteria that
spread to one another thru contact with
contaminted surfaces, body fluid, blood
products, insect bites or thru air.
 Malaria, measles, chicken pox, hepatitis,
HIV, dengue fever, diarrhea, TBC, SARS,
ebola, influenza. Find the pathogenesis
 TBC: mycobacterium is mostly from china.
The bact destroy our lungs. We have
defense system in our lungs. The bact
multiplies rapidly. The bact is very
resistant to antibiotic.
 Malaria: happend in most tropical and
subtropical area. The transmission is from
anopheles mosquito that is infected by
plasmodium. After that the mosq spread
or bite most of the population.
 Plasmodium enters the hepatocytes and it
goes to the blood stream then it enters
 erythrocytes. Plasmo have lots of stages.
When it reached ery it turned into
tropozoites and turns into schizonts then
the rbc will rupture then the schizonts will
cause fever meanwhile the tropozoites
enters the cycle around
 Mosquito acts a vector
 Ebola: it is from bats as a reservoir. And it
is able the virus without being infected.
Humans become infected by contact with
bats or living animals that is infected by
bats. If between humans, it is transmitted
thru body fluid. Incubation period last 2 -
21 days. And pathogenesis involvs
immune suppression and systemic
inflammatory response that cause
damage to the vascular system and then
coagulation and immune system which
leads to multi organ failure. (ebola
hemorrhagic fever). Important for the
caretakers in dead humans or dead
 animal because the virus will still be active
in dead humans/animals.
 5 species of ebola virus: ZEBOV, SUDAN
EBOLA VIRUS, CEBOV, BEBOV, REBOV.
 HIV: Transmitted to blood and thru sexual
intercouse. The virus will interact with
CD4 because it has the same beta
receptors then using reverse transcriptase
enzyme the virus will produce DNA copy
to make RNA. Then it also destroy CD 4
resulting depletion of CD4. There are 3
infections phases of HIV: initial acute
infection (happens in 2-10 days, sharp
drop in concetration of CD4 followed by
acute system such as fever, influenza, and
pharingitis); asymptomatic (simultaneous
drop of CD4 and viral load rises); AIDS
(happens if CD4 is below 200 cells/mm3)
 CHOLERA: The transmission is denmark. It
is waterial diarrhea. The management is
by rehydration and water sterilization and
for moderate to sever patient it must be
 managed with intravenous fluid.
(Communicable diseases and outbreak
control, Jonathan Ameli, 2015)
 Dengue: secondary heterogenous dengue
infection
2. Definition of endemic disease with the
examples. And special endemic disease in
indonesia and the contagious disease
(mechanism)
 Special endemic disease in Indo: Malaria,
Leptospirosis, Anthrax, Fillariasis, dengue
hemorrhagic fever
 Spreading mechanism of communicable
disease (malaria and dengue fever)
Animal reservoir
3. What is an outbreak (the outbreak)
 Sudden increase in occurences of a
disease in a particular time n place
excessively
 And may last for few days or even years
 Occur in more restricted area, but not
only that, for example kantor desa
  Epidemic occurs in shorter period that
outbreak
4. Criteria of outbreak
 New diases that is not existed in
geographical area
 Increase of the case in 3 periods of time
which is hours, days, and weeks
 The case fatality rate in one period of
time is increased by 50% or more
 The proportional rate increased by twice
or more in one period of time.
Proportional rate the percentage of new
cases towards the total of all new case
visitors. Ex: DBD/Malaria+chikungunya+
dll.
 The increased in death of disease
incidence by twice or more compared to
the last period
 Sickness or death due to poisoning in a
group of community
5. Kinds of disease that can be a outbreak
  Malaria, measles, chicken pox, hepatitis,
HIV, dengue fever, diarrhea, TBC, SARS,
ebola, influenza, chollera, PES
 Emerging: infection that can increase
recently or are threatening to increase in
near future. These infection could be
completely new like SARS, respecting in
an area like dengue in south florida and
old infections that has become resistance
to antibiotic like staphylococcus.
6. Outbreak classificaton
Classified by the cause
 From toxin (enterotoxin: s. Aureus, e. Coli,
chollera, exotoxin: clostridium, and
endotoxin)
 From infection
 Biological toxin (fungus) and chemical
toxins (organic chemical compound and
heavy metal)
Classified by the source
 Human
 Human activity (usage of syringe)
  Animals (worms, rabies)
 Insects
 Environment
Classified by the spread
 Common source of outbreak
When one of the person are all exposed
to an infectious agent from the same
source
Continuos source is common source
outbreak where the exposure is over
multiple incubation period
Point source is less than one
 Propagated outbreak
Transmission is direct by person to person
contact
 Mixed outbreak
Incubation period
7. Factors that affects a outbreak
 Environment (phys, bio, chem)
 Susceptible host
 Agent
 The form of infection
  The process of spreading
 Source of infecton
 Mode of transmission
 Natural or social factors
8. The main aspects of infectious disease from 1
person to another
Time
The period of time between when the disease
enter the host and the ability of the host to
infects others
Herd immunity
Immunity in community againts the
pathogens
The main factor in a outbreak
Attack rate
Some cases that develop/occur in a period of
time in a community that have risk to that
disease
9. How to investigate outbreak disease and
outbreak
 Conduct diagnosis
  To make sure that it is an outbreak
disease
 To connect the occurence of the outbreak
disease and the factors like time, place,
and ppl there
 Make a hypothesis
 To collect epidemiological data (primer
data by quisioner and secondary data is
data case in one period of time)
 Data processing, Analysis, and
Interpretation
10 steps:
Identifying
Define
Develop hypothesis
Refine the hypothesis

10. Purpose of outbreak and/or outbreak

investigation
 To get better understanding of
 Determine the treatment and prevention
method
  Determine the source and mode of
transmission
 Identifying risk factors
 Elimination of infection
 Eradication of infection globally

11. How to control an outbreak

4 steps
 Preparation
Preapration of how to treat in case theres
more case in the future
 Detection
Developing the early warning system for
epidemics
 Response
Confirming diagnosis, formulating
hypothesis of source, transmission
method, and prevention
 Evaluation
Changing public health policy as needed
and assessing pevious step
12. How to prevent an outbreak
 Dental promotion, simulation, immunization
13. Is HIV a outbreak? Define the outbreak
first
 WHO: occurence of cases of disease in
excess of what would normally expected
in a define community, geographical area
or season.
 HIV outbreak: hiv used to be an outbreak,
but now it’s endemic especially in africa.
(transformation of HIV from endemic to
low level a pubheatlh approach due to
combination prevention)
 The status of outbreak is relative to the
usual frequency of the disease in the
same area among the same season.
(communicable disease management
protocol manual, by manitoba health pub
health)
14. Vaccine or immunization? The difference
 WHO: vaccine is a process that stimulate
the bodies own immune system to
 protect the person againts the
subsequent infection or disease
 Vaccination: when a vaccine is
administered or injected to your body
(National Perscribing Service). Getting a
vaccine into the body in order to produce
immunity to a specific disease(CDC).
 Immunization: process whereby a person
is made immune or resistance to an
infectious disease
 Imm: what happen in our body after
getting vaccination. (pathogenesis of
infectious disease and mechanism of
immunity)
 Passive – antibody is injected
 Active – antigen is injected
15.