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International Health Regulations, the most recent: 2005, Enacted July 2007
General Preview
2.8
USA / Canada 35.2 million
2.4
3.6
4.6 1.6
6.1
Japan 11.4 million
2.3
19
7.8
6.8
2.5 1.9
1.3
4.8 2.6
INA <1 million AUS / NZ 3.3 million
1.2
General preview
1. Number of people traveling internationally increasing every year. 2. WTO; 2010 reached 999 million.
Hepatitis A - or immune globulin (IG) hepatitis B if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment Japanese encephalitis only if you plan to visit rural areas for 4 weeks or more, except under special circumstances, such as a known outbreak of Japanese encephalitis Rabies - if you might be exposed to wild or domestic animals through your work or recreation
Typhoid Tetanus - booster dose as needed, diphtheria - booster dose as needed, measles - booster dose as needed
Pre-Travel
Visitors
Post-Travel
1. Pre-travel a) Consultation (age, pregnancy & disability). b) Health education c) Immunization d) Prophylaxis 2. During travel a) First aid medical kit b) Doctors letter 3. After travel (if) a) Had exposure b) Injury c) Further consultation after travel
Mortality:
1) Cardiovascular Disease (50 to 70%). 2) Accidents/Trauma (20-25%). 3) Infectious diseases (2.8-4%).
19
20
Immunizations
Advised recommendations:
Routine (wajib) Required (tambahan) Recommended (anjuran)
Immunizations (cont.)
1. Routine (7 immunizations):
T-dap/DPT (Tetanus + Diphtheria +Pertusis); Africa, Asia, America, Middle East, Europe. (3x/>2 bln) MMR/Campak (2x/9 bln); Africa & Asia. Influenza (seasonal) Australia, China Hepatitis A & Hepatitis B: all destinations (3x/<1bln) Polio (4x/<1bln) Varicella (1x/9 bln) Tuberculosis (BCG/1x/<2 bln)
Immunizations (cont)
2. Required (Tambahan) Yellow fever (virus/manusia/A.aegypty), Influenza (virus/manusia/unggas/babi) Meningococcal (virus/bakteri/manusia) (for Hajj):
tropical Africa tropical South America [none in Asia]
Immunizations (cont)
3. Recommended (anjuran)
Typhoid fever (1x/>2thn) Consider: rabies (3x/all age) Consider: Japanese encephalitis (3x/adult) Cholera: No.
Mosquitoes: 1.Aedes
a.Dengue fever b.Rift Valley fever c.Yellow fever d. Chikungunya a. Lymphatic filariasis b. Malaria a. Japanese encephalitis b. Lymphatic filariasis c. West Nile fever
2. Anopheles 3. Culex
Malaria
1) Protozoan organism, vector is Anopheles mosquito. 2) Illness characterized by high fevers, sweats, chills. 3) P. falciparum is the most prevalent species worldwide; associated with significant mortality. 4) There are approx. 100 countries in which malaria is endemic.
1. 2. 3. 4. 5.
Treatment of diarrhoea
1. Most diarrhoeal episodes are self-limiting, with recovery in a few days. 2. avoid becoming dehydrated. 3. fluid intake should be maintained with safe liquids (boil, bottled) 4. < 2 thn (50-100 ml)/0.5 L 5. 2-9 thn (100-200 ml)/1 L 6. > 10 thn (as much as wanted)/2 L /a day.
Jet Lag
1982
1983
Jml Kasus
National Guidelines
Travel Health Guidelines Malaria Guidelines Immunisation Guidelines Antibiotic Guidelines Journals Seminars
PRESCRIBE
(Script/Drs letter/bracelet)
Always Regular medication medical kit (first aid) Sometimes Anti malarial medication Diarrheal self-treatment. Condoms.
Correct advice is even better if the advice is actually followed by the traveller
Documentation Follow-up
Traveled Prevention
Traveled Prevention
1. Check-list for the traveller a) Risk related to the area (urban or rural) b) Type of accommodation (hotel, camping) c) Length of stay d) Altitude (alcohol) e) Security of problem (e.g: conflict) f) Availability of medical facility 2. Vaccination (4-8 weeks before departure) 3. Malaria 4. Specific local disease who travel med.PDF - Ixxxviii 5. Meningococcal disease is required by Saudi Arabia for pilgrims visiting Mecca for the Hajj.
6. 7.
8. 9.
Precaution
1. Avoid direct contact with domestic animals in areas where RABIES OCCURS, and with all wild and captive animals. 2. Avoid behaviour that may STARTLE (mengejutkan), frighten or THREATEN (menakut-nakuti) an animal.
3. Ensure that children do not APPROACH (mdekati), TOUCH (myentuh) or otherwise provoke any animal.
4. Treat any animal bite immediately by WASHING with disinfectant or soap and seek medical advice 5. If a significant risk of exposure to rabies is foreseen (dipastikan), seek medical advice before travelling.
Epidemiology Schistosomiasis
PICTURE SPECIES WORM CAUSE LYMPHATIC FILARIASIS IN INDONESIA (POSITIVE MICROFILARIASIS) (Source: Health Department Agam District)
POSITIF MICROFILARIASIS If the speciment blood we find species worm causes lymphatic filariasis by the laboratory test (microscopically)
Sub-District
2005
2006
2007
2008
Tanjung Mutiara
30
34
34
49
Lubuk Basung
35
IV. Nagari
Palembayan
Tanjung Raya
TOTAL
37
44
48
91
Tanjung Mutiara Lubuk Basung IV. Nagari Palembayan Tanjung Raya TOTAL
30 7 37
34 9 1 44
34 9 3 1 1 48
49 35 5 1 1 91
34 50 5 1 1 91
Case-clustering (Satscan)
SATSCAN is a method to measure or find clustering between all cases based on geoanalyses distance all filariasis cases.
1.Coordinates : 00,185790 S/-99.775720 E 2.Radius : 840 m (high risk)
Study Objective
1. To confirm spatial distribution of Lymphatic Filariasis in Agam District to ensure interventions target appropriate populations at-risk.
To assist risk factor for Lymphatic Filariasis in Agam District.
2.
Epidemiology Schistosomiasis
Dengue Virus
1. Causes dengue fever and dengue hemorrhagic fever 2. (20 million) cases of dengue infection result in an estimated 24.000 deaths annually 3. Flavivirus group. 4. Transmitted by mosquitoes (female). 5. (4 serotypes/DEN-1, 2, 3, 4)
Epidemiology Dengue
Epidemiology Dengue
Dengue Viruses
Each serotype provides specific lifetime immunity, and short-term cross-immunity All serotypes can cause severe and fatal disease Genetic variation within serotypes Some genetic variants within each serotype appear to be more virulent or have greater epidemic potential
Aedes aegypti
Dengue transmitted by infected female mosquito Primarily a daytime feeder Lives around human habitation Lays eggs and produces larvae preferentially in artificial containers
Dengue fever
Key Point Dengue 1. Beda DHF dengan DF bukan perdarahan 2. Hemokonsentrasi bukan PCV > 3 X Hb 3. Kurang tepat bila pemeriksaan Dengue blot dilakukan pada awal penyakit 4. Deteksi keadaan syok jangan terfokus pada tekanan darah saja. 5. Jangan lupa memantau diuresis 6. DSS bukan hanya DBD grade IV saja
PENATALAKSANAAN 1. Terlalu dini/agresif memberi IVFD 2. Terlambat menghentikan/ memperlambat tetesan IVFD. 3. Terlambat memberikan cairan koloid pada kebocoran plasma yang hebat. 4. Terlambat memberi transfusi darah pada perdarahan tersembunyi. 5. Terlalu agresif memberi suspensi trombosit. 6. Jangan lupa memberi Oksigen pada kasus DSS
HIV/AIDS
10 Provinces in Indonesia with the highest reported AIDS cases up to June 30, 2005
1800 1611 1600 1400 1200 1000 800 600 435 400 255 185 156 200 0 DKI Papua Jatim Jabar Bali Jakarta
111
107
72
61
52 Riau
Cumulative percentage on reported AIDS cases in Indonesia by age group up to June 30, 2005
60 50 40 53.87
Percent
30 20 10
25.58
8.46
0.83
0
< 1 yr
0.57
1-4 yrs
0.18
3.90
1.94
0.74
3.93
5-14 yrs 15-19 yrs 20-29 yrs 30-39 yrs 40-49 yrs 50-59 yrs 60 yrs
Unkown
Age groups
Cumulative Percentage on AIDS Cases in Indonesia by Mode of Transmission up to June 30, 2005
50 45 47.2
40 35
36.4
Percent
30 25 20 15 10 5 0
Homosexual Heterosexual
Risk factors
20 18 16 14
(KASUS)
12 10 8 6 4 2 0
1,8-9 1 0
10-14 0 0
15-19 3 0
20-24 15 8
25-29 19 11
30-34 13 11
35-39 8 1
40-44 3 3
45-49 1 0
Unknown 0 2
HIV AIDS
KASUS HIV/AIDS MENURUT PROFESI DI PROPINSI NTB TAHUN 1992 - 2006 (30 DESEMBER)
25
20
(KASUS)
15
10
0 GUIDE 2 1 NAPI 5 1 SWAST CLN TKI A 3 0 21 15 M TN TKW 2 0 PNS/HO IBU RT SOPIR NOR 6 2 3 1 0 1 PKJ WST 0 1 PLJ/M H S 3 2 BRH KSR 0 2 WPS 7 0
HIV AIDS
PERSENTASE KUMULATIF KASUS HIV/AIDS BERDASARKAN FAKTOR RISIKO TAHUN 1992 - 2006 (30 DESEMBER)
45.00
42.42
40.00
35.00
31.31
30.00
(PERSENTASE)
25.00
22.22
20.00
15.00
10.00
5.00
(FAKTOR RISIKO)
Female Male
29.8
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0
Persentase pelajar SMA di Jakarta dan Surabaya yang melaporkan pernah berhubungan seks
(Sumber : Utomo dan Dharmaputa, 2000)
25
22
20
15
11.4
10
8.8 8
5
2 0.5 1997
Remaja pria di Jakarta Remaja pria di Surabaya
4.3
1998
Remaja perempuan di Jakarta Remaja perempuan di Surabaya
Papua
Riau
HIV Prevalence among Waria (Transvestites), Male Sex Workers, and Gay Men
21.7 Waria
3.8 Male Sex Workers HIV rates for Gay Men and Male Sex Workers in 2002 similar to rates for Waria in 1996 2.5 Gay
60
HIV Prevalence trend among IDUs In Jakarta and Bogor, Year 1996 - 2002
48
RSKO, Jakarta
50
45 41
40
30
30
20 16 10
14
16
0
1996
0
1997 1998 1999 2000 2001 2002
Source: PMI
ODHA
ODHA (22 thn) hamil 7 Bulan Gambar diambil 22 Juli 2004 Meninggal 27 Juli 2004
DURING THE TRIP Avoiding mosquito-borne diseases 1.Mosquito can transmit several lethal diseases such as yellow fever, dengue fever and malaria. 2.Avoid being outdoors during mosquito feeding times (between dusk and dawn for Malaria; daytime for Dengue Fever). 3.While outdoors, wear long-sleeved clothing to cover the arms , legs, and particularly the ankles.