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Leptospirosis Outbreak

Investigation in Sampang
District
Madura, East Java-
Indonesia
Farida D. Handayani
Ristiyanto
Mega Tyas
Abdul Haris
Misriyah
IVRCRD NIHRD-Directorate General of DC-EH
Ministry of Health, Republic of Indonesia
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IVRCRD SALATIGA
Institute for Vector and Reservoir Research
and Development
NIHRD-Ministry of Health
Vector borne diseases
and zoonosis control
Plague
Leptospirosis Nipah
Hantavirus Rabies

Malaria
Japanese encephalitis
Filariasis
Chikungunya

Dengue

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THE ORGANIZATIONAL STRUCTURE OF
NATIONAL INSTITUTE OF HEALTH RESEARCH AND DEVELOPMENT

NATIONAL INSTITUTE OF
HEALTH RESEARCH
AND DEVELOPMENT
(NIHRD)

SECRETARY OF NIHRD

CENTER FOR CENTER FOR APPLIED CENTER FOR CENTER FOR HUMANITIES,
BIOMEDICAL AND TECHNOLOGY OF HEALTH INTERVENTION POLICY, HEALTH,
BASIC TECHNOLOGY AND CLINICAL TECHNOLOGY OF AND PUBLIC
OF HEALTH EPIDEMIOLOGY PUBLIC HEALTH EMPOWERMENT

INSTITUTE FOR VECTOR


INSTITUTE FOR MEDICINE AND RESERVOIR
PLANTS AND
CONTROL RESEARCH
TRADITIONAL MEDICINES
(IMPTM) AND DEVELOPMENT
(IVRCRD)
Ministry of Health
communicable disease
control priorities
AVIAN INFLUENZA
RABIES
LEPTOSPIROSIS
ANTHRAX
PLAGUE

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Leptospirosis Studies (2004-
2015)
Leptospirosis Epidemiology
Reservoir
Agent of leptospirosis
Environmental Risk Factors
Leptospirosis Control
Rodent Control
Molecullar Epidemiology
Mollecullar Diagnosis

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6
Research sites:
Type of leptospirosis areas in
Indonesia

Highland areas

Rice Field
Flood Areas Area

Rice field
200-900 m
Slum Areas

50-200 m

sawah

25-50 m

025m
Environment, Host-Reservoir and Risk
Factors
Demak District Klaten Purworejo Kulonprogo,
Risk Factor District
Risk Factor Risk Factor
DIY
Risk Factor
Occupation related Housewife and Rice-field Farmers;
to the dirty places, domestic coconut-palm
Farmers
wetlands and workers (EI, plantation
rivers; 2005) Reservoir farmer
Rat infestation Sugar cane R. tanezumi
Reservoir
plantation Serovar
R. tiomanicus
Reservoir farmer Autumnalis
Serovar
R.norvegicus, R. Reservoir
Icterohaemorrh
tanezumi dan R. R. tanezumi agia dan
exulans
Serovar Bataviaea
Serovar Semak/ hutan sekunder
Autumnalis &
Autumnalis & L. Icterohaemorrha
sawah (Kec. Nanggulan, D.I Yogyakarta ;
Icterohaemorrhagi giae dan

tinggi/pegunungan
pegunungan 200-400 m)

Ekosistem datran
ae dan Bataviaea pemukiman
Bataviaea (Kec. Jogonalan, Kab. Klaten
dan Kec. Purworejo, Kab.
pantai sawah
Purworejo, Jawa Tengah;
(Kec. Bonang, Kab. Demak; dataran rendah, 50-200 m, )
daerah pantai, 0-50 m)
Leptospirosis Outbreak in
Sampang District? (Madura-
East Java)

Penelitian Kerjasama Balai Besar Penelitian dan


Pengembangan Vektor dan Reservoir Penyakit
Salatiga dan Dinas Kesehatan Kota Semarang,
2012
SITUATION OF SAMPANG
LEPTOSPIROSIS OUTBREAK
April 8, 2013 - Big flood (10Y cycle)
April 10, 2013 - leptospirosis cases suspect (2 cases)
April 12, 2013 one suspect died
April 24, 2013 21 cases were reported
April 27, 2013 4 probables died; Outbreak announced
April 29, 2013 IVRCRD informed by Zoonosis sub-
directorate
April 30, 2013 Outbreak team departed to Sampang
May 4, 2013 65 cases reported, 8 died (CFR 12,3%)
Outbreak Area

input Intervention output


The discovery of 1.The proportion of
the source of leptospirosis
infection; 2.Source of
1.Fever population transmission
2.Water/environment
evaluation Changes in knowledge
3.Reservoir ; rodents Health of leptospirosis
promotion and transmission &
Community
treatment prevention
methods
Environment Changes in the
Puddle Antibacterial /
disinfectant condition of water
Drain
contaminated with
Containers
pathogenic bacteria
leptospira
Rodent control Changes in the relative
The main Reservoir; Livetrap density of reservoirs of
Rats; rodents inside/outside leptospirosis (rodents)
houses

Leptospirosis
Cases Decline
Screening of
Leptospirosis
1. Human
1. Human 2. Reservoir
2. Reservoir

3.Environme
3.Environme
nt
nt
Mapping of
Mapping of leptospiosis
leptospiosis

Spatial
Spatial
analysis
analysis

Intervention
Intervention
1.
1. 2.
2.
Community Environment
Community Environment
3. Rodent
3. Rodent control
control
Coordination
Provincial level - District level- community level

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Screening Results in
Humans

Screening team Interview Blood sampling

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Rapid diagnostic test
Detection of pathogenic leptospires in
human cases


Hasil RDT Merk Hasil RDT Merk
Hasil PCR SD Focus Keterangan
Lane1 m : Marker
Lane2 K+ : Kultur lepto Positive
Lane3 M1 : Choirul Umam Human blood Negative negative Positive Sampel darah terlalu sedikit
Lane4 M2 : Bahri Human blood Negative - Negative
Lane5 M3 : M.ali Human blood Positive - Positive
Lane6 M4 : Moh.subhan Human blood Positive Positive tidak dilakukan
Lane7 M5 : Moh.Aditya Human blood Positive - Negative
Lane8 M6 : Fauziah Human blood Positive - Negative
Lane9 M7 : Sugianto Human blood Positive Positive Positive
Lane10 M8 : Khoirunisa Human blood Positive - Negative
Lane11 M9 : Tuma Human blood Positive Positive Negative
Lane12 M10 : Namartatula Human blood Positive - Positive
Lane13 M11 : Leyza Tara Human blood Positive - Positive
Lane14 M12 : Hanaf Human blood Negative - Negative
Lane15 M13 : Fathorahman Human blood Positive - Positive
lane 16 M14 : Abd.Aziz Human blood Positive - Negative
Lane17 M15 : M.abdullah Human blood Positive - Negative
Lane18 M16 : Syamsiyah Human blood Positive Positive Positive
Lane19 M17 : Murawati Human blood Positive negative Negative istri pasien atas nama ali
Lane20 M18 : Rahmat N Human blood Positive Positive tidak dilakukan
Lane21 M19 : Sahdi Human blood Positive - Positive
Lane22 M20 : Ach.Animan Human blood Positive - Positive
Lane23 M21 : Sugiarto Human blood Positive - Positive
Lane24 M22 : Chitamul Human blood Positive tidak dilakukan Positive Awal MRS dengan diagnosa DBD
Lane25 K- : Kontrol Negative Negative
Lane26 K- : Kontrol Negative Negative
Leptospirosis laboratory (IVRCRD
Salatiga)

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Storage of Serovar

Culturing 20 serovars
MAT (Microscopic Agglutination Test)

MAT Patient Serum


1:160
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Gender and Leptospirosis in
Sampang
Woman
Man

Leptospirosis patients mostly were male (62%)


Age of Leptospirosis cases

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Clinical symtoms of
Leptospirosis cases 1. Fever
2. Contact with flood
water
3. Headache
4. Nausea
5. Myalgia
6. Ikterik
7. Brown urin
8. Cough
9. Asphyxiate
10. Conjuntivitis

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Laboratory test from Sampang
Hospital
1. SGOT
2. Kreatinin
3. SGPT
4. Hiperglikemia
5. Hiperbilirubinemia
6. High urea in
blood

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Distribution and
CFR of
leptospirosis
cases in
Sampang

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Environmental investigation and
intervention
Environment surveys in Sampang, East Java
1. Chlorine survey in the water reservoir
Chlor content Chlor measurements * (mg/L)
Sub requirement for
Distric killing Water container Puddle/Drain
t Leptospira sp Pre Post Pre Post Well
(mg/L)
Ron Tengah 0 1.23 0 0,5 Changing Chlor levels at
Gn. Sekar 0.5 3 0,25 1.90 0 0,25 pre and post application of
Kontrol 0 0 0 0 Sodium Hypochlorite.
(Dalpinang)

2. Disinfectant (Sodium
hypochlorite)
Water container in Ron Tengah
was positive bacteria
pathogenic Leptospira
Water examination after
intervention of Sodium
Hypochlorite was negative
Administration of Disinfectants Sodium
Hypochlorite 1%

Water sampling in
river

Giving disinfectants in
public
Percentage of population receiving and using
sodium hypochlorite in Sampang district,
East Java
(2 villages; n = 150 samples)
Pengujian sodium hipoklorit thd
tumbuhan di Lab. B2P2VRP

48% (72 of 150 samples of the population accepted and


used sodium hypochlorite).
Residents who do not use sodium hypochlorite, because of
the smell and kill fish.
2. Rodent survey in Sampang

Domestic rodent R.
tanezumi (40%) and R.
norvegicus (36%) were
dominant than other
species

R. norvegicus was positive


leptospirosis
Trap Success at Treatment and Control Areas
(number of trap = 100 units / days)

Treatments Control

There is no signifcant difference (p> 0.5) relative density


of Rats before and after the intervention of rodent control
(livetrap) by 2 days observation
Health Promotion for Prevention
Leptospirosis

Handed poster to

Pemasangan
baliho

Penyuluhan
Health Promotion
leptospirosis prevention
materials
Leptospirosis Etiology
Cause Baliho
Transmission pathway
Symptoms
Reservoir

Preventive and Rodent Control Poster


Method for rodent control
Method to avoid direct contact with the
bacteria
Method for washing the trap properly
The benefits of sodium hypochlorite
Awarness to visit doctor or hospital in early
Leaflet
infection
UMUR JENIS KELAMIN

Perlakuan Kontrol
(Kel.Ron Tengah & Gn. (Kel. Dalpinang)
Sekar) N=55
N=45 (Ron) ; 57 (Gn.Sekar) Perlakuan
TINGKAT PENDIDIKAN

Kontrol
There was a transtition of knowledge of leptospirosis
prevention before and after the health promotion intervention
(p<0,5).
Health Promotion Method which was
preferred by respondents in Sampang, Jawa
Timur

Face to face counseling was preferred by respondents


(81,4-83,3%)
Conclusions
1. Leptospirosis outbreaks had occurred in Sampang District,
Madura, East Java, by 65 Leptospirosis cases and 8 died
CFR 12.30%.
2. Face-to-face counseling was preferred by respondents
compared with the method of leaflets, posters and billboards.
3. Administration of a dose of 1% sodium hypochlorite can
increase the levels of chlorine in water
4. Potential sources of transmission of leptospirosis in the
outbreak area in Sampang district were water environment;
puddles and drains.
5. Leptospirosis reservoir potential in Sampang district, East
Java were R. norvegicus, R. tanezumi, and R. exulans.
Training leptospirosis at IVRCRD
Salatiga by WHO CC for
leptospirosis, Port Blair India
Thank you
TERIMA KASIH
MATUR SUWUN

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