Dengue Haemorrhagic Fever Outbreaks in Indonesia

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1 Dengue Haemorrhagic Fever Outbreaks in Indonesia By Suroso T., Holani Achmad, Ali Imran Directorate of Vector Borne Disease Control, Directorate-General of Communicable Diseases Control and Environmental Health, Ministry of Health, Indonesia Abstract Since the last three decades, dengue haemorrhagic fever (DHF) has been endemic in Indonesia. The DHF incidence fluctuates monthly and reaches its peak in December- January every year except in big cities such as Jakarta, Bandung and Surabaya, where the highest incidence occurs in April-May. During the period November 1997-May 1998, DHF outbreaks occurred in 18 districts/municipalities of 11 provinces in Indonesia. The total number of DHF cases reported were with 250 deaths (CFR 1.5%.) The highest number of cases in 1998 were reported in April when the peak was reached in Jakarta. Control measures were carried out by each regency/municipality which were supported from provincial and central levels. The activities included: health education to communities through the mass media, and Ae. aegypti larval source reduction through community participation and mass larvaciding. In addition, insecticide ULV fogging was applied in areas with a high concentration of DHF cases. Keywords: Dengue fever, Aedes aegypti, outbreak, Indonesia. Introduction The appearance of DHF cases in Indonesia was first reported from Jakarta (1) and Surabaya in 1968 (2). At that time, only two districts (0.6% of the total number of districts) were affected by the disease and the Dengue Bulletin Vol 22,

2 number of cases reported was 53 with 24 deaths (CFR=45.3%). Since then, the areas affected have enlarged and the DHF incidence has increased from year to year. Up to 1997, the disease had spread to 240 districts (78.9% of the total number of districts) and cases with 705 deaths (CFR=2.2%) had been reported. The DHF incidence fluctuates annually due to the occurrence of DHF outbreaks every year in different aras of Indonesia. During the 30-year period from 1968 to 1998 (3), there were four significant DHF outbreaks, which occurred in 1973, 1983, 1988 and The number of DHF cases in Indonesia usually increases during December-January every year (Fig.1). Figure 1. Number of DHF Cases in Indonesia by Months, However, in big cities such as Jakarta, Bandung and Surabaya, the incidence reaches its peak in April- May. Ae. aegypti, the main vector of DF/DHF, is widely disitributed in houses and public places. The average house index (HI) estimated for A. aegypti larvae in different provinces of Indonesia in 1997 was 20.8%. DHF outbreaks in Dengue Bulletin Vol 22, 1998

3 1998 During the period November May 1998, DHF outbreaks were reported from 18 districts/municipalities in 11 provinces in Indonesia. The total number of cases was with 250 deaths (Table 1). All the outbreak areas were urban, which were either the headquarters of districts/ municipalities or the capital cities of provinces. The total population of the affected areas was of which Jakarta accounted for people (79%). outbreaks occurred in the eastern part of Indonesia (all provinces in Sulawesi island and the provinces of West Nusatenggara and East Timor) which started from December 1997, followed by the outbreak in Ambon, the capital of Maluku province, in February In Jakarta the outbreak began in March The period of the DHF outbreaks ranged from 2 to 3 months. Period of outbreaks The outbreak started during November 1997 in Jambi, South Sumatera, and Lampung (western part of Indonesia) and lasted till January- February Subsequently, the Table 1. Number of DHF cases reported by Provincial Distrct from November 1997 May 1998 Province District Populatio n (000) Period Cases Deaths CFR (%) AR (0/00 0)** South Palembang 1264 Nov.97-Feb Sumatera Muaraenim 690 Nov.97-Feb Banyuasin 1355 Nov.97-Feb Musirawas 564 Nov.97-Feb Dengue Bulletin Vol 22,

4 Sub total Jambi Jambi(M) 356 Nov.97-Jan Lampung Tig.Bawang 255 Dec.97-Jan DKI Jakarta Cent.Jakarta 1371 Mar.98-May East Jakarta 2643 Mar.98-May S.Jakarta 2389 Mar.98-May W.Jakarta 2376 Mar.98-May N.Jakarta 1843 Mar.98-May Sub total South Sulawesi Maros 262 Jan.97-Feb Central Sulawesi Palu 227 Jan.98-Feb North Sulawesi Manado 362 Jan.98-Feb Southeast Sulawesi Buton 429 Jan.98-Feb NTB Bima 472 Jan.98-Apr East Timor Diti 154 Jan.98-Apr Maluku Ambon 302 Feb.98-Apr Total *CFR=Case fatality rate ** AR=Attack rate The number of cases reported from the outbreak areas totalled , of which cases (76.7%) were from Jakarta alone. The average attack rate (AR) was 1.2 per 1000 population. The districts and municipalities with an attack rate of more than 1.0 per 1000 population were: Jambi, Palembang, Central Jakarta, North Jakarta, East Jakarta, South Jakarta and West Jakarta. The highest attack rate occurred in Palembang (1.6 per 1000 pop.), Jambi (1.4 per 1000 pop.) and North Jakarta (1.4 per 1000 pop.). The average case fatality rate (CFR) during the outbreaks was 1.5%. The districts and municipalities with the case fatality rate of more than 2.5 % were: Palembang, Muaraenim, Banyuasin, Musirawas, Palu, Maros, 48 Dengue Bulletin Vol 22, 1998

5 Buton, Bima and Ambon. The highest CFR was reported from: Buton (10.0%), Bima (9.3%), Ambon (7.1%), and Muaraenim (6.4%). Factors influencing the high CFR in these four towns included: (1) the first time occurrence of DHF cases/ outbreaks in the areas (Bima and Buton) had led to a poor understanding of the disease by the community as well as health providers, and (2) shortage of resources including laboratory facilities, especially in small towns which resulted in poor case management in hospitals. Control of outbreaks The control of DHF outbreaks was carried out by each regency or municipality and their efforts were supported by provincial and Central governments and the private sector (4). The Central government, together with provincial authorities, provided technical guidance, insecticides and additional equipment including the infuse sets and operational funds. A campaign to control Ae. aegypti larvae was announced at the Central level by the Minister of Health in April 1998 which called for the community to empty and refill water tanks regularly and to cover water containers and all other possible articles conducive for Ae. aegypti breeding. In Jakarta and other provinces, the Governors instructed all Mayors and district chiefs to personally supervise the control activities, including the campaign for source reduction, to control Ae. aegypti larvae. Mass larviciding was largely implemented by trained personnel who were supervised by health centres. In addition, insecticide fogging was applied by district or municipal health offices in areas which had a high concentration of DHF cases. Ae. aegypti larval source reduction was carried out by schoolchildren under the direction of teachers. Education to the community was conducted through TV, radio and other branches of mass media. Communication and information activities on DHF prevention to mothers were carried out by cadres and PKK (Family Welfare Foster) through group education and house visits. References 1. Kho LK et al. Dengue haemorrhagic fever in Jakarta. Majalah Kedokteran Indonesia, 1969, 19:417. Dengue Bulletin Vol 22,

6 2. Partana et al. Haemorrhagic fever shock syndrome in Surabaya, Indonesia. Kobe J Med Sci, : Suroso T. Dengue haemorrhagic fever in Indonesia: Epidemiological trend and development of control policy. WHO/SEARO Dengue Bulletin 1996, 20: Suroso T and Ali Imran. Dengue haemorrhagic fever in Indonesia Unpublished report Dengue Bulletin Vol 22, 1998

Dengue Haemorrhagic Fever in Thailand

Dengue Haemorrhagic Fever in Thailand By Wiwat Rojanapithayakorn Office of Dengue Control, Department of Communicable Diseases Control, Ministry of Public Health, Thailand Abstract Dengue haemorrhagic fever was first reported in Thailand in