Alex Chairulfatah

Hospital based clinical surveillance for dengue haemorrhagic fever in Bandung, Indonesia 1994–1995

In Indonesia, by law dengue haemorrhagic fever (DHF) cases must be reported within 24 h to the district health authority. The objective of this study was to evaluate the adequacy, accuracy and reporting delay of this reporting system. In four major hospitals of the city of Bandung, medical records of hospitalised DHF cases admitted between April 1994 and March 1995 were reviewed. This list of DHF cases was compared with the list of reported cases to the Bandung Municipality Health Office. During the study period, 569 DHF cases and 81 dengue shock syndrome (DSS) cases were diagnosed. Only 199 (31%) of the 650 hospitalised cases with suspected DHF/DSS were reported to the Bandung Municipality Health Office. The percentage of fatal cases was significantly lower among all hospitalised cases 11/650 (1.7%) than among reported cases 5/199 (2.5%). In only 443 of the 583 hospitalised cases (76%) in which a dengue serological test was performed, was this test positive. Of the 199 reported DHF/DSS cases 151 (76%) had a positive haemagglutination inhibition test. This study shows that the surveillance system for DHF/DSS in Bandung should be strengthened. DHF/DSS cases should be reported on the basis of a diagnosis made during hospitalisation preferably after a serological confirmation is obtained.

Wabah Difteri di Kecamatan Cikalong Wetan, Kabupaten Cianjur, Jawa Barat, Indonesia

Latar belakang. Sejak tahun 1986 tidak ditemukan lagi kasus difteri yang dirawat di Rumah Sakit Hasan Sadikin Bandung Jawa Barat. Namun, wabah difteri selalu terjadi di beberapa kabupaten di Jawa Barat seperti yang dilaporkan sejak tahun 1993 sampai tahun 2010. Kementerian Kesehatan juga melaporkan peningkatan kasus difteri di beberapa provinsi di Indonesia tahun 2010. Suatu penelitian saat wabah di Kecamatan Cikalong Wetan Kabupaten Cianjur tahun 2001 sebagai gambaran kejadian wabah di salah satu kabupaten di Jawa Barat. Tujuan. Menggambarkan kejadian wabah difteri, mengetahui tingkat kekebalan dengan mengukur kadar antibodi difteri dan untuk menemukan kemungkinan adanya kuman C. difteriaeberedar di masyarakat di daerah wabah. Metode. Data kejadian penyakit dan kematian diperoleh dari Puskesmas Cikalong Wetan RS Cianjur dan Dinas Kesehatan Kabupaten Cianjur. Data kadar antibodi diperoleh dengan mengukur kadar anti bodi terhadap difteri pada 698 subyek, yang dibagi menurut kelompok usia. Titer antibodi diukur dengan menggunakan teknik ELISA ganda. Hasil. Selama wabah terdapat 25 kasus yang dilaporkan dari Puskesmas Cikalong Wetan dengan angka kematian/crude fatality rate(CFR) 28%. Diduga kuat bahwa kasus pertama berasal dari kecamatan yang berdekatan dengan Kecamatan Cikalong Wetan. Beberapa bulan sebelumnya dijumpai kasus rawat inap 21 pasien, 55% di antaranya balita, dengan angka kematian 35% terutama disebabkan oleh miokarditis. Walaupun cakupan imunisasi difteri pertusis tetanus (DPT) tinggi pada anak kurang dari 1 tahun di Kecamatan Cikalong Wetan, hanya 19,3% anak usia 1 tahun memiliki tingkat kekebalan protektif yang memadai. Titer antibodi terus berkurang sesuai dengan meningkatnya usia anak, bahkan tidak ada subjek yang memiliki kadar protektif yang memadai pada kelompok usia 5 – 6 tahun. Enam dari 324 biakan apus tenggorokan pada masyarakat tumbuh strain toxigenic C. difteriae gravis. Kesimpulan. Wabah yang terjadi di Kecamatan Cikalong Wetan Kabupaten Cianjur disebabkan oleh karena rendahnya kadar antibodi terhadap toxigenic C.difteriaepada masyarakat.

Giardiasis in daycare centers at Rancabali tea plantation, Bandung District, Indonesia

Background In developing countries, the prevalence of giardia- sis in daycare centers is considerably high. There had been inad- equate report of giardiasis in Indonesia. Objective To know the prevalence of giardiasis in children and the number of children with symptomatic and asymptomatic giar- diasis who attended daycare centers at Rancabali tea plantation, Bandung district. Methods This descriptive study was conducted in daycare cen- ters between August to October 2002. Giardiasis was defined as the occurrence of G. lamblia cyst in stool specimen independent from the presence or absence of symptoms. Four of 12 daycare centers were chosen by cluster random sampling. All children aged 1 to 60 months attending daycare and staying for at least 2 weeks were included in this study. Three consecutive stool specimen pre- served by 10% formalin, concentrated by formalin ether, were ex- amined microscopically to find the G. lamblia cyst. Results Giardia lamblia cysts were found in 27 (29%) of the 92 children attending the daycare centers at Rancabali tea plantation (95%CI 20;38.6%). Of these children, 15 showed symptoms such as diarrhea episodes (8 children), diarrhea (5 children), bloating (5 children), abdominal cramp (5 children), and vomiting (3 children). Three children showed mild to moderate malnutrition. Ten children aged 13 to 36 month-old with G. lamblia-positive stool showed such symptoms. Conclusion The prevalence of G. lamblia infection in children at- tending daycare centers at Rancabali tea plantation was almost similar with other place in developing countries. More than half of patients had symptomatic disease