Dengue Haemorrhagic Fever Outbreaks in Indonesia 1997-1998 By Directorate of Vector Borne Disease Control, Ministry of Health, Indonesia
Suroso T., Holani Achmad, Ali Imran
Directorate-General of Communicable Diseases Control and Environmental Health,
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 DecemberJanuary 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 16 005 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 Dengue Bulletin – Vol 22, 1998
that time, only two districts (0.6% of affected by the disease and the 45
the total number of districts) were
Dengue Haemorrhagic Fever Outbreaks in Indonesia 1997-1998
number of cases reported was 53 with 24 deaths (CFR=45.3%). Since then, 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 31 had been reported. the areas affected have enlarged and
The
DHF
incidence
fluctuates
annually due to the occurrence of DHF outbreaks every year in different aras of Indonesia. During the period from 1968 to 1998(3), 30-year there
were four significant DHF outbreaks, which occurred in 1973, 1983, 1988 and 1998. The number of DHF cases December-January every year (Fig.1).
784 cases with 705 deaths (CFR=2.2%)
in Indonesia usually increases during
Figure 1. Number of DHF Cases in Indonesia by Months, 1994-1998
However, in big cities such as Jakarta, Bandung and Surabaya, the incidence reaches its peak in AprilMay. Ae. aegypti, the main vector of DF/DHF, is widely disitributed in houses and public places. The average 46
house index (HI) estimated for A. Indonesia in 1997 was 20.8%.
aegypti larvae in different provinces of
DHF outbreaks in 1997Dengue Bulletin – Vol 22, 1998
Dengue Haemorrhagic Fever Outbreaks in Indonesia 1997-1998
1998 During the period November 1997May 1998, DHF outbreaks from in The in Indonesia. were 18 11 total reported provinces
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 1998. In Jakarta the outbreak began in March 1998. The period of the DHF outbreaks ranged from 2 to 3 months.
districts/municipalities
number of cases was 16 005 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 13 441 009 of which Jakarta accounted for 10 621 814 people (79%).
Period of outbreaks The outbreak 1997 started in Jambi, during South November Sumatera, and Lampung (western part of Indonesia) and lasted till JanuaryFebruary 1998. Subsequently, the Table 1. Number of DHF cases reported by Provincial Distrct from November 1997 – May 1998 Province South Sumatera District Palembang Muaraenim Banyuasin Musirawas Populatio n (000) 1264 690 1355 564 Period Nov.97-Feb 98 Nov.97-Feb.98 Nov.97-Feb.98 Nov.97-Feb.98 Cases 2094 140 114 249 Deaths 73 9 3 10 CFR (%) 3.5 6.4 2.6 4.0 AR (0/00 0)** 1.6 0.2 0.08 0.4
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Dengue Haemorrhagic Fever Outbreaks in Indonesia 1997-1998
Sub total Jambi Lampung DKI Jakarta Jambi(M) Tig.Bawang Cent.Jakarta East Jakarta S.Jakarta W.Jakarta N.Jakarta Sub total South Sulawesi Central Sulawesi North Sulawesi Southeast Sulawesi NTB East Timor Maluku Total Bima Diti Ambon Maros Palu Manado Buton
3873 356 255 1371 2643 2389 2376 1843 10622 262 227 362 429 472 154 302 13441 Jan.97-Feb.98 Jan.98-Feb.98 Jan.98-Feb.98 Jan.98-Feb.98 Jan.98-Apr.98 Jan.98-Apr.98 Feb.98-Apr.98 Nov.97-Jan.98 Dec.97-Jan.98 Mar.98-May 98 Mar.98-May 98 Mar.98-May 98 Mar.98-May 98 Mar.98-May 98
2597 514 129 1679 3169 2397 2377 2667 12289 69 57 80 120 172 44 14 16005
95 13 3 12 20 16 25 30 103 2 2 2 12 16 1 1 250
3.6 2.5 2.3 0.7 0.6 0.6 1.0 1.1 0.8 2.8 3.5 2.5 10.0 9.3 2.3 7.1 1.5
0.6 1.4 0.5 1.2 1.2 1.0 1.0 1.4 1.2 0.3 0.3 0.2 0.3 0.4 0.3 0.04 1.2
*CFR=Case fatality rate
** AR=Attack rate
The number of cases reported from the outbreak areas totalled 16 005, of which 12 289 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, North Palembang, Jakarta, East Central Jakarta, Jakarta, South
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,
Jakarta and West Jakarta. The highest 48
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Dengue Haemorrhagic Fever Outbreaks in Indonesia 1997-1998
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 providers, resources which as and well (2) as health of shortage
and to cover water containers and all other possible articles conducive for
Ae. aegypti breeding. In Jakarta and other provinces, all the Governors and district the Mass were In was instructed control control trained supervised addition, Mayors
chiefs to personally supervise the activities, including larvae. who fogging campaign for source reduction, to
Ae.
aegypti
larviciding was largely implemented by personnel by health insecticide centres.
including in
laboratory poor case
facilities, especially in small towns resulted management in hospitals.
applied by district or municipal health offices in areas which had a high concentration of DHF cases.
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 additional authorities, equipment provided the technical guidance, insecticides and including 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
aegypti larval source reduction was
Ae.
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.
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Dengue Haemorrhagic Fever Outbreaks in Indonesia 1997-1998 2. Partana et al. Haemorrhagic fever shock syndrome in Surabaya, Indonesia. Kobe J Med Sci, 1970 16:189-201. 3. Suroso T. Dengue haemorrhagic fever in Indonesia: Epidemiological trend and development of control policy. WHO/SEARO Dengue Bulletin 1996, 20:35-39. 4. Suroso 1996. T and fever Ali Imran. report Dengue 19681997. haemorrhagic in Indonesia
Unpublished
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