EPIDEMIC OF

DENGUE HAEMORRHAGIC
FEVER IN INDONESIA, 2004

R. Kustriastuti, U.Fahmi, A.Suwandono, T.Suroso

& S.Wuryadi

EPIDEMIOLOGY SITUATION
AND TRENDS (1969-2003)

ANALISIS SITUASI & KECENDERUNGAN

40

350

35

300

IR per 100.000 pddk

30

250

25
200

20
150

15
100

10

50

0
68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Tahun
IR per 100.000 pddk

Kab/Kota Terjangkit

Kab/Kota Terjangkit

INSIDENS DAN KAB/KOTA TERJANGKIT DBD PER TAHUN

DI INDONESIA TAHUN 1968-2003

AVERAGE YEARLY DHF CASES FATALITY RATE

BY 5 YEARS DEVELOPMENT PHASE
14

13.9

12
10
8
6

4.9

4.8

3.8

3.3

2.5

1.5

I (68-73)

II (73-78)

III (78-83)

IV (83-88)

V (88-93)

VI (93-98)

VII (99-01)

PERCENTAGE OF DHF CASES BY AGE

GROUPS (1993-2003)
YEAR

< 1 TH

1-4 TH

5-15 TH

> 15 TH

1993

0.7

18.8

60.0

20.5

1994

1.7

13.9

58.1

26.3

1995

0.4

12.3

57.0

30.3

1996

3.2

18.3

44.4

34.1

1997

2.8

15.6

46.1

35.5

1998

2.8

14.4

46.3

36.5

1999

3.4

15.6

34.0

47.0

2000

2.5

12.7

35.5

49.3

2001

2.6

12.6

33.9

50.9

2002

3.6

16.3

36.9

43.2

2003

3.7

14.6

30.3

51.4

Average No. DHF cases by months in Indonesia, 1997-2001

7000
6000
5000
4000
3000
2000
1000
0
JAN

FEB

MRT APR

MEI

JUN

JUL

AGT

SEP

OKT

NOP

DES

Jumlah rata-rata kasus per bulan

PJB/AS

PJB/AS

PJB/AS

PJB/AS

CASE MANAGEMENT, DHF SURVEILLANCE, COMMONUNICATION-INFORMATION-EDUCATION,

INDIVIDUAL CASE INVESTIGATION, FOCAL FOGGING.

Jumlah rata-rata kasus DBD per bulan di DKI Jakarta, 1996-2001

1200

J u m la h ka su s

1000
800
600
400
200
0
Jumlah kasus

Jan

Feb

499

690

Sumber: Dinkes Prop. DKI Jakarta

Maret April
969

769

Mei

Jun

Jul

Agust

Sept

Okt

Nop

Des

911

794

562

398

300

238

275

358

Bulan

GRAFIK TREND KASUSDAN CURAH HUJAN PER MINGGU DI WILAYAH

JAKARTA TIMUR TAHUN 1998-2002
500

500

KASUS
HUJAN

400

300

300

200

200

100

100

mm

400

0
1

7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 3

9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 2

8 11 14 17 20 23 26 29 32 35 38 41 44 47 50

7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 3

9 12 15 18 21 24 27 30 33 36 39 42 45 48 51

M I N GGU / T A H U N

1998

1999

2000

2001

2002

AVERAGE HOUSE INDICES

IN 27 PROVINCES OF INDONESIA
Types

HOUSE INDEX (%)

1992
1996

Houses
Schools
Public
places

29.2

22.5

25.9

28.7

23.8

16.2

Average

26.3

19.2

DHF EPIDEMIC 2004

30000

JUMLAHCASES
KASUS DBD
BULAN (1998-2004)
NUMBER
OFNASIONAL
DHF BYPER
MONTHS
(1998-2004)

25000

20000

15000

10000

5000

0
J F MA M J J A SO N D J F MA M J J A S O N D J F MA M J J A S O N D J FMA M J J A S O N D J F MA M J J A S O N D J F MAM J J A S O N D J F MA
1998

1999

2000

2001

2002

2003

2004

DENGUE OUTBREAK 2004

PROVINSI KLB MENURUT GRAFIK MIN-MAX

POTENSIAL
KLB

N
W

900

900

1800 Miles

No. DHF cases, deaths, in

Indonesia & Jakarta,
Jan-Apr 2004
----------------------------------------------------------Areas Cases Incidence Deaths CFR
(per 100.000)
(%)
----------------------------------------------------------Indon. 58,861
27.3
669
1.1
Jakrta 16,950
150.7
79
0.4
-----------------------------------------------------------

DHF Incidence Rates by Provinces, Jan-Apr.2004

15 0
14 0
13 0
12 0
110
10 0
90
80
70
60
50
40
30

IR = 10/100.000

20
10
0

D KI
Jak
a rt
a
IR 14 5

K a li
m a B al
nta i
n
59 48

Nu
sa
Te
ngg
43

Ja
wa
B ar
at
42

DI
Yo
g ya
kar
35

Sul
N u J a J a K a li K a li
M a
a w B a s a w a w a m a m a R ia L a P a lu k
nte
mp
esi
T e T i T e nta nta u
u
n
ung pua
Sel
n
ngg m u nga n
Uta
2 0 2 0 19 18 18 14 13 12 11 10 9 .4

Su
ma
ter
a
7 .9

Su
ma
ter
a
5 .8

Ba
B e ngk
ngk
a
u lu
B el
5 .3 5 .2

Sul
aw
esi
Uta
4 .5

Na
ngg
ro e
Ac
3 .6

Sul
aw
esi
Te
2 .8

K a li
m a Ja
nta m bi
n
1.9 1.8

Sul
aw
esi
Te
1

Su
ma
ter
a
0 .7

Go
ro n M a
lu k
tal
u
o
0 .7 0

Sumber : Data Posko DBD Pusatc

HI TEST FROM JAKARTA, JAN-APR 2004

No

HOSPITALS

SINGLE SERA
(Acute cases)
< 1280

>1280

PAIRED SERA
No. 4 fold increase
Pos Primer

Pos Sekunder

<1280

1280

Neg.

Total

Koja

35

12

21

86

RSPI SS

39

10

14

73

Pershbatan

25

13

19

26

88

Budi Asih

26

15

61

Smb. Waras

11

19

35

36

105

Cengkareng

10

16

Fatmawati

73

14

15

19

128

Tebet

40

10

65

Tarakan

19

43

10

St. Carolus

49

11

70

317

59

77

153

129

735

Total

Clinical sign&symptoms of 735 Sero confirmed

SIGNS & SYMPTOMPS

Total(%)

Restlesness-unconcious

3.2

Dyspnoe

0.6

Skinrash-echymosis

3.6

Conjunctiva injection

2.3

Headache

16.7

Nausea

13.7

Vomiting

1.7

Epigastric pain

3.0

headache, nausea, vomiting

12.7

head, nausea, vomit , epigast pain

21.6

- , nausea, vomit, epigast pain

6.8

,nausea, vomit,

10.2

- , nausea, vomit, rash

2.1

Head, nausea,vomit, epigast, rash

Total

1.9
100.0

PCR Test of 65 samples.

TYPES

NO. IDENTIFIED

PERCENT.

DEN-1
4
6.0 %
DEN-2
6
9.0 %
DEN-3
24
37.0 %
DEN-4
12
19.0 %
DEN-3&4
2
3.0 %
DEN-1&3
1
1,5 %
DEN-1&2
1
1,5 %
Negatif
15
23.0 %
------------------------------------------------------------------TOTAL
65
100.0 %
Notes : 2 of 3 death due to DEN-4

DENGUE SEROTYPE IN INDONESIA (1975-2004)

TAHUN

DEN-1

DEN-2

DEN-3

DEN-4

1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
TOTAL
%

4
18
10
7
5
6
9
7
5
4
3
17
11
9
1
48
5
9

3
21
20
21
18
15
14
20
17
12
10
33
17
12
2
30
3
8

2
54
56
18
14
22
29
31
16
18
13
39
53
32
7
33
2
9

0
15
9
0
2
1
2
0
3
1
0
4
6
3
0
9
1
7

39
42

43
46

84
38

18
25

259
19.92

365
28.08

570
43.85

106
8.15

2004
%

6
11.11

7
12.96

27
50.00

14
25.93

KET

KLB

1300

54

SUMMARY
1. DHF is endemic with epidemic every 5 years.
2. DEN-3 increased 1-2 years prior to epidemics
3. Epidemic 2004 :
a. Headache, nausea, vomiting, epigastric
pain are the most common symptoms.
b. 64% paired sera --> positive with HI test,
of which 65 % secondary infection.
c. DEN-3 (37%) and DEN-4 (19%)
predominant, instead of DEN-3 and DEN-2
d. DNA sequencing is underway.

Thank you