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Definisi dari WHO = Early warning system -A communicable disease surveillance and response
system designed to detect as early as possible any departure from the usual or normallyobserved frequency or phenomenon. Merupakan suatu sistem pengawasan dan pemberian
respons yang dapat dikmunikasikan untuk mendeteksi keganjilan dari suatu frequensi
atau fenomena seawal mungkin.
2. Early Warning Outbreak Recognition System (EWORS) is a software-driven surveillance tool
that enables operators to input and analyze the signs and symptoms of patients reporting to
medical treatment facilities with suspected infectious diseases. EWORS can detect suspicious
rises of clustered signs and symptoms suggestive of outbreak occurrence. EWORS relies on
instant relay of disease data utilizing new information technologies and provides for instant and
meaningful interpretation of data through graphic presentations; EWORS mapping features
allow for geographical case clustering, making investigation and/or intervention more efficient.
Merupakan suatu alat bantu pengawasan yang dijalankan menggunakan software yang
memberdayakan operator untuk memberi input dan menganalisa tanda-tanda dan gejala
dari pasien yang datang ke fasilitas pelayanan medis dengan kecurigaan terjangkit
penyakit infeksi. EWORS dapat mendeteksi kenaikan sekelompok tanda dan gejala yang
mencurigakan yang dapat merupakan suatu KLB. EWORS berguna dalam
pengelompokan kasus, sehingga investigasi atau pencegahan dapat dijalankan dengan
lebih efisien.
EWORS di Indonesia:(kalo mau tau aja)
U. S. Naval Medical Research Unit No.2
U. S. Naval Medical Research Unit No.2 (NAMRU-2)
Box 3 Unit 8132
FPO AP 96520-8132
Kompleks P2MPLP/Litangkes
JL. Percepakan Negara No. 29
Jakata Pusat Indonesia
Tel: 011 62-21-424-4463
Fax: 011-62-21-425-4507
The first Navy Medical Research Unit Two (NAMRU-2) was established in cooperation with the
Rockefeller Institute as a research facility on Guam, during World War II. Its primary mission was to
study infectious diseases of military significance in Asia. In 1955, NAMRU-2 was moved to Taipei,
Taiwan, Republic of China, where infectious disease research was conducted for the next 24 years. In
1968, discussions were initiated with the Indonesian Ministry of Health (MoH) to establish a Jakarta
Detachment of the main facility in Taipei. As a result, NAMRU-2 Detachment, Jakarta, was established
in Indonesia in 1970 to investigate infectious diseases of importance both for the Republic of Indonesia
and the U.S. Navy. In 1979, the NAMRU-2 Command relocated from Taiwan to Manila, Republic of

Philippines. In 1990 the U.S. Department of the Navy negotiated with the U.S. Department of State and
the Government of Indonesia to transfer the parent unit to Jakarta, Indonesia. NAMRU-2 has been
located in Jakarta, Indonesia since then.
The mission of the NAMRU-2 Jakarta, Indonesia is to support American medical research interests in
the Pacific Theater and advance U.S. diplomacy in the region by studying infectious diseases of critical
public health importance to the United States, Indonesia, and other regional partners. NAMRU-2
provides our country with a continued forward presence that combines virology, microbiology,
epidemiology, immunology, parasitology, and entomology into a comprehensive capability to study
tropical diseases where they occur. Only in this environment can new preventive measures and
treatments be tested and evaluated to provide better health measures for U.S. Government personnel
working in the region and to collaborate with our host country colleagues in improved public health
NAMRU-2 is hosted by the Indonesian National Institute of Health Research and Development. Our
joint activities include both collaborative research on diseases of public health significance and disaster
relief in the wake of the 2004 Sumatra tsunami and the 2005 Central Java earthquake. NAMRU-2 has
expanded operations to other countries in Southeast Asia, including Laos, Singapore, Thailand, and
Cambodia. In Phnom Penh, Cambodia, NAMRU-2 opened, outfitted, and staffed a satellite laboratory
to conduct regional infectious disease outbreak research, and diagnostic laboratory support. In Laos,
NAMRU-2 Collaborates with the National Center for Laboratory and Epidemiology in the study of
acute respiratory diseases. In addition to this, NAMRU-2 assisted Laos in the implementation of the
Early Warning Outbreak Recognition system or EWORS. This system provides the only electronic
system of disease outbreak recognition and warning in the country.
Parasitic Diseases Program (PDP)
The PDP focuses on clinical, epidemiological, immunological, and molecular genetic research on
malaria. Major areas of interest include the emergence and spread of drug resistant malaria in Southeast
Asia, development of improved epidemiological and mathematical methods for estimating malaria risk,
improved methods to control mosquito vectors, vector bionomics, and quality assurance in malaria
diagnosis. PDP labs have facilities for in vitro malaria culture; measurement of circulating anti-malarial
drug levels; multiplexed analysis of immune responses to multiple Plasmodium antigens; PCR, RTPCR, and RFLP analysis of Plasmodium genetics; and the conduct of clinical studies in compliance
with current Good Clinical Practices.
Laboratory Animal Medicine
The Animal Facility of Laboratory Animal Medicine Department is an AAALAC (Association for
Assessment and Accreditation of Laboratory Animal Care, Int) accredited facility since 1996. It has
always had an integral role in NAMRU-2s ability to accomplish its mission. Animals have been used
to isolate unknown disease agents, to prepare reagents fro diagnostic assays, and to study pathogenesis
of infectious agents and recently, the efficacy of vaccines.
The Viral Diseases Program (VDP)
The VDP conducts epidemiologic and laboratory research on viral hemorrhagic fevers, influenza,
encephalitis, and rickettsioses. VDP produces information about critical disease threats and maintains
the logistical infrastructure and relationships necessary to support vaccine and treatment trials, through
prospective cohort and cross-sectional studies of dengue epidemiology and pathogenesis and

prospective studies to detect and characterize regionally important respiratory pathogens including
influenza, carried out in collaboration with host nation institutions. Multi-national in scope, VDP
operates studies of febrile diseases from Indonesia to Indochina.
The Bacterial Diseases Program (BDP)
The BDP identifies pathogens from pediatric diarrhea, dysentery, sexually transmitted diseases (STD)
and febrile illness surveillance studies. BDP molecular diagnostic capabilities have identified influenza
as an enteric pathogen and determined the prevalence of rotavirus genotypes among diarrhea patients in
Indonesia. Testing of antimicrobial resistant enteric and STD pathogens by the BDP clinical section has
helped guide national public health policies. In addition, febrile illness studies have identified
pathogens causing diseases of previously unknown etiology.
The Emerging Diseases Program (EDP)
The EDP pursues a multi-fold strategy to develop disease regional outbreak response capabilities
including: (1) infectious disease outbreak response training workshops; (2) direct and indirect support
to outbreak investigations; (3) development of laboratory diagnostic capabilities; (4) implementation of
the syndromically based Early Warning Outbreak Recognition System (EWORS), developed by
NAMRU-2, in hospitals throughout Indonesia, Cambodia, Vietnam and Laos, PDR.
NAMRU-2 Jakarta is located in 50,000 square feet of laboratory, office and storage spaces in three
buildings within the Indonesian MoH, National Institutes of Health (Badan LITBANGKES)
compound. The facilities are well equipped and the animal facility is accredited by the Association for
Assessment and Accreditation of Laboratory Animal Care (AAALAC). Current staffing is 20
Americans and 168 Indonesians.
3. Kejadian Luar Biasa (KLB) adalah salah satu status yang diterapkan di Indonesia untuk
mengklasifikasikan peristiwa merebaknya suatu wabah penyakit.
Status Kejadian Luar Biasa diatur oleh Peraturan Menteri Kesehatan RI No.
949/MENKES/SK/VII/2004. Kejadian Luar Biasa dijelaskan sebagai timbulnya atau meningkatnya
kejadian kesakitan atau kematian yang bermakna secara epidemiologis pada suatu daerah dalam kurun
waktu tertentu.
Kriteria tentang Kejadian Luar Biasa mengacu pada Keputusan Dirjen No. 451/91, tentang Pedoman
Penyelidikan dan Penanggulangan Kejadian Luar Biasa. Menurut aturan itu, suatu kejadian dinyatakan
luar biasa jika ada unsur:
Timbulnya suatu penyakit menular yang sebelumnya tidak ada atau tidak dikenal
Peningkatan kejadian penyakit/kematian terus-menerus selama 3 kurun waktu berturut-turut
menurut jenis penyakitnya (jam, hari, minggu)
Peningkatan kejadian penyakit/kematian 2 kali lipat atau lebih dibandingkan dengan periode
sebelumnya (jam, hari, minggu, bulan, tahun).
Jumlah penderita baru dalam satu bulan menunjukkan kenaikan 2 kali lipat atau lebih bila
dibandingkan dengan angka rata-rata perbulan dalam tahun sebelumnya.
Pengertian Wabah Penyakit Menular. Mengacu pada Undang-Undang No. 4 Tahun 1984 tentang Wabah
Penyakit Menular dalam Bab I Pasal 1a, Departemen Kesehatan mendefinisikan wabah penyakit
menular sebagai berikut:

Wabah penyakit menular adalah kejadian berjangkitnya suatu penyakit menular dalam masyarakat
yang jumlah penderitanya meningkat secara nyata melebihi daripada keadaan lazim pada waktu dan
daerah tertentu serta dapat menimbulkan malapetaka. (Ditjen PPM & PLP, 1987, hal. 2).
Sedangkan dalam Peraturan Menteri Kesehatan No. 949/Menkes/SK/VIII/2004 tentang Pedoman
Penyelenggaran Sistem Kewaspadaan Dini Luar Biasa (KLB), Departemen Kesehatan mendefinisikan
wabah sebagai berikut:
Wabah adalah berjangkitnya suatu penyakit menular dalam masyarakat yang jumlah penderitanya
meningkat secara nyata melebihi daripada keadaan yang lazim pada waktu dan daerah tertentu serta
dapat menimbulkan malapetaka.
A. KLB - Penangulangan wabah/KLB penyakit menular diatur dalam UU No. 4 tahun 1984 tentang
wabah penyakit menular, PP No. 40 tahun 1991 tentang penanggulangan wabah penyakit menular,
peraturan mentri kesehatan No. 560 tentang Jenis penyakit tertentu Yang Dapat Menimbulkan Wabah.
Pada tahun 2000, Indonesia menerapkan secara penuh UU No. 22 tahun 1999 tentang Pemerintah
daerah dan UU No. 25 tahun 1999 tentang Perimbangan Keuangan Antara Pemerintah Pusat dan
daerah, yang kemudian diikuti dengan terbitnya PP No. 25 tahun2000 tentang Kewenangan Pemerintah
dan kewenangan Propinsi Sebagai Daerah Otonom yang berpengaruh terhadap penyelenggaraan
penanggulangan wabah.
B. DBD - Program sosial ini, menitikberatkan pada upaya pencegahan infeksi dengue dengan
pemberantasan sarang nyamuk (PSN) melalui pelaksanaan 3M+ (menutup, menguras, mengubur dan
menggunakan anti nyamuk terpercaya).
"Infeksi dengue adalah penyakit yang disebabkan oleh virus dan menyebar melalui gigitan nyamuk
Aedes Aegypti. Perlu kerjasama semua pihak baik masyarakat, pemerintah maupun pihak swasta untuk
mencegah infeksi dengue dengan melakukan pemberantasan sarang nyamuk (PSN) melalui
pelaksanaan 3M+ secara rutin yaitu menguras, menutup, mengubur dan menggunakan anti nyamuk,"
ujar Kepala Dinas Kesehatan Propinsi DKI Jakarta Dr. Wibowo B. Sukijat, MPH.