Mosquito Borne Diseases

Mosquito Borne Diseases
Dr. E. Garianto, M.Kes
10/8/2009 Dr. Efyluk Garianto, M.Kes 1

Mosquito Borne Diseases
•Dengue Hemorrhagic Fever

•Malaria
•Chikungunya
•Filariasis

Dengue Hemorrhagic Fever

I. Virus, Vector and Transmission

Dengue Virus
• Causes dengue and dengue hemorrhagic fever

• Is an arbovirus
• Transmitted by mosquitoes
• Composed of single-stranded RNA
• Has 4 serotypes (DEN-1, 2, 3, 4)

Dengue Viruses
• Each serotype provides specific lifetime immunity, and

short-term cross-immunity
• All serotypes can cause severe and fatal disease
• Genetic variation within serotypes
• Some genetic variants within each serotype appear to
be more virulent or have greater epidemic potential

Transmission of Dengue Virus
by Aedes aegypti
Mosquito feeds / Mosquito refeeds /

acquires virus transmits virus
Extrinsic Intrinsic
incubation incubation
period period
Viremia Viremia
0 5 8 12 16 20 24 28
DAYS
Illness Illness
Human #1 Human #2

Replication and Transmission
of Dengue Virus (Part 1)
1. Virus transmitted 1
to human in mosquito
saliva
2
2. Virus replicates 4
in target organs
3. Virus infects white
3
blood cells and
lymphatic tissues
4. Virus released and

10/8/2009 circulates in blood Dr. Efyluk Garianto, M.Kes 8
Replication and Transmission
of Dengue Virus (Part 2)
5. Second mosquito 6
ingests virus with blood
6. Virus replicates
in mosquito midgut 7
and other organs,
infects salivary
glands 5
7. Virus replicates
in salivary glands
Aedes aegypti Mosquito

Aedes aegypti
• Dengue transmitted by infected female mosquito

• Primarily a daytime feeder
• Lives around human habitation
• Lays eggs and produces larvae preferentially in
artificial containers

II. Clinical Manifestations of Dengue
and Dengue Hemorrhagic Fever
CENTERS FOR DISEASE CONTROL

10/8/2009 Dr. Efyluk Garianto, M.Kes AND PREVENTION
12
Dengue Clinical Syndromes
•Undifferentiated fever
•Classic dengue fever
•Dengue hemorrhagic fever
•Dengue shock syndrome

Undifferentiated Fever
• May be the most common manifestation of dengue

• Prospective study found that 87% of students
infected were either asymptomatic or only mildly
symptomatic
• Other prospective studies including all age- groups
also demonstrate silent transmission
DS Burke, et al. A prospective study of dengue infections

in Bangkok. Am J Trop Med Hyg 1988; 38:172-80.
Clinical Characteristics of Dengue Fever
• Fever
• Headache
• Muscle and joint pain
• Nausea/vomiting
• Rash
• Hemorrhagic manifestations

Signs and Symptoms of
Encephalitis/Encephalopathy
Associated with Acute Dengue Infection
• Decreased level of consciousness: lethargy,

confusion, coma
• Seizures
• Nuchal rigidity
• Paresis

Hemorrhagic Manifestations
of Dengue
• Skin hemorrhages: petechiae, purpura, ecchymoses
• Gingival bleeding
• Nasal bleeding
• Gastro-intestinal bleeding: hematemesis, melena,
hematochezia
• Hematuria
• Increased menstrual flow

Clinical Case Definition for
4 Necessary Criteria:
• Fever, or recent history of acute fever

• Hemorrhagic manifestations
• Low platelet count (100,000/mm3 or less)
• Objective evidence of “leaky capillaries:”
• elevated hematocrit (20% or more over baseline)
• low albumin
• pleural or other effusions
Clinical Case Definition for Dengue
Shock Syndrome
• 4 criteria for DHF
• Evidence of circulatory failure manifested indirectly by all
of the following:
• Rapid and weak pulse
• Narrow pulse pressure ( 20 mm Hg) OR hypotension
for age
• Cold, clammy skin and altered mental status
• Frank shock is direct evidence of circulatory failure

Four Grades of DHF
• Grade 1
• Fever and nonspecific constitutional symptoms
• Positive tourniquet test is only hemorrhagic manifestation
• Grade 2
• Grade 1 manifestations + spontaneous bleeding
• Grade 3
• Signs of circulatory failure (rapid/weak pulse, narrow pulse
pressure, hypotension, cold/clammy skin)
• Grade 4
• Profound shock (undetectable pulse and BP)

Danger Signs in
•Abdominal pain - intense and sustained

•Persistent vomiting
•Abrupt change from fever to hypothermia,
with sweating and prostration
•Restlessness or somnolence
Martínez Torres E. Salud Pública Mex 37 (supl):29-44, 1995.

Warning Signs for Dengue Shock
Alarm Signals:
• Severe abdominal pain
• Prolonged vomiting
Four Criteria for DHF: • Abrupt change from fever
• Fever to hypothermia
• Hemorrhagic manifestations • Change in level of
• Excessive capillary permeability consciousness (irritability
•  100,000/mm3 platelets or somnolence)
Initial Warning Signals:

• Disappearance of fever When Patients Develop DSS:
• Drop in platelets • 3 to 6 days after onset of
• Increase in hematocrit symptoms

Malaria

What is Malaria
• (Italia) Mala-Aria reffered for bad air

• Disease due to Plasmodium infection, an
intracellular parasitic
• Transmitted by anophelines mosquito
• Human is the only one reservoir in nature

Agent
4 Species Plasmodium
• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium malariae
• Plasmodium ovale
Vector
Anopheles mosquitoes (72 species)

Global situation
•300 to 500 million clinical cases of malaria each

year.
•Malaria kills more than 2,000,000 people per year.
•40% of the world's population are at risk in about 90
countries and territories.
•80% to 90% of malaria deaths occur in Sub-
Saharan Africa.

Malaria Endemic Countries
P. falciparum (most
prevalent) and P.
malariae in all
shaded areas
P.ovale predominant
in Sub-Saharan
Africa and P. vivax
in the other areas
Centers for Disease Control and Prevention

Countries and Territories With Malarious Areas
Afghanistan French Guiana Oman
Algeria* Gabon Pakistan
Angola Gambia Panama
Argentina* Georgia* Papua New Guinea
Armenia* Ghana
Paraguay
Azerbaijan* Guatemala
Bangladesh Guinea
Peru
Belize Guinea-Bissau Philippines
Benin Guyana Rwanda
Bhutan Haiti Sao Tome and Principe
Bolivia Honduras Saudi Arabia
Botswana India Senegal
Brazil Indonesia Sierra Leone
Burkina Faso Iran, Islamic Republic of Solomon Islands
Burundi Iraq* Somalia
Cambodia Kenya
South Africa
Cameroon Korea, Democratic People's Republic
Cape Verde of*
Sri Lanka
Central African Republic Korea, Republic of* Sudan
Chad Kyrgyzstan Suriname
China Lao People's Democratic Republic Swaziland
Colombia Liberia Syrian Arab Republic*
Comoros Madagascar Tajikistan
Congo Malawi Tanzania, United Republic of
Congo, Democratic Republic of the Malaysia Thailand
(former Zaire) Mali
* = P. vivax risk only Timor-Leste
Costa Rica Mauritania
Togo
Côte d'Ivoire Mauritius*
Mayotte
Turkey*
Djibouti
Mexico Turkmenistan*
Dominican Republic
East Timor Morocco* Uganda
Ecuador Mozambique Vanuatu
Egypt Myanmar Venezuela
El Salvador Namibia Viet Nam
World Health Equatorial Guinea Nepal Yemen
Nicaragua
Organization Eritrea Zambia
Ethiopia
10/8/2009 Niger
Dr. Efyluk Garianto, M.Kes Zimbabwe 28
Nigeria
Endemisitas
Endemisitas malaria define by Spleen rate atau parasite

rate at children 2 – 9 years old
• Hypoendemic: spleen/parasite rate 0-10 %
• Mesoendemic: spleen/parasite rate 10-50 %
• Hyperendemic: spleen/parasite rate 50-75 %, spleen rate
high in adult
• Holoendemic: spleen/parasite rate > 75 %, spleen rate
low in adult.

Malaria Incubation Period
• Corresponds with liver stage of malaria parasite

• P. falciparum 12 Days
• P. vivax 14 Days*
• P. ovale 14 Days*
• P. malariae 30 Days
* May be 8 - 10 months or longer for some strains

Life Cycle of Malaria Parasite

Centers for Disease Control and Prevention Division of Parasitic Diseases
(cont.)
• Infected mosquito takes blood meal and injects
sporozoites into human host
• Sporozoites infect liver cells, multiply and mature
into schizonts that rupture and release
merozoites into the bloodstream
• In P. vivax and P. ovale, a dormant stage
(hypnozoites) can persist in the liver and cause
relapses by invading the bloodstream weeks, or
even years, later
• Merozoites infect red blood cells

(cont.)
• Some merozoites mature into schizonts that rupture into the

bloodstream releasing more merozoites
• Some merozoites differentiate into sexual cells (male and female
gametocytes)
• Mosquito ingests gametocytes during blood meal
• Gametocytes mature and produce a fertilized egg that grows,
ruptures and releases sporozoites
• Sporozoites migrate to mosquito’s salivary gland waiting to be
injected into a new human.

Clinical Features of Malaria
• Prepatent period • Cold stage hr
• Flu-like initially • Headache/shiver/rapid
weak pulse
• Intermittent fever • Hot stage 6hrs
• Recurrence • Intense
• Coma/death headache/nausea/thirst/di
stress
• Sweating stage 4hrs
• Chronic infection • Profuse sweating
• Relapses Sleep!

Fever Charts

Malaria
Paroxysm
• paroxysms associated with
synchrony of merozoite
release
• between paroxysms temper-
ature is normal and patient
feels well
• falciparum may not exhibit
classic paroxysms
(continuous fever)
tertian malaria
quartan malaria

Chikungunya

• Chikungunya is a self-limiting febrile viral disease characterized
by arthralgia or arthritis, primarily in the wrist, knee, ankle and
small joints of the extremities, which last from days to months.
• Chikungunya (chick-un-GUNE-ya) is an arthropod-borne virus
transmitted to humans via a mosquito bite.
• The agent is Chikungunya virus from the family Togoviridae and
the genus Alphavirus.
• Chikungunya virus infection was first described during the
1950s by scientists Marion Robinson and W.H.R.Lumsden.

Chikungunya virus

• The first outbreak occurred during 1952 in Africa.
• the first outbreak in India was in 1963 in Calcutta.
• Transmission of the disease is known to occur in regions within
India, Africa, Southeast Asia, the Philippines, and the
Caribbean.
• since 2000, infections have occurred worldwide as travelers
have contracted chikungunya from infected mosquitoes while
traveling through endemic regions
• Vector of chikungunya is mosquito from genus aedes (aedes
aegypti and aedes albopictus)

• In 2005, there was a reemergence of chikungunya in
India with 180,000 cases reported between 2005 and
2007
• The World Health Organization considers chikungunya
an important re-emergent disease (a disease capable
of causing large outbreaks after a period of relatively
few occurrences).

Clinical manifestation
• Chikungunya manifests in 1 to 12 days (usually about a week)
after being bitten by an infected mosquito.
• Most cases result in a range of symptoms, although there have
been some asymptomatic cases.
• The most common symptoms are: fever, headache, joint pain,
swelling of joints, arthritis of the joints, chills, nausea, and
vomiting
• A rash may also occur, and in rare cases, bleeding and
hemorrhaging result.
• The symptoms of chikungunya are similar to dengue fever --
sometimes misdiagnosed.
• Life-long immunity is thought to occur following chikungunya
infection.
Diagnosis
• A presumptive diagnosis of an arboviral disease is

often based on the patient's clinical features, places
and dates of travel (if the patient is from a non-
endemic country or area), activities, and
epidemiologic history of the location where
infection occurred.
• Laboratory diagnosis of arboviral infections is
generally accomplished by testing of serum or
cerebrospinal fluid (CSF) to detect virus-specific IgM
and neutralizing antibodies.
Treatment
• Treatment of chikungunya is aimed at relieving symptoms.
• No vaccine or specific antiviral treatment is available.
• The most common treatments for symptoms include rest,
fluids, and anti-inflammatory or analgesic drugs such as
ibuprofen, naproxen, acetaminophen, or paracetamol.
• These treatments help relieve fever, aches, joint pains, and
arthritis.
• In most cases, people recover fully from chikungunya, often
in a few days.
• In rare cases, joint pain can persist, or prolonged fatigue may
be experienced.

Filariasis

Filaria limfatik
• Filariasis adalah penyakit yg disebabkan infeksi

cacing filaria
• Cacing Filaria adalah nematoda jaringan
• Termasuk Ordo Spirurida, Superfamili Filarioidea,
Famili Onchocercidae.
• Ada 3 stadium: stadium dewasa, mikrofilaria dan
stadium larva (L1, L2, L3, L4, L5).
• Stadium dewasa hidup di saluran limfe sampai lebih
dari 20 tahun dan menghasilkan mikrofilaria.
• Stadium mikrofilaria hidup dalam darah, secara
berkala berada di dalam darah tepi, masa hidup
beberapa bulan hingga 1tahun.
• Mikrofilaria yang terhisap nyamuk akan berubah
menjadi larva L1, L2, dan terakhir L3. sedang
perubahan menjadi L4 dan L5 terjadi dalam tubuh host.
• Yang dapat menginfeksi manusia hanya 3 species:
wuchereria bancrofti, Brugia malayi dan Brugia
timori.
Distribusi Geografik
• Wuchereria bancrofti terdistribusi luas di daerah

tropis di Asia, Afrika, Amerika, dan pasifik, terutama
di daerah dgn iklim panas dan kelembaban tinggi.
• Brugia malayi ditemukan di Asia tenggara, barat
daya India, Cina selatan & Tengah.
• Brugia timori hanya di jumpai di timor-timur, dan
pulau-pulau disekitarnya.
Siklus Hidup & Transmisi
• Cacing filaria dewasa hidup di saluran limfe host.

• Ukuran W.bancrofti betina 80 -100 x 0,25 mm,
jantan 40 x 0,1 mm. Ukuran spesies Brugia hanya
setengah dari spesies wuchereria.
• Mikrofilaria dihasilkan ovum dalam uterus cacing
betina. Mikrofilaria memiliki sarung/selubung dan
berukuran 260 x 8 µm.
• Mikrofilaria akan terhisap nyamuk selama
menghisap darah host. Dalam lambung nyamuk
mikrofilaria keluar dari sarungnya dan berubah
menjadi larva L1.
B. malayi B. malayi
W. bancrofti
• Larva L1 menembus dinding lambung nyamuk dan
masuk ke otot thoraks. Dalam otot thoraks mengalami 2
kali perubahan menjadi larva L3 yang infektif berukuran
1500 x 20 µm. Perkembangan dlm tubuh nyamuk butuh
waktu 10 - 12 hari.
• Larva infektif yang mature bermigrasi ke kelenjar ludah
dan siap ditularkan saat nyamuk menghisap darah
manusia.
• Setelah masuk tubuh manusia larva bermigrasi ke sitem
limfe dan tumbuh menjadi cacing dewasa. Mikrofilaria
ditemukan dalam darah setelah 8 bulan pd W.bancrofti
dan 3 bulan pd B.malayi dan timori.
• Cacing dewasa dapat hidup dan memproduksi
mikrofilaria selama lebih dari 20 Tahun.
• Mikrofilaria dapat hidup selama sekitar 1 tahun.
Kepadatan mikrofilaria dpt mencapai 10.000/ml
darah.
Periodisitas mikrofilaria
• Konsentrasi mikrofilaria dalam darah tepi
mempunyai periodisitas tertentu, hal ini merupakan
respon adaptasi terhadap pola kebiasaan waktu
menggigit nyamuk vektornya.
• Jenis vektor sangat dipengaruhi kondisi geografis
dan kepadatan populasi.
• W.bancrofti di daerah urban mempunyai vektor
nyamuk Culex quinquefasciatus yg mempunyai
habitat di air kotor dan mempunyai kebiasaan
menggigit indoors atau outdoors. Didaerah rural
W.bancrofti punya beberapa vektor nyamuk dgn
bionomik yang berbeda.
• Pada umumnya W.bancrofti dan B.malayi
mempunyai priodisitas nokturnal dimana kadar
puncak mikrofilaria dalam darah tepi dicapai saat
tengah malam. Pd tempat-tempat tersebut
penularan dilakukan oleh vektor yang menggigit
malam hari.
• Terdapat subperiodik diurnal dan noktrunal dimana
mikrofilaria dapat ditemukan dlm darah tepi
sepanjang hari, tapi ada konsentrasi lebih tinggi
pada tengah siang atau tengah malam.
• Di Indonesia B.malayi ditularkan oleh nyamuk Anopheles

barbirostris yang terutama punya habitat dipersawahan.
• Terdapat tipe subperiodik dan nonperiodik yg
mempunyai beberapa vektor nyamuk spesies Mansonia
yg menggigit sore dan malam hari.
• Tipe nonperiodik B.malayi ditemukan dipedalaman hutan
dimana nyamuk mansonia menggigit malam ataupun
siang karena hutan yang gelap.
• B.timori ditemukan di persawahan dgn vektor anopheles
barbirostris.
Reservoar host
•Hanya tipe subperiodik dan non periodik

B.malayi yg mempunyai reservoar host
binatang. Di daerah hutan endemis
ditemukan pd Presbytis cristatus, kucing
domestik juga dpt sbg reservoar.
Patogenesis
• Gangguan/kelainan pd tubuh host berkaitan dgn
cacing dewasa dan lokasi mereka di sistem limfe.
• Di daerah endemis gejala klinis bervariasi, mulai
dari tidak ada gejala (asymptomatic carrier) atau
adanya gejala dan tanda gangguan limfe akibat
cacing dewasa berupa demam dan berkembang
menjadi kelainan limfe kronis.
Patogenesis
• Sebagian besar penduduk di daerah endemis telah

memiliki respon imun thd antigen filaria akibat paparan
yg terus-menerus.
• Respon imun akut diperantarai T helper 2 dan
terbentuknya antibodi. Sedang pada kondisi kronis
diperantaraiT helper 1.
• Semua individu dgn filaria dewasa dlm sistem limfenya
mengalami lymphangiectasia
• Filaria dewasa dpt mati karena tbknya granulomatous
nodul atau karena acute filarial lymphangitis (AFL).
• Respon lebih berat berupa acute dermato lymphangia
adenitis  oedem daerah yang terkena.
Patogenesis Filariasis
Gejala klinis dapat berupa:

• Tanpa gejala
• Asymptomatic microfilaremia
• Filarial fever
• Chronic lymphatic pathology
• Tropical pulmonary eosinophilia
Filariasis Elephantiasis
(blocked lymph nodes,
nematode worms
carried by mosquitos)
Terapi
Anti filaria drug yg sudah setengah abad digunakan adalah

diethylcarbamazine citrate (DEC) (Filarzan) mempunyai efek
mikrofilaricidal dan makrofilaricidal untuk B.malayi, B.timori,
dan W.bancrofti.
Ivermectin poten sebagai mikrofilaricidal tetapi tidak dapat
membunuh cacing dewasa.
Terapi
• DEC di Indonesia dipasarkan dgn nama Filarzan

(100mg/tablet).
• Dosis standart anjuran WHO: 3 x 2mg/kgBB selama 12 hari
• ESO yg timbul disebabkan reaksi dari matinya parasit, dapat
berupa demam, nyeri kepala, sendi, dan tubuh, dizzines,
anoreksia, malaise dan vomiting. Gejala lokal dapat berupa
lymphadenitis, abses dan lymphoedema.
Terapi
• Karena Efek samping yang berat dapat diberikan dosis

rendah 100 mg tiap minggu untuk dewasa dan 50 mg untuk
anak-anak selama 40 minggu.
• Dapat juga diberikan dalam medicated salt dengan
konsentrasi 0,1 % selama 6bulan dan 0,2 % selama 4 bulan.
• Ivermectin single dose 150 ug/kgBB
• Terapi pembedahan (hasil krg memuaskan)
Prevention mosquitoes
borned diseases

Behaviour Modification To Prevent mosquito
Biting To Protect Mosquito Borne Diseases
• Limit outdoor activity after dark during peak mosquito
season.
• Avoid known mosquito-infested areas (e.g. swamps,
marshes, etc.) during those times as well.
• When outdoors after dark during mosquito season, wear
long sleeves and long pants to physically limit mosquito
biting.

Prevent mosquito biting to protect
mosquito borne diseases
• Use screens on windows and doors.

• When camping out, sleep under mosquito nets.
• When you are outdoors, use insect repellent
• Remove or regularly clean sources of standing water where
mosquitoes can breed: tires, cans, pet dishes, clogged rain
gutters, etc.

DoD Insect Repellent System
MAXIMUM
+ + = PROTECTION
Permethrin DEET On Properly

On Exposed Worn
Uniform Skin Uniform
YOU NEED TO KNOW…

Dry cleaning removes permethrin from the uniform
US Army Center for Health Promotion and Preventive Medicine
Pengendalian Nyamuk anopheles
• Larva anopheles umumnya di air yg ada di alam dengan kondisi

tergenang atau mengalir lambat, bersih, tdk ada polusi
• Ada 3 cara managemen lingkungan untuk pengendalian malaria:
a. Modifikasi lingkungan. Ditujukan mengubah secara permanen
kondisi tanah, air atau tumbuh-tumbuhan sehingga
mengurangi habitat vektor
b. Manipulasi lingkungan. Secara temporer membuat kondisi yg
menyulitkan bagi vektor utk berkembang biak, upaya ini perlu
diulang-ulang
c. Modifikasi atau manipulasi tempat tinggal manusia atau
perilakunya. Upaya ini ditujukan untuk mengurangi kontak
antara manusia dengan vektor

• Manajemen lingkungan lebih diutamakan karena tidak bersifat toksik,
mudah dikerjakan dan bisa dilakukan terus secara berkesinambungan.
• Tahap-tahap modifikasi lingkungan meliputi:
a. Drainase
b. Meratakan tanah
c. Menimbun lubang ditanah, celah, kolam.
d. Membangun waduk
e. Modifikasi tepi sungai
f. Melapis saluran-saluran air untuk mencegah kebocoran
g. Membangun konstruksi pengairan seperti bendungan untk
mencegah stagnasi

• Di lingkungan perkotaan manajemen lingkungan

juga meliputi membangun saluran air, modifikasi
disain rumah meliputi membuat selokan, talang air
dan membangun fasilitas pengolahan air limbah
• Sekitar 42 % Kematian karena malaria bisa dicegah
dengan managemen lingkungan

Pengendalian Nyamuk Aedes
• Pencegahan DHF dilakukan terutama dengan mengelola

tempat/wadah penampungan air atau tempat air dapat
tertampung baik di dalam maupun di luar rumah.
• Vektor utama DHF Aedes aegypti berkembang biak di
tempat penampungan air temporer di lingkungan rumah
seperti tandon air, pot tanaman air/vas bunga, tempat
minum hewan piaraan, tempat penampung air di bagian
belakang kulkas. Juga air yg tertampung di barang-barang
bekas seperti ban mobil, kaleng bekas makanan, dll

Fogging Focus pd Kasus DBD
• Tujuan: menurunkan kepadatan nyamuk Aedes aegypti dgn cepat untuk

mencegah penularan DBD
• Syarat administratif:
- Ada pendertita DBD (laporan dari Puskesmas atau RSUD)
- Ada kematian krn DBD
- Hasil PE bila ditemukan penderita DBD lain (1 atau lebih) atau
ditemukan > 3 penderita demam tanpa sebab yg jelas ( dlm
radius 100 m atau 20 rumah sekitar penderita)
- angka ABJ < 95 % atau ditemukan jentik > 5 %
- Bila tdk ditemukan penderita lain tetapi ABJ < 95 % cukup
dilakukan penggerakan masyarakat PSN, larvasidasi dan penyuluhan

Persyaratan teknis:
• Tersedianya Alat Mesin Fogg / ULV ( Ultra Low Volume )
• Pelaksana Petugas Dinas Kesehatan Kab/kota dan tenaga
Lain yang telah dilatih
• Lokasi meliputi seluruh wilayah terjangkit dengan radius
200 meter dari rumah penderita
• Sasaran Fogging rumah dan Tempat-tempat Umum
• Dosis Insektisida sesuai dosis
• Cara Fogging / ULV dilaksanakan 2 Siklus dengan Interval 1
minggu

Kompetensi petugas:
• 5 Orang petugas yang meliputi 1 orang Supervisor dan 4
orang petugas Fogging
• Petugas pelaksana harus sudah mengikuti Pelatihan / on
the job trining Operasional Mesin Fogg yang
diselenggarakan oleh Dinas Kesehatan Kabupaten / Propinsi
• Klasifikasi Pendidikan Petugas Pelaksana Fogging minimal
SD/Sederajat.

Sarana dan Prasarana fogging:
• 1 buah kendaraan roda 4 untuk mengangkut petugas, alat, bahan ke
lokasi
• 1 buah megaphone untuk menyampaikan pesan-pesan pada
masyarakat
• 1 set perlengkapan operasional yang terdiri dari : Baju lengan panjang
( katle pack ); Masker pelindung,; kaca mata pelindung; Topi lapangan;
Sarung tangan; Sepatu Lapangan
• Insektisida untuk 2 siklus fogging
• 1 Set bahan pembantu operasional yang terdiri dari : 3 Buah jerigen 20
lt untuk solar yang digunakan hari itu; 2 buah jerigen 5 lt untuk
cadangan premum; 1 buah jrigen 2 lt untuk cadangn insektisida; 8
buah baterai untuk 2 unit mesin fogging; 2 buah corong besar
bersaring; 2 buah corong kecil bersaring; 4 lembar kain lap
Insektisida dan Larvasida:

• Insektisida yang digunakan untuk pengendalian vektor
Demam Berdarah Dengue adalah Malathion, Metil
pyrimifos, Cypermetrin,
Alfacypermetrin
• Larvasida yang digunakan untuk mengendalikan
larva/jentik nyamuk vektor Demam Berdarah Dengue
adalah Temephos, Pyriproxyfen, Bacillus thuringiensis
sub sp israelensis.

He he he… monyet koq
pacaran.. Ini yg namanya
cinta monyet

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Mosquito Borne Diseases - HO2 PDF

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Dr. E. Garianto, M.Kes

10/8/2009 Dr. Efyluk Garianto, M.Kes 1

•Dengue Hemorrhagic Fever

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• Causes dengue and dengue hemorrhagic fever

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• Each serotype provides specific lifetime immunity, and

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Mosquito feeds / Mosquito refeeds /

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4. Virus released and

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• Dengue transmitted by infected female mosquito

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CENTERS FOR DISEASE CONTROL

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• May be the most common manifestation of dengue

DS Burke, et al. A prospective study of dengue infections

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• Decreased level of consciousness: lethargy,

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• Fever, or recent history of acute fever

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•Abdominal pain - intense and sustained

Martínez Torres E. Salud Pública Mex 37 (supl):29-44, 1995.

Initial Warning Signals:

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• (Italia) Mala-Aria reffered for bad air

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•300 to 500 million clinical cases of malaria each

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Centers for Disease Control and Prevention

Endemisitas malaria define by Spleen rate atau parasite

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• Corresponds with liver stage of malaria parasite

* May be 8 - 10 months or longer for some strains

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• Some merozoites mature into schizonts that rupture into the

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• A presumptive diagnosis of an arboviral disease is

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• Filariasis adalah penyakit yg disebabkan infeksi

• Wuchereria bancrofti terdistribusi luas di daerah

• Cacing filaria dewasa hidup di saluran limfe host.

• Di Indonesia B.malayi ditularkan oleh nyamuk Anopheles