SURVEILANS DAN PENYELIDIKAN

EPIDEMIOLOGI COVID-19
Dr. dr. Retno Asti Werdhani, MEpid
 SURVEILANS DAN
PENYELIDIKAN
EPIDEMIOLOGI COVID-19
 • KMK No. HK.01.07-MENKES-247-2020
tentang Pedoman Pencegahan dan
Pengendalian Covid-19
• Zhou Fei, et all. Clinical Course and risk
factors for mortality of adult inpatients
with covid-19 in Wuhan, China: a
SUMBER retrospective cohort study, Lancet 2020
INFORMASI • Why Do We Need Antibody Test for
Covid-19 and How to Interpret Test
Results, Diazyme Laboratories, 2020
• Pedoman Penanganan Cepat Medis
dan Kesehatan Masyarakat Covid-19 di
Indonesia. Gugus Tugas Percepatan
Penanganan Covid-10. Maret 2020
 Introduction

• The goals of medicine are to promote health, to preserve health, to restore health
when it is impaired, and to minimize suffering and distress.
• Successful prevention depends upon a knowledge of causation, dynamics of
transmission, identification of risk factors and risk groups, availability of
prophylactic/protection or early detection and treatment measures, an organization
for applying these measures to appropriate persons or groups, and continuous
evaluation of and development of procedures applied
• The objective of preventive medicine is to interrupt or oppose the "cause" and
thereby the disease process. This epidemiological concept permits the inclusion of
treatment as one of the modes of intervention
Control
• Control activities focus on primary prevention or secondary
prevention, but most programs combine both.

control

elimination

eradication
Control

Concept of control:

The term disease control describes ongoing operations aimed at reducing:

• The incidence of disease

• The duration of disease and consequently the risk of transmission

• The effects of infection, including both the physical and psychosocial
complications
• The financial burden to the community.
Control of infectious diseases (the 4 C s)

Control

Cases Contacts Carriers Community

Diagnosis
notification
Epidemiological
isolation observation detection
Investigation &
disinfection containment
treatment
follow up
release
Disease Elimination

• Between control and eradication, an intermediate goal has been described,

called "regional elimination"

• The term "elimination" is used to describe interruption of transmission of

disease, as for example, elimination of measles, polio and diphtheria from
large geographic regions or areas (now: Coronavirus by physical distancing,
wearing mask, hand hygiene)

• Regional elimination is now seen as an important precursor of eradication

 Disease
Eradication
• Eradication literally means to "tear out by roots".

• It is the process of Termination of all transmission of infection

by extermination of the infectious agent through surveillance
and containment .

• Eradication is an absolute process, an "all or none"

phenomenon, restricted to termination of an infection from the
whole world. It implies that disease will no longer occur in a
population.

• To-date, only one disease has been eradicated, that is

smallpox.
 Monitoring
• Monitoring is "the performance and analysis of routine
measurements aimed at detecting changes in the
environment or health status of population" (Thus we
have monitoring of air pollution, water quality, growth
and nutritional status, etc).

• It also refers to on-going measurement of performance

of a health service or a health professional, or of the
extent to which patients comply with or adhere to advice
from health professionals.
 Surveillance

• Surveillance means to watch over/supervise/keep

an eye on new and changing trends with great
attention, authority and often with suspicion

• According to another, surveillance is defined as

"the continuous scrutiny (inspection) of the factors
that determine the occurrence and distribution of
disease and other conditions of ill-health"
 Objectives of
Surveillance
• The main objectives of surveillance are:

• to provide information about new and changing

trends in the health status of a population, e.g.,
morbidity, mortality, nutritional status or other
indicators and environmental hazards, health
practices and other factors that may affect health

• to provide feed-back which may be expected to

modify the policy and the system itself and lead to
redefinition of objectives, and

• provide timely warning of public health disasters so

that interventions can be mobilized.
 Evaluation
• Evaluation is the process by which results are compared with the
intended objectives, or more simply the assessment of how well a
program is performing.

• Evaluation should always be considered during the planning and

implementation stages of a program or activity.

• Evaluation may be crucial in identifying the health benefits derived

(impact on morbidity, mortality, sequelae, patient satisfaction).

• Evaluation can be useful in identifying performance difficulties.

• Evaluation studies may also be carried out to generate information

for other purposes, e.g., to attract attention to a problem, extension
of control activities, training and patient management, etc.
 PENERAPAN SURVEILANS COVID-19

Kegiatan surveilans
Kegiatan surveilans Kegiatan surveilans
terhadap OTG dilakukan
terhadap ODP dilakukan terhadap PDP dilakukan
selama 14 hari sejak
selama 14 hari sejak selama 14 hari sejak
kontak terakhir dengan
mulai munculnya gejala mulai munculnya gejala
kasus positif COVID-19
 • Kegiatan ini dilakukan untuk menemukan adanya
indikasi OTG, ODP, dan PDP COVID-19 yang harus
segera direspon

• Bentuk respon dapat berupa verifikasi, rujukan

kasus, investigasi, notifikasi, dan respon
DETEKSI DINI penanggulangan

(TELUSUR KASUS) • Bentuk kegiatan verifikasi dan investigasi adalah

penyelidikan epidemiologi

• Kegiatan respon penanggulangan antara lain

identifikasi dan pemantauan kontak, rujukan,
komunikasi risiko dan pemutusan rantai penularan.
PENYELIDIKAN EPIDEMIOLOGI

• Karakteristik demografis dan population at risk

• Identifikasi kontak erat

• Pemantauan kontak erat

• Identifikasi kasus tambahan

• Identifikasi risiko

• Penilaian risiko

• Memberikan rekomendasi upaya penanggulangan

PENYELIDIKAN EPIDEMIOLOGI
• Setiap ODP, PDP dan kasus konfirmasi harus dilakukan
penyelidikan epidemiologi menggunakan formulir

• Kegiatan penyelidikan epidemiologi dilakukan terutama

untuk menemukan kontak erat/OTG menggunakan
formulir

• Hasil penyelidikan epidemiologi dapat memberikan

masukan bagi pengambil kebijakan dalam rangka
penanggulangan atau pemutusan penularan secara
lebih cepat
PELACAKAN KONTAK ERAT
- 36 -

• Identifikasi kontak

• Pendataan kontak

• Tindak lanjut kontak

Gambar 2.2. Contoh hubungan kontak erat

2. Pendataan Kontak Erat

Semua kontak erat yang telah diidentifikasi selanjutnya dilakukan
wawancara secara lebih detail dan mendata hal-hal berikut ini yaitu
a. Identitas lengkap nama lengkap, usia, alamat lengkap, alamat
kerja, nomer telepon, nomer telepon keluarga, penyakit penyerta
(komorbid), dan sebagainya sesuai dengan formulir pelacakan
kontak erat/OTG.
b. Selanjutnya petugas harus juga menyampaikan kepada kontak
erat
1) Maksud dari upaya pelacakan kontak ini
 - 26 -

Gambar 2.1 Alur Deteksi Dini dan Respon di Pintu Masuk dan Wilayah
 IX. ALUR PELAYANAN & BENTUK KEGIATAN

Tahapan dalam alur pelayanan Covid-19:

1. Melakukan penapisan seluruh masyarakat yang berada di wilayah kerja Puskesmas
terkait.
Sasaran:
- Peserta JKN Puskesmas
 Articles

Survivors

Fever
Cough
Dyspnoea
ICU admission
Systematic corticosteroid
SARS-CoV-2 RNA positive
Days after illness onset Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day 19 Day 20 Day 21 Day 22

Sepsis ARDS Discharged

Non-survivors

Fever
Cough
Dyspnoea
ICU admission
Invasive ventilation
Systematic corticosteroid
SARS-CoV-2 RNA positive
Days after illness onset Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day 19 Day 20

Sepsis ARDS Death

Zhou Fei, et all. Clinical Course and risk factors for mortality of adult inpatients with covid-19 in Secondary infection
Acute kidney injury
Wuhan, China: a retrospective cohort study, Lancet 2020 Acute cardiac injury

Figure 1: Clinical courses of major symptoms and outcomes and duration of viral shedding from illness onset in patients hospitalised with COVID-19
Figure shows median duration of symptoms and onset of complications and outcomes. ICU=intensive care unit. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. ARDS=acute respiratory
distress syndrome. COVID-19=coronavirus disease 2019.

increase in differential expression of genes associated pneumonia include older age, pre-existing cardiovascular
with inflammation, whereas expression of type I inter- diseases, and greater severity of pneumonia at presen-
feron beta was reduced. The age-dependent defects in
16
tation.22 Coronary heart disease has also been found to be
T-cell and B-cell function and the excess production of associated with acute cardiac events and poor outcomes
type 2 cytokines could lead to a deficiency in control of in influenza and other respiratory viral infections.22–24 In
viral replication and more prolonged proinflammatory this study, increased high-sensitivity cardiac troponin I
responses, potentially leading to poor outcome.17 during hospitalisation was found in more than half of
SOFA score is a good diagnostic marker for sepsis those who died. The first autopsy of a 53-year-old woman
and septic shock, and reflects the state and degree of with chronic renal failure in Jinyintan Hospital showed
multi-organ dysfunction. 18,19
Although bacterial infec- acute myocardial infarction (data not published; personal
tions are usually regarded as a leading cause of sepsis, communication with a pathologist from the Chinese
viral infection can also cause sepsis syndrome. Previ- Academy of Science). About 90% of inpatients with
ously, we determined that sepsis occurred in nearly pneumonia had increased coagulation activity, marked by
40% of adults with community-acquired pneumonia due increased d-dimer concentrations.25 In this study, we
to viral infection.20 In the current study, we found that found d-dimer greater than 1 µg/mL is associated with
more than half of patients developed sepsis. Additionally, fatal outcome of COVID-19. High levels of d-dimer have a
we found that more than 70% of patients had white reported association with 28-day mortality in patients
blood cell count below 10·0 × 10⁹ per L or procalcitonin with infection or sepsis identified in the emergency
below 0·25 ng/mL, and no bacterial pathogens were department.26 Contributory mechanisms include systemic
detected in these patients on admission. Sepsis was a pro-inflammatory cytokine responses that are mediators
common complication, which might be directly caused of atherosclerosis directly contributing to plaque rupture
by SARS-CoV-2 infection, but further research is needed through local inflammation, induction of procoagulant
Why Do We Need Antibody Test for Covid-19 and How to Interpret
to investigate the pathogenesis of sepsis in COVID-19 factors, and haemodynamic changes, which predispose to
Test Results, Diazyme Laboratories, 2020
illness.
Figure 1: Variation of the Levels of ischaemia and thrombosis.27–29
SARS-CoV-2 In addition,
RNA and angiotensin
Antigen, IgM and IgG after infection.
Cardiac complications, including new or worsening converting enzyme 2, the receptor for SARS-CoV-2, is
heart failure, new or worsening arrhythmia, or myocardial expressed on myocytes and vascular endothelial cells,30,31
References: infarction are common in patients with pneumonia. so there is at least theoretical potential possibility of direct
Cardiac arrest occurs in about 3% of inpatients with cardiac involvement by the virus. Of note, interstitial
1. Weaver, C. Questions About Accuracy of Coronavirus Tests Sow Worry. The Wall Street Journal.
pneumonia.
nd
21
Risk factors of cardiac events after mononuclear inflammatory infiltrates in heart tissue has
April 2 , 2020. Retrieved from https://www.wsj.com/articles/questions-about-accuracy-of-coronavirus-
tests-sow-worry-11585836001
1060 www.thelancet.com Vol 395 March 28, 2020
2. Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, Shaman J2. Substantial undocumented infection
facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science. 2020 Mar 16. pii:
eabb3221.
 - 96 -
- 97 -

Formulir 6.
FORMULIR PENYELIDIKAN EPIDEMIOLOGI
CORONAVIRUS DISEASE (COVID-19)
- 98 -
 - 109 -

Formulir 13.

FORMULIR PENDATAAN KONTAK (CONTACT LISTING)

Nomer Indek Alamat Lengkap
Nomer Jenis Tanggal Hubungan APD
Kasus Nama Jalan Desa Kecamatan Kabupaten Kategori
identifikasi Kelamin Usia No.HP kontak/ dengan yang Durasi5
Konfirmasi/ Lengkap kontak3
kontak 2 (L/P) paparan kasus dipakai4
primer1
INOCOVID K1
#1
K2

Keterangan:
1 Nomer indeks kasus konfirmasi misal INOCOVID#1
2Nomer identifikasi kontak misalnya K1 merujuk pada kontak nomer 1
3 Kategori kontak: kontak rumah tangga, rumah sakit, puskesmas, klinik, rekan kerja, sosial (di restoran misalnya), sekolah, satu kendaraan
4Jika menggunakan APD terutama kategori kontak fasilitas layanan kesehatan (rumah sakit, IGD, puskesmas, klinik): masker bedah, sarung tangan, masker

N95, dll
5Perkiraan lama kontak misalnya 5 menit, 1 jam dsb.
 - 105 -

- 106 -
Formulir 11.
FORMULIR PELACAKAN KONTAK ERAT /OTG 4. Informasi Paparan*)
2. Data Petugas Pengumpul Data
Jenis kontak
ID Kasus Primer/ No Pelacakan Kontak
1. Status Kasus Primer Sebutkan tanggal kontak dan Tanggal (dd/mm/yyyy)
Nama : durasi kontak dengan kasus Durasi (Menit/ Hari)
Institusi : Telp / Email konfirmasi/pasien dalam
Tanggal Pengisian Formulir (Hari/ Tanggal/ Tahun) / / pengawasan dari sejak kontak
Tanggal Pelacakan Kontak/ Interview (Hari/ Tanggal/ Tahun) : pertama ketika kasus primer
3. Informasi Kontak Erat bergejala
Nama No Identitas / KTP : 5 Informasi Paparan (Petugas Kesehatan) , Diisi apabila Kontak adalah petugas
-laki Perempuan Kebangsaan / Etnik (Suku kesehatan*)
Tanggal lahir (Hari/ Tanggal/ Tahun)____/ / Usia (Tahun, bulan)
Posisi pekerjaan : Tempat bekerja :
/
Hubungan dengan kasus Konfirmasi/ kasus pasien dalam pengawasan :
Alamat tempat tinggal :
Puskesmas terdekat :
Sekolah/ Universitas / Tempat Bekerja/ Tinggal di rumah : NIOSH- N95,
4.1 Kontak Erat *) memakai APD
*) Apabila Ya kotak disilang, apabila tidak kotak dikosongkan, apabila tidak tahu,kotak
dilingkari
………………………………………
APD yang dipakai untuk melakukan prosedur tersebut :
Riwayat Perjalanan……………..
Tanggal perjalanan ____ / / sampai / / -

Riwayat Perjalanan……………..
Tanggal perjalanan ____ / / sampai / / 5a Gejala Kontak*)
Lampirkan Daftar nama orang, alamat dan no telp orang yang pernah kontak dengan
kontak erat.
-nCoV 2019 atau pasien dalam
sebelum kasus
pengawasan 2019-
Konfirmasi/pasien dalam pengawasan menimbulkan gejala sampai hari ini ?
nCoV 2019 ; Apabila Ya, kontak terakhir / /_____________
Pekerjaan Tanggal onset timbulnya gejala (Tanggal/bulan/ / /
Petugas Kesehatan Petugas laboratorium Bekerja berhubungan dengan binatang tahun)
Pelajar Lainnya :……..
Untuk setiap pekerjaan, sebutkan lokasi, fasilitas dan alamat : 5b. Gejala pernafasan*)

Trasportasi yang digunakan sehari-hari dalam 14 hari terakhir

Sejak tanggal………. Sejak tanggal………. Sejak
-lain, sebutkan………… tanggal………. Sejak tanggal……….
4.2 Informasi Kontak Erat (Kontak Serumah)*) 5c. Gejala lainnya*)
Lokasi rumah/ alamat kontak apabila berbeda
dengan kontak primer
Sakit otot
Tanggal terakhir kontak dengan kasus primer
(Tanggal/bulan/tahun)
_______

Jumlah hari kontak beraktifitas di ruangan yang sama dengan kasus primer sejak kasus
primer tersebut sakit 6. Kondisi Komorbid*)
………………… -
Apakah kontak pernah melakukan aktifitas dibawah ini dengan kasus primer pada saat
kasus primer sakit di
rumah sebelum ke rumah sakit ?
mengantar ke rumah sakit Kehamilan , Apabila Ya, sebutkan

Estimasi kelahiran ……………../……………/……………..

sama
 - 107 -

primer
Apabila ya, tanggal vaksinasi ……………………..Vaksinasi di negara
mana…………………………
………………

7. Status Kontak, Diisi apabila kontak menderita sakit*)

___________/______________/_________

___/______/_____

sakit : …………………

Hasil Autopsi : …………………………………………………………………………………………

8. Pengambilan spesimen kontak dan pemeriksaan laboratorium*)

Tanggal pengambilan specimen …………………………………….

Hasil pemeriksaan laboratorium :