Program Pengendalian Demam Tifoid di Indonesia: Tantangan dan Peluang

Typhoid fever (hereinafter referred to as typhoid) is a communicable disease with a heavy publichealth burden estimated at 22 million cases per year globally resulting in 216,000 to 600,000 deathsannually. In Indonesia, typhoid should receive serious attention from various parties as it is endemic.The purpose of this study is to review the typhoid control program in Indonesia as well as the challenges and opportunities in the implementation of the program. The method used is review of literature and documents related to the study obtained from National Institute of Health Research and Development library, as well as Directorate General of Disease Control and Environmental Health, and the google search results with the keywords “demam tifoid”, “typhoid fever”, “program pengendalian demam tifoid”, and “typhoid fever control program”. Overall, we collected 31 articles and documents relevant to the study topic. The study found that the typhoid control program has not been implemented optimally in Indonesia with many outstanding challenges such as lack of financing the control program as well as the increasing cases of carriers or relapse and resistance. To strengthen the typhoid control program and reduce the typhoid morbidity, there is a need to intensify advocacy, improve cooperation across programs and sectors particularly on access to clean water, the role of travel agents in typhoid vaccination for travelers, study of the effectiveness of typhoid vaccination in control program for adding the vaccine to a national immunization program, prevention of carriers or relapse and resistance, as well as financing the control program in provinces and districts/cities

Avian Influenza H5N1 Transmission in Households, Indonesia

BACKGROUND: Disease transmission patterns are needed to inform public health interventions, but remain largely unknown for avian influenza H5N1 virus infections. A recent study on the 139 outbreaks detected in Indonesia between 2005 and 2009 found that the type of exposure to sources of H5N1 virus for both the index case and their household members impacted the risk of additional cases in the household. This study describes the disease transmission patterns in those outbreak households. METHODOLOGY/PRINCIPAL FINDINGS: We compared cases (n = 177) and contacts (n = 496) in the 113 sporadic and 26 cluster outbreaks detected between July 2005 and July 2009 to estimate attack rates and disease intervals. We used final size household models to fit transmission parameters to data on household size, cases and blood-related household contacts to assess the relative contribution of zoonotic and human-to-human transmission of the virus, as well as the reproduction number for human virus transmission. The overall household attack rate was 18.3% and secondary attack rate was 5.5%. Secondary attack rate remained stable as household size increased. The mean interval between onset of subsequent cases in outbreaks was 5.6 days. The transmission model found that human transmission was very rare, with a reproduction number between 0.1 and 0.25, and the upper confidence bounds below 0.4. Transmission model fit was best when the denominator population was restricted to blood-related household contacts of index cases. CONCLUSIONS/SIGNIFICANCE: The study only found strong support for human transmission of the virus when a single large cluster was included in the transmission model. The reproduction number was well below the threshold for sustained transmission. This study provides baseline information on the transmission dynamics for the current zoonotic virus and can be used to detect and define signatures of a virus with increasing capacity for human-to-human transmission

Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings

10.1371/journal.pone.0073243PLoS ONE88-POLN

Manual Pemberantasan Penyakit Menular

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Strengthening Indonesia’s Field Epidemiology Training Programme to address International Health Regulations requirements

Problem: According to the International Health Regulations (IHR), countries need to strengthen core capacity for disease surveillance and response systems. Many countries are establishing or enhancing their field epidemiology training programmes (FETPs) to meet human resource needs but face challenges in sustainability and training quality. Indonesia is facing these challenges, which include limited resources for field training and limited coordination in a newly decentralized health system. Approach: A national FETP workplan was developed based on an evaluation of the existing programme and projected human resource needs. A Ministry of Health Secretariat linking universities, national and international partners was established to oversee revision and implementation of the FETP. Local setting: The FETP is integrated into the curriculum of Indonesian universities and field training is conducted in district and provincial health offices under the coordination of the universities and the FETP Secretariat. Relevant changes: The FETP was included in the Ministry of Health workforce development strategy through governmental decree. Curricula have been enhanced and field placements strengthened to provide trainees with better learning experiences. To improve sustainability of the FETP, links were established with the Indonesian Epidemiologists' Association, local governments and donors to cultivate future FETP champions and maintain funding. Courses, competitions and discussion forums were established for field supervisors and alumni. These changes have increased the geographic distribution of students, intersectoral and international participation and the quality of student performance. Lessons learnt: The main lesson learnt is that linkages with universities, ministries and international agencies such as the World Health Organization are critical for building a sustainable high-quality programme. The most critical factors were development of trusting relationships and clear definitions of the responsibilities of each stakeholder

Strengthening Indonesia's Field Epidemiology Training Programme to address International Health Regulations requirements

PROBLEM: According to the International Health Regulations (IHR), countries need to strengthen core capacity for disease surveillance and response systems. Many countries are establishing or enhancing their field epidemiology training programmes (FETPs) to meet human resource needs but face challenges in sustainability and training quality. Indonesia is facing these challenges, which include limited resources for field training and limited coordination in a newly decentralized health system. APPROACH: A national FETP workplan was developed based on an evaluation of the existing programme and projected human resource needs. A Ministry of Health Secretariat linking universities, national and international partners was established to oversee revision and implementation of the FETP. LOCAL SETTING: The FETP is integrated into the curriculum of Indonesian universities and field training is conducted in district and provincial health offices under the coordination of the universities and the FETP Secretariat. RELEVANT CHANGES: The FETP was included in the Ministry of Health workforce development strategy through governmental decree. Curricula have been enhanced and field placements strengthened to provide trainees with better learning experiences. To improve sustainability of the FETP, links were established with the Indonesian Epidemiologists' Association, local governments and donors to cultivate future FETP champions and maintain funding. Courses, competitions and discussion forums were established for field supervisors and alumni. These changes have increased the geographic distribution of students, intersectoral and international participation and the quality of student performance. LESSONS LEARNT: The main lesson learnt is that linkages with universities, ministries and international agencies such as the World Health Organization are critical for building a sustainable high-quality programme. The most critical factors were development of trusting relationships and clear definitions of the responsibilities of each stakeholder

Routes of travel for Indonesian pilgrims, arrival in and departure from Jeddah.

<p>Routes of travel for Indonesian pilgrims, arrival in and departure from Jeddah.</p

Timing of deaths on the Hajj.

<p>(a) Hour of death, as risk per 100,000 pilgrim-hours, with 95% confidence intervals. (b) Cumulative number of deaths over course of the Hajj, for two routes, per 100,000 pilgrimages. 93,357 pilgrims took route 1, and 113,474 route 2. Both routes start and end in Jeddah. (c) Mortality rate over the duration of the Hajj. Numbers of deaths are presented in grey bars; rate per 100,000 pilgrim-days and 95% confidence intervals are presented in black.</p

Interval between onset of illness for cases (n = 34) in outbreaks of avian influenza H5N1 infection.

<p>Panel A shows the interval between onsets of illness of index and secondary cases in outbreaks. Panel B shows the interval between onsets of illness of serial cases in outbreaks. Black denotes cases not exposed to zoonotic sources of virus and white denotes cases exposed to zoonotic sources of virus.</p

Household size and secondary attack rate for outbreaks of avian influenza H5N1 infection.

a<p>SAR declines to 0.047 when outlier cluster is excluded.</p>b<p>SAR declines to 0.044 when outlier cluster is excluded.</p