Some students of SD Negeri Cigadung elementary school, Bandung, West Java, given Measles Rubella immunization on Friday (11/8). The government is currently carrying out an MR vaccine program to schools. The purpose of the vaccines given to children aged nine to 15 months is to save the children from congenital abnormalities such as hearing disorders, vision impairment, heart disorder and mental disorder caused by rubella at the time of pregnancy.
JAKARTA, KOMPAS — The health of Indonesian children is under threat. The increasing number of diphtheria cases shows the immunity of Indonesian children is not strong enough to protect them from disease. It is also because of the poor coverage of basic immunization. In fact, several children have yet to receive immunizations.
According to information that Kompas collected, a number of parents are reluctant to have their children immunized and doubt the quality of the vaccines. Junaidi, 34, an Aceh Besar resident, for example, refused to take his two children for immunizations because he was worried the vaccine quality was under standard due to poor storage.
“There is no guarantee the vaccine is stored at a special storage facility at preferred temperature. If the vaccine is damaged, I am afraid it will affect the health of my children,” he said. A report from the Health Ministry directorate general for disease mitigation and prevention shows the coverage of basic immunization (IDL) for 2008-2011 period was above 90 percent. However, since 2012 through 2015 it decreased to under 90 percent.
Basic Health Research 2013 says there are children who did not receive full basic immunization. Also, there are children who have never received immunizations. The number of children who have got full immunization is 41.6 percent (2007), 53.8 percent (2010) and 59.2 percent (2013). At the same time, the number children who have never received immunizations stands at 9.1 percent (2007), 12.7 percent (2010) and 8.7 percent (2013).
Such a condition makes children prone to a number of diseases. An example is diphtheria, the number of cases of which has continued to increase since 2014, with 396 cases in 2014, 596 cases in 2015 and 558 cases in 2016.
In the January-November 2017 period, 96 of 213 regencies or cities reported cases of diphtheria with the number of patients standing at 593.
Uneven coverage
Health Ministry director for surveillance and quarantine Elizabeth Jane Soepardi on Saturday (9/12) in Jakarta said along with the growing number of people and population density the basic immunization coverage should also be high or minimum 95 percent. The basic immunization should cover villages.
However, it has never been fulfilled. The fact is the coverage is uneven. There are regions with high coverage and others with low one. “It creates loopholes. The immunity of community is uneven. There are enclaves with poor immunization coverage,” she said.
If the un-immunized children are concentrated on one region, the risk of outbreak is very big. In East Java, not all children born this year get full basic immunization. Since January through Dec. 10, 2017, the IDL coverage in East Java was 77.66 percent. Consequently, there are children who prone to diseases that actually could be prevented with immunization.
In Surabaya, East Java Health Office head Kohar Hari Santoso said from 566,870 infants born in 2017 only 440,204 infants got full basic immunization. The remaining 126,666 infants born this year have not got basic immunization.
Bondowoso Regency has the highest immunization coverage with 133.45 percent. The lowest coverage is in Bangkalan Regency with 54.18 percent.
Suburban
The non-maximum IDL coverage, Kohar said, was because parents who did not know the benefits of immunization did not take their children to health facilities to get vaccinated. It usually happens in the suburbs with poor education and economy.
“Parents’ lack of understanding about immunization could lead them to baseless issues, such as the opinion that vaccines cause fever among children,” Kohar said.
In the province bordering with Jakarta, namely West Java, IDL coverage is also uneven. The coverage is only 91 percent because several parents or groups in society do not understand and reject immunization.
“Such condition has become one of the causes of the diphtheria outbreak. There are people who have not understood the importance of full basic immunization,” West Java Health Office surveillance and immunization head Yus Ruseno said.
Aceh Health Office disease control and public health head Abdul Fatah said the IDL coverage in Aceh has never reached 100 percent. There are factors that obstruct the realization of immunization, such as poor public understanding, the rise of anti-vaccine community and rumors about immunization consisting non-halal elements.
In 2013, IDL coverage in Aceh was 82 percent, dropped to 77.3 percent in 2014. A year later, the coverage decreased to 67.05 percent. In 2016, it went up slightly to 69.1 percent and in 2017 through November it reached 70 percent.
Poor IDL coverage directly connected to several diseases, which could actually be prevented with immunization, such as diphtheria. “The diphtheria cases emerged 3-4 years later. If this year the diphtheria case increases, we know for sure the immunization coverage was poor in the past years,” Fatah said.
In 2013, there were six diphtheria cases in Aceh, two people died. In 2014, there were five cases, one died. In 2015, there was no diphtheria case. But in 2016, there were 11 cases with 4 people died. “In 2017, there was a dramatic increase. By December, there were 90 cases with four people died,” Fatah said.
Poor IDL coverage also happens to West Sumatra. As of October 2017, the coverage was 66.6 percent from the target of 92.5 percent. This year, the disease that can be prevented with immunization in West Sumatra is diphtheria. According to West Sumatra Health Office head Merry, there were 23 suspected diphtheria in West Sumatra in January-November 2017, two of them were positive diphtheria and both never got immunization.
In Papua, the low number of medical workers and limited facilities has made the IDL coverage not maximal.
Papua Health Office health problem prevention head Aaron Rumainum said the office found many infants and kids below 5 years old had never received immunization in isolated villages in nine regencies.
Beside, the other cause was a lack of storage for the vaccines, which resulted in medical workers being unable to administer vaccines to the targeted children.
