Diphtheria Cases Continue to Increase
New diphtheria cases continue to crop up despite the government’s continuous effort to curb its spread by conducting re-vaccination.
A young woman is given a diphtheria vaccination at Syarif Hidayatullah hospital in South Tangerang, Banten, on Wednesday (27/12). The vaccinations, which are for children aged 1-19, are being given for free until December 29.
JAKARTA, KOMPAS – New diphtheria cases continue to crop up despite the government’s continuous effort to curb its spread by conducting diphtheria re-vaccinations in three provinces since Dec. 11. The government must increase the vaccination program’s scope in order to have overall community immunity.
Health Ministry data shows that 96 out of 214 regencies and cities across the country declared diphtheria-related health emergencies (KLB) between January and November 2017. In total, there were 593 patients and 32 deaths – or 5.4 percent of the number of cases – within the period.
The diphtheria outbreak continues to expand. As of Dec. 16, 2017, diphtheria cases have been reported in 130 regencies and cities in 26 provinces. Some 40 people have died and more than 600 have been hospitalized. Recent reports say that diphtheria outbreaks have occurred in 28 provinces, with the disease having hit 903 individuals.
In response to the health emergency, the government is holding a diphtheria re-vaccination program called outbreak response immunization (ORI) in Jakarta, West Java and Banten.
Health Ministry health surveillance and quarantine director Elizabeth Jane Soepardi said on Wednesday (27/12/2017) that the average coverage of the ORI diphtheria program in the three provinces was only 40 percent. One of the suspected causes was that the ORI diphtheria program was held during school exams and holidays.
The increasing number of diphtheria cases was caused by years of parental failure to vaccinate their children.
Despite the poor ORI coverage, reports say that the number of diphtheria cases has dropped. Before Dec. 22, there were between 10 and 20 reports of new diphtheria cases every day. Since Dec. 22, only five new cases are reported daily. “We do not know for sure the correlation between poor ORI coverage and the dropping number of diphtheria cases,” Jane said.
Jane said diphtheria transmission occurred in places of activities, such as schools, boarding schools, Islamic schools and workplaces. As school starts after the Christmas and New Year’s holidays in January 2018, it will be known for sure whether or not the diphtheria outbreak is under control.
The increasing number of diphtheria cases, Jane said, was caused by years of parental failure to vaccinate their children. Reports say that some 60 percent of diphtheria patients have never been vaccinated.
The incubation period for diphtheria is between five and 10 days. Those who test positive may have been infected long before. Meanwhile, immunity from the vaccination takes two weeks to kick in.
Enthusiasm
After the diphtheria-related health emergency in a number of regions and the introduction of the ORI diphtheria program, people have shown enthusiasm for the program. Children and adults alike have requested diphtheria vaccinations.
Syarif Hidayatullah Hospital got 200 diphtheria vaccine ampoules from the South Tangerang Health Agency every day.
The public’s enthusiasm for the ORI diphtheria program is obvious at the Syarif Hidayatullah Hospital in South Tangerang. Every day, more than 100 people show up at the hospital to be vaccinated. They register the day before. On Wednesday at 9 a.m., people were seen queuing at the hospital.
Local resident Nur Afifah, 18, said she participated in the ORI diphtheria program as she was concerned for her health after news of diphtheria cases was reported in the media. Furthermore, she had no idea of her vaccination history as her parents did not keep her immunization records.
“I got information about the diphtheria vaccination in a WhatsApp message. I came here immediately to register as I was afraid due to news about the spread of diphtheria,” Nur Afifah said.
Her concern grew after news of a Syarif Hidayatullah State Islamic University (UIN) student dying from diphtheria. Nur Afifah lives near UIN and said she would do anything to prevent catching the disease.
Syarif Hidayatullah Hospital marketing and development manager Happy Christina said the hospital got 200 diphtheria vaccine ampoules from the South Tangerang Health Agency every day. There are three types of vaccines, namely pentabio for toddlers between one and five years old, DT for children between five and seven years old and TD for children and teenagers between seven and 19 years old. All are free.
People with complete vaccination history can only receive one booster every 10 years.
Vaccination for those 19 years old and above is done by request. Adults wishing to be vaccinated must wait until Friday to be vaccinated. “We need to order the vaccines first for patients 19 years old and above. Vaccine availability in the market is a little low as many are participating in this re-vaccination program,” Happy said.
Health Ministry disease prevention and control director general Mohamad Subuh said that 76 percent of the diphtheria cases occurred in patients between one and 18 years old. Therefore, people in this age range get priority in the ORI diphtheria program.
Those 18 years old and above may get TD vaccines by request only if their vaccination history is incomplete or if they have never been immunized against diphtheria. Vaccinations are given three times, with the second vaccination given one month after the first one and the third one given six months after the second one. People with complete vaccination history can only receive one booster every 10 years.
Indonesian Pediatrician Association (IDAI) chairman Aman Bhakti Pulungan said the public should not misunderstand the concept of comprehensive basic vaccination. In order to prevent an individual from catching diphtheria, that individual must have received four DPT (diphtheria-pertussis-tetanus) vaccinations up until the age of five. Later, the person must also have five DPT vaccinations and eight DPT/DT/TD immunizations until the age of 19.
Limited meeting
In response to the spread of diphtheria, the government has made continuous efforts to curb the disease. On Wednesday, President Joko Widodo and Vice President Jusuf Kalla held a limited closed-door meeting on the diphtheria health emergency. The meeting discussed the latest updates on the ORI diphtheria program in Jakarta, West Java and Banten, of which the total coverage is below 50 percent. Follow-up efforts were also discussed.
Now, the re-vaccination program covers only three provinces and coverage is just 50 percent.
Furthermore, the government has decided to expand the re-vaccination program’s scope, especially in areas with a high prevalence of diphtheria cases, including Aceh, East Java and West Sumatra. The hope is to get the diphtheria outbreak under control.
“The President orders that we continue what we have been doing. Now, the re-vaccination program covers only three provinces and coverage is just 50 percent. We will extend the program to other provinces,” Health Minister Nila Moeloek said after the limited meeting at the Bogor Palace in West Java on Wednesday afternoon.
Nila said that there was no way to curb the spread of diphtheria other than vaccination. Therefore, the government asked that the people understand the importance of vaccination.
In order to inform the public about the importance of diphtheria vaccination, Nila specifically asked for the help of Religious Affairs Minister Lukman Hakim Saifuddin at the limited Cabinet meeting. The Religious Affairs Ministry has been requested to spread information of the importance of vaccination, especially among those who reject vaccinations for religious reasons.
The government has also asked state-owned vaccine manufacturer PT Bio Farma to prepare diphtheria vaccine stocks. “We ask PT Bio Farma to continue to make the vaccines in order to ensure sustainable immunization,” Nila said.
The ORI diphtheria program in Jakarta was being held at Puskesmas, Posyandu and schools in several stages until January 2018.
Bio Farma has also been asked to prepare diphtheria serum (ADS) to treat diphtheria patients, including by importing it. Currently, the government only has 1,200 ADS vials, some of which were donated by the Indian government.
Meanwhile, Jakarta Health Agency chief Kusmedi said the ORI diphtheria program in Jakarta was being held at public health centers (Puskesmas), integrated healthcare posts (Posyandu) and schools in several stages until January 2018.
(ADH/NTA/DEA)
