The majority of Indonesian regions are at high risk of polio, three cases of polio reported

A total of 32 provinces and 399 cities/regencies in Indonesia are high risk areas for polio transmission.

KOMPAS/FERGANATA INDRA RIATMOKO

Kindergarten students received polio immunization at TK Kanisius Pendowo, Magelang City, Central Java, on Monday (19/2/2024). The polio vaccine administration is part of the second round of the National Immunization Week (PIN) Sub-Week for Polio.

JAKARTA, KOMPAS — Most areas in Indonesia are in the high risk category for transmission of polio. By 2024, there will be at least three reported cases of polio. Low coverage and disparities in coverage immunization are the causes.

Based on data from the Ministry of Health as of February 29, 2024, a total of 32 provinces, or 84 percent of provinces and 399 municipalities or regencies, or 78 percent of regencies or municipalities in Indonesia are classified as being at high risk of polio. Meanwhile, six other provinces are at moderate risk, namely South Sumatra, East Kalimantan, Central Java, South Sulawesi, Banten, and Yogyakarta Special Region.

"However, we know that vaccine-preventable diseases have no administrative boundaries. So, even if one area is green and low risk, if transmissions occur in surrounding areas, the transmission can also occur in that area," said Endang Budi Hastuti, Head of the Immunization Task Force for Women of Reproductive Age, PD3I Surveillance, and Post-Immunization Adverse Events at the Ministry of Health, in Jakarta on Tuesday (7/5/2024).

Also read: The Irony of Polio Eradication

Endang revealed that the high risk of polio transmission in Indonesia has resulted in ongoing outbreaks of polio in the community. By 2024, there will have been at least three reported cases of polio outbreaks.

KEMENTERIAN KESEHATAN

High risk areas for polio

In detail, one case of VDPV2-n or a case with polio virus derived from type 2 polio vaccine was found in Nduga, Papua, in a 6 year old boy on February 20 2024 VDPV2-n case was also found in an 8 year old boy in Sidoarjo, East Java, on February 29 and another case in Asmat, Papua.

Surveillance

Currently, surveillance efforts have been carried out in an effort to monitor the risks of the PD3I outbreak. Health officials are asked to immediately report suspected polio cases or cases that indicate polio within 24 hours if found in health facilities or the community. This is especially true for cases of paralysis. Cleanliness and sanitation are required to be improved.

We know that vaccine-preventable diseases (PD3I) have no administrative borders. So, even if a region is categorized as green and low-risk, if there is transmission and spread in surrounding areas, transmission can occur in that region as well.

Along with that, education and information are also continuously provided regarding polio surveillance and other preventable diseases through immunization. The implementation of immunization will be strengthened through routine immunization followed by catch-up immunization.

According to Endang, the threat of PD3I outbreaks that are still occurring, including polio cases, is due to the low coverage of immunization in the community. In addition, immunization coverage is not evenly distributed throughout the region.

Also read: Extraordinary Polio Incident Reported Again, Immunization Increased

"The low coverage of immunization and the gap in immunization coverage in each region are still widely found. This causes the existence of regions with low immunization coverage pockets that have the potential to cause outbreaks," he said.

KOMPAS/FERGANATA INDRA RIATMOKO

Elementary students received polio immunization at Kanisius Pendowo Elementary School in Magelang City, Central Java on Monday (19/2/2024). The administration of the polio vaccine is part of the National Immunization Week (PIN) Sub-Week for the second round of polio vaccination.

The Expert Committee of the Central AFP Surveillance Team who is also Professor at the Faculty of Medicine, University of Indonesia (FKUI) Irawan Mangunatmadja explained that apart from low immunization coverage, polio cases that are still found in the community can also be caused by AFP surveillance (acute flaccid paralysis ) or acute paralysis.

However, proper surveillance can lead to faster detection and handling of cases. The chain of transmission can also be prevented. The low AFP surveillance may be caused by a lack of understanding of AFP surveillance among healthcare workers. Some healthcare workers in health facilities are found to be afraid to report AFP cases for fear of being evaluated poorly.

"Health workers play a very important role in improving AFP surveillance. "If you meet the requirements, immediately report the AFP," said Irawan.

The criteria for cases of sudden withering paralysis include cases found in children under 15 years of age, paralysis which is flaccid in nature (flaccid), occurs suddenly within 1-14 days, and paralysis which is not caused by traumatized. If there is any doubt in identifying an AFP case, it is best to still report it as an AFP case.

In paralysis examination, there are five degrees of paralysis that can be identified. Degree 0 when there is no movement at all. Degree 1 if there is only muscle movement or contraction. Degree 2 when unable to lift the leg from the bed or can only slide it.

KOMPAS/P RADITYA MAHENDRA YASA

A mother carrying her baby attends the polio vaccination at the Mekarsari Integrated Health Center, Tambakrejo Village, Semarang City, Central Java, on Monday (15/1/2024). The Ministry of Health held the National Immunization Week (PIN) for Polio simultaneously starting on January 15, 2024. The polio PIN was carried out after a case of paralysis occurred in Pamekasan Regency, Madura.

Level 3 if one can still lift their leg but cannot resist detainment. Meanwhile, level 4 if one can still resist detainment and level 5 if there is no evidence of paralysis.

Also read: Polio Virus Circulates, Strengthen Immunization and Environmental Cleanliness

"If we suspect there is acute flaccid paralysis, it is best to report it. Especially with the current situation where polio cases are appearing everywhere, we must be more careful and conduct better surveillance," said Irawan.