Dengue Fever Continues to Spread
JAKARTA, KOMPAS – Dengue fever will remain a threat until the rainy season ends. The high number of cases has been caused by climate change and the ineffective eradication of mosquito habitats.
Cases of dengue hemorrhagic fever (DHF) have surged in several regions in January-February, with some regions declaring extraordinary occurrence status for the disease. Although the DHF outbreak recurs every year, the efforts to prevent it remain weak.
DHF continues to spread. Reza Wardhana, 30, who lives in Surabaya, East Java, said he was hospitalized for a week for dengue fever. "At first, I developed a high fever. Over time, my entire body felt weak. My upper abdomen felt painful when pressed," he said.
Susanti, 35, was staying with her son, who was hospitalized last week at the Dr. Wahidin Sudirohusodo General Hospital in Mojokerto, East Java. It has been three days since the 9-year-old developed dengue fever.
The number of dengue cases generally increased during January and February, as it has in previous years. Although the risk of contracting the disease increases during the peak of the rainy season, dengue also spreads during the seasonal transition to the dry season as well as during a dry season with localized rainfall.
DHF cases continued to emerge in several regions from January to early February. The Health Ministry recorded 23,305 cases with 207 dengue-related deaths from January to Feb. 19.
Dengue cases in January more than doubled compared to the same period last year, with most of the cases found in West Java, East Java and Central Java. Other cases were also found from East Nusa Tenggara to Papua. The provincial transmission rate per 100,000 population continued to change in 2013-2017. Bali and East Kalimantan were frequently in the top five provinces with the highest incidence of DHF, even though the number of cases declined.
However, high incidence of DHF is not directly related to a high mortality rate. Nationwide deaths from DHF in 2017 fell compared to the previous year. The highest mortality rate occurred in Gorontalo province with 2.18 percent, followed by North Sulawesi with 1.55 percent and Southeast Sulawesi with 1.47 percent.
So far, DHF cases have been found in almost all districts/municipalities. Cirebon regency recorded 106 dengue cases in February, a significant increase from 10 cases in January. "In the last five years, dengue cases usually increased in December-April, during the rainy season and until the transition to the dry season," said Sartono, head of infectious diseases prevention and control at the Cirebon health office.
Central Kalimantan Health Agency head Suyuti Syamsul said that the number of dengue cases remained high in Palangkaraya, although it had declined. In Kapuas regency last year, the local administration declared an extraordinary occurrence of DHF outbreak.
East Nusa Tenggara (NTT) Health Agency head Dominik Minggu Mere said that cases of DHF were found every year in Kupang, and that it had become more widespread. In 2018, 17 districts and municipalities were categorized as dengue-endemic areas, which had increased to 22 districts and cities with 2,312 cases this year.
The administrations of the four regions with the highest number of dengue cases have declared an extraordinary occurrence. Papua recorded 191 cases in 11 districts in the last two weeks, a year-on-year jump of 50 dengue cases.
"This year, the number of DHF cases in Papua has increased dramatically. We will again send diagnostic tools for dengue, Abate powder [larvicide] and liquid fumigates to Biak Numfor, which has the greatest number of cases," said Yamamoto Sasarari, the health and disease crisis management head of the Papua Health Agency.
Earlier this year, Jakarta saw an increase of 146 DHF cases over four days to total 613 cases. February saw an increase in DHF cases from January, but Jakarta is a dengue-endemic area.
Since it first appeared in 1968 in Surabaya, East Java and Jakarta, DHF has turned into an urban disease. Increased urbanization, the development of more cities and poor urban planning have caused growth in the threat of DHF transmission. "Climate change makes it warmer, so the distribution area of the Aedes aegypti mosquito has become wider," said Budi Haryanto of the University of Indonesia\'s Research Center for Climate Change.
The improvement in transportation and connectivity between cities and villages has also caused easier transmission of dengue to rural areas in many countries. In September 2018, the World Health Organization (WHO) reported that before 1970, only nine countries experienced a dengue epidemic. Today, dengue has spread to 141 tropical and subtropical countries on five continents.
Control
Eradicating the Aedes aegypti mosquito, which carries the dengue virus, is the key to preventing the disease. This is especially so since 1952, when the first known case of DHF, which has severe clinical symptoms and has no known cure, was recorded in Manila, the Philippines.
Although mosquito control is the key, eradication efforts face major challenges in the field. "Public awareness of the 3M Plus [prevention] movement is poor," said Upik Kesumawati Hadi, the pest control head at Bogor Agricultural University’s school of veterinary medicine.
The 3M Plus program advocates for the eradication of mosquito habitats by draining and closing water containers, as well as reusing goods that could potentially become the breeding ground of the mosquitoes.
This measure must be accompanied by additional efforts, such as sprinkling larvicidal powder in containers of water, using anti-mosquito medicines or lotions, and installing mosquito nets. People are also encouraged to keep mosquito larvae predators and mosquito repelling plants, regulate light and ventilate homes, and avoid hanging wet laundry indoors.
However, these efforts to suppress the mosquito population would only be effective if they are implemented en masse, sustainably and consistently. Eradication efforts should be implemented not only in residential areas, but also at offices, schools, markets, hospitals, places of worship and other public facilities. "It\'s useless if they are implemented in only one [location], because mosquitoes can move," said Upik.
The Health Ministry’s director of vector and zoonotic diseases, Siti Nadia Tarmizi, said the government encouraged residents to have one larva controller per house. This was expected to foster awareness that each household was responsible for preventing dengue transmission. "Using 3M Plus to eradicate mosquito habitats with must be done throughout the year," she said. (BRO/TAN/PDS/WER/FLO/IDO/BAY/IKI/SYA/ETA/NSA/KOR/DEA/ISW/MZW)