Epidemiological Investigation in Diphtheria Control in Banda Aceh, Indonesia

Zahratul Aini, Eti Poncorini Pamungkasari, Ari Natalia Probandari


Background: Extraordinary events (KLB) diph­theria are still found in the city of Banda Aceh. An action is needed to break the chain of diph­theria cases and reduce the number of diphtheria mor­bidity or mortality, one of which is by con­ducting an epidemiological investiga-tion of diph­theria. This study aims to see how the implementation of diphtheria epidemiology investigations in the city of Banda Aceh and how it relates to the presence of diphtheria cases in the city of Banda Aceh.

Subjects and Method: This was a qua­­li­ta­tive multiplecase study. Data were collect­ed by con­ducting interviews with doctors in five sample com­munity health center in Ban­da Aceh City. Community health centers were se­lect­­ed by pur­posive sampling based on primary data regard­ing the distribution of diphthe­ria during 2017 and 2018 in Banda Aceh City. This study combined source tri-angulation. The source triangulation infor­mant is surveil­lance who serv­ed in the Banda Aceh City Health Service.

Results: The epidemiological investigation effort at the puskesmas began by immediately send­ing a diphtheria fast-moving team to carry out a chronological-related survey of cases and collect data on close contacts in the case envi­ron­ment. In close contact data collection there are com­munity health center that do not record com­plete close contact so prophylaxis cannot cover all close contacts. The stage of exa­mi­na­tion of throat or nose specimens for close con­tact is also not carried out in some com­munity health center.

Conclusion: Epidemiological investigations play an important role in breaking the chain of diph­­theria distribution. Skipping stages in epidemiological investigations can provide a gap for the development of diphtheria in the case envi­ronment. Puskesmas that carry out a com­­plete stage of epidemiological investigation are proven to be able to eradicate the incidence of diphtheria in their working area.

Keywords: diphtheria, surveillance, epidemio­logy investigation

Correspondence: Zahratul Aini. Masters Program in Family Medi­cine, Universitas Sebelas Maret, Jl. Ir. Su­tami 36A, Surakarta 57126, Central Java. E­mail: dr.­zahratulaini@gmail.com. Mobile: +62­8­­1360003­747.

Journal of Epidemiology and Public Health (2020), 05(02): 141-149

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Afif (2018). Aceh Jadi Provinsi Ketiga di Indonesia Pengidap Difteri Terbanyak (Aceh Becomes the Third Province in Indonesia with the Most Diphtheria). Retrieved from: https://www.merdeka.com/peristiwa/aceh-jadi-provinsi-ketiga-di-indonesia-pengidap-difteri-terbanyak.html

Aini Z, Poncorini E, Probandari AN (2019). Optimization of surveilance and laboratory technicians in diphtheria outbreak control in Banda Aceh, Aceh. International conference on Public health. https://doi.org/10.26911/theicph.2019.01.27.

Anggraeni ND, Yosephine P, Natalia U, Mazanova D, Handini S, Widodo N, Anom IB, et al (2017). Pedoman Pencegahan dan Pengendalian Difteri (Guidelines for Prevention and Control of Diphtheria). Jakarta: Kementerian Kesehatan Republik Indonesia

Fitriana, Novriani H (2014). Penatalaksanaan Difteri (Management of Diphtheria). Jurnal Indon Med Assoc, 64(12): 541–545

Haryato E (2018). Difteri Pada Anak (Diphtheria in Children). Sari Pediatri. 19(5): 300–306

Irawan H (2014). Diphteria: Re Emerging Disease Dalam Current Evidences In Pediatric Emergencies Management. Jakarta: Departemen Ilmu Kesehatan Anak FKUI/RSCM

Jané M,Vidal MJ, Camps N, Campins M, Martínez A, Balcells J, Martin Gomez MT, et al. (2018). A case of respiratory toxigenic diphtheria: contact tracing results and considerations following a 30-year disease-free interval, Catalonia, Spain, 2015. Euro Surveill. 23(13): pii= 17-00183. https://doi.org/10.2807/1560-7917.ES.2018.23.13.17-00183

Ministry of Health RI (2013). Petunjuk teknis pelaksanaan imunisasi dan surveilans dalam rangka penganggulangan kejadian luar biasa (KLB) Difteri (Technical Guidelines for the Implementation of Immunization and Surveillance in the Context of Overcoming Diphtheria Extraordinary Events (KLB)). Jakarta: Direktorat Jendral Pengendalian Penyakit dan Penyehatan Lingkungan Kementerian Kesehatan Republik Indonesia

Murhekar M (2017). Epidemiology of Diphtheria in India, 1996–2016: Implications for Prevention and Control. The American Journal of Tropical Medicine and Hygiene. 97(2): 313 – 318. https://doi.org/10.4269/ajtmh.170047

Phalkey RK, Bhosale RV, Joshi AP, Wakchoure SS, Tambe MP, Awate P, Marx M (2013). Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India. BMC Public Health. 13: 317. https://dx.doi.org/10.1186%2F14712458-13-317

Phan LT, Pham Q, Phan HC, Nguyen TV, Phan TV, Luong QC, Vo DTT, et al.. (2018). An investigation of an outbreak of diphtheria in adolescents and adults in southern Vietnam. Int J Infect Dis. 73(90): 3–398. https://doi.org/10.1016/j.ijid.2018.04.3628.

Poorwo S, Garna H, Rezeki S, Irawan H (2008) Infeksi dan Pediatri Tropis (Infections and Tropical Paediatrics). Kedua. Jakarta: bagian IKA Fakultas Kedokteran Universitas Indonesia

Rahman F, Hargono A, Susilastuti F (2016). Penyelidikan Epidemiologi KLB Difteri Di Kecamatan Geneng dan Karang Jati kabupaten Ngawi tahun 2015 (Epidemiological investigation of diphtheria outbreaks in Geneng and Karang Jati Districts in Ngawi Regency in 2015). Jurnal Wiyata. 3(2): 199–212. http://dx.doi.org/10.20473/jbe.V6I22018.103-111.

Ramdan IM, Susanti R, Ifroh RH, Noviasty R (2018). Risk factors for diphtheria outbreak in children aged 1-10 years in East Kalimantan Province, Indonesia. F1000Research. 7: 1625. https://doi.org/10.12688/f1000research.16433.1

Washington State Department of Health (2016) Diphtheria Reporting and Investigation Guideline. Washington DC: Washington State Department of Health

Widoyono (2008). Penyakit Tropis, Epidemiologi, Penularan, Pencegahan Dan Pemberantasannya (Tropical Disease, Epidemiology, Transmission, Prevention and Eradication). Jakarta: Erlangga


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