Current situation of dengue fever
Who does not know Dengue Hemorrhagic Fever or commonly abbreviated as DHF? DHF is a disease caused by the dengue virus which can be transmitted by mosquitoes Aedes aegypti and Aedes albopictus. This disease, which is identical to the rainy season, has existed in Indonesia since 1968. DHF was first discovered in the city of Surabaya. Since then, dengue has spread to almost all provinces in Indonesia. It was recorded that in 2020, DHF had spread in 472 districts/cities in 34 provinces (Kemenkes RI, 2020). The death rate due to dengue is still fluctuating. In 2020, deaths due to DHF occurred in 219 districts/cities in Indonesia. DHF can attack all ages with the highest percentage of sufferers being at the age of 15-44 years, while the most deaths attack the age group 5-14 years. DHF disease also does not look at gender, both men and women are susceptible to the disease (Ministry of Health, 2020).
Dengue Virus-Carrying Mosquitoes
Mosquito Aedes is a cosmopolitan mosquito because it can be found in any habitat in the world. Initially, the spread of mosquitoes may be limited to certain geographic areas, but the existence of very high human activity and mobility plays an important role in the spread of mosquito species. Until now, mosquitoes Aedes aegypti and Aedes albopictus spread over more than two-thirds of the world (Pontes et al., 2000). Global warming is thought to have contributed to creating breeding grounds for mosquitoes Aedes aegypti. This time, Aedes aegypti has been found in cold places such as mountainous regions.
Why do dengue cases increase during the rainy season?
Mosquito Aedes aegypti and Aedes albopictus coexist with humanshuman-loving) and is anthropophilic (prefers human blood over animal blood). Mosquito breeding place Aedes are places that can hold water both inside, outside, around the house and in public places. Mosquito breeding place Aedes can be classified into a water storage area (TPA) for daily needs such as drums, bathtubs/wcs, reservoir tanks, etc., non-daily landfills such as water dispensers/refrigerators, clogged gutters, and used goods (used tires, cans, bottles, plastic, etc.) as well as natural landfills such as banana fronds, pieces of bamboo, stone basins, and others (Ministry of Health, 2017).
Actually, dengue cases also exist during the dry season, but the number increases rapidly during the rainy season. This is closely related to the increase in breeding places or mosquito nests. Water reservoirs that are not covered or used goods that are filled with rainwater and allowed to stagnate will become places for mosquitoes to lay eggs. Mosquito Aedes happy to lay eggs in relatively clean water, different from mosquitoes Culex who like to lay eggs in dirty water. Mosquito Aedes will lay eggs on the edges of the water reservoir then after 2 days the eggs will soon hatch into mosquito larvae. Mosquito eggs Aedes can withstand drought conditions for up to 8 months.
Risk factor
Mosquito blood sucking activity Aedes usually starting in the morning and late in the evening, ie at 09.00-10.00 and Pkl 16.00-17.00. Research on various risk factors for DHF has been carried out. These risk factors include community behavioral risk factors, environmental risk factors, and health factors. The habit of activities outside the home, the habit of hanging clothes, the habit of cleaning the house, the habit of closing water reservoirs, and having a history of traveling out of town, especially to dengue endemic areas are examples of risk factors for community behavior.
Environmental risk factors that play a role in the development of DHF include population growth without a certain pattern, uncontrolled urbanization, high population mobility, inadequate sewage treatment systems and clean water supply, and poor environmental sanitation. In addition, health factors such as a person’s immunological status, viral strain/serotype of the infecting virus, age and genetic history also increase the risk of developing dengue disease.
DHF Vector Control Management
DHF is a complex disease. If we look from the perspective of the epidemiology of DHF, there are hosts (humans), agents (dengue virus), and the environment that play a very important role in it. These three things are related and need each other so that dengue fever can continue to be around us. The role of mosquitoes as vectors (carriers) of dengue disease should also not be forgotten. Then, how the government’s efforts so far? The Ministry of Health of the Republic of Indonesia has issued Guidelines for the Prevention and Control of Dengue Hemorrhagic Fever in Indonesia in 2017. The guidelines include protocols for diagnosis and management of dengue cases, epidemiology, surveillance, vector control and counseling as well as community empowerment (Ministry of Health, 2017).
Controlling dengue fever is not only the responsibility of the government, but also requires the active participation of community members in maintaining the cleanliness of their living environment. Fogging or fumigation is not a solution to eradicate dengue vector mosquitoes. In fact, this is the last method that will be taken when there is a case of DHF and it is proven that there is transmission of DHF in the area.
So what can the community do to prevent dengue at this time? The Mosquito Nest Eradication Program (PSN) with 3 M plus is one of the effective and efficient ways to prevent DHF, namely: 1) Draining, which is cleaning water reservoirs, 2) Closing, namely closing water reservoirs tightly, and 3) Burying/ Reuse / Recycle used goods that have the potential to become mosquito nests. The word “plus” that accompanies 3 M is a form of other prevention activities such as sprinkling larvicide powder such as abate in water reservoirs that are difficult to clean, using mosquito nets while sleeping, maintaining mosquito larvae predator fish (betta fish, guppy fish/guppy fish, Sumatran fish and tilapia chicks, planting anti-mosquito plants (lavender, zodia, lemongrass, etc.) others), wearing shirts and trousers when doing activities outside the home, and using mosquito repellent lotion.
The Ministry of Health through the Community Health Center has collaborated with the community to form a Jumantik (Lartic Observer) to make the community more involved in the mosquito control program. Jumantik plays a role in monitoring and monitoring the cleanliness of residents’ homes from mosquito larvae. Fridayik usually consists of PKK women who are routinely trained by the Puskesmas to help monitor the cleanliness of the environment around where they live. In addition, jumantik can also help monitor dengue cases so that reports can immediately reach the Puskesmas and immediately follow up. However, it is the awareness of each individual that needs to be built. Often people only clean water reservoirs and get rid of used goods that have the potential as mosquito nests when there will be monitoring from the Puskesmas or even when there are already dengue fever victims. Busyness and high mobility often make 3 M plus activities simply forgotten. The government should also actively educate through mass media and social media to remind the dangers of dengue disease. Massive education can be done by imitating education on prevention of Covid-19 disease with banners, banners, billboards and inserting advertisements on television, radio and newspapers. Education can also involve health educators through social media platforms.
Looking to the Future with Dengue Vaccine
The clinical manifestations of DHF can start from mild symptoms such as dengue fever to blood plasma leakage in DHF or shock syndrome that can lead to death. The dengue vaccine is a vaccine to prevent dengue infection or reduce a person’s risk of developing a severe dengue infection. According to the Indonesian Pediatrics Association (IDAI), the third phase clinical trial (vaccine efficacy and safety) of Sanofi Pasteur’s dengue vaccine ended in 2017. In one study, it was stated that this vaccine had 56.5 percent efficacy and reduced the risk of hospitalization. by 80 percent and reduce severe infections by 93 percent when given to children over the age of 9 years. In addition, there were no severe side effects or AEFIs from the administration of this vaccine. Since September 2016, the world’s first dengue vaccine has received approval from BPOM and is officially circulating as a tetravalent dengue vaccine in Indonesia (IDAI, 2017).
Along the way, the use of the tetravalent dengue vaccine was discontinued, because it turned out that the use of the dengue vaccine in children under the age of 9 actually increased the risk of severe dengue. In addition, the dengue vaccine actually increases the risk of dengue disease in people who have never been infected with the dengue virus before. Therefore, BPOM then re-evaluated the safety and benefits of the vaccine with WHO and IDAI in 2018. The results of the evaluation are 1) Dengvaxia vaccine circulating in Indonesia can be used to reduce the risk of incidence and severity of DHF in children aged 9-16 years who have previously been infected with DHF, and 2) Dengvaxia vaccine should not be used in individuals who have never been infected with DHF.
Apart from the mandatory requirements for the provision of vaccines and the relatively expensive price of the vaccine, which is 1 million rupiah for each injection dose (IDAI recommendation is 3 injections), it is clear that the dengue vaccine provides fresh air for the prevention of severe dengue infection. But keep in mind, vaccination without PSN efforts with 3 M plus will not be effective in preventing DHF. As a momentum to increase public awareness of the dangers of DHF, every April 22 is celebrated as “National Dengue Fever Day”.
Written by: Dila Hening Windyaraini (Graduate Student of Doctor of Biology Study Program, Faculty of Biology UGM)
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