Indonesia has a strategic geographical position. It is located in the tropics between two continents (Asia and Australia), between two oceans (the Pacific and Indian ocean). It is passed by the equator and consists of islands and archipelagos stretching from west to east. It is surrounded by vast oceans. Such conditions make the region of Indonesia has a variety of weather and climate.
The diversity of Indonesia’s climate is influenced by global phenomena such as El Nino Southern Oscillation (ENSO) which is from the Central Pacific Equatorial region, as well as the Indian Ocean Dipole (IOD) sourced from the Indian Ocean region, west of Sumatra to east Africa.
The climate variability is also influenced by regional phenomena, such as the Asian-Australian monsoon wind circulation. Inter Tropical Convergence Zone (ITCZ) is a region of cloud growth, as well as sea surface temperature conditions around Indonesia.
Indonesian local topography which has mountainous areas, many beaches, affects the variety of climatic conditions in Indonesia, either by space (region) or time.
Based on the analysis on the average data for the last 30 years (1981-2010), climatologically Indonesia has 407 climate patterns, 342 patterns are the Zone of Season (ZOM) where there is a clear distinction between rainy and dry season periods. While the other 65 patterns are Non Zone of Season (Non ZOM), which generally have twice maximum rainfall in a year (Equatorial pattern) of areas whose rainfall rate is always high or low.
According BMKG’s information, the rainy season 2017/2018 in most of Indonesia began late October-November 2017 with 260 ZOM (76.0%), while the peak of the rainy season occurred in December 2017-February 2018.
To date, the biggest health problems in Indonesia are in infectious diseases or tropical diseases. Since the Dutch colonial period, hundreds of years ago, infectious diseases such as smallpox, polio, malaria, cholera, tuberculosis, leprosy and elephantiasis have been eradicated with various methods and substantial cost. But until now, most of the diseases are still contagious in certain groups of people and areas.
Data from the Ministry of Health showed that up to November 2017 there were 95 regencies / cities from 20 provinces reporting diphtheria cases so overall, there are 622 cases, 32 of them had caused mortality.
While from October to November 2017 there are 11 provinces that reported the occurrence of diphtheria outbreaks, West Sumatra, Central Java, Aceh, South Sumatra, South Sulawesi, East Kalimantan, Riau, Banten, DKI Jakarta, West Java and East Java. This data increased by about 42% compared to 2016 where there were 415 cases with 24 deaths.
This high prevalence indicates diphtheria is still an endemic disease in many countries. In early 1980s there was an increased incidence of diphtheria in the former countries of Soviet Union, due to chaotic immunization programs. In 1990s there was still a great epidemic in Russia and Ukraine then in 2000s epidemic diphtheria still occurs and spreads to neighboring countries.
Diphtheria is a rare disease disorder. Typically, the disease affects teenagers and adults. In the United States during 1980-1996, 71% of the cases attacked younger teenagers, less than 14 years. In 1994 there were more than 39,000 cases of diphtheria with 1,100 cases of death (CFR = 2.82%), mostly attacked people over 15 years. In Ecuador, South America, in 1993-1994 there was an explosion of this disease with 200 cases, 50% of them were children aged 15 years or older.
From 1980 to 2010, there were 55 cases of diphtheria reported by the National CDC Disease Surveillance System. Most (77%) of the cases attacked the age of 15 and above, four out of five fatal cases occurred among unvaccinated children. While the fifth case is the 75 year old man who returned to the US from an endemic country.
Diphtheria, in some developing countries remains endemic diseases, such as in Caribbean countries, Latin America, Eastern Europe, Southeast Asia, and Africa. From this outbreak, the majority of cases afflict teenagers and adults, not children! Why? Because many adolescents and adults have not received routine vaccinations, or doses of diphtheria toxoid booster .
In 2011 with 806 diphtheria cases, Indonesia was the second highest country after India. This number has increased, compared to 2010, where Indonesia is also the second highest country with 385 cases of diphtheria. Then in 2009 there were 189 cases or increased from 2008 (219 cases).
While the highest diphtheria cases in the world occurred in India. In the country of Mahabharata, in 2008, 3.977 cases of diphtheria had happened. Then it declined in the year 2009 with 3,529 cases, and in 2010 with 3,123 cases. But in 2011 it increased again with 3,485 cases.
Sudan is the second highest country with 193 diphtheria cases in 2011. Nepal is the third highest country with 146 diphtheria cases in 2010, and 277 cases in 2009, and 149 cases in 2008.
Corynebacterium Diphteriae is a gram-positive (aerobic bacillus) bacteria , immobile, pleomorphic, not encapsulated, does not form spores, and can die at 60º Celsius warm, but withstand frost and dryness. Corynebacterium diphtheria can be classified by bacteriophage lysis into 19 types.
Type 1-3 are mythic types. Type 4-6 are intermedius type. Type 7 is a non-malign gravis type, while other types include virulent gravis types.
Corynebacterium diphtheria, whether in the form of one or two variants that are not malignant, can be found in the human throat, in the mucous membrane. This is why humans are the single reservoir and the main source of diphtheria transmission, both as a sufferer and as a carier.
The mode of transmission of this diphtheria can be through contact with the patient, ie at the incubation period or the entry of disease through contact with the carrier through coughing, sneezing or talking and indirect contact through dust, clothes, books or toys contaminated by diphtheria bacteria.
Incubation period of diphtheria is between 2-5 days, while the period of transmission of patients 2-4 weeks since incubation period, while the period of transmission of carrier can be up to six months.
Transmission of the infective germs can go through salivary droplets from coughing, sneezing, and talking or through contaminated tools or clothing and food or drink. The level of immunity to diphtheria in each country varies. It is influenced by high density, poor sanitation, and hygiene.
With properties as such, we are very vulnerable to environmental-based diseases in this rainy season, such as Upper Channel Infection (ISPA), including diphtheria. This is due to the transmission of diphtheria bacteria through the air or droplets.
High rainfall intensity due to weather anomaly makes many locations flooded. Accumulated garbage as well as rapid change of air temperature, make our body’s resistance decreased, especially in children and adolescents.
Improving the immune system of children by consuming nutritious food and beverages containing vitamin C, regular diet and maintaining sleep patterns, including vaccination organized by the government, are preventive measures in the face of tropical diseases, including diphtheria. Be more careful. (*)
Editor: Bambang Bes