k1 - epidemiologi penyakit tropis 01092014

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    Oleh:Oleh:

    dr. Agung S. Dwi Laksana, MSc.PHdr. Agung S. Dwi Laksana, MSc.PH

    EPIDEMIOLOGI PENYAKIT TROPISEPIDEMIOLOGI PENYAKIT TROPIS(TROPICAL DISEASE EPIDEMIOLOGY)(TROPICAL DISEASE EPIDEMIOLOGY)

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    OUTLINEOUTLINE

    PENDAHULUANPENDAHULUANDETEMINANTS O! TOPI"ALDETEMINANTS O! TOPI"AL

    DISEASEDISEASEDE#ELOPMENT O! TOPI"ALDE#ELOPMENT O! TOPI"AL

    DISEASEDISEASEDOMINANT !A"TOS TO $EDOMINANT !A"TOS TO $E

    DIS"USSED IN TOPI"AL MEDI"INEDIS"USSED IN TOPI"AL MEDI"INESOME E%AMPLES O! TOPI"ALSOME E%AMPLES O! TOPI"AL

    DISEASES EPIDEMIOLO&'DISEASES EPIDEMIOLO&'

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    PENDAHULUANPENDAHULUAN

    PEN&ETIAN ()HO*PEN&ETIAN ()HO*Tr+ical diseases enc+-ass all diseasesTr+ical diseases enc+-ass all diseases

    ha +ccur s+lel/, +r rinciall/, in he r+ics.ha +ccur s+lel/, +r rinciall/, in he r+ics.

    In racice, he er- is +0en aken + re0er +In racice, he er- is +0en aken + re0er +

    in0eci+us diseases ha hri1e in h+, hu-idin0eci+us diseases ha hri1e in h+, hu-id

    c+ndii+ns, such as -alaria, leish-aniasis,c+ndii+ns, such as -alaria, leish-aniasis,

    schis+s+-iasis, +nch+cerciasis, l/-haicschis+s+-iasis, +nch+cerciasis, l/-haic0ilariasis, "hagas disease, A0rican0ilariasis, "hagas disease, A0rican

    r/an+s+-iasis, and dengue.r/an+s+-iasis, and dengue.

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    The w+rd +0 r+ical disease is -+reThe w+rd +0 r+ical disease is -+re

    c+n1enien han accuraec+n1enien han accuraeDisease eculiar + and c+n0ined + he r+icDisease eculiar + and c+n0ined + he r+ic

     All disease +ccurring in he r+ic All disease +ccurring in he r+ic

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    DETEMINANTS O! TOPI"AL DISEASEDETEMINANTS O! TOPI"AL DISEASE

    Muncul dan 2erke-2angn/a en/akiMuncul dan 2erke-2angn/a en/aki

    r+is diengaruhi +leh 0ak+r:r+is diengaruhi +leh 0ak+r:&ENETI3&ENETI3

    LIN&3UN&ANLIN&3UN&AN

    PEILA3U 4 SOSIO5$UDA'APEILA3U 4 SOSIO5$UDA'A

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    Deer-inans +0 r+ical diseaseDeer-inans +0 r+ical disease

    TROPICAL

    DISEASE

    TROPICAL ENVIRONMENT SOSIO-BUDAYA

    MEDICAL GENETIC

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    DE#ELOPMENTS O! TOPI"AL DISEASEDE#ELOPMENTS O! TOPI"AL DISEASE

    TROPICAL

    DISEASE

    ENVIRONMENT AGENT

    HOST

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    DE#ELOPMENTS O! TOPI"AL DISEASE ("ONT.*DE#ELOPMENTS O! TOPI"AL DISEASE ("ONT.*

    TROPICAL

    DISEASE

    ENVIRONMENT AGENT

    HOST

    6SIFAT GENETIK6STATUS IMUNOLOGI

    6STATUS GIZI

    6MIKROBA

    6PARASIT6AGENT LAIN

    6KARAKTER GENETIK6PERUBAHAN GENETIK

    6EVOLUSI GENETIK

    GENETIC

    6BUDAYA6PERILAKU

    SOCIO-

    CULTURE

    ENVIRON

    MENT

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    DOMINANT !A"TOS TO $EDOMINANT !A"TOS TO $E

    DIS"USSED IN TOPI"AL MEDI"INEDIS"USSED IN TOPI"AL MEDI"INE

    7.7. Pri-ar/ "are: r+1isi+n +0 r+-+i1e,Pri-ar/ "are: r+1isi+n +0 r+-+i1e,

    re1eni1e, curai1e and reha2iliai1ere1eni1e, curai1e and reha2iliai1e

    a*a* Disease c+nr+l r+gra-Disease c+nr+l r+gra-

    2*2* Nurii+nal sule-enai+nNurii+nal sule-enai+nc*c* "lean and sa0e waer sul/"lean and sa0e waer sul/

    8.8. Eide-i+l+g/ +0 disease:Eide-i+l+g/ +0 disease:

    a*a* Disri2ui+n and deer-inansDisri2ui+n and deer-inans

    2*2* !+cus +n si9 deadl/ diseases: neu-+nia,!+cus +n si9 deadl/ diseases: neu-+nia,

    diarrh+eal illness, -alaria, -easles and HI#AIDSdiarrh+eal illness, -alaria, -easles and HI#AIDS

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    ;.;. Tradii+nal healer Tradii+nal healer 

    a*a* !re

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    >.>. I--un+l+gical asecI--un+l+gical asec

    a*a* H+s 0ac+rsH+s 0ac+rs

    2*2* Delicae 2alance in1+l1ing h+s andDelicae 2alance in1+l1ing h+s and

    in1ading ah+gensin1ading ah+gensc*c* Mechanis- in1+l1e in h+s suscei2ili/ andMechanis- in1+l1e in h+s suscei2ili/ and

    arasie e1asi+narasie e1asi+n

    ?.?. Ec+n+-ic and 0inancingEc+n+-ic and 0inancinga*a* P+1er/P+1er/

    2*2* Inade

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    DENGUE FEVERDENGUE FEVER

    Dengue 0e1er is an acue 0e2rile 1iral disease characeri@edDengue 0e1er is an acue 0e2rile 1iral disease characeri@ed2/ sudden +nse, 0e1er +0 ;5> da/s, inense headache,2/ sudden +nse, 0e1er +0 ;5> da/s, inense headache,-/algia, anhralgic rer+5+r2ial ain, an+re9ia, &I-/algia, anhralgic rer+5+r2ial ain, an+re9ia, &Idisur2ances and rash.disur2ances and rash.

    Dengue 1iruses are 0la1i1iruses and include 0+ur ser+/esDengue 1iruses are 0la1i1iruses and include 0+ur ser+/es7, 8, ; and = (Dengue 4 7, 58, 5; and 5 =*.7, 8, ; and = (Dengue 4 7, 58, 5; and 5 =*.

    These 1iruses are als+ res+nsi2le 0+r DengueThese 1iruses are als+ res+nsi2le 0+r DengueHae-+rrhagic !e1er (DH!*.Hae-+rrhagic !e1er (DH!*.

    The 1iruses are rans-ied + -an 2/ he 2ie +0 in0eci1eThe 1iruses are rans-ied + -an 2/ he 2ie +0 in0eci1e-+s

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    Dengue 0e1er (D!* wih is se1ere -ani0esai+ns suchDengue 0e1er (D!* wih is se1ere -ani0esai+ns suchas Dengue Hae-+rrhagic !e1er (DH!* and Dengueas Dengue Hae-+rrhagic !e1er (DH!* and DengueSh+ck S/ndr+-e (DSS* has e-erged as a -aB+r u2licSh+ck S/ndr+-e (DSS* has e-erged as a -aB+r u2lichealh r+2le- +0 inernai+nal c+ncern.healh r+2le- +0 inernai+nal c+ncern.

    The ge+grahical disri2ui+n has greal/ e9anded +1erThe ge+grahical disri2ui+n has greal/ e9anded +1erhe las ;C /ears, 2ecause +0 increased +enial 0+rhe las ;C /ears, 2ecause +0 increased +enial 0+r2reeding +02reeding +0 Aedes aegypti  Aedes aegypti , he 1ec+r secies., he 1ec+r secies.

    This has 2een r+-ed 2/ de-+grahic e9l+si+n,This has 2een r+-ed 2/ de-+grahic e9l+si+n,raid gr+wh +0 ur2an cenres wih a srain +n u2licraid gr+wh +0 ur2an cenres wih a srain +n u2licser1ices, such as +a2le waer.ser1ices, such as +a2le waer.

    This has 2een aug-ened 2/ rainwaer har1esing inThis has 2een aug-ened 2/ rainwaer har1esing indi1erse /es +0 c+nainers resuling in -ulile s+ragedi1erse /es +0 c+nainers resuling in -ulile s+rageracices.racices.

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     As er curren esi-aes, a1aila2ili/ +0 a leas As er curren esi-aes, a1aila2ili/ +0 a leas

    7CC c+unries are ende-ic 0+r DH! and a2+u7CC c+unries are ende-ic 0+r DH! and a2+u

    =C +0 he w+rld +ulai+n (8.> 2illi+n e+le*=C +0 he w+rld +ulai+n (8.> 2illi+n e+le*

    are a risk in r+ics and su25r+ics.are a risk in r+ics and su25r+ics. As er esi-aes, +1er >C -illi+n in0eci+ns wih As er esi-aes, +1er >C -illi+n in0eci+ns wih

    a2+u =CC,CCC cases +0 DH! are re+reda2+u =CC,CCC cases +0 DH! are re+red

    annuall/ which is a leading cause +0 childh++dannuall/ which is a leading cause +0 childh++d

    -+rali/ in se1eral Asian c+unries.-+rali/ in se1eral Asian c+unries.

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    SITUASI DEN&UE DI ASIA TEN&&AASITUASI DEN&UE DI ASIA TEN&&AA

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    L'MPHATI" !ILAIASISL'MPHATI" !ILAIASIS

    L/-haic 0ilariasis (L!* +r elehaniasis isL/-haic 0ilariasis (L!* +r elehaniasis is+ne +0 he -+s de2iliaing and dis0iguring+ne +0 he -+s de2iliaing and dis0iguringsc+urge a-+ng all diseases.sc+urge a-+ng all diseases.

    I is a -aB+r u2lic healh r+2le- in -an/I is a -aB+r u2lic healh r+2le- in -an/S+uh5Eas Asian c+unries.S+uh5Eas Asian c+unries.

    Nine +u +0 he 77 c+unries in he egi+nNine +u +0 he 77 c+unries in he egi+n

    are kn+wn + 2e ende-ic 0+r 0ilariasis.are kn+wn + 2e ende-ic 0+r 0ilariasis.The in0eci+n is caused 2/ hel-inhicThe in0eci+n is caused 2/ hel-inhic

    w+r-s inha2iing he l/-haics.w+r-s inha2iing he l/-haics.

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     All he hree l/-haic 0ilaria arasies 1i@. All he hree l/-haic 0ilaria arasies [email protected] bancrofti Wuchereria bancrofti ,, Brugia malayi Brugia malayi  andand B.B.timori timori  are re1alen in he egi+n.are re1alen in he egi+n.

    $ancr+0ian 0ilariasis rans-ied 2/ he$ancr+0ian 0ilariasis rans-ied 2/ heu2i

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    Twenty-tw ! "# $%&'ne w*'* +$%'e ! ,$$%'+,te.y /01 +'..'n

    $e$.e ,%e et'+,te2 t 3e en2e+' !% LF4

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    S+il5rans-ied Hel-inhiasisS+il5rans-ied Hel-inhiasis

    S+il5rans-ied hel-inhiasis (STH* +r inesinal w+r-S+il5rans-ied hel-inhiasis (STH* +r inesinal w+r-in0eci+n is he c+--+nes arasiic in0eci+n w+rldwide.in0eci+n is he c+--+nes arasiic in0eci+n w+rldwide.

    The c+--+n hel-inhs are r+undw+r-The c+--+n hel-inhs are r+undw+r- (Ascaris(Ascarislumbricoides)lumbricoides), whiw+r-, whiw+r- (Trichuris trichiura)(Trichuris trichiura) andand

    h++kw+r-h++kw+r- (ecator americanus)(ecator americanus)..  A2+u >CC -illi+n e+le in he S+uh5Eas Asia egi+n A2+u >CC -illi+n e+le in he S+uh5Eas Asia egi+nare chr+nicall/ in0eced wih STHare chr+nicall/ in0eced wih STH

     All 77 c+unries in he egi+n are ende-ic. All 77 c+unries in he egi+n are ende-ic. In0eci+n raes di00er acc+rding + ec+l+g/, 2u, in s+-eIn0eci+n raes di00er acc+rding + ec+l+g/, 2u, in s+-e

    c+--uniies, are as high as >.c+--uniies, are as high as >.

    The in0eci+ns red+-inanl/ +ccur in sch++l5ageThe in0eci+ns red+-inanl/ +ccur in sch++l5agechildren.children.

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    'A)S'A)S

    'aws is a c+nagi+us, n+n1enereal, re+ne-al in0eci+n in hu-ans'aws is a c+nagi+us, n+n1enereal, re+ne-al in0eci+n in hu-ansha resens -ainl/ in children /+unger han 7> /ears.ha resens -ainl/ in children /+unger han 7> /ears.

    In0eci+n wihIn0eci+n wih Treponema pertenueTreponema pertenue, a su2secies +0 Tre+ne-a, a su2secies +0 Tre+ne-aallidu- (he causai1e agen +0 s/hilis*, causes he disease. Iallidu- (he causai1e agen +0 s/hilis*, causes he disease. I+ccurs ri-aril/ in war-, hu-id, r+ical areas a-+ng ++r rural+ccurs ri-aril/ in war-, hu-id, r+ical areas a-+ng ++r rural+ulai+ns where c+ndii+ns +0 +1ercr+wding, ++r saniai+n and+ulai+ns where c+ndii+ns +0 +1ercr+wding, ++r saniai+n andinade

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    'aws is classi0ied in+ he 0+ll+wing = sages:'aws is classi0ied in+ he 0+ll+wing = sages: Pri-ar/ sage: Iniial /aws lesi+n de1el+s aPri-ar/ sage: Iniial /aws lesi+n de1el+s a

    in+culai+n siein+culai+n sie

    Sec+ndar/ sage: )idesread disse-inai+n +0Sec+ndar/ sage: )idesread disse-inai+n +0re+ne-es resuls in -ulile skin lesi+ns si-ilar +re+ne-es resuls in -ulile skin lesi+ns si-ilar +

    ri-ar/ /aws lesi+Nri-ar/ /aws lesi+N

    Laen sage: Usuall/, n+ s/-+-s are resen, 2uLaen sage: Usuall/, n+ s/-+-s are resen, 2u

    skin lesi+ns can relaseskin lesi+ns can relase Teriar/ sage: $+ne, B+in, and s+0 issue de0+r-iiesTeriar/ sage: $+ne, B+in, and s+0 issue de0+r-iies

    -a/ +ccur -a/ +ccur 

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    In he egi+n, India, Ind+nesia and Ti-+r5In he egi+n, India, Ind+nesia and Ti-+r5

    Lese sill ha1e a 0ew 0+ci wih aci1eLese sill ha1e a 0ew 0+ci wih aci1e

    cases resriced + 1er/ 0ewcases resriced + 1er/ 0ew

    disricsr+1incesdisricsr+1inces A2+u >,CCC cases are re+red annuall/, A2+u >,CCC cases are re+red annuall/,

    =,CCC in Ind+nesia, 7,CCC in Ti-+r5Lese=,CCC in Ind+nesia, 7,CCC in Ti-+r5Lese

    and a 0ew cases in India.and a 0ew cases in India.