Oleh:dr. Agung S. Dwi Laksana, MSc.PHEPIDEMIOLOGI PENYAKIT TROPIS (TROPICAL DISEASE EPIDEMIOLOGY)

OUTLINEPENDAHULUANDETERMINANTS OF TROPICAL DISEASEDEVELOPMENT OF TROPICAL DISEASEDOMINANT FACTORS TO BE DISCUSSED IN TROPICAL MEDICINESOME EXAMPLES OF TROPICAL DISEASES EPIDEMIOLOGY

PENDAHULUANPENGERTIAN (WHO)Tropical diseases encompass all diseases that occur solely, or principally, in the tropics.In practice, the term is often taken to refer to infectious diseases that thrive in hot, humid conditions, such as malaria, leishmaniasis, schistosomiasis, onchocerciasis, lymphatic filariasis, Chagas disease, African trypanosomiasis, and dengue.

The word of tropical disease is more convenient than accurateDisease peculiar to and confined to the tropicAll disease occurring in the tropic

DETERMINANTS OF TROPICAL DISEASEMuncul dan berkembangnya penyakit tropis dipengaruhi oleh faktor:GENETIKLINGKUNGAN PERILAKU SOSIO-BUDAYA

Determinants of tropical diseaseTROPICALDISEASETROPICAL ENVIRONMENTSOSIO-BUDAYAMEDICAL GENETIC

DEVELOPMENTS OF TROPICAL DISEASETROPICALDISEASEENVIRONMENTAGENTHOST

DEVELOPMENTS OF TROPICAL DISEASE (CONT.)TROPICALDISEASEENVIRONMENTAGENTHOSTSIFAT GENETIKSTATUS IMUNOLOGISTATUS GIZIMIKROBAPARASITAGENT LAINKARAKTER GENETIKPERUBAHAN GENETIKEVOLUSI GENETIKGENETICBUDAYAPERILAKUSOCIO-CULTUREENVIRONMENT

DOMINANT FACTORS TO BE DISCUSSED IN TROPICAL MEDICINEPrimary Care: provision of promotive, preventive, curative and rehabilitativeDisease control programNutritional supplementationClean and safe water supplyEpidemiology of disease:Distribution and determinantsFocus on six deadly diseases: pneumonia, diarrhoeal illness, malaria, measles and HIV/AIDS

Traditional healerFrequently the first point of contact for patients in the tropicPlay a significant role in access to health careHave an important role in the framework of common tropical disease treatmentGeneticsPattern of autosomal and sex-linkage inheritanceDiversity of human genomeSelective pressure of human genomeGenetic contribution to common disease (ex: HLA type that confer resistance or susceptibility)

Immunological aspectHost factorsDelicate balance involving host and invading pathogensMechanism involve in host susceptibility and parasite evasionEconomic and financingPovertyInadequate resources due to economic reason

DENGUE FEVERDengue fever is an acute febrile viral disease characterized by sudden onset, fever of 3-5 days, intense headache, myalgia, anthralgic retro-orbital pain, anorexia, GI disturbances and rash.Dengue viruses are flaviviruses and include four serotypes 1, 2, 3 and 4 (Dengue 1, -2, -3 and - 4). These viruses are also responsible for Dengue Haemorrhagic Fever (DHF).

The viruses are transmitted to man by the bite of infective mosquitoes, mainly Aedesaegypti. The incubation period is 4-7 days (range 3-14 days). This disease is now endemic in most tropical countries. DHF caused by the same viruses, is characterized by increased vascular permeability, hypovolaemia and abnormal blood clotting mechanisms.

Dengue fever (DF) with its severe manifestations such as Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) has emerged as a major public health problem of international concern. The geographical distribution has greatly expanded over the last 30 years, because of increased potential for breeding of Aedes aegypti, the vector species.

This has been prompted by demographic explosion, rapid growth of urban centres with a strain on public services, such as potable water. This has been augmented by rainwater harvesting in diverse types of containers resulting in multiple storage practices.

As per current estimates, availability of at least 100 countries are endemic for DHF and about 40% of the world population (2.5 billion people) are at risk in tropics and sub-tropics. As per estimates, over 50 million infections with about 400,000 cases of DHF are reported annually which is a leading cause of childhood mortality in several Asian countries.

SITUASI DENGUE DI ASIA TENGGARA

LYMPHATIC FILARIASISLymphatic filariasis (LF) or elephantiasis is one of the most debilitating and disfiguring scourge among all diseases. It is a major public health problem in many South-East Asian countries. Nine out of the 11 countries in the Region are known to be endemic for filariasis. The infection is caused by helminthic worms inhabiting the lymphatics.

All the three lymphatic filaria parasites viz. Wuchereria bancrofti, Brugia malayi and B. timori are prevalent in the Region. Bancroftian filariasis transmitted by the ubiquitous principal vector, Culex quinquefasciatus, is the most predominant infection in South AsiaBrugian infections transmitted by Mansonia and Anopheles vectors predominate in Indonesian Archipelago.

Twenty-two of 27 provinces which comprises of approximately 150 million people are estimated to be endemic for LF.

Soil-transmitted Helminthiasis Soil-transmitted helminthiasis (STH) or intestinal worm infection is the commonest parasitic infection worldwide. The common helminths are roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and hookworm (Necator americanus).About 500 million people in the South-East Asia Region are chronically infected with STH

All 11 countries in the Region are endemic. Infection rates differ according to ecology, but, in some communities, are as high as 95%. The infections predominantly occur in school-age children.

YAWSYaws is a contagious, nonvenereal, treponemal infection in humans that presents mainly in children younger than 15 years. Infection with Treponema pertenue, a subspecies of Treponema pallidum (the causative agent of syphilis), causes the disease. It occurs primarily in warm, humid, tropical areas among poor rural populations where conditions of overcrowding, poor sanitation and inadequate water supply prevail. The major route of infection is through direct person-to-person contact. The treponemes associated with yaws are present primarily in the epidermis.The ulcerative skin lesions present early in the disease are teaming with spirochetes, which can be transmitted via direct skin-to-skin contact and via breaks in the skin from trauma, bites, or excoriations.

Yaws is classified into the following 4 stages: Primary stage: Initial yaws lesion develops at inoculation siteSecondary stage: Widespread dissemination of treponemes results in multiple skin lesions similar to primary yaws lesioNLatent stage: Usually, no symptoms are present, but skin lesions can relapseTertiary stage: Bone, joint, and soft tissue deformities may occur

In the Region, India, Indonesia and Timor-Leste still have a few foci with active cases restricted to very few districts/provinces About 5,000 cases are reported annually, 4,000 in Indonesia, 1,000 in Timor-Leste and a few cases in India.

PENYAKIT-2 PADA KESEHATAN MASYARAKAT DI INDONESIAMALARIAPESKHOLERACACARBUSUNG LAPARDIAREDEMAM BERDARAH DENGUE (DBD)LEPRA / KUSTATUBERCULOSAISPAP3DI ( PENYAKIT YG DAPAT DICEGAH DENGAN INFEKSI )AIDS ( AQUIRED IMMUNO DEFICIENCY SYNDROME)FLU BURUNG .

TERIMA KASIH