The Threat of Emerging and Re-emerging Infections in Indonesia
Beside new diseases, tuberculosis, dengue virus, malaria and diphteria are continuously reported in Indonesia and classified as re-emerging illnesses. On this edition data on diphteria epidemiology in Indonesia will be shown by Karyanti et al.6 A recent outbreak of diphteria in Indonesia which involved almost all province in the country has led to a response named ORI (outbreak response of Immunization). Regardless of immunization, proper treatment including the distribution of anti-toxin and antibiotics are needed to stop the spread of this particular bacteria, further decreasing the mortality rate. In conclusion, the author of this paper mentioned that immunization gap needs to be handle systematically. Immunization data released on 2017 showed that complete immunization was given only to 20% of targeted group, while almost 75% were either unvaccinated or unknown. During the outbreak of diphteria in Indonesia, the WHO also reported several countries with similar problem such as Bangladesh, Haiti and Yamen. It was shown that a coordination between doctors in clinic/hospital with public health officer to conduct an epidemiological investigation, in conjunction with giving prophylaxis and assuring the logistics of anti-diphteria toxin and antibiotics were accessible were the key of success in eliminating diphteria like it was in Bangladesh.
Adherence to treatment are multifactorial for all illnesses. First, is the duration of treatment and the potential adverse event due to the medication. The Ministry of Health of the Republic of Indonesia has support the early diagnosis of HIV and delivering treatment as soon as possible, in order to avoid transmission of the disease. Second, looking at another side of the story for HIV infected patients, receiving ARV treatment as a long life treatment could possibly cause an adverse event somewhere along the line. Budiman et.al reported factors that might contribute to liver injury. His study shows that measuring baseline liver function test AST routinely might minimize the toxicity of ARV to patients particularly with a low body mass index. Last, despite the adherence to treatment and procedures in minimizing the risk of adverse event to medication, we are now facing the primary resistance virus that transmitted in the community as mentioned by Megasari et al.8 on her report regarding the transmission of drug resistance HIV virus to naïve patients in Bali.
The Indonesian government through the Indonesian Ministry of Health has established a collaboration and one health approaches to tackle the threat of diseases in the country, particularly in infectious diseases.
Agustina R, Dartanto T, Sitompul R, et al. Indonesian Health Systems Group. Universal health coverage in Indonesia: concept, progress, and challenges. Lancet. 2019;393:75-102.
CDC Global Helath Indonesia. Available online: https://www.cdc.gov/globalhealth/countries/indonesia/default.htm. Accessed on September 30, 2019.
WHO 2017. Kajian nasional respons HIV di bidang kesehatan Republik Indonesia. Available online: http://www.searo.who.int/indonesia/publications/hiv_country_review_indonesia_bahasa.pdf. Accessed on October 15, 2019.
Wesley de Jong, Musofa Rusli, Soerajja Bhoelan, et al. Endemic and emerging acute virus infections in Indonesia: an overview of the past decade and implications for the future. Crit Rev Microbiol. 2018;44(4):487-503.
Ministry of Health 2018. Indonesia health profile year 2017. Available online: https://www.depkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/indonesia-health-profile-2017.pdf. Accessed on October 10, 2019.
Karyanti MR, Nelwan EJ, Assyidiqie IZ, Satari HI. Hadinegoro SR. Diphtheria epidemiology in Indonesia during 2010 – 2017. Acta Med Indones. 2019;51(3):204-12.
Ismoedijanto. Difteri di Indonesia. Presented at the workshop of diphteria in Surabaya, 2018. [unpublished article].
Megasari NLA, Oktafiani D, Fitriana E, et al. The emergence of HIV-1 transmitted drug resistance mutations among antiretroviral therapy-naive individuals in Buleleng, Bali, Indonesia. Acta Med Indones. 2019;51(3):197-204.
Karyana M, Kosasih H, Samaan G, et al. INA-RESPOND. A multi-centre clinical research network in Indonesia. Health Res Policy Syst. 2015;13:34.
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