Dengue fever (DF)/dengue haemorrhagic fever (DHF) is a growing public health problem in the subtropics. Dengue was first reported in Indonesia in 1968 and since then the number of reports in the literature and the number of dengue virus (DENV)-infected cases reported by the Indonesian health authorities have increased. This review addresses the changing epidemiology of dengue in Indonesia by means of a chronological overview. Over time, the morbidity and mortality of dengue disease have increased and DHF epidemics occur throughout all the 29 provinces. The outbreak trend of DHF in the country has become irregular, with a high inter-epidemic background. All dengue serotypes are circulating, although severe disease is predominantly attributed to DENV-3. The case-fatality rate is dropping over time, probably reflecting increased awareness and improved treatment protocols. An increasing percentage of adolescents and adults develop DHF relatively earlier in the course of the disease, compared with the days when DHF was considered a primarily paediatric illness. Many inter-related factors such as environmental, biological and demographic issues influence dengue epidemiology and transmission.

Changing epidemiology of dengue haemorrhagic fever in Indonesia

Although epidemiological and molecular epidemiological (serotype, genotype, and lineage information) data are available for several major cities in Indonesia, there is yet to be a comprehensive national study of dengue in Indonesia over time. This study was conducted to provide a comprehensive epidemiology of circulating dengue viruses (DENV) in Indonesia between 1973 and 2016. This was conducted through a systematic review of the literature and phylogenetic analysis of available DENV sequences. Available data from National Disease Surveillance System have indicated an increasing trend of dengue incidence in Indonesia over the past 50 years. Incidence rates appear to be cyclic, peaking approximately every 6 to 8 years. In contrast, the case fatality rate has decreased approximately by half with each decade since 1980. Over this 50-year time span, serotype shifts, genotype displacement within DENV-1 and DENV-2, and introduction of DENV-1 and DENV-3 genotype from other countries occurred. These events were associated with increased incidence of dengue cases. Our study also provides a valuable national snapshot of DENV genetic diversity in Indonesia that may contribute to development of more effective dengue vaccine compositions for the region.

Dengue viruses circulating in Indonesia: A systematic review and phylogenetic analysis of data from five decades.

Dengue berdarah dengue yang ditularkan melalui vektor nyamuk Aedes aegypty masih merupakan masalah kesehatan penting di dunia. Di Indonesia, demam berdarah dengue mulai dikenal pertama kali pada tahun 1968 di DKI Jakarta dan Surabaya, dan terus menyebar ke seluruh tiga puluh tiga propinsi di Indonesia. Pola epidemiologi infeksi dengue mengalami perubahan dari tahun ke tahun, jumlah kasus memuncak setiap siklus 10 tahunan. Dari tahun 1968-2008 angka kesakitan demam berdarah dengue terus meningkat. Pada tahun 2008 didapatkanangka kesakitan 58,85/ 100.000 penduduk. Angka kematian menurun dengan stabil dari 41% pada tahun 1968 menjadi kurang dari 2% sejak tahun 2000, dan pada tahun 2008 angka kematian menurun menjadi 0,86%.Semua serotipe virus dengue ditemukan di Indonesia, namun serotipe virus den-3 masih dominan menyebabkan kasus dengue yang berat dan fatal. Surveilans epidemiologi, dukungan edukasi masyarakat dan program pengendalian vektor diperlukan untuk mencegah transmisi. Pengembangan vaksin dengue merupakan salah satu upaya mencegah penyakit dengue.

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Perubahan Epidemiologi Demam Berdarah Dengue Di Indonesia

Although neurological manifestations associated with dengue viruses (DENV) infection have been reported, there is very limited information on the genetic characteristics of neurotropic DENV. Here we describe the isolation and complete genome analysis of DENV serotype 3 (DENV-3) from cerebrospinal fluid of an encephalitis paediatric patient in Jakarta, Indonesia. Next-generation sequencing was employed to deduce the complete genome of the neurotropic DENV-3 isolate. Based on complete genome analysis, two unique and nine uncommon amino acid changes in the protein coding region were observed in the virus. A phylogenetic tree and molecular clock analysis revealed that the neurotropic virus was a member of Sumatran-Javan clade of DENV-3 genotype I and shared a common ancestor with other isolates from Jakarta around 1998. This is the first report of neurotropic DENV-3 complete genome analysis, providing detailed information on the genetic characteristics of this virus.

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Isolation and complete genome analysis of neurotropic dengue virus serotype 3 from the cerebrospinal fluid of an encephalitis patient.

Dengue is an acute mosquito-trans-mitted disease caused by any of fourvirus serotypes (DEN-1, DEN-2, DEN-3, or DEN-4) that is characterized by asudden onset of fever, headache,myalgia, and rash. The disease is en-demic, with increasing incidence inmost tropical areas, and constitutesone of the world’s emerging microbialdisease threats ( 1, 2 ). Large outbreaksof dengue and dengue hemorrhagicfever (DHF) have occurred recently inSouth and Central America and theCaribbean islands. Only one mosquitovector, Aedes aegypti , has been impli-cated in dengue transmission in theseareas. Dengue fever (DF) is usually self-limited and not life-threatening. Thepotentially life-threatening DHF ismost commonly reported in SoutheastAsia, where over a million cases werereported from 1986 to 1990, and whereDHF has become a frequent cause ofhospitalization and death in children( 3 ). The feature distinguishing DHFfrom DF is not the occurrence of hem-orrhage, but rather the occurrence of Rev Panam Salud Publica/Pan Am J Public Health

Clinical manifestations of dengue hemorrhagic fever in Puerto Rico

From 1975 to 1983, we clinically studied 1,451 serologically confirmed cases of dengue hemorrhagic fever in Jakarta, Indonesia. Of these cases, 142 were virologically confirmed. Considering these 142 cases, dengue type 3 was the predominant virus type isolated, but all 4 dengue virus serotypes were found. Dengue type 3 was the serotype most frequently associated with severe infections. Whereas 67 (47%) of the 142 patients had a dengue type 3 infection, this serotype was associated with 27 of the 34 fatal cases (79%). Dengue type 3 was found in 42 of the 75 cases with shock (56%), 31 of the 42 cases with encephalopathy (74%), and 19 of the 30 cases with gastrointestinal bleeding (63%).

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Wuryadi S

Papers

Clinical observations on hospitalized patients with virologically confirmed dengue hemorrhagic fever in Jakarta, Indonesia 1975-1983.