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.

background

A report on dengue hemorrhagic fever patients with viral isolation.

Changing epidemiology of dengue haemorrhagic fever in Indonesia

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

Possibilities of developing an anti-dengue vaccine are discussed based on our experimental findings with a dengue virus type 1 (DEN-1) Mochizuki strain. The Mochizuki strain virus was attenuated for human beings in the course of several passages through mouse brains since its isolation from the blood of a dengue patient in the 1943 epidemic in Nagasaki, Japan. This attenuated virus in the living state induced no abnormal symptoms after injection into human volunteers or monkeys, yet it stimulated production of specific anti-DEN-1 NT and HI antibodies and induced a prophylactic effect on the human beings against virulent dengue viruses (in the form of patient's serum) given experimentally. The immunogenic effects of the virus was maintained after passages in primary monkey kidney tissue cultures. Using the tissue culture virus, together with the 17D yellow fever (YF) vaccine, a combined immunization of human beings against DEN and YF was possible; production of the antibodies of significant titers against both viruses was unequivocally demonstrated. The partially purified virus was similarly effective in stimulating production of the anti-DEN antibodies, and the same statements could be made as to the viral components obtained by sucrose density gradient centrifugation. The virus was shown to multiply in the WI-38 cell line cultures, and this suggests application of this cell line to produce a live tissue culture vaccine.Conclusions of this review are : (1) the Mochizuki virus is completely attenuated; (2) yet it stimulates production of specific anti-DEN antibodies and induces protection against DEN-1 infection by virulent human virus; and (3) that possibility of developing a live tissue culture vaccine is suggested; this also makes possible a combined DEN-YF vaccination on the experimental basis. It is stated in the connection that the purified virus or its components can be used for the above purposes.Problems regarding the implication of “hypersensitivity hypothesis” of dengue and dengue hemorrhagic fever-shock syndrome in anti-DEN vaccination are in addition discussed.

A report on dengue hemorrhagic fever patients with viral isolation.

Citations

Changing epidemiology of dengue haemorrhagic fever in Indonesia

Perubahan Epidemiologi Demam Berdarah Dengue Di Indonesia

Virologic considerations on anti-dengue vaccine

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