Communicable and Natural Disease, Surveillance Control and Outbreak Investigation

Jontari HutagalungField Epidemiology Training Program (FETP)

Brief Outline

1. Communicable disease’s and NCD2. Surveillance3. Natural Disease’s4. Outbreak Investigation5. Indeks case (First case)

Why Need Investigate/Surveillance?

1. Control and prevention. 2. Severity and risk to others (AR, OR & RR). 3. Research opportunities. 4. Training opportunities. 5. Program considerations. 6. Public, political, or legal concerns.

Emerging Infection Nature

Emerging Infection Nature

Emerging Infection Nature (One Health)

Communicable Disease (Source: CDC, 2010)

An infectious disease TRANSMISSIBLE (as from person to person) by DIRECT CONTACT with an affected individual or the individual's discharges or by INDIRECT MEANS (as by a vector) compare contagious.

35. 000 000people died fromchronic diseases

in 2005 (WHO, 2005)

Source: WHO, 2005 and Nawi Ng, UGM, 2012

Global Burden of Disease 2004-2010Global Burden of Disease 2004-2010

Leading Causes of Death in Developed Region, 1990-2010 (in thousands)

Deseases Number Percent

Ischemic heart disease Cerebrovascular disease Trachea, bronchus, and lung cancers Lower respiratory infections Chronic obstructive pulmonary disease Colon and rectum cancers Stomach cancer Road traffic accidentsSelf–inflicted injuries Diabetes mellitus

2.6951.427523385324277241222193176

24.713.14.83.53

2.52.22

1.81.6

Source: WHO, Preventing Chronic Disease – A Vital Investment, 2005

Leading Causes of Death in Developing Region, 1990-2010 (in thousands)

Deseases Number PercentLower respiratory infections Ischemic heart disease Cerebrovascular disease Diarrheal diseases Conditions during the perinatal period Tuberculosis Chronic obstructive pulmonary disease Measles Malaria Road traffic accidents

3.9153.5652.9542.9402.3611.9221.8871.058856777

9.99

7.57.46

4.94.82.72.22

Source: WHO, Preventing Chronic Disease – A Vital Investment, 2005

Disease Of Wealthy Nations

WHO, Preventing Chronic Disease – A Vital Investment, 2005

Masalah Kesehatan di Masyarakat Indonesia (Triple burden)

Chronic diseases are being neglected Chronic diseases are being neglected in the MDG’s (year 2000)in the MDG’s (year 2000)

Triangle Epidemiology

KONSEP PENYEBAB & PROSES TERJADINYA PENYAKIT

Proses kejadian suatu penyakit krn adanya proses interaksi antara Manusia (HOST), Penyebab (AGENT) serta lingkungan (ENVIROMENT) lebih

sesuai dengan penyakit INFEKSI

HOW IS THE RELATION SHIP

H A

E

Sehat seimbang antara host, agent, enviroment

H

A

E

Sakit perubahan lingkungan yang mempermudah penyebaran agent . Ex. Akibat banjir

H

A

E

Sakit perubahan menurunnya daya tahan tubuh

Epidemiologic triangle

Is comprised of HOST, AGENT and ENVIRONMENT.

1. A host: is a living organism capable of becoming infected.

2. An agent: is a factor that must be present (potential missing) for the occurrence of a disease.

3. An environment: extrinsic force of situation affecting the host’s opportunity to be exposed to an agent.

List some of the components affecting disease

Host Characteristics Agent Characteristics

Environment Characteristics

1. Age2. Genetics3. Sex4. Socio economic 5. Immunity

1. Environ. stability2. Virulence3. Resistance (over prescription AB, mutation, survival) 4. Infectivity5. Pathogenicity

1.Biologic (vectors & Reservoirs).2. Physical (heat & pop. density)3. Social (culture)

Transmisi

NATURAL HISTORY OF DISEASE

NATURAL HISTORY OF DISEASE

Pre-clinical Phase Clinical Phase

Tk. Pencegahan I Tk. Pencegahan II Tk. Pencegahan III

1. Promkes2. Special protect3. Reducing expos

1. Screening2. APD3. Smoke4. Personal hygiene5. Avoid allergen

1.Penemuan dini. 2. Cure diseases (TB, Malaria, Ca) 3. Slow the progression4. Cut transmission5. Prevent complication

1. Limition disability

2. Restoration of effective function

3. Rehabilitation

‘McDonalization’

Herd immunity concept

Natural History Of Disease

Mode of Transmission

Chain of infection (mode of transmission)(from principal of epidemiologi, 2nd ed, US, CDC)

1. Droplet2. Airborne3. Direct contact4. Vector5. Vehicle

Suspectible Host

1. Direct2. In-dIrect

Portal of Entry

(penular)

RESERVOAR

AGENT

1. Reservoir: Habitat alamiah dari sebuah agent yg infeksius (manusia, binatang, sumber lingkungan).

2. Sumber infeksi: Orang atau objek yg tempat asal agent yg menginfeksi penjamu.

3. Carrier: Seseorang yg terinfeksi namun tidak menunjukkan gejala penyakit secara klinis (HIV; tergantung kpd pekerjaan, eq: pramugara, pembuat burger).

4. Transmisi: Penghubung dalam rantai infeksi (berguna u pencegahan, eq: ventilasi, kawat nyamuk, dll)

Skala Prioritas Dalam Melakukan Investigasi dan Penanggulangan (Control) Wabah Berdasarkan Sumber, Cara

Penularan, dan Agen Penyebab

Sumber/Cara Penularan

Diketahui Tidak Diketahui

Agen Penyebab

DiketahuiInvestigasi + Investigasi +++Control +++ Control +

Tidak Diketahui

Investigasi +++ Investigasi +++Control +++ Control +

Control and Prevention

Tujuan sistem kewaspadaan diniDan Outbreak Investigation

Sumber data Kejadian Luar Biasa (KLB)

Data penderita diare di Puskesmas Gondokusuman

Laporan Penyakit Menular DBD

1. Musim2. Cuaca

Masa pencegahan (PSN)

Gambaran Kasus Diare Pada Beberapa Kecamatan Kab.Agam, SUMBAR (Januari,

2010)

Definisi KLB (Kejadian Luar Biasa)

Adalah timbulnya suatu kejadian kesakitan/kematian dan atau meningkatnya suatu kejadian kesakitan/kematian yang bermakna secara epidemiologis pada suatu kelompok penduduk dalam kurun waktu tertentu (Undang-undang Wabah, 1969).

Pada penyakit yang lama tidak muncul atau baru pertama kali muncul disuatu daerah (non-endemis).

Outbreak is simply a higher frequency of disease or injury than is expected for a typical population and time period.

Definisi Wabah

Wabah adalah kejadian yang melebihi keadaan biasa, pada satu/sekelompok masyarakat tertentu (MacMahon and Pugh, 1970; Last, 1983, Benenson, 1990).

Peningkatan frekuensi penderita penyakit, pada populasi tertentu, pada tempat dan musim atau tahun yang sama (Last, 1983).

Perbedaan wabah dengan KLB

1 Wabah harus mencakup jumlah kasus yang besar.

2 Daerah yang luas.3 Waktu yang lebih lama.4 Dampak yang timbulkan lebih berat.

The difference between epidemic, endemic and pandemic

1. Epidemic: That each infected person is infecting multiple other individuals, so the number of infected persons is growing exponentially (other words each infected person is rapidly) Out break

2. Endemic:The disease that always present, to a greater or lesser extent geographic location

3. Pandemic:is an epidemic that is widespread over a large area or “all” of a geographic area.

How do we detect outbreaks?

Sources:1. Surveillance data.2. Medical Practitioner.3. Affected persons/groups.4. Concerned citizens.5. Media

Pemastian Diagnosa

Gejala klinis N %

Mual 15 83

Sakit perut 15 83

Sakit kepala 14 78

Pucat 11 61

Lemah 8 44

Berkeringat dingin 8 44

Muntah 7 39

Sesak Nafas 3 16

Pemastian Diagnosa

No GejalaFrekuensi Persentase

(n) (%)1 BAB cair/encer ≥3x dalam sehari 72 100,00

2 Lemah 36 50,00

3 Muntah 29 40,28

4 Demam 27 37,50

5 Mual 19 26,39

6 BAB tidak tertahankan 15 20,83

7 Pusing 15 20,83

8 Keringat dingin 11 15,28

9 BAB bau amis 10 13,89

10 Dehidrasi 9 12,50

11 Kram perut 7 9,72

12 BAB disertai lendir 5 6,94

13 BAB disertai darah 4 5,56

14 Mata cekung 2 2,78

Menentukan sumber dan cara penularan

No Tempat Jumlah Persentase (%)

1 SMP N 1 Kokap 73 83,90

2Pondok Pesantren Ittihadul

Mujtahidin 7 8,05

3SMP N 1 Kokap dan Pondok

Pesantren Ittihadul Mujtahidin 7 8,05

Total 87 100,00

Distribusi Kasus Berdasarkan Dusun Kec. Cawas Kab. Klaten

Construct and interpret and epidemic curve

Kegunaan kurva epidemik

1 Menentukan cara penularan (Tipe kurva)2 Identifikasi waktu paparan.3 Mencari indeks case (Orang yang pertama

sakit).

Outbreak Pattern of Spread

The overall shape of the epi curve can reveal the type of outbreak1. Common source (sumber penyakit sama)2. Propagated (sumber penyakit dari berbagai

org/sumber)3. Mix (common source and propagated)

Common Source Epidemic Curve

Y

X

0

2

4

6

8

10

12

14Tanggal Mulai Sakit (minggu)JUMLAH KASUS

Propagated Epidemic Curve

Epidemic Curve (Mix)

47

Cara Membuat Curva Epidemic

1. Masa inkubasi maksimum dan minimum2. Masa inkubasi rata-rata

Estimating the date of common source exposure(Minimum-maximum method) n; 81

8 hari

14 hari

Maret April

Minimum-maximum method

1. Epidemi mulai 24 maret dan berakhir pada 5 april2. Lama epidemi 12 hari.3. Masuk dalam kisaran masa inkubasi penyakit

tertentu (ex : tifoid 8-14 hari, mean 11 hari).4. Kasus pertama terpapar > 7 hari sebelumnya yaitu

tgl sebelum 17 maret (Masa inkubasi tifoid terpendek 8 hari).

5. Kasus terakhir terpapar sebelum 21 maret (masa inkubasi terpanjang 14 hari).

6. Hipotesis : Paparan terjadi antara 17-21 Maret

Estimating the date of common source exposure (Metode incubasi ratata) n: 81

11 hari

Maret April

Cara lain(Masa inkubasi rata-rata)

1. Tentukan rerata masa inkubasi (tifoid 11 hari).

2. Tentukan kasus median (kasus ke 40 atau 41 secara kronologis dari 81 kasus).

3. Hitung ke belakang rerata masa inkubasi.4. Hipotesis : paparan diduga tgl 15 Maret

TERIMA KASIH