Indonesia is the largest archipelago nation in the world with 257.5 million inhabitants, containing thousands of islands scattered around the equator (Worldbank Indonesia Data 2016). Its tropical climate and resulting relative high humidity are, however, both suitable conditions for the spread of vector-borne diseases. Also, Indonesia creates infamous repositories of zoonotic diseases such as chickens, rats, wild birds, dogs, pigs, and monkeys with a huge and increasing population (Konishi et al. 2009; Yamanaka et al. 2010; Dash et al. 2013; Townsend et al. 2013; Lane-DeGraaf et al. 2014).
Both people living in Indonesia and travelers visiting the archipelago are compromised by this relentless pace of contamination and possible local outbreaks. Infectious diseases, especially in countries with a (sub) tropical climate, remain one of the leading causes of morbidity and mortality worldwide (WHO 2014b).
Due to factors such as the tropical climate, ecology, and regular encounters between humans and animals, Indonesia is regarded as a hotspot for different diseases. The CIA World Fact book reports that with a very high degree of risk, some of the most common diseases in Indonesia are as follows:
Dengue is a vector-borne disease transmitted by infected female mosquito bites that can spread more readily in an area that lacks effective sanitation or frequently generates garbage. New research published in PLOS Neglected Tropical Diseases showed that by the age of five, more than half of all children in Indonesia’s urban areas had been infected with dengue virus and more than 80% had been infected with dengue virus by the age of 10 at least once. Usually, every three or four years, the epidemic occurrence spikes, with the most recent surge having occurred at the beginning of 2016.
The Ministry of Health of Indonesia estimated that in 2014, 71,668 cases of dengue fever were reported, with 641 of these cases resulting in death. While there appears to be a decrease in the number of cases at the national level, the number has risen in many regions, including North Sumatra, Riau, West Kalimantan, North Kalimantan, North Sulawesi, Bali, and Jakarta.
In recent decades, epidemiological developments have demonstrated that the prevention and management of dengue virus transmission have failed. No vaccine for dengue viruses or successful mosquito control systems dealing with breeding locations is available. The focus has been put in the affected focal areas on disease monitoring and rapid reaction using space sprays targeting adult mosquitoes. Strategies are currently being updated to concentrate on citizen interest in the removal of breeding sites and to promote collaboration and professionalism among program managers at all ranks.
For efficient Aedes aegypti surveillance, a decentralized integrated approach that targets larval mosquitoes is being introduced. Community participation is an essential condition for vector regulation, alongside high-level government engagement.
Malaria is another of the most common illnesses in Indonesia. Although the risk of malaria is comparatively free in Jakarta, Surabaya, Bali, and other major cities, other places in the world are still vulnerable to the disease. In the provinces of Papua, East Nusa Tenggara, Maluku, North Maluku, and West Papua, malaria is still rampant, according to data from the Ministry of Health. An Indonesian health official from the province of Maluku, whose local health department has been carrying out efforts to eradicate the disease, said that ensuring a safe climate, killing mosquito larvae by fogging, daily blood testing and the use of mosquito nets will be needed to eliminate the disease.
The revival of malaria in Indonesia has been aided by deforestation, logging, active massive relocation of people, and other growth activities. A partnership is the goal of the rollback malaria solution, which was launched as GEBRAK Malaria in 2000. The malaria prevention policy focuses primarily on monitoring of vectors and pathogens, early identification and timely care, coordinated management of vectors, and involvement in the community.
Efficient coordination, the long-term viability of vector control activities, human relocation, and environmental shifts are the key barriers to malaria control programs. The main threats for the future are both anti-malaria drug resistance and insecticide resistance.
Measles virus (MV), a morbillivirus belonging to Paramyxoviridae, is an extremely infectious virus, varying in amount from 12 to 16 new infections that can occur from one infected human (also referred to in the literature as the R0). It travels by virus-containing aerosols directly from human to human. Individuals naive to the infection, those not vaccinated and children who lose passive antibodies after birth, are especially in danger. The illness is distinguished by fever, cough, coryza, conjunctivitis, and Koplik’s spots disease. A typical erythematous and maculopapular rash that lasts 3-5 d occurs (Moss and Griffin 2012). In 40 percent of cases, measles infection is complicated owing to relative immunosuppression following measles virus infection, such as pneumonia (de Vries et al. 2012; Mina et al. 2015).
The prevalence of MV is successfully decreased by vaccination, while outbreaks arise due to vaccine safety and vaccine coverage, both in countries with and without a vaccination program (WHO 2012; Durrheim et al. 2014). The introduction of the standard MV immunization program has resulted in vaccine coverage above 90% in most of Indonesia, a target set by the WHO, with a dwindling number of provinces struggling to reach this target in recent years (Dalimunthe et al. 1990; Serquina-Ramiro et al. 2001; MoH-RI 2014). It can be seen that the average 1st dose coverage for one-year-olds is still below the 90 percent target by contrasting these results to WHO records (WHO 2016a). There is also no indication of MV outbreaks in ProMED-mail records, though MoH-RI still reports several cases with an incident rate of around 5-6 per 100,000 inhabitants (MoH-RI 2014, 2015).
A variety of Lyssaviruses, including the rabies virus and bat Lyssaviruses, are caused by Rabies (RABV). Saliva can spread the virus to humans from infected animals and ultimately cause a fatal brain infection. Dogs spread the virus in most cases, but the propagation of rabies from other wildlife should be taken into account (Wang et al. 2014). The total number of deaths caused by RABV is between fifty and one hundred thousand every year. Of the overall recorded diseases, the Asian and African continents account for 95% of the worldwide deaths (Leung AK et al. 2007).
In Indonesia, especially in Bali and East Nusa Tenggara, RABV is endemic and has probably been present since the 1880s, based on many manuscripts documenting clinical cases following bites from “mad dogs” (Ward 2014). An outbreak in Bali and the surrounding islands began in 2008 after being last identified in the late 1980s (Waltner-Toews et al. 1990) (MoH-RI 2009). In laboratory-confirmed human cases, up to 100 human cases and a patient fatality rate of 100% were registered during the outbreak until 2010 (Susilawathi et al. 2012).
HEPATITIS A (HAV)
Indonesia is widely known to be one of the world’s infectious regions for Hepatitis A (HAV). In endemic areas, this foodborne HAV virus, linked to reduced sanitation conditions, infects more than 90% of children under 10 years of age (Barzaga 2000). Since infection is rather asymptomatic before the age of five, the burden of disease is rather low for citizens in endemic areas, resulting in a high degree of community-based immunity for acute HAV infections. Therefore, within the population, barely any diseases happen. However, in developing economies such as Indonesia, the number of infectious children declines as a result of a strong rise in the level of sanitation with a corresponding increase in symptomatic infections at an older age (Vranckx et al. 1997). In Indonesia and other continental countries, this decrease in seroprevalence among children and adolescents has been documented (Kunasol et al. 1998).
This transition in epidemiological trends has ramifications for clinical and public health, where the implementation of the national HAV vaccine could be cost-effective at some stage relative to the symptom-driven treatment of acute HAV infection (Suwantika et al. 2014). HAV vaccination is commonly recommended by travel medicine guidelines for people traveling to Indonesia (refer to Table 1), especially for adults, and imported cases of HAV from travelers to and from Indonesia have been widely documented in the literature (Boggild et al. 2010; Utsumi et al. 2014).
WEST NILE VIRUS (WNV)
West Nile Virus (WNV), a flavivirus spread by arthropods, is a zoonotic infection, especially in birds and horses. As a reservoir, birds serve and transmission takes place through mosquitoes. In West Asia, as well as Africa, Europe, the Middle East, and North America, WNV is located (Chancey et al. 2015). Mammals are called dead-end hosts that do not contribute to the dissemination of the pathogen outbreak (van der Meulen et al. 2005). 2-14 d. The normal incubation time lasts. 20% of affected individuals will experience a moderate manifestation of non-specific disorders, including high fever, cough, myalgia, often rash, and lymphadenopathy; Less than 1% will show severe neurological symptoms (Watson et al. 2004).
Data concerning WNV epidemiology is scarce in Indonesia. A 15-year-old patient with fever in 2004 was isolated from WNV. In Africa, phylogenetic research revealed a relationship with isolated WNV strains (Myint et al. 2014). There are only a few records on WNV in humans in Indonesia. For instance, there is a suggestion of WNV infection in humans in Indonesia based on the work of Nasronudin et al. (2014) and Wicaksono et al. (2014). However, since they used a sub-optimal approach and confirmation by a third party laboratory was not carried out, these studies provide a low degree of support. There is no WNV monitoring network and there are no entries on ProMED-mail, so only existing case studies indicate possible WNV circulation in Indonesia.
In Indonesia, diarrhea was once the leading cause of death for children under 5 years of age, accounting for about 25 percent of infant mortality. While efforts to combat mortality from the disease have lowered death rates to about 2.5 per 1,000, the prevalence of bacteria in children under the age of five has remained stagnant at 25 to 30 million per year. The fact that there has not been a change in the number of outbreaks suggests the need for more creative ways to cope with the epidemic.
Diphtheria is a severe illness caused by strains of toxin-producing (poison) bacteria called Corynebacterium diphtheriae. It may result in respiratory problems, heart disease, paralysis, and even death.
Indonesia is seeing an epidemic of diphtheria triggering anxiety among the population and the government. The bacteria have infected hundreds, creating a thick coating in the back of the throat, and spread rapidly not only to regions with poor health care but also to the capital of the country, Jakarta, where health facilities are much improved.
The government reported 593 cases of diphtheria, distributed across 95 regencies in 20 provinces, between January and November 2017. The number of deaths has reached 32. Data on diphtheria supported by the World Health Organisation indicates that the number of cases in Indonesia has fluctuated since the 1980s.
Just about 75% of Indonesian children have received diphtheria vaccines. Antibiotics’ success in battling the disease is also diminishing.
RECOMMENDED VACCINES FOR CONTAGIOUS DISEASES IN INDONESIA
Suppose you intend to travel to various locations in Indonesia or to head out to the more isolated parts of Bali for a longer time. A more cautious approach is recommended in that case. Because vaccinations need to be taken before arrival at your holiday destination, 4-8 weeks before your planned departure, you need to prepare your vaccination strategy. Like MMR (measles, mumps, and rubella) and DTT (diphtheria and tetanus), all normal immunizations should be present. Furthermore, the following are recommended:
- Hepatitis A
- Hepatitis B
- Rabies (depending on location and occupational risk)
- Adult polio booster
- Japanese B encephalitis (in certain areas)
- Malaria prophylaxis
Making sure that they get all their routine childhood vaccines is one of the most important things that a parent can do for their kid. It is the most successful way to keep them healthy from a host of dangerous and potentially deadly infectious diseases. The value of immunizations cannot be overstated in a country like Indonesia where access to the international quality of healthcare can be restricted. Tragically, children who do not have access to immunization services still die from vaccine-preventable illnesses or suffer from chronic diseases.
Additional beneficial precautions include:
- Avoid Mosquitoes Bite.
- Changing the water in flower pots after a thorough cleaning once a week.
- Avoiding herb trays with standing water.
- Daily scrubbing of plant trays to get rid of any mosquito eggs.
- Cover all buckets of water and other items capable of collecting rainwater.
- Ensure that there is no clogging in roof gutters.
- Excluding aerated swimming baths and ornamental pools, filling or draining areas with impounded water.
- Larvicides or mosquito larvae are used to consume fish in rivers that cannot be drained.
- Application of screens to doors and windows and mosquito nets to beds.
- Barzaga BN. 2000. Hepatitis A shifting epidemiology in South-East Asia and China. Vaccine. 18:S61–S64.
- CDC. 2016. One Health. Centers for Disease Control and Prevention; [accessed 2016]. https://www.cdc.gov/onehealth/
- Chancey C, Grinev A, Volkova E, Rios M. 2015. The global ecology and epidemiology of West Nile virus. Biomed Res Int. 2015:376230.
- Chen LH, Wilson ME. 2010. Dengue and chikungunya infections in travelers. Curr Opin Infect Dis. 23:438–444.
- de Vries RD, McQuaid S, van Amerongen G, Yuksel S, Verburgh RJ, Osterhaus AD, Duprex WP, de Swart RL. 2012. Measles immune suppression: lessons from the macaque model. PLoS Pathog. 8:e1002885.
- Durrheim DN, Crowcroft NS, Strebel PM. 2014. Measles – the epidemiology of elimination. Vaccine. 32:6880–6883.
- Kunasol P, Cooksley G, Chan VF, Isahak I, John J, Loleka S, Villar EP, Poovorawan Y, Seong NH, Sulaiman HA, et al. 1998. Hepatitis A virus: declining seroprevalence in children and adolescents in Southeast Asia. Southeast Asian J Trop Med Public Health. 29:255–262.
- Indonesian Ministry of Health Information Center. Indonesian Health Profile 2016. Jakarta: Ministry of Health Republic of Indonesia
- Endemic and emerging acute virus infections in Indonesia: an overview of the past decade and implications for the future https://www.tandfonline.com/doi/full/10.1080/1040841X.2018.1438986
- Medical Advice for Travelers to Indonesia: Disease Concerns and Health Precautions https://www.expat.or.id/medical/traveladvicetoindonesia.html
- Indonesia’s diphtheria outbreak: problems in vaccination and antibiotics efficacy https://theconversation.com/indonesias-diphtheria-outbreak-problems-in-vaccination-and-antibiotics-efficacy-89036
- The Most Common Diseases In Indonesia https://borgenproject.org/common-diseases-in-indonesia/