Prevent Diphtheria Transmission from Increasingly Widespread

JAKARTA, KOMPAS – The diphtheria extraordinary event that occurred in Garut, West Java, is a lesson in the importance of optimal immunization coverage in the community. Efforts to control and strengthen surveillance are now being strengthened to prevent transmission from becoming more widespread.

Director of Immunization Management at the Directorate General of Disease Prevention and Control of the Ministry of Health Prima Yosephine, when contacted in Jakarta, Thursday (23/2/2022), said that reports of diphtheria outbreaks (KLB) confirmed in Garut have currently reached at least seven cases. A total of five cases are still in the suspect category.

It was also reported that there were seven cases of death, some of which had an epidemiological relationship to the outbreak area and some did not have complete medical records. Outbreak Response Immunization (ORI) services by administering vaccines will also be carried out as a follow-up to the outbreak report.

“Outbreak Response Immunization (ORI) is planned to start on February 27 2023 in Pangatikan (Garut) District. The target is around 11,000 children aged two months to 15 years,” he said.

Also read: The Danger of Diphtheria

Prima added, epidemiological studies are continuing to be carried out to determine whether the expansion of ORI implementation is necessary. In addition, reinforcement of complete routine immunization is carried out for each child in all regions. Decreased immunization coverage can be a cause of extraordinary events in diseases that should be prevented by immunization (PD3I).

Immunization coverage

Based on data from the Ministry of Health, complete basic immunization coverage in Garut Regency, West Java, in 2019 was 88.79 percent. This coverage continues to decline to 86.2 percent in 2020 and 70.20 percent in 2021. This coverage is uneven in several regions. In a number of areas the immunization coverage is quite low, including in Pangatikan District, where diphtheria cases were found.

Outbreak Response Immunization (ORI) which is planned to start on February 27 2023 in Pangatikan (Garut) District. The target is around 11,000 children aged two months to 15 years.

Prima explained, other efforts have also been made in overcoming and strengthening surveillance in diphtheria cases with early detection of cases through an early alert and response system. Monitoring was also carried out to anticipate additional cases in the outbreak area.

“We did anyway refreshing training related to diphtheria surveillance and management for affected provinces and districts/cities in stages,” said Prima.

Also read: High Diphtheria in Aceh Impact of Low Immunization Coverage

Other treatments carried out to prevent the spread of transmission include limiting the activities of sick patients outside the home, giving prophylaxis to close contacts, and managing cases starting from taking swab tests, administering anti-diphtheria serum (ADS) and isolating cases. Prophylactic drug monitoring (PMO) officers in close contacts have also been appointed.

Diphtheria is an infectious disease that can be spread through coughing, sneezing or open wounds. Symptoms that can appear are sore throat and breathing problems. Transmission of diphtheria is mainly caused by a bacterial infection Corynebacterium diphtheriae which attacks the mucous membranes of the nose and throat and can affect the skin.

Diphtheria can attack all ages and has a risk of causing serious infections. If not treated immediately, the bacteria that cause diphtheria can be toxic which can damage the heart, kidneys or brain. The risk of death is also very high.

Separately, Professor of Pediatrics at Padjadjaran University, Cissy Kartasasmita, said that there were findings of diphtheria cases in the community due to low or declining immunization coverage. This transmission also occurs because of transmission from an infected person to an area.

Also read: Increasing Immunization Coverage

As a quick response, he said, vaccination must be carried out immediately for the area designated as an outbreak and the surrounding area. Antibiotics should also be given in close contacts.

“Diphtheria is very dangerous because it can cause death for all ages. Administration of anti-diphtheria serum must be carried out immediately to overcome the toxic effects caused by the infecting bacteria,” said Cissy.