Photo Diary: Dawn Raid

fumigation to prevent dengue fever carried out early in the morning at 4:30 AM

DHF was first reported in 1968 during an outbreak that occurred in Surabaya and Jakarta. In the epidemic of DHF, which occurred in 1998, a total of 47 573 cases of DHF were reported with 1 527 deaths. These cases were reported from 201 of 304 districts of Indonesia. Aedes aegypti is the main vector and high indices reported in the many areas of the country indicate that the vector is widespread throughout.

During 2004, cases were reported every month with a total of 78,690 and 954 deaths (CFR = 1.2%). The outbreak peaked in February and March. The reported cases from 1985-2004 indicate an increasing trend. During the last 20 years, the outbreak in 2004 was the most serious followed by the one that occurred in 1998 (72,133 cases and 1,414 deaths; CFR = 2%). Since November 2004, the number of cases has increased gradually with the peak in January 2005 (6,043 cases).

The outbreak (December 2004 to 22 February 2005) reported a total of 10,517 cases with 182 deaths (CFR = 1.73%) for all 30 provinces. The most serious outbreak occurred in DKI Jakarta province (2768 cases with CFR = 0.76) followed by Jabar (1863 cases with high CFR =2.84). Out of 16 provinces with at least 100 cases during that period, five provinces were with a CFR>2 and 13 provinces were with a CFR>1.

In 2005, Indonesia is the major contributor of dengue cases in SEAR (53%) with a total of 95,270 cases and 1298 deaths (CFR = 1.36%) reported. The caseload has increased by 17% and deaths by 36% as compared to 2004. The case load reported is the highest ever in the history of dengue in Indonesia.

Indonesia has faced major outbreak in April 1998 and March 2004. Since 2004 Indonesia reported the highest number of dengue cases among the countries in the Region.  Unlike in other years, in 2005 the outbreak started from the month of July and increases further till it peaked in the month of December. One reason may be due to several natural disasters in Indonesia in these last five years creating environment conducive for dengue vectors and also due to diversion of national priorities to more   curative and rehabilitative work post natural disasters.

In 2006 Indonesia alone reported 57% of the dengue cases and almost 70 % of the dengue deaths in SEAR (1132 deaths out of total of 1558 dengue deaths in the region). In 2006 the provinces that have reported increased dengue cases are  Aceh, Bali, Sumsel, Lampung, Kalbar, Jatim , Jabar, Gorontalo and  DKI Jakarta .   The increase is very significant in two provinces Jatim and Jabar (almost four fold as compared to 2002). The case fatality rate is as high as 5% in one province Sumsel. The provinces with CFR more than 1% are Aceh, Sumut, Riau, Kep Riau, Jambi, Bengkulu, Banten, Jating, Jatim, Kalbar, Kateng, Kalsel, Katim, Sulut, Sulteng and Sulbar.

There is correlation between dengue cases and rainfall as studied in Indonesia.  A five year study showed that the cases start increasing after start of rainfall and significantly peaks at about 9 weeks of rainfall that is the time of the out break.

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