TEMPO.CO, Jakarta - DIPHTHERIA seems to have been resurrected from the grave. Indonesia was declared almost free from the disease in the 1990s, but it has apparently re-emerged. Between January and mid of last week, 714 people in 25 provinces were infected by Corynebacterium diphtheria, the bacterium causing diphtheria. No fewer than 32 died. Eleven provinces have reported an extraordinary situation (KLB) for diphtheria.
At the beginning of last week, the health ministry performed an Outbreak Response Immunization (ORI) after an outbreak of the disease in Jakarta, West Java, and Banten, three provinces with the highest numbers of active patients. The vaccinations are targeted at 7.9 million children between the ages of one to 19.
Although deadly, the disease can be prevented through vaccination. Health Minister Nila Djuwita Moeloek, however, has found that many parents do not wish for their child to be vaccinated. "I suspect the return of diphtheria is caused by the many anti-vaccination movements," said Nila, 68. Two-thirds of the total number of infected patients have zero immunity against diphtheria.
Nila Moeloek, 68, a professor at University of Indonesia’s Faculty of Medicine, appeals to the public to see the dangers posed by anti-vaccination attitudes. "If they get infected by the disease and end up infecting someone else, then what?"
Last week, Nila received Tempo reporters Nur Alfiyah, Angelina Anjar, and Reza Maulana at her office in the health ministry in Kuningan, South Jakarta. Several of her subordinates were also present, including Secretary-General Untung Suseno Sutarjo and Director for Health Supervision and Quarantines Elizabeth Jane Soepardi, both of whom joined in to answer questions on several occasions.
Why is diphtheria re-emerging now?
I suspect it’s because of the many anti-vaccination movements. Two-thirds of patients from all cases have zero immunity to diphtheria. For example, when I visited the Sulianti Saroso Hospital for Infectious Diseases in North Jakarta last Monday, of the 33 cases there, 22 were children. Their average age was four years, meaning they were born in 2013. That was when the number of diphtheria cases dropped after a brief appearance in 2009. Some parents really do not want their children to be vaccinated, but there are also some who lack discipline. Their children’s vaccinations are incomplete.
What is the result?
It leads to an immunity gap within the population. This is caused by an accumulation of groups vulnerable to diphtheria, who are not immunized or whose vaccinations are incomplete. Lately, we’ve often seen the refusal to vaccinate, which results in a low immunization coverage.
Is there yet a mapping of the causes for the zero immunity?
Not yet. I asked one of the mothers of a patient in Sulianti Saroso Hospital I had chosen at random. She said her child was not vaccinated. She was afraid to have it done, she said, but she could not explain what she was afraid of.
When was the first case of the latest diphtheria outbreak detected?
It began to emerge in January and several areas have now successfully overcome it, among others Malang in East Java. They performed an Outbreak Response Immunization- ORI. Gorontalo and West Kalimantan got it under control. So the 714 patients and the 11 provinces with an extraordinary situation status are a cumulative total. Most have already resolved the situation. An area may be declared to be in an extraordinary situation for diphtheria even if only a single clinical case is found there.
So, why is such a fuss being made about it only now?
Now the number of cases has soared again. People today have a high degree of mobility. Someone infected may not feel ill, and will then travel and become a carrier, spreading the bacteria to someone else.
Is there a difference between this year’s diphtheria and previous years?
Jane: Now an adult or an elderly can also catch it. We found one infected 59-year-old.
Why are adults also susceptible to diphtheria?
Diphtheria vaccination does not provide lifetime immunity, so repeated booster vaccinations are still necessary. Someone who has already had diphtheria must still also be vaccinated as catching the disease does not mean future immunity.
What are the latest developments on diphtheria cases?
No fewer than 26 provinces have reported cases between January and last Tuesday. The highest numbers are in East Java, West Java, and Aceh. However, after carrying out an ORI, no fewer than 66 regencies and urban areas have not reported any new cases since October. Currently, around 50 regencies and towns in 11 provinces still have cases of diphtheria. In East Java there are 14 regencies, in West Sumatra one regency, in South Sumatra one regency, and so forth.
Read the full interview in this week's edition of Tempo English Magazine.
