Oleh:

dr. Agung S. Dwi Laksana, MSc.PH

EPIDEMIOLOGI PENYAKIT TROPIS
(TROPICAL DISEASE EPIDEMIOLOGY)
OUTLINE
PENDAHULUAN
DETERMINANTS OF TROPICAL
DISEASE
DEVELOPMENT OF TROPICAL
DISEASE
DOMINANT FACTORS TO BE
DISCUSSED IN TROPICAL MEDICINE
SOME EXAMPLES OF TROPICAL
DISEASES EPIDEMIOLOGY
PENDAHULUAN
PENGERTIAN (WHO)
Tropical diseases encompass all diseases
that occur solely, or principally, in the
tropics.
In practice, the term is often taken to refer to
infectious diseases that thrive in hot, humid
conditions, such as malaria, leishmaniasis,
schistosomiasis, onchocerciasis, lymphatic
filariasis, Chagas disease, African
trypanosomiasis, and dengue.
The word of tropical disease is more
convenient than accurate
Disease peculiar to and confined to the tropic
All disease occurring in the tropic
DETERMINANTS OF TROPICAL DISEASE
Muncul dan berkembangnya penyakit
tropis dipengaruhi oleh faktor:
GENETIK
LINGKUNGAN
PERILAKU SOSIO-BUDAYA
Determinants of tropical disease
TROPICAL
DISEASE
TROPICAL ENVIRONMENT SOSIO-BUDAYA
MEDICAL GENETIC
DEVELOPMENTS OF TROPICAL DISEASE
TROPICAL
DISEASE
ENVIRONMENT AGENT
HOST
DEVELOPMENTS OF TROPICAL DISEASE (CONT.)
TROPICAL
DISEASE
ENVIRONMENT
AGENT
HOST
SIFAT GENETIK
STATUS IMUNOLOGI
STATUS GIZI
MIKROBA
PARASIT
AGENT LAIN
KARAKTER GENETIK
PERUBAHAN GENETIK
EVOLUSI GENETIK
GENETIC
BUDAYA
PERILAKU
SOCIO-
CULTURE
ENVIRON
MENT
DOMINANT FACTORS TO BE
DISCUSSED IN TROPICAL MEDICINE
1. Primary Care: provision of promotive,
preventive, curative and rehabilitative
a) Disease control program
b) Nutritional supplementation
c) Clean and safe water supply
2. Epidemiology of disease:
a) Distribution and determinants
b) Focus on six deadly diseases: pneumonia,
diarrhoeal illness, malaria, measles and HIV/AIDS
3. Traditional healer
a) Frequently the first point of contact for patients in
the tropic
b) Play a significant role in access to health care
c) Have an important role in the framework of
common tropical disease treatment
4. Genetics
a) Pattern of autosomal and sex-linkage inheritance
b) Diversity of human genome
c) Selective pressure of human genome
d) Genetic contribution to common disease (ex: HLA
type that confer resistance or susceptibility)
5. Immunological aspect
a) Host factors
b) Delicate balance involving host and
invading pathogens
c) Mechanism involve in host susceptibility and
parasite evasion
6. Economic and financing
a) Poverty
b) Inadequate resources due to economic
reason
DENGUE FEVER
Dengue fever is an acute febrile viral
disease characterized by sudden onset,
fever of 3-5 days, intense headache,
myalgia, anthralgic retro-orbital pain,
anorexia, GI disturbances and rash.
Dengue viruses are flaviviruses and
include four serotypes 1, 2, 3 and 4
(Dengue 1, -2, -3 and - 4).
These viruses are also responsible for
Dengue Haemorrhagic Fever (DHF).
The viruses are transmitted to man by the
bite of infective mosquitoes, mainly
Aedesaegypti.
The incubation period is 4-7 days (range
3-14 days).
This disease is now endemic in most
tropical countries.
DHF caused by the same viruses, is
characterized by increased vascular
permeability, hypovolaemia and abnormal
blood clotting mechanisms.
Dengue fever (DF) with its severe
manifestations such as Dengue
Haemorrhagic Fever (DHF) and Dengue
Shock Syndrome (DSS) has emerged as a
major public health problem of
international concern.
The geographical distribution has greatly
expanded over the last 30 years, because
of increased potential for breeding of
Aedes aegypti, the vector species.
This has been prompted by demographic
explosion, rapid growth of urban centres
with a strain on public services, such as
potable water.
This has been augmented by rainwater
harvesting in diverse types of containers
resulting in multiple storage practices.

As per current estimates, availability of at
least 100 countries are endemic for DHF
and about 40% of the world population
(2.5 billion people) are at risk in tropics
and sub-tropics.
As per estimates, over 50 million infections
with about 400,000 cases of DHF are
reported annually which is a leading cause
of childhood mortality in several Asian
countries.
SITUASI DENGUE DI ASIA TENGGARA
LYMPHATIC FILARIASIS
Lymphatic filariasis (LF) or elephantiasis is
one of the most debilitating and disfiguring
scourge among all diseases.
It is a major public health problem in many
South-East Asian countries.
Nine out of the 11 countries in the Region
are known to be endemic for filariasis.
The infection is caused by helminthic
worms inhabiting the lymphatics.
All the three lymphatic filaria parasites viz.
Wuchereria bancrofti, Brugia malayi and B.
timori are prevalent in the Region.
Bancroftian filariasis transmitted by the
ubiquitous principal vector, Culex
quinquefasciatus, is the most predominant
infection in South Asia
Brugian infections transmitted by Mansonia and
Anopheles vectors predominate in Indonesian
Archipelago.
Twenty-two of 27 provinces which comprises of approximately 150 million
people are estimated to be endemic for LF.
Soil-transmitted Helminthiasis
Soil-transmitted helminthiasis (STH) or
intestinal worm infection is the commonest
parasitic infection worldwide.
The common helminths are roundworm
(Ascaris lumbricoides), whipworm
(Trichuris trichiura) and hookworm
(Necator americanus).
About 500 million people in the South-East
Asia Region are chronically infected with
STH
All 11 countries in the Region are
endemic.
Infection rates differ according to ecology,
but, in some communities, are as high as
95%.

The infections predominantly occur in
school-age children.

YAWS
Yaws is a contagious, nonvenereal, treponemal infection in humans
that presents mainly in children younger than 15 years.
Infection with Treponema pertenue, a subspecies of Treponema
pallidum (the causative agent of syphilis), causes the disease. It
occurs primarily in warm, humid, tropical areas among poor rural
populations where conditions of overcrowding, poor sanitation and
inadequate water supply prevail.
The major route of infection is through direct person-to-person
contact.
The treponemes associated with yaws are present primarily in the
epidermis.
The ulcerative skin lesions present early in the disease are teaming
with spirochetes, which can be transmitted via direct skin-to-skin
contact and via breaks in the skin from trauma, bites, or
excoriations.

Yaws is classified into the following 4 stages:
Primary stage: Initial yaws lesion develops at
inoculation site
Secondary stage: Widespread dissemination of
treponemes results in multiple skin lesions similar to
primary yaws lesioN
Latent stage: Usually, no symptoms are present, but
skin lesions can relapse
Tertiary stage: Bone, joint, and soft tissue deformities
may occur
In the Region, India, Indonesia and Timor-
Leste still have a few foci with active cases
restricted to very few districts/provinces
About 5,000 cases are reported annually,
4,000 in Indonesia, 1,000 in Timor-Leste
and a few cases in India.
PENYAKIT-2 PADA KESEHATAN
MASYARAKAT DI INDONESIA
MALARIA
PES
KHOLERA
CACAR
BUSUNG LAPAR
DIARE
DEMAM BERDARAH DENGUE (DBD)
LEPRA / KUSTA
TUBERCULOSA
ISPA
P3DI ( PENYAKIT YG DAPAT DICEGAH DENGAN INFEKSI )
AIDS ( AQUIRED IMMUNO DEFICIENCY SYNDROME)
FLU BURUNG .
TERIMA KASIH