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ZOONOSISPenyakit yang secara alami dapat dipindahkan dari hewan vertebrata ke manusia atau sebaliknya.
Ada 150 penyakit zoonosa di dunia. Di Indonesia terdapat lebih dari 50 zoonosis antara lain: rabies, pes, anthrax, taeniasis/cysticercosis, JE, leptospirosis, hanta, toxoplasmosis, schistosomiasis, dsb
LEPTOSPIROSISWEIL,S DISEASECANICOLA FEVERHAEMORRHAGIC JAUNDICETRENCH FEVERSWINEHERD,S DISEASEMUD FEVERRICE FIELD FEVERFLOOD FEVER
LEPTOSPIROSISAdalah penyakit infeksi yang disebabkan oleh kuman Leptospira sp. karena kontak dengan urine tikus yg mengandung Leptospira atau air, lumpur yg terkontaminasi kuman ini dg menembus kulit lecet atau mukosa.
DISTRIBUSI LEPTOSPIROSISDi dunia :Rusia, Argentina, Inggris, Brazilia, Australia, Israel, Spanyol, Amerika Serikat, Afganistan, Malaysia, Indonesia dsb.
INTRODUCTION LEPTOSPIROSISWorldwide zoonosisOCCUPATIONAL DISEASECost for medical treatment and Decrease of productivity and income
INTRODUCTION INFECTED DOMESTIC ANIMALSCost for treatment and control, Economic losses due to reproductive failures, and Reduced milk yield.WORLDWIDE UNDERESTIMATION OF LEPTOSPIROSIS Difficulty to diagnose : Clinic and Laboratory
INTRODUCTION 180 serotype has been isolatedIn Indonesia the research on Leptospirois has been started very long time (L.medanensis, L.javanica, L.hardjo, L.sentot, L.mankarso, etc).Contact directly and indirectlyRelated to Occupation
Situasi Leptospirosis di Indonesia,th 2003 - 2008
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Situasi Leptospirosis Menurut Lokasi
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DKI1386578625147037
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Kasus Leptospirosis dilaporkan dari:DKI Jakarta: Jaktim, Jaksel, Jakbar, JakpusJawa Barat : BekasiBanten: TangerangJawa Tengah: Demak, Purworejo, Klaten, Semarang, PatiDIY: Sleman, BantulJawa Timur: Gresik , Surabaya, Malang (kota dan kabupaten)Sulawesi Selatan: Makassar
PENYEBARAN DI INDONESIAJawa Barat Sulawesi UtaraJawa Tengah Sulawesi SelatanDI Yogyakarta Kalimantan BaratLampung Kalimantan TimurDKI JakartaSumatera SelatanBengkuluRiauSumatera BaratSumatera UtaraBaliNTB
KLB LEPTOSPIROSIS1986, KLB di Kuala Cinaku, Riau : transmigrasi pasang surut). 2002 KLB di DKI Jakarta (Febr-Apr) pasca banjir : dari 138 spesimens serum, 61 positif (44,2%), hasil sero survey.103 orang dirawat di RS, kematian 21 orang (20%).
Gambar 1Leptospira dilihat dengan mikroskop lapangan gelap (Dark microscoup).
Gambar 2. Leptospira interrogans dilihat dengan Elektron Mikroskop.
CARA PENULARANKontak dg air, tanah/lumpur, tanaman yg tercemar air seni hewan penderita leptospirosis. Masuk ke dlm tubuh melalui selaput lendir/mukosa (mata, hidung, atau kulit yg lecet).Melalui saluran pencernaan dari makanan yang terkontaminasi oleh urine tikus yang terinfeksi Leptospira, tetapi jarang terjadi
AGENT PENYEBABBakteri berbentuk spiral dari genus Leptospira, ordo Spirochaetales, famili Trepanometaceae.Sumber penularan : Tikus, babi, sapi, kambing, domba, kuda, anjing, kucing, burung, landak, kelelawar, tupai dan rubah. Reservoir : tikus
SUMBER TRANSMISI LEPTOSPIRADikutip dari Faine S, et al, 1999; Leptospira and Leptospirosis.
Walking through flooded area is a risk factor for leptospirosis Semarang, downtown district, January 2003
GEJALA KLINISMasa inkubasi : 419 hari, rata-rata 10 hari
GAMBARAN KLINIS : Leptospirosis ringan (an-ikterik) Leptospirosis berat (ikterik)
Leptospirosis ringan (an-ikterik) :Paling banyak di masyarakat 90% dari seluruh kasus leptospirosis.Demam ringan/berat, nyeri kepala, menggigil, myalgia.Nyeri otot terutama di daerah betis, punggung, dan paha.Conjuctival suffusion (mata merah)Penderita dapat sembuh sendiri (self limited disease), 2-3 minggu.
CLINICAL ASPECT Main symptom and Signs : acute febrile illness and chills, severe headache, body pains is severe : lower limbs (the calves and thighs), anorexia, vomiting, The most characteristic finding : conjuntival suffusion and severe myalgia)
Conjunctivalsuffusion
LEPTOSPIROSIS BERAT (IKTERIC)Biasanya penderita datang terlambat, angka kematian 30 50%.Demam tinggi, nyeri kepala, myalgia, gagal ginjal, hipotensi, manifestasi perdarahan, pneumonitis haomorrhagiae.Penderita ikterik.Komplikasi leptospirosis berat (ikterik) :Acute renal failure (gagal ginjal akut = GGA)Uveitis pada mata.Hepatomegali terjadi pada hari ke 4 6 disertai jaundice (mata kuning)Paru-paru haemorrhagic pneumonitis dg batuk darah, nyeri dada, ARDS (acute respiratory distress syndrome). Jantung aritmia, dilatasi jantung, gagal jantung.Perdarahan saluran pernafasan, pencernaan, ginjal, dan saluran genitalia, ini o.k vascular damage.Abortus dsb.
PATOGENESISMasuk mll luka di kulit, kunjungtiva, Selaput mukosa utuhMultiplikasi bakteriDan menyebar mllAliran darahKerusakan endotel Pembuluh darah kecil :Ekstravasasi sel danperdarahanPerubahan patologi di organ & jaringan :Ginjal- hati- paru- otot lurikjantung
Diagnosis klinisAnamnesisPemeriksaan fisik ( gejala klinik menonjol conjungtival suffusion dan mialgia)Pemeriksaan lab (umum :darah,fungsi ginjal, fungsi hati ; khusus :kultur, inukulasi hewan)Pemeriksaan tdk langsung: MAT, ELISAMolekuler : PCR
TEST DIAGNOSTIC (penyaring)Lepto Tek Dri-Dot 1 menitLepto Tek lateral Flow 10 menitLepto Dupstick assay 2,5 smp 3 jam
Hasil postif / negatif
PENGOBATANPengobatan dilakukan kepada semua penderita / tersangka penderita yang ditemukan pada pengamatan.Obat pilihan (drug of choice) Penicillin Dapat diberikan derivatnya al ampicillin, amoxicillin, dan bila alergi penicilline dapat diberikan erythromicin, doxycyclin, tetracyclin, cephalosporin, cyprofloxacin.
PENCATATAN DAN PELAPORANUntuk daerah endemis, sesuai dengan sistem yang berlaku.Bila terjadi KLB Laporan 24 jam (format W1).Laporan khusus mingguan (W2)Laporan penanggulangan KLB
SITUASI LEPTOSPIROSISDI JAWA TENGAH
D.I.YKAB/KOTA ENDEMIS LEPTOSPIROSISDI JAWA TENGAHREMBANGWONOGIRIKUDUSKOTA SMGKab. SemarangBLORAPKLONGANJEPARAPATITEGALPEMALANGKENDALBoyolaliSKHJGROBOGANDEMAKSRAGENKRANYARBATANGBREBESCILACAPBANYUMASKEBUMENPWREJOMglTMGPBLGWNSBBjngrKLATEN
SITUASI KASUS LEPTOSPIROSISTAHUN 2005-2008 (JUNI)
Kab/KotaTahun2005200620072008Kt Smg19 / 326 / 714 / 135 / 1Demak9 / 28 / 230 / 671 / 6Klaten2 / 10 / 021 / 01 / 1Purworejo4 / 40 / 01 / 00 / 0Pati0 / 00 / 00 / 06 / 0Kab Smg0 / 01 / 01 / 00 / 0Total34 / 1035 / 967 / 7113 / 8
Hasil pengendalian faktor risiko Leptospirosisdi Kabupaten Demak, September 2008Hasil penangkapan tikus per mingguDesa Karangmlati, kec. DemakDesa Moro, kec. Bonang
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REKAPAN HARIAN PFR LEPTO DESA MORO DEMAK KEC BONANG KAB DEMAK
NONAMAMINGGU IMINGGU IIMINGGU IIIMINGGU IV
JUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPAN
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KR MLATI
REKAPAN HARIAN PFR LEPTO DESA KARANGMLATI KEC DEMAK KAB DEMAK
NONAMAMINGGU IMINGGU IIMINGGU IIIMINGGU IV
JUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPAN
TIKUSCECURUTDAPURLUMBUNGK.TIDURK. MAKANK. MANDIR. TAMUKIOSKANDANGATAS LEMARILUAR RUMAHLAIN-LAINIKANKELAPAAYAMTEMPEBAKWANJAGUNGKRUPUKSEMANGKABAKSOLAIN-LAINTIKUSCECURUTDAPURLUMBUNGK.TIDURK. MAKANK. MANDIR. TAMULUAR RUMAHGUDANGKANDANGKIOSLAIN-LAINIKANKELAPAAYAMTEMPE/TAHUBAKWANJAGUNGKRUPUKYUYUBAKSOLAIN-LAINTIKUSCECURUTDAPURLUMBUNGK.TIDURK. MAKANR. TAMULUAR RUMAHGUDANGKANDANGKIOSLAIN-LAINIKANKELAPAAYAMTEMPEBAKWANJAGUNGKRUPUKYUYUBAKSOLAIN-LAINTIKUSCECURUTDAPURLUMBUNGK.TIDURK. MAKANR. TAMUK MANDIGUDANGKANDANGLUAR RUMAHLAIN-LAINIKANKELAPAAYAMTEMPEBAKWANJAGUNGKRUPUKBAKSOLAIN-LAIN
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Sheet3
mM TaromSudarnoMadekanMuhlisinDjuremiMudawanPriyo UM Kadir
TIKUS5836159416
CECURUT1011781605
ABCDEFGH
TIKUS282724830235043233
CECURUT239240461134111
TIKUS9418835121717120
CECURUT7112361151762
TIKUS32128161341068
CECURUT1196975543
TIKUS583615941666
CECURUT101178160548
1234
TIKUS2331206866
CECURUT111624348
mM TaromSudarnoMadekanMuhlisinDjuremiMudawanPriyo UM Kadir
TIKUS4541573096577586
CECURUT3211561627402161
DAPUR409
LUMBUNG31
K TIDUR46
R.MAKAN30
K MANDI14
R TAMU122
KIOS5
KANDANG7
LUAR RUMAH56
LAIN-LAIN14
*
DAPUR199937047
LUMBUNG14458
K TIDUR271045
R.MAKAN8958
K MANDI11102
R TAMU53341322
KIOS1220
KANDANG4111
LUAR RUMAH1817714
LAIN-LAIN5414
IKAN169214016246
KELAPA90514127209
TL AYAM46241627113
TEMPE/TAHU13158339
BAKWAN721111
JAGUNG5101218
KERUPUK10001
SEMANGKA20002
BAKSO03104
YUYU11002
LAIN-LAIN541414
JML TIKUS/CECURUT TERTANGKAP
IKAN246
KELAPA209
TL AYAM113
TEMPE/TAHU39
BAKWAN11
JAGUNG18
KERUPUK1
SEMANGKA2
BAKSO4
YUYU2
LAIN-LAIN14
MG 1
12345678
TIKUS11231121481011
CECURUT15141361299
MG 2
12345678
TIKUS3106152494
CECURUT30326150
MG 3
12345678
TIKUS610867821
CECURUT00428731
MG 4
12345678
TIKUS2162170816
CECURUT145125522
MG 1 - 4
12345678
TIKUS11231121481011
CECURUT15141361299
TIKUS3106152494
CECURUT30326150
TIKUS610867821
CECURUT00428731
TIKUS2162170816
CECURUT145125522
MG 1 - 4
12345678
TIKUS2259274516482222
CECURUT195162925251912
HASIL TANGKAPAN TOTAL PERMINGGU
1234
TIKUS99624852
CECURUT69202536
DAPUR73264750
LUMBUNG0002
K TIDUR512115
R.MAKAN0000
K MANDI1602
R TAMU6000
ATAS LEMARI1000
LUAR RUMAH1000
LAIN-LAIN4000
DAPUR196
LUMBUNG2
K TIDUR33
K MANDI9
R TAMU6
ATAS LEMARI1
LUAR RUMAH1
LAIN-LAIN4
HSL TANGKAPAN
IKAN92265346
KELAPA1561214
TL AYAM5100
TEMPE/TAHU3100
BAKWAN/ KUE0046
JAGUNG0000
KERUPUK3000
HSL TANGKAPAN
IKAN217
KELAPA47
TL AYAM6
TEMPE/TAHU4
BAKWAN/ KUE10
KERUPUK3
Sheet3
00
00
00
00
00
00
00
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TIKUS
CECURUT
JML TIKUS/CECURUT
00000000
00000000
00000000
00000000
00000000
00000000
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00000000
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TIKUS
CECURUT
TIKUS
CECURUT
TIKUS
CECURUT
TIKUS
CECURUT
00
00
00
00
00
00
00
00
TIKUS
CECURUT
NAMA KADER
JUMLAH TIKUS/CECURUT
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JML TIKUS/CECURUT TERTANGKAP
00
00
00
00
00
00
00
00
TIKUS
CECURUT
KADER
HSL TANGKAPAN
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00
00
00
00
00
00
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TIKUS
CECURUT
KADER
HSL TANGKAPAN
00
00
00
00
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00
00
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TIKUS
CECURUT
KADER
HSL TANGKAPAN
00
00
00
00
00
00
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TIKUS
CECURUT
KADER
HSL TANGKAPAN
00
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00
00
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TIKUS
CECURUT
KADER
HSL TANGKAPAN
00
00
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TIKUS
CECURUT
MINGGU
HSL TANGKAPAN
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TIKUS
CECURUT
MINGGU
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Hasil penangkapan tikus berdasarkan tempat pemasangan perangkapDesa Karangmlati, kec. DemakDesa Moro, kec. Bonang
Hasil penangkapan tikus berdasarkan jenis umpanDesa Karangmlati, kec. DemakDesa Moro, kec. Bonang
Mandi dan mencuci di sungaiKebersihan dapur belum dikelola baikBecekSisa makanan
TH 2006TH 2007TH 2008STRATA ENDEMISITAS LEPTOSPIROSIS PERKEC DI KAB. DEMAK
NoTahun Lokasi Kasus Wil Pusk Kec Desa 1200657522007823133200812447
TH 2006TH 2007TH 2008STRATA ENDEMISITAS LEPTOSPIROSIS PERDESA DI KAB. DEMAK
TH 2006TH 2007TH 2008DISTRIBUSI KASUS LEPTOSPIROSIS DI KAB. DEMAK
KASUS LEPTOSPIROSIS KOMULATIF TH 2006-2008DI KABUPATEN DEMAK : SUNGAI: JALAN
Kasus Leptospirosis berdasarkanKelompok umur dan Jenis kelaminJumlah kasus meninggalTH 2006 s/d 2008
TH 2006TH 2007TH 2008
CURAH HUJAN DAN KASUS LEPTOSPIROSISTH 2006 S/D 2008
FAKTOR RESIKO KASUS LEPTOSPIROSISDI KABUPATEN DEMAK Lingkungan tempat tinggal becekLokasi Daerah RobKebiasaan mandi disungaiPemukiman dekat pembuangan sampahMempunyai lukaKerja di sawah yang banyak airPerumahan dekat sawah
PROGRAM PENANGGULANGAN LEPTOSPIROSIS
TUJUANMenurunkan angka kesakitan dan kematianMencegah penularan di daerah endemis dari hewan ke manusia.Menjadikan lingkungan sehat, terbebas dari penularan Leptospira, krn habitat /sarang2 tikus dapat dihilangkan.
KEGIATAN POKOKPencegahan penularan Leptospirosis ke manusia.Surveillance pada manusia.Pengobatan penderita di Puskesmas/RSPenyelidikan epidemiologi (KLB)Penyuluhan Kepada masyarakat.Koordinasi LS/LP terkait dlm penanggulangan Leptospirosis.Pencatatan dan Laporan.
SURVEILANS (PENGAMATAN PENYAKIT)SURVEILANS PADA MANUSIA DI DAERAH ENDEMIS :Daerah rawan banjir/sering banjir aktif & pasifPenampungan para pengungsi aktif & pasifDaerah persawahan & pertambangan pasifDaerah rawa / lahan gambut pasif
SURVEILANS AKTIFPencarian tersangka/penderita dari rumah ke rumah (dengan gejala demam, nyeri otot terutama di betis atau persendian, mata merah, icterus, dsb)Skrining penderita dengan mengambil darah 3-5 ml, kemudian diambil serumnya utk pemeriksaan lab untuk pemeriksaan serologis.
SURVEILANS PASIFDilakukan di RS, Puskesmas, Pustu, Pukesmas Keliling, & sarana yan kes lainnya, bila ditemukan tersangka / penderita, maka dilakukan pengambilan darah 3-5 ml, kmd diambil serumnya.
SISTEM KEWASPADAAN DINI (SKD)Untuk daerah endemis, khususnya musim hujan (banjir dan pasca banjir), tikus2 keluar dari sarangnya berkeliaran, urinnya mencemari air dan lingkungan. Jadi perlu peningkatan kewaspadaan dan kebersihan lingkungan serta individu.Pengamatan intensif di daerah endemis pada musim penghujan di puskesmas dan RS.Bila ditemukan kasus leptospirosis di RS/puskesmas segera melaporkan ke Dinas Kes setempat.
TINDAKAN PENANGGULANGAN KLB LEPTOSPIROSISPE PADA MANUSIAPenemuan penderita aktif dan pasif. Bila ditemukan suspect / kasus -> ambil darah 3-5 ml kmd serum dipisahkan u/ diperiksa lab.Berikan pengobatan.Penyuluhan kesehatan kepada masyarakat.
PE PADA RODENT DAN HEWAN LAINNYA Di desa yang ada kasus dilakukan penangkapan rodent bersamaan waktunya dg pencarian penderita tambahan.Rodent / tikus diidentifikasi, kemudian diambil darah/serumnya untuk pemeriksaan lab. Untuk hewan peliharaan/ternak LS.Intervensi lingkungan dilakukan atas partisipasi masy dan LS terkait.Dianjurkan vaksinasi hewan peliharaan
INTERVENSI LINGKUNGANPengaturan Kebersihan lingkungan :Selokan, saluran air, stagnant waterTempat air dan kolam renangTempat-tempat yg dapat menjadi sarang tikusHealth education tentang personal hygiene. Rodent control, bila kondisi memungkinkan
PENATALAKSANAAN PENANGGULANGAN KASUS / TERSANGKA LEPTOSPIROSIS DI PUSKESMAS
KASUS TERSANGKA
- Demam akut < 9 hr, suhu 39oC atau lebih
- Nyeri kepala mendadak
- Myalgia
(terutama nyeri otot betis & pinggang)
- Conjungtiva suffusion
IKTERUS
YA
TIDAK
DD/ - Leptospirosis berat
DD/ - Leptospirosis ringan
- Hepatitis
- Viral hemoraghic fever
- Malaria (berat)
(dengue,chikungunya, hantaan)
- Demam tifoid
- Influenza
( Faktor risiko
( Faktor risiko
(lingkungan, pekerjaan, olahraga/
(lingkungan, pekerjaan, olahraga/
aktivitas lain, riwayat bepergian)
aktivitas lain, riwayat bepergian)
( Daerah endemis leptospirosis
( Daerah endemis leptospirosis
- Diobati di Puskesmas
- Ambil spesimen darah
- Diobati di Puskesmas
Rujuk ke RS
Pemeriksaan Lab.
Positif Leptospirosis
Lapor ke DINKES. KAB.
Penyelidikan Epidemiologi :
- Pencarian kasus tersangka leptospirosis lainnya
- Pengobatan selektif
- Pengambilan spesimen serum darah tersangka
- Penyuluhan kpd masyarakat
KLB
BUKAN KLB
PENANGANAN KEJADIAN LUAR BIASA
LEPTOSPIROSIS
KLB LEPTOSPIROSIS
- Hasil PE ditemukan peningkatan kasus
Leptosiprosis
- Ditemukan kasus leptospirosis di daerah
bebas
Dinkes. Kab.
PUSKESMAS
Rumah Sakit
- Pengobatan penderita
- Pengambilan spesimen
Dinkes. Prop.
Dit.Jen. PPM&PL
Penanggulangan KLB
Mencari tersangka lainnya
Pengambilan spesimen
Traping Rodent
serum darah tersangka
Pengobatan selektif
Penyuluhan intensif
PSM dgn membersihkan sarang
- Identifikasi Rodent
tikus (sampah, got, dsb)
- Pengambilan spesimen
Serum darah
Pemeriksaan spesimen
Pemeriksaan spesimen
RS / BLK
Balitvet, Bogor
Balitvet, Bogor
(Rapid Test)
(MAT, Isolasi)
(MAT, Isolasi)
SISTEM KEWASPADAAN DINI (SKD) LEPTOSPIROSIS
DI PUSKESMAS
Variabel penunjang penularan Leptospirosis :
Musim hujan yang disertai dengan banjir
Pada saat air pasang di daerah pantai
Daerah rawa / lahan gambut
Kebersihan lingkungan secara umum menurun
Pengamatan kasus leptospirosis di Puskesmas & RS
lebih intensif dengan pemeriksaan klinis yang mengarah
ke Leptospirosis.
Bila ditemukan tersangka
penderita Leptospirosis
- Diobati di Puskesmas
- Ambil spesimen
Pemeriksaan spesimen
Di RS / BLK / Balitvet
Negatif leptospirosis
Positif leptospirosis
Lapor ke DINKES KAB.
Penyelidikan epidemiologi
- Mencari faktor risiko
- Pencarian tersangka lainnya
- Pengambilan spesimen
serum darah
- Pengobatan selektif
- Penyuluhan
PENCEGAHANPengendalian tikus di dalam rumahPengendalian tikus di luar rumahMelaksanakan safety precaution
Pengendalian Tikus di Dalam Rumah Usahakan rumah selalu bersih (dapur) Makanan ditutup Tempat sampah tertutup rapat Perangkap tikus Racun tikus Tutup lubang
Pengendalian Tikus di Luar Rumah Bersihkan semak-semak Perangkap / racun tikus Natural predator
Melaksanakan safety precautionMembersihkan tempat yg sering dilewati tikusPenanganan tikus matiTindakan keselamatan utk petugas yg masuk rumah orang yg sudah dikonfirmasi menderita infeksi hantavirus atau rumah penuh dg tikusTindakan keselamatan bagi pekerja yg sering terpajandgn rodensia5.Tindakan keselamatan bagi yg berkemah, pejalan kaki
APA PERAN KITA ????
PRINSIP PENANGGULANGANPenemuan dini dan pengobatan cepatSurveilansPemberantasan reservoirPenanggulangan KLBPenyuluhan / promosi kesehatan termasuk sanitasi lingkungan
TINDAK LANJUT - 1DIAGNOSA DINI DAN PENGOBATAN CEPAT & TEPATKenali gejala klinisSegera tegakkan diagnosaBeri pengobatan : Drug of choiceSURVEILANSCari sumber penularan, FR -> utk putus rantai penularanCari kasus tambahan -> kontak lingkunganAnalisis data epidemiologi
TINDAK LANJUT - 2PEMBERANTASAN RESERVOIRPenyuluhan kepada masyarakat ttg pencegahan.Pembasmian tikus koordinasi dg Kepala Wilayah.PENANGGULANGAN KLBAnalisis epidemiologiRencana tindakan penanggulangan sesuai hasil analisisPengobatanGerakan sanitasi lingkungan
TINDAK LANJUT - 3PROMOSI KESEHATANKoordinasi dengan Kepala WilayahSebarkan leaflet, siaran radio dll
TERIMAKASIH
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