Inf Dis Ind

8/18/2019 Inf Dis Ind

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COMMUNICABLE DISEASE TOOLKIT

Communicable Diseases Working Group on Emergencies, WHO/HQWHO Regional Office for South-East Asia (SEARO)

WHO/CDS/2005.30

IndonesiaCommunicable disease profile


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© World Health Organization 2005

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.'* 8#0))%5%80(%1/ 15 80)*) 0&*, 6/,*$ U 4*0$) 0881$,%/& (1 ('* /0(%1/0# D[GD&6%,*#%/*)? :'%8' ,%55*$ )#%&'(#4 5$12 ('* "cID &6%,*#%/*)? %) 0) %/,%80(*, 7*#1:-

Children aged 2 months up to 5 years:

• PneumoniaSymptoms: G16&' 1$ ,%55%86#( 7$*0('%/&N andSigns: UY 1$ 21$* 7$*0(') 3*$ 2%/6(* 51$ %/50/() 0&*, K 21/(') 63 (1 J 4*0$? or

QY 1$ 21$* 7$*0(') 3*$ 2%/6(* 51$ 8'%#,$*/ 0&*, J 63 (1 U 4*0$) 1#,NandX1 &*/*$0# ,0/&*$ )%&/)? 8'*)( %/,$0:%/& 1$ )($%,1$ %/ 0 80#2 8'%#,-

• Severe pneumonia or very severe disease

Symptoms: G16&' 1$ ,%55%86#( 7$*0('%/& and 0/4 &*/*$0# ,0/&*$ )%&/) 1$8'*)( %/,$0:%/& 1$ )($%,1$ %/ 0 80#2 8'%#,-General danger signs" 6/07#* (1 ,$%/C or 7$*0)(5**,N +12%() *+*$4('%/&N81/+6#)%1/)N #*('0$&%8 1$ 6/81/)8%16)-

Infants aged under 2 months:

Severe cases %/ 416/& %/50/() 0$* 8#0))%5%*, 7$10,#4 0) lPossible serious bacterialinfectionl? 70)*, 1/ ('* 3$*)*/8* 15 0/4 15 Jo )%&/) 1$ )423(12)? 021/& :'%8'0$* 0#)1 $*)3%$0(1$4 )%&/) )68' 0) 50)( 7$*0('%/& OoY 1$ 21$* 7$*0(') 3*$ 2%/6(*R?)*+*$* 8'*)( %/,$0:%/&? /0)0# 5#0$%/&? &$6/(%/& 0/, :'**>%/&- =('*$ )%&/) %/8#6,* 0#)15*+*$ 1$ #1: 71,4 (*23*$0(6$*? (43%80# )%&/) 15 %/5*8(%1/ O*0$ 0/, )C%/R? ,0/&*$ )%&/)0/, 5**,%/& 3$17#*2)-

Mode oftransmission "%$71$/* 74 ,$13#*( )3$*0,-

Incubation @*3*/,) 1/ ('* %/5*8(%+* 0&*/(N 6)60##4 KkU ,04)-

Period ofcommunicability

@*3*/,) 1/ ('* %/5*8(%+* 0&*/(N 6)60##4 ,6$%/& ('* )423(120(%8 3'0)*-


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;1$#, 0(%1 / $0(*) F Multiple indicator cluster survey ? D/,1/*)%0? KYYYR-

Z$123( %,*/(%5%80(%1/ 0/, ($*0(2*/( 15 80)*) 74 033$13$%0(* '*0#('80$*3$1+%,*$) %) ('* 21)( %231$(0/( 81/($1# 2*0)6$*-

Without proper treatment, the case-fatality rate can be very high (20% ormore in emergency situations).

Food shortages Yes E11, %/)*86$%(4 %) #%C*#4 (1 1886$ 021/&)( D@Z)- ",,%(%1/0# $%)C 508(1$) %/8#6,*F311$ 7$*0)(5**,%/& 3$08(%8*) O#*)) ('0/ KYn 15 %/50/() 0&*, 6/,*$ Q 21/(') 0$**98#6)%+*#4 7$*0)(5*,R? #%C*#4 '%&' 20#/6($%(%1/ %/,%80(1$) O#1: 7%$(' :*%&'(?20#/6($%(%1/? +%(02%/ " ,*5%8%*/84R 0/, 311$ 5**,%/& 3$08(%8*) ,6$%/& %##/*))OH16$8*F Multiple indicator cluster survey ? D/,1/*)%0? KYYYR-

Lack of safe waterand poorsanitation

Yes UTn 15 ('* 3136#0(%1/ '0) 088*)) (1 )0/%(0$4 2*0/) 15 *98$*(0 ,%)31)0#? ('*3*$8*/(0&* 7*%/& #*)) ('0/ KYn 51$ ('* 311$ '16)*'1#,) /0(%1/0##4- "88*)) (1)16$8*)- 15 )05* :0(*$ +0$%*) 81/)%,*$07#4? *)3*8%0##4 74 )(0/,0$,) 15 #%+%/&?:%(' ('* 311$ '0+%/& +*$4 #%2%(*, 088*)) (1 ('*2- OH16$8*F Multiple indicatorcluster survey ? D/,1/*)%0? KYYYR-

Others Yes D/,11$ 0%$ 31##6(%1/- c1: (*23*$0(6$*) 204 %/8$*0)* ('* $*#0(%+* $%)C 158'%#,$*/i) 08e6%$%/& 3/*621/%0-


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PREVENTION AND CONTROL MEASURES

Case management .'* 3$%1$%(4 %) *0$#4 $*81&/%(%1/ 0/, 0,*e60(* ($*0(2*/( 15 80)*)-

.'* 5%$)(V#%/* 0/(%7%1(%8 51$ 80)*) 0&*, 6/,*$ U 4*0$) 8#0))%5%*, 0) 3/*621/%0 %) 81V($%2190>1#*N ('* )*81/,V#%/* 0/(%7%1(%8 %) 0219%8%##%/-

Z$*V$*5*$$0# 0/(%7%1(%8) 51$ )*+*$* 80)*) ('0( 80//1( (1#*$0(* 1$0# 0/(%7%1(%8) 1$ 51$($*0(2*/( 15 )*+*$* 80)*) ('0( 80//1( 7* $*5*$$*, 0$*F

− %/($026)86#0$ 8'#1$023'*/%81# 51$ 8'%#,$*/ 0&*, K 21/(') 63 (1 U 4*0$)N 0/,

− %/($026)86#0$ 7*/>4#3*/%8%##%/ and &*/(02%8%/ 51$ %/50/() 0&*, 6/,*$ K 21/(')-

G'%#,$*/ :%(' 5*+*$? %/ 0,,%(%1/ (1 816&' 1$ ,%55%86#( 7$*0('%/&? 204 0#)1 7* ($*0(*, 51$ 20#0$%00881$,%/& (1 ('*%$ *931)6$* (1 20#0$%0 $%)C O'%&' +)- #1: 20#0$%0 $%)C 0$*0)R0/, #071$0(1$4 $*)6#() O7#11, 5%#2R %5 ('*)* )*$+%8*) 0$* 0+0%#07#*-

H6331$(%+* 2*0)6$*) )68' 0) 81/(%/6*, 5**,%/& (1 0+1%, 20#/6($%(%1/? +%(02%/ " %5%/,%80(*,? 0/(%34$*(%8) (1 $*,68* '%&' 5*+*$ 0/, 3$1(*8(%1/ 5$12 81#, O*)3*8%0##4 C**3%/&416/& %/50/() :0$2R 0$* 30$( 15 %/(*&$0(*, 80)* 20/0&*2*/(- Z$*+*/(%1/ 15 #1: 7#11,ʩ)* %) 80$$%*, 16( 51$ )*+*$* 80)*)-

D/(*&$0(*, 20/0&*2*/( 15 %##/*)) %) 3$08(%8*, %/ 0/4 )%8C 8'%#, )**/ 74 0 3$1+%,*$ ($0%/*, %/D[GD-

Z$13*$ 0,+%8* %) &%+*/ (1 80$*(0C*$) 15 /1/V)*+*$* 80)*) 1/ '12* 80$*? %/8#6,%/&8123#%0/8* :%(' 0/(%7%1(%8 ($*0(2*/( %/)($68(%1/)-

H%&/) 15 20#/6($%(%1/ 0$* 0))*))*, 0) ('%) %/8$*0)*) ('* $%)C 15 ,*0(' ,6* (13/*621/%0- H*+*$*#4 20#/16$%)'*, 8'%#,$*/ O:*%&'(V51$V'*%&'( %/,*9 pMYnR 26)( 7*$*5*$$*, (1 '1)3%(0#-

Prevention 0(%1/ 81+*$0&* $0(*) 51$ ('*)* 0/(%&*/) 0$*86$$*/(#4 )6713(%20# %/ D/,1/*)%0-


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Case management B0$#4 0/, 033$13$%0(* ('*$034 %) +*$4 %231$(0/(F ($*0(2*/( :%(' 0/ *55*8(%+*0/(%2%8$17%0# 80/ $*,68* ('* )*+*$%(4 0/, ,6$0(%1/ 15 )'%&*##1)%)- H*#*8(%1/ ,*3*/,) 1/$*)%)(0/8* 30((*$/) 15 ('* 708(*$%0 0/, ,$6& 0+0%#07%#%(4-

.'* 3$17#*2 15 $03%, 08e6%)%(%1/ 15 0/(%2%8$17%0# $*)%)(0/8* %/ ($*0(%/& H'%&*##0,4)*/(*$4 %) 0 806)* 15 81/8*$/- D( %) ('*$*51$* %231$(0/( (1 81/5%$2 ('* )*/)%(%+%(4 15S. dysenteriae (1 0/(%7%1(%8) %/ ('* *0$#4 )(0&*) 15 0/ 16(7$*0C 15 )'%&*##1)%)-I*)%)(0/8* 30((*$/) 204 +0$4 ,6$%/& ('* 816$)* 15 0/ 16(7$*0C 0/, $*&6#0$ )(11#)023#%/& %) $*e6%$*,- G%3$15#1908%/ %) ('* 86$$*/( 5%$)(V#%/* 0/(%7%1(%8 15 8'1%8*$*8122*/,*, 51$ ($*0(2*/( 15 S.dysenteriae (43* J-

H6331$(%+* ($*0(2*/( 6)%/& 1$0# $*'4,$0(%1/ )0#() O=IHR? 81/(%/6*, 5**,%/& O5$*e6*/()20## 2*0#)R 0/, 0/(%34$*(%8) (1 $*,68* '%&' 5*+*$ %) 0#)1 *))*/(%0#-

S.dysenteriae (43* J %) 15(*/ 21$* )*+*$* 1$ 50(0# %/ 416/& 8'%#,$*/? ('* *#,*$#4 0/, ('*20#/16$%)'*,? 0/, 3$123( ($*0(2*/( :%(' 0/(%7%1(%8) %) *))*/(%0#- D5 %/ )'1$( )633#4?0/(%7%1(%8) )'16#, 7* $*)*$+*, 51$ )68' '%&'V$%)C &$163)-

Epidemic control D/51$2 ('* '*0#(' 06('1$%(%*) :'*/ 1/* 1$ 21$* )6)3*8(*, 80)*) 0$* %,*/(%5%*,- B0$#4,*(*8(%1/ 0/, /1(%5%80(%1/ 15 *3%,*2%8 ,4)*/(*$4? *)3*8%0##4 021/& 0,6#()? */07#*)(%2*#4 217%#%>0(%1/ 15 $*)16$8*) 51$ 033$13$%0(* G0)* 20/0&*2*/( 0/, 81/($1#-

G1/5%$2 ('* 16(7$*0C %/ 0881$,0/8* :%(' ;


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;1$#, 4#3*/%8%##%/ L D[OoYY YYY 6/%() 51$ 8'%#,$*/ 0&*, 6/,*$ o 4*0$)N J-K 2%##%1/ 6/%() 51$ ('1)* 0&*, o4*0$) 1$ 1#,*$R- B$4('$1248%/ 80/ 7* 6)*, 0#)1 0) )*81/, 8'1%8*- D5 86#(6$* %)31)%(%+*? &%+* 0/(%7%1(%8) 0) 51$ 30(%*/() 071+*-

Carriers "## 80$$%*$) 26)( $*8*%+* 0 )%/* ,1)* 15 7*/>0('%/* 7*/>4#3*/%8%##%/ L D[ OoYY YYY6/%() 51$ 8'%#,$*/ 0&*, 6/,*$ o 4*0$)N J-K 2%##%1/ 6/%() 51$ ('1)* 0&*, o 4*0$) 0/,1#,*$R-

Note: Clinical diphtheria does not necessarily confer natural immunity, and patients shouldtherefore be vaccinated before discharge from a health facility.

1 Close contacts include household members and other persons with a history of direct contact with a case, as well as health care workers exposed to oralor respiratory secretions of a case.


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D/ */,*2%8 )%(60(%1/)? ., +088%/* O0 8127%/0(%1/ 15 ,%3'('*$%0 0/, (*(0/6)(191%,) :%(' $*,68*, ,%3'('*$%0 81/(*/(R )'16#, 3$*5*$07#4 7* &%+*/-

.1 */)6$* )05*(4 15 %/j*8(%1/ ,6$%/& %226/%>0(%1/? 06(1V,%)07#* )4$%/&*) 0/,)05*(4 719*) 0$* $*8122*/,*,- H05* ,%)31)0# 15 6)*, )'0$3) )'16#, 7**/)6$*,-


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I*81+*$4 15 6/($*0(*, 80)*) 80/ (0C* )*+*$0# 21/(')- G0)* 50(0#%(4 $0(* %) #1: 76(%/8$*0)*) :%(' 0,+0/8%/& 0&* 0/, 204 $*08' KYn 1$ 21$* %/ 30(%*/() :%(' j06/,%8*1$ C%,/*4 ,020&* :'1 '0+* /1( 7**/ ($*0(*, :%(' $*/0# ,%0#4)%)F ,*0(') 0$*3$*,12%/0/(#4 ,6* (1 '*30(1$*/0# 50%#6$*? +0)86#0$ 077/1$20#%(%*) :%(' '*021$$'0&*?0,6#( $*)3%$0(1$4 ,%)($*)) )4/,$12* 1$ 80$,%08 0$$('42%0) ,6* (1 24180$,%(%)-

Laboratory diagnosis

@%0&/1)%) %) 81/5%$2*, 74F

• D)1#0(%1/ O0/, (43%/&R 5$12 8#%/%80# 20(*$%0#) ('$16&' 86#(6$* 15 30('1&*/%8#*3(1)3%$*)- I*8122*/,*, )023#*) 51$ %)1#0(%1/F

─ D)1#0(%1/ 15 #*3(1)3%$*) 5$12 7#11, :%('%/ ('* 5%$)( M ,04) 15,%)*0)*-

─ D)1#0(%1/ 15 #*3(1)3%$*) 5$12 GHE 7*(:**/ ,04) Q 0/, JY-

─ D)1#0(%1/ 15 #*3(1)3%$*) 5$12 6$%/* 05(*$ ,04 JY-

• Z1)%(%+* )*$1#1&4? 3$*5*$07#4 [%8$1)813%8 "&(%/0(%1/ .*)( O[".R? 6)%/&0 $0/&* 15 Leptospira )($0%/) 51$ 0/(%&*/ ('0( )'16#, 7* $*3$*)*/(0(%+*) 15#180# )($0%/)- Z1)%(%+* )*$1#1&4 2*0/)? )*$181/+*$)%1/ 1$ 0 QV51#, (%($* $%)*1$ '%&'*$ %/ 30%$*, )023#*)- E1$ 0 )%/* )023#* 0 )655%8%*/(#4 '%&' 86(V155+0#6* )'16#, 7* '0/,#*, O51$ [". 0 86(V155 (%($* 15 JFTYY %) $*8122*/,*,R-

Case classification

SuspectedF " 80)* ('0( %) 81230(%7#* :%(' 8#%/%80# ,*)8$%3(%1/-ConfirmedF " )6)3*8( 80)* ('0( %) 81/5%$2*, %/ 0 8123*(*/( #071$0(1$4-

c*3(1)3%$1)%) %) 15(*/ 81/56)*, :%(' 1('*$ ,%)*0)*) 1$ /1( 81/)%,*$*, 0( 0##- D/ 0##80)*) 15 5*+*$ :%(' 6/C/1:/ 1$%&%/? #*3(1)3%$1)%) 26)( 7* %/8#6,*, %/ ('*,%55*$*/(%0# ,%0&/1)%)-


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;1$#, * 367#%8 '*0#(' 0/, +*(*$%/0$4 :1$C*$) 1/ ,%)0)(*$ %23#%80(%1/) 51##1:%/&5#11,%/&-

• B,680(* ('* 367#%8 1/ 21,*) 15 ($0/)2%))%1/? (1 0+1%, ):%22%/& 1$ :0,%/& %/31(*/(%0##4 81/(02%/0(*, :0(*$) k 1$ (1 6)* 3$1(*8(%1/ :'*/ :1$C $*e6%$*) )68'*931)6$*-

• Z$1(*8( :1$C*$) %/ '0>0$,16) 188630(%1/) 74 3$1+%,%/& 711()? +*) 0/,03$1/)-

• I*81&/%>* 31(*/(%0##4 81/(02%/0(*, :0(*$) 0/, )1%# 0/, ,$0%/ )68' :0(*$):'*$* 31))%7#* 1$ 3#08* :0$/%/& )%&/)-

• G1/($1# $1,*/() %/ '620/ '07%(0(%1/)-

• G#*0/%/& 15 3$*2%)*) 15 '620/ '07%(0(%1/) 0/, 188630(%1/ ('0( 0(($08( $1,*/()

• H*&$*&0(* %/5*8(*, ,12*)(%8 0/%20#)-

• ;'*$* 31))%7#*? %226/%>* 50$2 0/, 3*( 0/%20#) (1 3$*+*/( %##/*))-


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;1$#, 10/ 30$0)%(*) Plasmodiumfalciparum 0/, Plasmodium vivax.

P. falciparum 806)*) ('* 21)( #%5*V('$*0(*/%/& 51$2 15 ('* ,%)*0)*-

Case definitionClinical case definition:Suspected malaria

" 3*$)1/ :%(' 5*+*$ 1$ '%)(1$4 15 5*+*$ vmTwG :%('%/ ('* #0)( QT '6$) :%(' 1/* 1$ 21$* 15('* 51##1:%/& )423(12)F /06)*0? 8122%((%/& 0/, ,%0$$'1*0? '*0,08'*? j1%/( 30%/)?8'%##) 0/, 240#&%0-

Severe malaria

" 30(%*/( :%(' )423(12) 0) 51$ 6/8123#%80(*, 20#0$%0? 3#6) ,$1:)%/*)) :%('*9($*2* :*0C/*)) 0/, 0))18%0(*, )%&/) 0/, )423(12) $*#0(*, (1 1$&0/ 50%#6$* O*-&-,%)1$%*/(0(%1/? #1)) 15 81/)8%16)/*))? 81/+6#)%1/)? )*+*$* 0/0*2%0? j06/,%8*?'0*21%/6$%0? )31/(0/*16) 7#**,%/&? 36#21/0$4 1*,*20 0/, )'18CR-

Confirmed case

@*21/)($0(%1/ 15 20#0$%0 30$0)%(*) %/ 7#11, 5%#2 74 *902%/%/& ('%8C 1$ ('%/ )2*0$)? 1$74 $03%, ,%0&/1)(%8 (*)( 51$ P. falciparum.

Mode oftransmission

b*8(1$V71$/*? ('$16&' %/5*8(%+* Anopheles 21)e6%(1 7%(*-

D/ "8*' 0/, X1$(' H620($0? ('* 20%/ 20#0$%0 +*8(1$) 0$* An.sundaicus and An.aconitus.

[0#0$%0 204 0#)1 7* ($0/)2%((*, ('$16&' 7#11, ($0/)56)%1/ 15 %/5*8(*, 7#11,-I0$*#4? %/50/() 204 81/($08( 20#0$%0 in utero ('$16&' ($0/)3#08*/(0# ($0/)5*$ 1530$0)%(*)? 1$ ,6$%/& ,*#%+*$4-

Incubation .'* %/8670(%1/ 3*$%1, 51$ 21)e6%(1V($0/)2%((*, %/5*8(%1/ %) 033$19%20(*#4 MkJQ,04) 51$ P. falciparum 0/, TkJQ ,04) 51$ P. vivax.


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;1$#, 0 O%-*-$6//4 /1)*R or 81/j6/8(%+%(%) O%-*- $*, *4*)RN

or "/4 3*$)1/ %/ :'12 0 8#%/%80# '*0#(' :1$C*$ )6)3*8() 2*0)#*) %/5*8(%1/-

Laboratory criteria:@*(*8(%1/ 15 2*0)#*)V)3*8%5%8 D&[ 0/(%71,%*)-

H6)3*8(*, 80)* "/4 3*$)1/ 2**(%/& ('* 071+* 8#%/%80# 80)* ,*5%/%(%1/-

G1/5%$2*, 80)* " 80)* ('0( %) #071$0(1$4V81/5%$2*, O0 #071$0(1$4 81/5%$2*, 80)* ,1*) /1( /**, (1 2**( ('*8#%/%80# 80)* ,*5%/%(%1/R

or " 80)* ('0( 2**() ('* 8#%/%80# 80)* ,*5%/%(%1/ 0/, %) *3%,*2%1#1&%80##4 #%/C*, 74 ,%$*8(81/(08( (1 0 #071$0(1$4V81/5%$2*, 80)* %/ :'%8' $0)' 1/)*( 1886$$*, MkJT ,04) *0$#%*$-

Mode oftransmission

"%$71$/* 74 ,$13#*( )3$*0,N 1$

@%$*8( 81/(08( :%(' ('* /0)0# 0/, ('$10( )*8$*(%1/) 15 %/5*8(*, 3*$)1/) 1$ +%0 17j*8()O*-&- (14)R ('0( '0+* 7**/ %/ 8#1)* 81/(08( :%(' 0/ %/5*8(*, 3*$)1/-

Incubation "5(*$ %/5*8(%1/ ('*$* %) 0/ 0)423(120(%8 %/8670(%1/ 3*$%1, 15 JYkJK ,04)? :%(' 0 $0/&*5$12 M (1 JT ,04) 5$12 *931)6$* (1 ('* 1/)*( 15 5*+*$-

Period ofcommunicability

[*0)#*) %) 21)( %/5*8(%16) 5$12 Q ,04) 7*51$* ('* $0)' 6/(%# JkK ,04) 05(*$ $0)' 1/)*(-

EPIDEMIOLOGY

Number of cases reported nationally:

1996 mUmTm

1995 mMoSm

1990 SKJYU

Burden

2003

2002

2001

2000

1999

1998

1997

JoTJT

JQQSK

mTKU

mmQQ

QMoM

JYmQ

JQmJm

O@0(0 )16$8*F ;


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;1$#, *,-

Recent epidemics "#('16&' )6$+*%##0/8* %) %/8123#*(*? )*+*$0# 16(7$*0C) 0$* $*31$(*, *08' 4*0$ 5$12D/,1/*)%0- .'* #0)( 20j1$ 16(7$*0C $*31$(*, (1 ;


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;1$#, 0(%1/ 31#%84 ('0( $*e6%$*) 0 ,1)* 15 )%/*V0/(%&*/2*0)#*) +088%/* 0( S 21/(') 15 0&* O)** "33*/,%9 JY: Immunization schedule forIndonesia)-

0(%1/ 08(%+%(%*) 0$* $*e6%$*, %/ 1$,*$ (1 $*,68* ('*$%)C 15 0 2*0)#*) 16(7$*0C-

RoutineImmunization

D226/%>* ('* 3136#0(%1/ 0( $%)C 0) )11/ 0) 31))%7#*- .'* 3$%1$%(4 %) (1 immunize children aged6 months through 14 years? $*&0$,#*)) 15 +088%/0(%1/ )(0(6) 1$ '%)(1$4 15 ,%)*0)*-B930/)%1/ (1 1#,*$ 8'%#,$*/ %) 15 #*))*$ 3$%1$%(4 0/, )'16#, 7* 70)*, 1/ *+%,*/8* 15 '%&')6)8*3(%7%#%(4 021/& ('%) 0&* &$163-

G'%#,$*/ :'1 0$* +088%/0(*, 0&0%/)( 2*0)#*) 7*51$* S 21/(') 15 0&* 26)( $*8*%+* 0)*81/, 2*0)#*) +088%/0(%1/- .'%) )'16#, 7* &%+*/ 0) )11/ 0) 31))%7#* 05(*$ S 21/(')? :%(' 0/%/(*$+0# 15 0( #*0)( J 21/(' 7*(:**/ ,1)*)-

"## 8'%#,$*/ 0&*, o 21/(') (1 US 21/(') )'16#, 0#)1 $*8*%+* 3$13'4#08(%8 +%(02%/ ")633#*2*/(0(%1/- D5 ('*$* %) *+%,*/8* 15 8#%/%80# +%(02%/ " ,*5%8%*/84 %/ 1#,*$ 0&* &$163)?($*0(2*/( :%(' +%(02%/ " )'16#, 7* %/%(%0(*, 0) 3*$ ;0(%1/? 06(1V,%)07#* )4$%/&*) 0/, )05*(4719*) 0$* $*8122*/,*,- H05* ,%)31)0# 15 6)*, )'0$3) )'16#, 7* */)6$*,-

Outbreak response D/51$2 ('* '*0#(' 06('1$%(%*) %22*,%0(*#4 %5 1/* 1$ 21$* )6)3*8(*, 80)*) 0$* %,*/(%5%*,-

G1/5%$2 ('* )6)3*8(*, 16(7$*0C? 51##1:%/& ;0(%1/ 15 &$163) 0( '%&'*)($%)C O*-&- 8'%#,$*/ 0&*, o 21/(') ('$16&' JQ 4*0$)R 0) )11/ 0) 31))%7#* *+*/ %/0$*0) /1( 4*( 055*8(*, 76( :'*$* ('* 16(7$*0C %) #%C*#4 (1 )3$*0,-

− Z$121(* )18%0# 217%#%>0(%1/ 15 30$*/() %/ 1$,*$ (1 */)6$* ('0( 3$*+%16)#46/+088%/0(*, 8'%#,$*/ 0&*, 5$12 o 21/(') (1 US 21/(') 0$* %226/%>*,-

− .'* 3$*)*/8* 15 )*+*$0# 80)*) 15 2*0)#*) %/ 0/ *2*$&*/84 )*((%/& ,1*) /1( 3$*8#6,* 02*0)#*) %226/%>0(%1/ 80230%&/- B+*/ 021/& %/,%+%,60#) :'1 '0+* 0#$*0,4 7**/*931)*, (1? 0/, 0$* %/8670(%/&? ('* /0(6$0# +%$6)? 2*0)#*) +088%/*? %5 &%+*/ :%('%/ m,04) 15 *931)6$*? 204 3$1+%,* 3$1(*8(%1/ 1$ 2%(%&0(* ('* 8#%/%80# )*+*$%(4 15 ('*%##/*))-

− D)1#0(%1/ %) /1( %/,%80(*, 0/, 8'%#,$*/ )'16#, /1( 7* :%(',$0:/ 5$12 5**,%/&3$1&$022*)-


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;1$#,


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;1$#, 0

O$6//4 /1)*R? )/**>%/&? #1:V&$0,* 5*+*$ 0/, 0 2%#,? 1880)%1/0# 816&'? )%2%#0$ (1 ('*81221/ 81#,- .'* 816&' &$0,60##4 7*812*) 21$* )*+*$* 0/, %$$%(0(%/&? 0/, 05(*$ J –K:**C) ('* )*81/, )(0&*? 1$ paroxysmal stage? 7*&%/)- .'* 30(%*/( '0) 76$)()? 1$30$194)2)? 15 /62*$16)? $03%, 816&')? 0330$*/(#4 ,6* (1 ,%55%86#(4 %/ *93*##%/& ('%8C2686) 5$12 ('* ($08'*17$1/8'%0# ($**- .'* 8'0$08(*$%)(%8 :'113 %) 806)*, 74 51$8*,%/)3%$0(%1/ ('$16&' 0 /0$$1:*, ((%) %22*,%0(*#4 05(*$ 0 30$194)2 15 0 ,1>*/ 1$ 21$*$03%,? )'1$( 816&') :%('16( %/(*$+*/%/& %/)3%$0(%1/-

D/ 416/&*$ %/50/()? 3*$%1,) 15 03/1*0 204 51##1: ('* 816&'%/& )30)2)? 0/, ('*30(%*/( 204 7*812* 840/1(%8 O(6$/ 7#6*R- Z/*621/%0 %) 0 $*#0(%+*#4 81221/8123#%80(%1/ O$*31$(*, KJ-Mn 15 80)*) %/ ,*+*#13*, 816/($%*)RN 1(%(%)? '0*21$$'0&*)O)6781/j6/8(%+0# 3*(*8'%0* 0/, *3%)(09%)R? 81/+6#)%1/)? */8*3'0#130('%*) 0/, ,*0('1886$ 21$* $0$*#4R- .'* ,%)*0)* #0)() Q –T :**C)- G123#%80(%1/) 0$* 21$* 5$*e6*/( 0/,)*+*$* %/ 416/&*$ %/50/()- D/ ,*+*#13*, 816/($%*)? ('* 80)*V50(0#%(4 $0(* 021/& %/50/()0&*, #*)) ('0/ J 21/(' '0) 7**/ $*31$(*, (1 7* 0$16/, Jn- =#,*$ 3*$)1/) O0,1#*)8*/(0/, 0,6#()R 0/, ('1)* 30$(%0##4 3$1(*8(*, 74 ('* +088%/* 204 7*812* %/5*8(*, :%(' B. pertussis 76( 6)60##4 '0+* 2%#,*$ ,%)*0)*-

D/ ('* convalescent stage? $*81+*$4 %) &$0,60#- .'* 30$194)2) 7*812* #*))5$*e6*/( 0/, 2%#,*$ 0/, ('* :'113 ,%)033*0$)- %/&-


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;1$#, 0(%1/ )*$+%8*)- H6)8*3(%7%#%(4 15 /1/V%226/%>*,%/,%+%,60#) %) 6/%+*$)0#? 0/, +088%/0(%1/ %) ('* 20%/)(04 15 3*$(6))%) 81/($1#-

Food shortages No

Lack of safe waterand poorsanitation

No


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;1$#, *, 8'%#,$*/- D( %) '%&'#4 81/(0&%16)- G'%#,$*/

0&*, 6/,*$ J 4*0$ 0/, 3$*&/0/( :12*/ 0$* 0( &$*0(*)( $%)C-


Case management• B$4('$1248%/ 1$ *$4('$1248%/ *)(1#0(* 1$ – %/ 80)* 15 0##*$&%*) (1 *$4('$1248%/ k

($%2*('13$%2k)6#502*('190>1#* O81/($0%/,%80(*, ,6$%/& 3$*&/0/84R )'16#, 7*0,2%/%)(*$*, 51$ M –JQ ,04) (1 0## cases 0/, 8#1)* contacts 15 3*$)1/) :%('3*$(6))%)? $*&0$,#*)) 15 0&* 0/, +088%/0(%1/ )(0(6)- @$6& 0,2%/%)($0(%1/ 71(' OJR21,%5%*) ('* 816$)* 15 %##/*)) O%5 %/%(%0(*, *0$#4R 0/, OKR *$0,%80(*) ('* 1$&0/%)25$12 )*8$*(%1/)? ('*$*74 ,*8$*0)%/& 81226/%807%#%(4-

• H423(120(%8 ($*0(2*/( 0/, )6331$(%+* 80)*V20/0&*2*/(-

D( %) %231$(0/( ('0( +088%/0(%1/ 81+*$0&* %) %23$1+*,- * 0/, ($*0( 80)*) 0/, 81/(08() 0) %/,%80(*, 7*#1:-

Immunization b088%/0(%1/ %) ('* 21)( *55*8(%+* :04 (1 81/($1# 3*$(6))%)- "8(%+* 3$%20$4 %226/%>0(%1/0&0%/)( B. pertussis %/5*8(%1/ :%(' ('* :'1#*V8*## +088%/* O:ZR %) $*8122*/,*, %/0))18%0(%1/ :%(' ('* 0,2%/%)($0(%1/ 15 ,%3'('*$%0 0/, (*(0/6) (191%,) [email protected] X1 )%/*V0/(%&*/ 3*$(6))%) +088%/* %) 0+0%#07#*-

"#('16&' ('* 6)* 15 08*##6#0$ +088%/*) %) #*)) 81221/#4 0))18%0(*, :%(' 0,+*$)*$*08(%1/)? 3$%8* 81/)%,*$0(%1/) 055*8( ('*%$ 6)*? 0/, :Z +088%/*) 0$* ('* +088%/*) 158'1%8* 51$ 21)( 816/($%*)? %/8#6,%/& D/,1/*)%0-

D/ &*/*$0#? 3*$(6))%) +088%/* O:ZR %) /1( &%+*/ (1 3*$)1/) 0&*, M 4*0$) 1$ 1#,*$? )%/8*#180# $*08(%1/) O81/+6#)%1/)? 81##03)*? '%&' (*23*$0(6$*R 204 7* %/8$*0)*, %/ 1#,*$8'%#,$*/ 0/, 0,6#()-

.'* *55%8084 15 ('* +088%/* %/ 8'%#,$*/ :'1 '0+* $*8*%+*, 0( #*0)( m ,1)*) %) *)(%20(*, (17* TYnF 3$1(*8(%1/ %) &$*0(*$ 0&0%/)( )*+*$* ,%)*0)* 0/, 7*&%/) (1 :0/* 05(*$ 0716( m4*0$)-


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;1$#, 0(%1/ %) $*e6%$*,? ('* 30(%*/( )'16#, 7* %)1#0(*,-@%)%/5*8(%1/ 15 ,%)8'0$&*)? 50*8*) 0/, )1%#*, 0$(%8#*)? 0/, %22*,%0(* $*31$(%/& 15 56$('*$80)*) 0$* *))*/(%0#-

Immunization .:1 (43*) 15 31#%1+%$6) +088%/* 0$* 0+0%#07#*F• =$0# 31#%1+%$6) +088%/* O=ZbRF

=Zb %) 0/ 1$0##4 0,2%/%)(*$*, +088%/* ('0( %/8#6,*) #%+* 0((*/60(*, )($0%/) 15 0##('$** +%$6) (43*)- D( %) *0)%#4 0,2%/%)(*$*, 74 '*0#(' :1$C*$) 1$ +1#6/(**$)?%/,68*) 0 &11, '621$0# O0/(%71,4R 0/, 2681)0# O%/(*)(%/*R %226/* $*)31/)*0/, %) 516$ (%2*) 8'*03*$ ('0/ %/08(%+0(*, 31#%1+%$6) +088%/* ODZbR- =Zb %) ('* 1/#4+088%/* 15 8'1%8* 51$ 31#%124*#%(%) *$0,%80(%1/ 7*806)* %( 08'%*+*) 268' 7*((*$2681)0# %226/%(4 ('0/ DZb :'%#* #%2%(%/& ('* ,%))*2%/0(%1/ 15 :%#, 31#%1+%$6) %/ ('*81226/%(4-

•

D/08(%+0(*, 31#%1+%$6) +088%/* ODZbRFDZb 80/ 7* &%+*/ 1/#4 74 %/($026)86#0$ %/j*8(%1/ 0/, $*e6%$*) ($0%/*, '*0#(':1$C*$)- D( *#%8%() 0/ *98*##*/( 0/(%71,4 $*)31/)* 76( 1/#4 2%/%20# %/(*)(%/0# 2681)0#$*)31/)*N %( %) 268' 21$* *93*/)%+* ('0/ DZb-

D/,1/*)%0 '0) 0 routine immunization policy ('0( $*e6%$*) Q ,1)*) 15 =Zb O)** "33*/,%9 MF Immunization schedule for IndonesiaR- 0(%1/ ,04)OX#@)R? )67VXD@) O20)) 80230%&/) )%2%#0$ (1 XD@) 76( 81/5%/*, (1 0 )20##*$&*1&$03'%80# 0$*0R? 0/, 213V63 80230%&/)? ,6$%/& :'%8' K =Zb ,1)*) 0$* &%+*/ 0(0/ %/(*$+0# 15 J 21/(' (1 0## 8'%#,$*/ 0&*, 6/,*$ U 4*0$)? 3$*5*$07#4 ,6$%/& ('* #1:($0/)2%))%1/ )*0)1/ 51$ */(*$1+%$6)*) O('* 811#*$ )*0)1/R-

H633#*2*/(0$4 %226/%>0(%1/ 08(%+%(%*) %/ D/,1/*)%0F XD@) )(0$(*, %/ JSSQ 51$ 31#%1*$0,%80(%1/ 08(%+%(4FV JJ /0(%1/0# 80230%&/) '0+* 7**/ 81/,68(*,? :%(' (:1 $16/,) 51$ *08'-V U )67VXD@) %/ )*#*8(*, '%&'V$%)C 0$*0) 81/,68(*, (:1 $16/,) 51$ *08'-V [X. O20(*$/0# 0/, /*1/0(0# (*(0/6) *#%2%/0(%1/ 80230%&/) :*$* 81/,68(*, %/ '%&'V$%)C#180#%(%*) OKTR 5$12 KYYY –KYYm-

Among displaced populations, all children aged 0–59 months should be vaccinated onarrival.

Any AFP case must be notified and investigated.


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;1$#, *,)30)2) 1886$? 5$*e6*/(#4 %/,68*, 74 )*/)1$4 )(%26#%N (43%80# 5*0(6$*) 15 ('*(*(0/%8 )30)2 0$* ('* 31)%(%1/ 15 13%)('1(1/1) 0/, ('* 508%0# *93$*))%1/ C/1:/ 0)risus sardonicus-


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Guide to Tetanus Prophylaxis in Wound Management

Type of Wound

Clear, minor wound All other wound

History of ActiveImmunization

.*(0/6)+088%/* 1$@. %/ 80)*15 8'%#,$*/7*#1: T 4$

.*(0/6)D226/1°#%/

.*(0/6)+088%/* 1$@. %/ 80)*15 8'%#,$*/7*#1: T 4$

.*(0/6)D226/176#%/

X1( %226/%>*, 1$ #*))('0/ m ,1)*)

z*) X1 z*) z*)

pU4*0$)%/8* #0)(,1)*

X1 X1 X1 X1

U (1 JY4*0$) )%/8*#0)( ,1)*

X1 X1 z*) X1

m,1)*)1$21$*

vJY 4*0$))%/8* #0)(,1)*

z*) X1 z*) z*)

"#)1 )**F Surgical Care in the District Hospital; ;1#* UYY2& _D@ OQ9],04R Db 1$ 1$0#- O0,j6)( ,1)* 51$

8'%#,$*/R- OZ*/%8%##%/*? B$4($1248%/*? (*($0848#%/*) 80/ 0#)1 7* 6)*,R

m- L%+* @%0>*302 Y-U (1 JU 2&]C&],04- H12* 3'4)%8%0/) &%+* ,%0>*302*+*$4 K (1 T '16$)? :'%#* 1('*$) &%+* U (1 JY 2& 0( *+*$4 )30)2-

Q- ;16/, ,*7$%,*2*/(-

U- c*( 30(%*/( $*)( %/ 0 e6%*( $112-

o- "8(%+* %226/%>0(%1/ :%(' (*(0/6) (191%, 0) )11/ 0) ('* 30(%*/(i) 81/,%(%1/%) )(07#%>*,-


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TB in HIV-positive patients


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Progression toactive disease

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Poor access tohealth services

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$*20%/ %/5*8(%16) 51$ 0 #1/&*$ 3*$%1,-

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Interruption of TBDrug Supply

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Food shortages No


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− Initial (intensive) phase: Kkm 21/(')? :%(' mkU ,$6&) &%+*/ ,0%#4 6/,*$ ,%$*8(17)*$+0(%1/-

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Previously treated case

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k Return after interruption: 81221/ 021/& D@Z)-

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k Relapse: 0 30(%*/( :'1 '0) 7**/ ,*8#0$*, 86$*, 15 .a %/ ('* 30)( 74 0 3'4)%8%0/

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k Chronic: 0 30(%*/( :'1 $*20%/*,? 1$ 7*802* 0&0%/? )2*0$V31)%(%+* 0( ('* */, 150 56##4 )63*$+%)*,? )(0/,0$,%>*, $*V($*0(2*/( $*&%2*/ O+*$4 )20## /627*$ 15$*+%16)# ($*0(*, 80)*) -


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Complementary control strategies:

− *, 30(%*/() 0$* C*3( %/ 0 )*30$0(* :0$, 51$ ('* 5%$)( K :**C) 15($*0(2*/(-

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Treatment of severe typhoid fever

Optimal therapy Alternative effective drugs

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Recommended Malaria Prophylaxis for Tsunami affected areas.

Country Prophylaxis Stand-by emergency treatmentNote: Should not be the same drug as the

one used for prophylaxis

Sri Lanka Chloroquine plus proguanil (Nivaquine® + Paludrine®, orSavarine®) first choice regimen.

If not available:Mefloquine (Lariam®; Mephaquine®),Doxycycline or Atovaquone /Proguanil (Malarone®) can be usedas alternatives

Artemether/lumefantrine (Coartem ®)or Atovaquone/Proguanil (Malarone®)orQuinine plus Tetracycline

Indonesia Mefloquine (Lariam®,Mephaquine®)orDoxycyclineor

Atovaquone/proguanil (Malarone®)

Artemether/Lumefantrine (Coartem ®)or Atovaquone/Proguanil (Malarone®)orQuinine plus Tetracycline

Maldives None None

Thailand

Note: No risk in maincities and main touristresorts

DoxycyclineorAtovaquone/proguanil (Malarone®)


India Chloroquine plus proguanil (Nivaquine® + Paludrine®, orSavarine®) first choice regimen.

If not available:

Mefloquine (Lariam®; Mephaquine®),Doxycycline or Atovaquone /Proguanil (Malarone®) can be usedas alternatives


Documents

Inf Dis Ind