Malang’s Department of Health is trying to head off another year of endemic diphtheria cases after several schools began reporting infected students.
Diphtheria (Dipteri) is a serious bacterial infection of the nose, throat, and lungs, sometimes the skin, with extreme cases resulting in death.
Diptheria is virtually unheard of in Australia thanks to a government funded program of free immunisations, yet Indonesia, which has the second highest rates of diphtheria in the world, also has a now free immunisation program.
Last year Malang was among 22 cities in Indonesia labelled endemic areas or KLB (kejadian luar biasa), with 83% of all cases occurring in East Java.
Dr Usep Eryadi from Puskesmas Mulyoro, overseen by the Department of Health (Dinas Kesehatan), said that although the vaccine is free, problems lie in storage of the vaccine and awareness about the importance of getting children immunised.
“Many parents are not willing have their children immunised because they fear the complications that can arise from vaccinations. But the complications are small compared to the risk. An infection or high fever from a needle happens in very few cases, but being protected from a serious illness like diptheria is more important in the grand scheme of things,” Eryadi said.
Health officials are currently circulating local schools in order to educate teachers and parents about diphtheria prevention. At the same time they are also taking advantage of audiences to reiterate dengue fever precautions, another disease with high affliction numbers in Indonesia.
Between 2005 and 2008, diphtheria rates were relatively low however in Malang there were 18 cases in 2009, which steadily increased spiking in 2011 with 69 cases and prompting the government to initiate the immunisation program. Despite the campaign, last year saw 42 cases.
Sigit Wahyudi also from Dinas Kesehatan believes the campaign did not reach enough people, hence their determination to cover more ground targeting both children and adults this year.
“Prevention is better than treatment” aims to encourage both parents and children to become immunised, but particularly children under fifteen as they are the beneficiaries of free vaccines and because they are often the first exposed to the infection.
“Schools are obliged to keep a register of immunised students. Doctors should give copies of the proof of immunisation to parents. Students are not prevented from attending school if they have not had their full immunisations, but this register is a chance for schools to encourage parents to have children immunised, “Wahyudi said.
Like most schools, at My Little Island Kindergarten and Primary there is no such register, leaving them uninformed about who is most at risk after last week s outbreak.
Two children from the same family were infected, forcing school closure for three days in order to sterilise all classrooms and for parents to have children tested if they showed symptoms. A subsequent meeting with parents and health officials was organised and the school has now established a temperature check protocol before students can enter their classes.
Wahyudi said the infection zone around a positive case extends 100 metres.
“Everyone with exposure must take a course of antibiotics and be swabbed for the disease, because a person can be a carrier for up to six months without realising.”
During the meeting at My Little Island, health officials made a point of showing parents how immunisation needles are used only once and any unused vaccine or unrefrigerated vaccine is discarded. Some parents expressed concern about the frequency of blackouts whereby fridges storing the medicine regularly lost power. Other parents enquired about reactions to vaccination needles.
Dr Eryadi assured parents that the risk of not immunising is far greater than the potential to have a reaction and that if parents were worried about the storage of vaccines at doctor’s clinics they could go to Puskesmas or the Health Department centre where generators were used in case of blackouts. They assured parents that even at doctors clinics, spoilt medicines could be discarded and restocked for free.
My Little Island today distributed a free course of antibiotics to all their students. Dinas Kesehatan is sending microbiologists to the school tomorrow to swab the students and teachers at a cost of RP35 000 per student.