Cases of diphtheria remain high despite the fact that the coverage of immunization against the disease has reached 90 percent.
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ANTARA FOTO/Yulius Satria Wijaya
An infant cries as he is injected with a diphtheria vaccine on Tuesday (5/12) at a clinic in Cibinong, Bogor regency, West Java. The government is fighting a diphtheria outbreak that it has declared an extraordinary situation (KLB). The disease, which is caused by the Corynebacterium diphtheriae bacterium, has claimed lives in 20 provinces across the country.
JAKARTA, KOMPAS – People have not been well protected against the diphtheria infection. Cases of diphtheria remain high despite the fact that the coverage of immunization against the disease has reached 90 percent.
This has happened in part because many people still doubt the importance of immunization and the quality of the existing vaccines.
According to data from the Health Ministry, the coverage of DPT immunization (diphtheria-pertussis-tetanus) reached 90.6 percent in 2007. In 2012, the coverage rose to 100.9 percent and fell to 93.1 percent in 2015. Meanwhile, the number of people infected by diphtheria, which totaled 183 patients in 2007, rose to 1,192 patients in 2012, and to 502 patients in 2015.
This year, 95 regencies and cities in 20 provinces reported 590 cases of diphtheria, with 6 percent of the infected people having died. The majority of patients were under 18 years of age. The local government of Tangerang regency, for example, has declared an extraordinary status for diphtheria since last November.
The secretary-general of the Association of Indonesian Public Health Experts, Husein Habsyi, said Tuesday in Jakarta that immunization coverage of 100 percent was ideal. However, it is difficult to achieve the goal because of limited resources and the people’s resistance against the immunization. "There is an immunization gap in the area," he said.
Diphtheria caused by Corynebacterium diphtheria can cause death. The most effective prevention is immunization. The more children are immunized, the safer people will be.
Meanwhile, the director of health surveillance and quarantine at the Health Ministry, Elizabeth Jane Soepardi, said the use of immunization in dealing with diphtheria outbreaks began in 2012, with diphtheria cases continuing to occur today.
In addition to immunization rejection, the spread of diphtheria is also partly caused by high mobility and low socioeconomic status. The Health Ministry has identified an immunization gap.
Misperception
According to information compiled by Kompas, outbreaks of diphtheria in some areas were triggered by, among other reasons, misperception of citizens against immunization and the changes in lifestyle. Another factor is the rejection of the immunizations due to religious factors and the lack of trust in the quality of the vaccine.
The head of the West Java health office, Dodo Suherman, said in Bandung that the transmission of diphtheria was triggered a lack of understanding on the immunization, as well as by people being too busy with work. "In some cases, people do not immunize their children because they do not have time to get the immunization," he said.
This is in line with the high number of recorded cases of diphtheria in industrial areas in West Java. Most of the cases were found in Purwakarta with 21 patients, one of whom died, followed by Karawang regency with 13 cases, Kota Depok with 12 cases and one death, and 12 cases in Bekasi regency. "There were 116 cases with 13 deaths," he said.
In Banten, due to a lack of information, many people are not aware if diphtheria can be prevented by immunization. In Banyuwangi, East Java, some parents refuse to immunize their children for doubting the method of storing the vaccines at health facilities. Taufiq, for example, admitted his five children did not get the vaccine because they believe every child is immune and that the vaccine is not stored properly.
"From the information I get, the vaccine is not stored well, stacked in a warehouse without a cooling system. In addition, how do we know if the vaccine is real or fake? I do not want my child to be used for an experiment," he added.
In Palembang, South Sumatra, some parents do not want to immunize their children because there was a case of a child who died after receiving the vaccine.
In the SD Negeri 75 Palembang elementary school, for example, from 100 second graders, only 15 people got the vaccine. Ayu, 29, a parent, did not allow her child to be immunized because she was worried about the side effects.
Arifianto, a pediatrician and author of Pro Kontra Imunisasi, said that the government needed to involve community groups that were aware of the importance of immunization throughout the immunization program campaign.
