Epidemiologi Penyakit Menular Dan Spesifitas

Geografis/Distribusi Global Penyakit Dan

Potensi Membahayakan Kesehatan

OLEH:

Dr. Rahmadani Sitepu, M.Kes

Dr. Syarifah Harahap, M.Kes
Dr. Budi Kurniawan, M.Kes

DEPARTEMEN ILMU KESEHATAN MASYARAKAT

FAKULTAS KEDOKTERAN UISU MEDAN
TA 2016/2017
 Epidemiologi

Epi : Pada, Tentang

Demos : Penduduk
Logos : Ilmu

Epidemiologi yaitu ilmu yang mempelajari tentang

distribusi dan determinan penyakit dan keadaan
kesehatan pada populasi serta penerapannya untuk
pengendalian masalah-masalah kesehatan.
 Epidemiologi penyakit menular

epidemiologi penyakit yang terfokus dalam mempelajari

distribusi dan determinan penyakit menular
dalam populasi
 Spesifitas Geografis/Distribusi Global Penyakit

Most Common Diagnoses

 Short Incubation Period (<2 weeks)
– Malaria(P. falciparum, P. knowlesi)
– Typhoid fever
– Dengue
– Rickettsial disease
– Hepatitis A
 Long Incubation Period (>2 weeks)
– Malaria (P. vivax, P. ovale, P. malariae)
– Tuberculosis
 Viral infection with
immunization

 Yellow fever vaccine: endemic zones (Africa and S. America)

– some countries may require as a condition for entry

 Vaccines against Japanese encephalitis, rabies, tick-borne

encephalitis and typhoid fever
– Quadrivalent meningococcal vaccine is required by Saudi
Arabia for religious pilgrims to Mecca for the Hajj or Umrah.

 Tetanus, pertussis, diphtheria, Haemophilus influenzae type b,

measles, mumps, rubella, varicella, Streptococcus pneumoniae,
and influenza

 Hepatitis A and B, poliomyelitis, and Neisseria meningitidis

– for travel as well as for routine health care
 Malaria
• Largely preventable

• Incubation period: 10 days

to 1 year

• Signs and symptoms: GI

symptoms, cyclical fevers,
anemia, splenomegaly

• Diagnosis: thick and thin CDC Public Health Image Library

peripheral blood smear
– Thrombocytopenia without
leukocytosis
 Infecting Organisms

 Plasmodium falciparum: potentially fatal and

considered an emergency
– Acquired in Africa = 3:1 likelihood
– 95% have clinical onset within 2 months exposure
– Peripheral blood smear: parasitemia > 2%, only ring forms,
banana-shaped gametocyte, erythrocytes of all sizes
infected, erythrocytes contain no Schuffner granules

 Other species: P. vivax, P. ovale, P. malariae, P.

knowlesi
– fevers occurring at regular intervals of 48 to 72 hours
 Severe Malaria

• Cerebral malaria, with abnormal behavior, impairment

of consciousness, seizures, coma, or other.
• Severe anemia due to hemolysis
• Hemoglobinuria
• Pulmonary edema or ARDS, which may occur even after
the parasite counts have decreased in response to
treatment
• Abnormalities in blood coagulation and
thrombocytopenia
• Shock
 Infecting Organisms
• Plasmodium falciparum: potentially fatal and
considered an emergency
– Acquired in Africa = 3:1 likelihood
– 95% have clinical onset within 2 months exposure
– Peripheral blood smear: parasitemia > 2%, only ring forms,
banana-shaped gametocyte, erythrocytes of all sizes
infected, erythrocytes contain no Schuffner granules
• Other species: P. vivax, P. ovale, P. malariae, P.
knowlesi
– fevers occurring at regular intervals of 48 to 72 hours
 Typhoid Fever
• Typically presentation of
food or water
contaminated 1-3 weeks
after ingewith Samonella
enterica serotype typhi

• Have visited Indian

subcontinent, in the
Philippines, or in Latin
America

• Fever and constitutional

symptoms
– May have insidious onset
– Abdominal pain, cough,
chills
– Diarrhea may eventually
develop
 Typhoid Fever

• Diagnosis: identify
organism in urine,
blood, stool, or bone
marrow
• Vaccines partially
effective
• Treatment: 3rd gen.
cephalosporin,
floroquinolone, or
azithromycin
– Relapse: 2-3 weeks after
treatment
 Dengue Fever

• Primary vector: Aedes mosquito

• Caused by one of four different serotypes of
Flavivirus
• Incubation period: 4-7 days
• Fever, severe myalgias, retro-orbital pain
• Leukopenia and thrombocytopenia
• Dengue shock syndrome and dengue
hemorrhagic fever: second infection with a
different serotype
Dengue Fever
 Diarrhea

• Between 20%-50% international travelers

– Onset: usually first week of travel but may occur later
• Most common agent: enterotoxigenic Escherichia coli
(ETEC)
• Primary source of infection: ingestion of fecally
contaminated food or water.
• Most important risk determinant: traveler's
destination
– Latin America, Africa, the Middle East, and Asia
– High-risk: young adults, immunocompromised, pts with
inflammatory-bowel disease , diabetes, and persons taking
H-2 blockers or antacids.
 Diarrhea
• Prevention: food and liquid hygiene
and provision for prompt self-
treatment in the event of illness
– Hydration, loperamide (if no fever >38.5
degrees C & no gross blood or mucus in
stool)
– Short course (1 dose to 3 days) of a
fluoroquinolone, azithromycin or rifaximin

• Usually resolves in 3-5 days

• Antibiotic prophylaxis is not

recommended for most travelers
 Hepatitis A Virus
• Transmitted through fecal contimination of food
and drink

• Treatment: supportive (no antivirals)

• Vaccination
– Should be immunized at least 2-4 weeks prior to
traveling
– Single dose: 100% protection by 4 wks
– 2nd dose administered 6 months later results in antibody
titers likely to last many decades
Rickettsial Diseases
• Tick transmitted, occur
throughout the world,
typically named for
geographic region
– African tick bite fever
(sub-Saharan)
– Meditterranean tick
bite fever (N. Africa and
Middle East)
African tick typhus – Exception: RMSF
Rickettsial Diseases
• Headache, fever, Rickettsial Diseases
myalgias and
often a truncal
maculopapular
or vesicular rash
• Clinical clue:
eschar at site of
bite
• Treatment:
doxycycline, self-
limited
 Fungal Infections
• Coccidioidomycosis: Southwest US, Mexico,
and parts of South America

• Histoplasmosis: Ohio River valley, Mexico,

Central America

• Penicillium marneffei: Southeast Asia, parts of

China, Hong Kong, and Taiwan
– Disseminated infection increasing in
immunocompromised patients (AIDS)
 Scabies
• Due to Sarcoptes
scabiei infection

• Common in
– Developing world
– Adventurous
backpackers

• Sexually active
travelers are those
most commonly
infected
 Cutaneous Larva Migrans
• Most frequent serpiginous lesion among travelers

• Results from migration of animal hookworms (e.g.,

Ancylostoma braziliense and A. caninum) in
superficial tissues

• Usually acquired after direct skin contact with soil or

sand contaminated with dog or cat feces

• Lesions
– may initially be papular or vesicular
– Pruritic
– commonly found on the foot or buttock
Cutaneous Larva Migrans

(Foot of a person who had recently visited the Caribbean)

Triangle of Epidemiology
Agent

Host Environment
 Risk Factor

AGENT
• Biologic, nutrient, chemical, physical, mechanical

HUMAN HOST
• Age, race, sex, habits genetic, personality defense
mechanism

ENVIRONMENT
• Physical, social,
• economic, biologic
• and psychologic.
 Penyakit/Masalah Kesehatan

Terjadi karena
ketidakseimbangan faktor
agen, pejamu, dan
lingkungan
Keadaan tidak berpenyakit
Agen Pejamu
Agen

Lingkungan

Pejamu Lingkungan
 Potensi Penyakit
A
P

A P

L L

P A

A
P
L L

A :Agen
P : Pejamu
L : Lingkungan
 Keadaan Membahayakan Kesehatan

Epidemilogi mempelajari wabah, tetapi apa

sebenarnya yang dimaksud dengan wabah ??

Epidemi/wabah adalah keadaan dimana didapat

frekuensi penyakit melebihi frekuensi biasa atau
dalam waktu yang singkat terdapat penyakit yang
berlebih (cth: Filariasis)
 Keadaan Membahayakan Kesehatan

 Endemi diartikan sebagai keadaan yang biasa

atau normal atau frekuensi penyakit tertentu
berada dalam keadaan normal pada suatu
daerah (cth: Malaria)

Pandemi adalah keadaan epidemi yang

melanda hampir semua populasi ataupun
hampir semua daerah/dunia (cth : H1N1,
H5N1)
Thank You