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Why Kaimana? A district in West Papua Province, Indonesia, with two outbreaks in 2 years: an environmental observation study
Meeting Abstracts
Why Kaimana? A district in West Papua Province, Indonesia, with two outbreaks in 2 years: an environmental observation study Antonius Oktavian, Tri Nury Kridaningsih, Hana Krismawati, Evi Iriani, Irawati Wike, Mardi Rahardjo
Abstract Published Online June 17, 2013 National Institute of Research and Development for Biomedicine, Jayapura, Papua, Indonesia (A Oktavian MD, T N Kridaningsih BS, H Krismawati MS, E Iriani BA, I Wike BA, M Rahardjo BA) Correspondence to: Antonius Oktavian, Health Department, National Institute of Research and Development for Biomedicine, Papua, Indonesia, JL Kesehatan, no. 10 Dok 2, Jayapura, Papua, Indonesia [email protected]
Background Kaimana is a district in West Papua Province, Indonesia; the port city ranges between 0 and 100 m above sea level. In October 2011, a diarrhoea outbreak resulted in 222 cases; of those, 167 patients were aged between 0 and 5 years and three cases died. According to the West Papua Health Department, the first outbreak of dengue haemorrhagic fever (DHF) in 50 years in Kaimana occurred in May and June 2012. There were 27 patients, most of whom were between 0 and 15 years old. Only three patients were aged older than 15 years and one patient died. The aim of this study was to find the agent of diarrhoea and the vector of DHF and to evaluate the environmental conditions surrounding the outbreaks. Methods The study has been carried out in two parts. Part one occurred between Nov 7 and 10, 2011, to examine the conditions surrounding the diarrhoea outbreak. This consisted of an examination of water resources, environmental observation and interviews of 30 participants including patients and health practitioners to determine the clinical symptoms of disease. 23 water samples were taken from the wells, springs, pipes, and reservoirs of the Indonesian Regional Water Utility Company. Part two examined the conditions surrounding the DHF outbreak and consisted of entomological investigation and environmental observation that was carried out between June 15 and 22, 2012. The existence of dengue virus was detected using RT-PCR method with D1 and D2 Lanciotti primer on 50 mosquitoes and larvae. Findings We found that all water samples (23 samples) were contaminated with high levels of coliform and Escherichia coli ranging from 4 to 979 most probable number per 100mL. Entomological investigation and virus detection revealed that Aedes albopictus was a vector in the DHF outbreak in Kaimana district. The environmental observation revealed that there were many easily accessible water resources in Kaimana. On the other hand, we found poor conditions surrounding the public drinking water. We found no evidence of water treatment before distribution and observed springs used for drinking water located near traditional latrines as well as surface level wells without barrier walls, used to prevent surface runoff from pouring back into the groundwater-fed wells—all conditions that make vector contamination possible. The DHF outbreak was presumptively caused by transmission of the dengue virus from infected temporal visitors, but we identified many suitable places for the Aedes breeding habitat within Kaimana. Interpretation The two outbreaks in Kaimana can be attributed to poor environmental conditions surrounding water resources and insufficient treatment of water for public consumption. Our findings suggest that a more systematic and sustainable health education programme related to water treatment is needed to raise public health awareness. Funding National Institute of Health Research and Development through the Ministry of Health for the Republic of Indonesia. Contributors AO was the principal author. TNK and HK were the coauthors of the manuscript. EI, IW, and MR contributed to the analysis. Conflicts of interest We declare that we have no conflicts of interest. Acknowledgments We are very thankful to National Institute of Health Research and Development and Health Department of Kaimana, West Papua Province.
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Why Kaimana? A district in West Papua Province, Indonesia, with two outbreaks in 2 years: an environmental observation study Antonius Oktavian, Tri Nury Kridaningsih, Hana Krismawati, Evi Iriani, Irawati Wike, Mardi Rahardjo
Abstract Published Online June 17, 2013 National Institute of Research and Development for Biomedicine, Jayapura, Papua, Indonesia (A Oktavian MD, T N Kridaningsih BS, H Krismawati MS, E Iriani BA, I Wike BA, M Rahardjo BA) Correspondence to: Antonius Oktavian, Health Department, National Institute of Research and Development for Biomedicine, Papua, Indonesia, JL Kesehatan, no. 10 Dok 2, Jayapura, Papua, Indonesia [email protected]
Background Kaimana is a district in West Papua Province, Indonesia; the port city ranges between 0 and 100 m above sea level. In October 2011, a diarrhoea outbreak resulted in 222 cases; of those, 167 patients were aged between 0 and 5 years and three cases died. According to the West Papua Health Department, the first outbreak of dengue haemorrhagic fever (DHF) in 50 years in Kaimana occurred in May and June 2012. There were 27 patients, most of whom were between 0 and 15 years old. Only three patients were aged older than 15 years and one patient died. The aim of this study was to find the agent of diarrhoea and the vector of DHF and to evaluate the environmental conditions surrounding the outbreaks. Methods The study has been carried out in two parts. Part one occurred between Nov 7 and 10, 2011, to examine the conditions surrounding the diarrhoea outbreak. This consisted of an examination of water resources, environmental observation and interviews of 30 participants including patients and health practitioners to determine the clinical symptoms of disease. 23 water samples were taken from the wells, springs, pipes, and reservoirs of the Indonesian Regional Water Utility Company. Part two examined the conditions surrounding the DHF outbreak and consisted of entomological investigation and environmental observation that was carried out between June 15 and 22, 2012. The existence of dengue virus was detected using RT-PCR method with D1 and D2 Lanciotti primer on 50 mosquitoes and larvae. Findings We found that all water samples (23 samples) were contaminated with high levels of coliform and Escherichia coli ranging from 4 to 979 most probable number per 100mL. Entomological investigation and virus detection revealed that Aedes albopictus was a vector in the DHF outbreak in Kaimana district. The environmental observation revealed that there were many easily accessible water resources in Kaimana. On the other hand, we found poor conditions surrounding the public drinking water. We found no evidence of water treatment before distribution and observed springs used for drinking water located near traditional latrines as well as surface level wells without barrier walls, used to prevent surface runoff from pouring back into the groundwater-fed wells—all conditions that make vector contamination possible. The DHF outbreak was presumptively caused by transmission of the dengue virus from infected temporal visitors, but we identified many suitable places for the Aedes breeding habitat within Kaimana. Interpretation The two outbreaks in Kaimana can be attributed to poor environmental conditions surrounding water resources and insufficient treatment of water for public consumption. Our findings suggest that a more systematic and sustainable health education programme related to water treatment is needed to raise public health awareness. Funding National Institute of Health Research and Development through the Ministry of Health for the Republic of Indonesia. Contributors AO was the principal author. TNK and HK were the coauthors of the manuscript. EI, IW, and MR contributed to the analysis. Conflicts of interest We declare that we have no conflicts of interest. Acknowledgments We are very thankful to National Institute of Health Research and Development and Health Department of Kaimana, West Papua Province.
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