The main steps that need to be done in the prevention of diphtheria

Diphtheria has spread again in Indonesia. The Ministry of Health reported that between October-November 2017, diphtheria bacteria were found to be spreading in 20 Indonesian provinces. That is why the Government is now making the diphtheria outbreak an outbreak, aka Extraordinary Events. What makes diphtheria plague again in Indonesia, what diphtheria prevention efforts can be done to avoid the dangers of this disease?

Overview of diphtheria disease

Diphtheria is a disease caused by Corynebacterium. This infection usually attacks the throat, nose, and skin.

Diphtheria spreads rapidly through airborne particles when coughing or sneezing carelessly (not covering your mouth or wearing a mask), spitting carelessly, and from skin contact with contaminated personal items. Touching a wound that is infected with the bacteria that causes it can also expose you to the disease.

Common symptoms of diphtheria are sore throat and hoarseness, difficulty breathing and swallowing, runny nose, excessive drooling, chills fever, slurred speech, and a hard cough.

This series of symptoms is caused by a toxin produced by the bacteria that causes diphtheria. When toxins are carried into the bloodstream, they can damage the heart, kidneys, nervous system, brain, and other healthy body tissues.

In general, diphtheria may not cause significant symptoms at first. That is why many people who have actually been infected are completely unaware that they are sick. This condition can rapidly expand the spread of diphtheria. In fact, there are ways to prevent diphtheria effectively, namely through vaccination.

Diphtheria epidemic in Indonesia

Indonesia has been named a diphtheria free country by the World Health Organization (WHO) since the 1990s. These bacteria had "visited" in 2009, but vaccination in children as an effort to prevent diphtheria was successful in eradicating the spread of this disease in 2013.

Until mid-October 2017, new cases of diphtheria emerged. It is recorded that almost more than 95 districts in 20 provinces have contracted diphtheria. The areas included are West Sumatra, Central Java, Aceh, South Sumatra, South Sulawesi, East Kalimantan, Riau, Banten, DKI Jakarta, West Java and East Java.

What causes diphtheria to spread again in Indonesia?

WHO has obliged every country to carry out routine vaccines to prevent outbreaks of infectious diseases. Diphtheria prevention measures through the national immunization program have actually been carried out by the Indonesian Ministry of Health for a long time.

Unfortunately, not all Indonesian children get a complete vaccine, including diphtheria immunization, due to various things.

According to data from the Indonesian Health Profile, in 2015 the complete basic immunization coverage for children under five only reached 86.54 percent. Meanwhile, the figure targeted by the government at that time was 91 percent. According to data from the Indonesian Ministry of Health, 66% of diphtheria cases that have recently emerged are due to unconsciousness, neglect or rejection of how to prevent diphtheria through vaccination.

Many parents are hesitant or even refuse to immunize their children because they believe in the misconceptions circulating in the community. For example, rumors say that immunization causes paralysis or autism, two myths that are not sufficiently validated in medical science.

Obstructed diphtheria prevention efforts like this have led to the return of diphtheria that has plagued Indonesia after so many years.

Various ways to prevent diphtheria

1. Early immunization to prevent diphtheria from an early age

The Indonesian Pediatrician Association (IDAI) and the Indonesian Ministry of Health constantly urge parents to immediately get their children to get diphtheria immunization as a step to prevent diphtheria from an early age.

In fact, diphtheria is very easy to attack children and toddlers who are not immunized and then spread to other areas. That is why every child is required to be immunized.

Even adults are still at risk for getting diphtheria. The emergence of diphtheria cases in adults is mostly due to not getting the adult diphtheria vaccine or incomplete immunization status since childhood.

Diphtheria immunization schedule for children

There are four types of vaccines for diphtheria, namely the DPT vaccine, the DPT-HB-Hib vaccine, the DT vaccine, and the Td vaccine. This vaccine is given at different ages. Each vaccine is given according to the development of the child's age.

Immunization as a preventive measure for diphtheria is usually carried out at puskesmas, posyandu, schools and other health facilities.

In more detail, the following are the rules for giving diphtheria vaccines which are included in the national basic immunization program of the Ministry of Health: Diphtheria is Contagious, Dangerous and Deadly, but Can be Prevented by Indonesian Immunization:

• Three doses of DPT-HB-Hib basic immunization (Diphtheria, Pertussis, Tetanus, Hepatitis-B and Haemophilus influenza type b) at 2, 3 and 4 months of age,
• One dose of DPT-HB-Hib follow-up immunization at 18 months of age,
• One dose of advanced immunization DT (Diphtheria Tetanus) for children in grade 1 SD / equivalent,
• One dose of advanced immunization Td (Tetanus diphtheria) for children in grade 2 SD / equivalent, and
• One dose of follow-up Td immunization for children in grade 5 SD / equivalent.

Now, now is the time for you to confirm whether your child has received complete immunizations according to their schedule, including this diphtheria vaccine. If it is deemed incomplete, please complete it immediately. Because the risk of diphtheria still lurks until he is an adult.

If the immunization program is delayed until age 7 years or is interrupted, three further immunization doses need to be completed by:

• Carrying out Td (Tenatus diphtheria) immunization which contains less diphtheria toxoid 4 to 8 weeks after continuing with the DT (Diphtheria Tetanus) immunization which contains more diphtheria toxoid
• Carry out Td immunization 6 to 12 months after the first dose

Even though your little one has received complete routine immunizations, he still does not acquire immunity to diphtheria for life. Your little one needs to repeat immunizations every 10 years as a way to prevent diphtheria as an adult.

2. Vaccines for the prevention of diphtheria in adults

The emergence of diphtheria cases in adults is largely due to not being vaccinated or incomplete immunization status since childhood.

That is why you need to make sure whether you have received the diphtheria vaccine or not. If you haven't, then you still need to be immunized again to prevent getting this disease.

So, what if you have been vaccinated, but you still get diphtheria as an adult? Well, even though you have been vaccinated, the immunity you get from vaccination may decrease over time. In essence, prevention of diphtheria through vaccination will not provide lifelong immunity to this disease.

How to prevent diphtheria in adults who have complete vaccination up to. age 11 or 12 years is to re-immunize every 10 years.

What are the types of diphtheria vaccine for adults?

The diphtheria vaccine for adults uses the Tdap and Td vaccines. Tdap itself is an innovation of the DTP vaccine, which is a type of vaccine used to prevent diphtheria in children.

The difference is that Tdap uses an acellular pertussis component in which the pertussis bacteria is made inactive so that it provides safer side effects than DTP.

While Td is an advanced vaccine (booster) for tenatus and diphtheria, with more tetanus toxoid components.

Diphtheria prevention that can be done in adults aged 19 to 64 years can follow the rules set by the CDC. The following are some of the provisions for diphtheria vaccine for adults:

• Adults who have never received the Td vaccine or who have not had complete immunization status: 1 dose of Tdap vaccine is given followed by Td vaccine as a booster every 10 years.
• Adults who have not been immunized at all: the first two doses are given 4 weeks apart and the third dose is given after 6 to 12 months of the second dose
• Adults who have not completed three doses of the Td vaccine: given the remaining unfulfilled dose.

3. Be aware of the symptoms of diphtheria before it's too late

How to prevent diphtheria so that the spread of the dangers of this disease stops can also be done by recognizing diphtheria symptoms from the start. Diphtheria may not cause any symptoms at first. However, still be aware of the early symptoms that may arise from this infection, such as:

• High fever (above 38 degrees Celsius),
• The appearance of gray membranes on the tonsils, throat and nose
• Pain when swallowing,
• Swelling around the neck or bull neck ,
• Shortness of breath and snoring sound.

If you suspect your child or other members of your family have contracted diphtheria, do not delay treatment and take it to the nearest hospital immediately.

Emergency treatment steps for diphtheria usually involve isolation (so as not to spread to other people) and administration of anti-diphtheria serum (ADS) and antibiotics (penicillin and erythromycin).

How to prevent diphtheria is not only you are at risk of transmitting this disease to other people, but also can avoid dangerous complications.

4. Applying a healthy and clean lifestyle

The immunity provided by the diphtheria vaccine cannot provide lifelong immunity. Meanwhile, the threat of the spread of diphtheria bacteria continues, especially in densely populated areas where the level of hygiene is less hygienic or has inadequate sanitation facilities.

Therefore, to maximize diphtheria prevention measures, it is necessary to maintain a clean environment and adopt healthy hygiene habits and behaviors. Some ways to prevent diphtheria that you can do in, whether you are infected with diphtheria or not are:

• Get in the habit of washing your hands using hand washing soap before and after activities that allow you to be exposed to disease bacteria
• Cleaning the house regularly, especially in rooms and furniture that have the potential to become a den of disease bacteria
• Ensure proper air circulation in the room by installing cross ventilation or using an air purifier
• Clean household items used by sufferers with antibacterial cleansers
• Increase body immunity by following a healthy diet, regular exercise, getting enough rest, and reducing alcohol and cigarette consumption
• Use a mask when experiencing symptoms such as coughing and sneezing
• Clean skin wounds that have infections regularly and cover them with a waterproof agent

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