Extraordinary events during an outbreak, what are the criteria?

Dengue hemorrhagic fever (DBD) cases in Indonesia have occurred 16,099 cases during the period from January to early March 2020. According to data from the Ministry of Health, during that two month period, dengue fever has claimed at least 100 lives and forced a number of regions to announce the status of extraordinary events (KLB).).

"There are 16,099 cases with the death of 100 (people) for the national. The efforts we have made are encouraging increased preventive activities, ”said the Director of Vector Infectious Diseases and Zoonotics of the Indonesian Ministry of Health, dr. Siti Nadia Tarmizi, as quoted by Antara News, Tuesday (3/10).

Some districts / cities determine the status of dengue fever outbreaks (DHF)

Since the beginning of 2020, dengue hemorrhagic fever has plagued several regions in Indonesia. In the first two months, there were 285 districts / cities that reported that their areas were infected with DHF.

There have been at least five districts / cities that announced the status of dengue fever outbreak (DHF) in their places. Among them are Belitung Regency in Bangka Belitung Province, six villages in Temanggung Regency, Central Java, and three districts in East Nusa Tenggara (NTT) Province, namely Alor, Lembata, and Sikka.

Health Minister Terawan Agus Putranto visited Sikka Regency, Monday (9/3), he said the number of dengue cases in Sikka continued to increase. Responding to this, the local government has even increased the status of the DHF outbreak to enter stage four.

Dengue outbreaks have occurred four times in Sikka Regency, namely in 2010, 2013, 2016 and this year.

When compared, throughout 2016 the number of cases of dengue fever outbreaks reached 620 cases with 13 people dying. While this year has only been running for 3 months but the cases have far exceeded previous incidents.

"In 2020, just entering March, the number of cases has reached 1,216 cases, with the death toll up to 14 people," said the Head of the Sikka District Health Office, Petrus Herlemus.

NTT Province is indeed one of the provinces with the largest number of cases. Starting from January 1 to March 9, 2020, the Ministry of Health noted that there were 1,195 cases spread across several regencies / cities with a total of 31 people.

According to Terawan, of the victims, many of them were children.

Apart from NTT, West Java Province is also one of the red zones for the dengue outbreak even though the governor has not declared the status of an outbreak. Head of the West Java Provincial Health Office, Berli Hamdani, said dengue cases in West Java had reached 4,192 and 15 deaths.

What is extenuating circumstances state and how is it applied

Extraordinary Events (KLB) is the emergence or increase in the incidence of illness and / or death which is epidemiologically significant in an area within a certain period of time. This situation can lead to an outbreak.

Certain types of infectious diseases that can cause outbreaks are Cholera, Pes, Dengue Hemorrhagic Fever, Measles, Polio, Diphtheria, Pertussis, Rabies, Malaria, Avian Influenza H5N1, Anthrax, Leptospirosis, Hepatitis, New Influenza A (H1N1) / Pandemic 2009, Meningitis, Yellow Fever, and Chikungunya.

In addition to these names, if there are certain other infectious diseases that can cause an outbreak, the minister of health will determine them, such as the current COVID-19 outbreak.

There are many questions as to why in cases of dengue fever (DHF) some areas with a high number of cases do not determine the status of an outbreak.

Determination of extraordinary events is regulated in the Regulation of the Minister of Health (Permenkes) RI No. 1501/2010 concerning Certain Types of Infectious Diseases That Can Cause Outbreaks and Prevention Efforts.

Terms and criteria for determining the KLB

In article 6, it is written that an area can be determined in an extraordinary event if it meets one of the following criteria.

1. It is said to be an outbreak if it meets one of the following criteria the emergence of an infectious disease that did not previously exist or was unknown in an area.
2. The incidence of disease increased continuously for 3 periods in hours, days, or weeks according to the type of disease.
3. Two or more times the pain increase compared to the previous period in hours, days, or weeks. according to the type of disease.
4. The number of new sufferers in a period of one month showed an increase of two or more times compared to the monthly average in the previous year.
5. The average number of morbidity incidents per month during one year showed an increase of two or more times compared to the average number of morbidity per month in the previous year.
6. The death rate in cases of a disease (Case Fatality Rate) in one period shows an increase of 50 percent or more.
7. Proportion rate of disease (proportional rate) new sufferers in one period showed an increase of two or more times compared to the previous period in the same period.

The purpose of determining the status of the outbreak

Determination of the status of an outbreak can be done by the head of the regional health office or the head of the provincial health office or the minister, depending on the area coverage of the outbreak.

When an area has been declared an outbreak, then all elements must come down to carry out integrated countermeasures. For dengue cases in several regions in Indonesia.

This integrated response includes investigations, prevention and vaccination, eradication of disease causes, handling of bodies, and counseling. The regions are obliged to form a rapid action team to carry out integrated countermeasures down to the roots.

For the COVID-19 outbreak, Indonesia has also established an outbreak status, but it is slightly different. The status of extraordinary events in COVID-19 is directly determined by the central government, namely the Minister of Health. That way all the financing for countermeasures is borne by the central government.

The decision on the status of an outbreak for COVID-19 was signed by Minister of Health Terawan on February 4, 2020. This decision is contained in the Decree of the Minister of Health Number HK.01.07 / MENKES / 104/2020.