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    Increase Immunization Coverage to Prevent the Emergence of Diphtheria Outbreaks

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    BANDUNG - Complete national immunization program has increased, although there are still areas in Indonesia whose immunization coverage is still below 80 percent, the number which is the national target figure. Of course this should be a serious concern, given the increasingly easy outbreaks of disease appear in Indonesia.

    The coverage of DTP-HB-Hib vaccine (diphtheria, tetanus, pertussis, recombinant hepatitis B, haemophilus influenzae type b) vaccines during 2013-2016 has actually reached 80 percent, but there are still four areas with coverage rates below 80 percent. The four regions are Aceh, East Nusa Tenggara (NTT), Papua and North Kalimantan provinces.

    In Java, of course the coverage is better, has reached 90 percent and some even reach 95 percent. But it was not a guarantee. The diphtheria outbreaks that have appeared in West Java and East Java have recently become evidence that immunizations that do not reach 100 percent remain at risk of disease outbreaks.

    Nevertheless there are still people who refuse immunization on the grounds that their children are afraid of high fever, or the issue of illegal vaccine that makes certain people reject the visit of health center officers to provide vaccines. Yet both issues have been refuted by the opinion of doctors and also the opinion of the MUI cleric, which asserted the vaccine is halal.

    The appearance of the diphtheria outbreak should recall the importance of complete vaccines since toddlers. Previously, diphtheria was susceptible to infectious to children. However, looking at data of patients with diphtheria in Dr. Hasan Sadikin Bandung, found 71-year-old sufferer enough to make us worry. While in Surabaya, when found cases of diphtheria in adulthood, the medical personnel had suspected that the disease is not diphtheria.

    Almost all areas in Indonesia found cases of diphtheria. On average, these cases affect the age group of 4 - 8 years and the age group of 15 and over.

    In a discussion at Padjadjaran University (Unpad) recently, Prof. Alex Chairul Fatah said still low immunization patterns cause Indonesian people immunity (herd immunity) are also low. Over time, various diseases will easily attack populations with low immunity and pass on back to others.

    In the case of diphtheria alone, one patient at risk of transmitting diphtheria to 6 to 7 people. If everyone's immunity is low, this epidemic risks transmitting to a number of other people. One person will be immune to diphtheria if immune immunity is above 85 percent.

    Unfortunately, the disease not only affects the age group of children, but also affects teenagers and the elderly. The vulnerability of adult age to diphtheria is due to the increasing number of adult population with weak immunity. Why? They were allegedly not getting vaccinated while still a toddler.

    "It can be life threatening. If left untreated and the patient has no immunity, his death rate will reach 50 percent. When treated will fall 10 percent. Outbreaks Response Imun (ORI) is one of the efforts to break the spread of diphtheria, especially for adults under 19 who have never received immunization, "he explained.

    Repeat immunization is important for preschoolers, teenagers, and elderly groups. Currently, the complete immunization pattern is still in the age group 0 - 1 year, 2 years, and school age. ORI efforts should be made when at least one person with diphtheria is found.

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