Negleted Tropical Diseases Treatment Bagian Farmakologi Fakultas Kedokteran
Negleted Tropical Diseases Treatment Bagian Farmakologi Fakultas Kedokteran Universitas Tadulako
11 dari 20 jenis Neglected Tropical Disease (NTD) terdapat di Indonesia, yaitu Filariasis, Kecacingan, Schistosomiasis, Dengue Haemorrhagic Fever (DHF), Rabies, Frambusia, Lepra, Japanese B. Encephalitis, Cysticercosis, Fasciolopsis, dan Anthrax. (Dir. Jen Pengendalian Penyakit dan Penyehatan Lingkungan Kemenkes RI – Prof. dr. Tjandra Yoga Aditama, Sp(K), MARS, DTM&H, DTCE)
Tan M, Kusriastuti R, Savioli L, Hotez PJ (2014) Indonesia: An Emerging Market Economy Beset by Neglected Tropical Diseases (NTDs). PLo. S Negl Trop Dis 8(2): e 2449. doi: 10. 1371/journal. pntd. 0002449
Snakebite affects the lives of around 4. 5 million people worldwide every year; seriously injuring 2. 7 million men, women and children and claiming some 125, 000 lives, according to the Global Snakebite Initiative. As a result, many are disabled, disfigured or paralyzed. These conditions practically take victims out of the workforce and cause financial hardships in the poor communities where most of them live. World Health Organization (WHO) listed snakebite envenoming as a “category A neglected tropical disease (NTD)”
Indonesia has the second highest burden of NTDs worldwide. An estimated 195 million people – including 50 million children – are at risk for soiltransmitted helminths, 125 million people are at risk for lymphatic filariasis and approximately 25, 000 – 50, 000 people are at risk for schistosomiasis. The number of dengue cases reported annually to the WHO ranks Indonesia as having the second largest number of cases worldwide, with all four serotypes represented. NTDs cause anemia, malnutrition, disability and stigma – preventing children from attending school, keeping adults from working, and increasing the consequences of other diseases – thereby contributing to decreases in human capital and worker productivity.
PATH, (2015). Diagnostic for NTDs. Seattle, USA.
Soil Transmitted Helminths Soil-transmitted helminths (STH) refer to a group of parasites that live in the human digestive system. These parasites include roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), and hookworm (Necator americanus and Ancylostoma duodenale). The parasites live in the soil in warm and humid climates and are spread through contact with feces of infected people. Image : WHO
Adult male T. trichiura removed during a colonoscopy Adult female A. lumbricoides Filariform (L 3) hookworm larva in a wet mount.
Soil Transmitted Helminths treatment WHO recommended medicines – albendazole (400 mg) or mebendazole (500 mg) – are effective, inexpensive and easy to administer by non-medical personnel (e. g. teachers). They have been through extensive safety testing and have been used in millions of people with few and minor side-effects Reduce the “fecal footprint”: Ensure that hygiene education emphasizes wearing shoes when outside and on dirt floors inside the home to help prevent hookworm transmission.
Lymphatic Filariasis • Approximately 125 million Indonesians are at risk for acquiring LF, representing approximately 9% of the global population at risk for LF • highest prevalence rates in Maluku, Papua, West Irian Jaya, East Nusa Tenggara, and North Maluku provinces in Eastern Indonesia • three species : Brugia malayi, Brugia timori, and Wuchereria bancrofti • LF can be treated using a combination of albendazole and either ivermectin or diethylcarbamazine. • major effort to control and eliminate LF in Indonesia is MDA with DEC and albendazole
Tan M, Kusriastuti R, Savioli L, Hotez PJ (2014) Indonesia: An Emerging Market Economy Beset by Neglected Tropical Diseases (NTDs). PLo. S Negl Trop Dis 8(2): e 2449. doi: 10. 1371/journal. pntd. 0002449
Lymphatic filariasis (LF) is a parasitic disease spread by mosquitoes. Larvae introduced into the body by mosquitoes enter the blood stream, and the adult worms damage the body’s lymphatic system, resulting in swelling and disfigurement of the limbs and genitalia Image: Al Granberg, The New York Times
Encourage lymphedema patients to wash their swollen limbs and feet daily to prevent infection. Foot hygiene, in addition to gentle exercise and elevation of the swollen limb, can reduce swelling and result in decreased disability. Limb washing can reduce swelling and infection. Photo: Ann Varghese for The Global Network for Neglected Tropical Lymphedema of the leg caused by lymphatic filariasis. Photo: BBC News
Schistosomiasis is caused by infection with parasitic blood flukes, which live in the veins leading to the urinary and intestinal tracts. People become infected when they come into contact with water bodies harboring freshwater snails that have been infected when urine and feces of infected people contaminate the water body in which they live. The parasite leaves the snail and enters the skin of people when they are in the water. The eggs of these parasites cause massive damage to tissues and organs, resulting in illness and even death. (WHO, 2012) Image adapted from: http: //www. uni-bielefeld. de/biologie/Didaktik/ Zoologie/html_deutsch/zyklus. html
two main types of schistosomiasis: intestinal and urogenital Odgen S. , Gallo K. , Davis S. , et al. , WASH and the Negleted Tropical Disease : A Manual for WASH Implementers Indonesia (2013). Sightsavers ; Department for International Development The International Trachoma Initiative ; Children Without Worms ; Water. Aid. WASH Advocates ; Center for Global Safe Water, Emory University ; CARE USA.
Schistosomiasis • In Indonesia, schistosomiasis caused by S. japonicum, mostly confined to two or three isolated areas—mostly in Lindu Valley and Napu Valley—located in the province of Central Sulawesi • approximately 25, 000– 50, 000 people at risk for acquiring S. japonicum infection, which represents less than 1% of the people at risk for schistosomiasis globally • eliminate schistosomiasis in Central Sulawesi by 2020 through praziquantel MDA of the entire population • high-risk groups—school-age children, adults in occupations involving contact with water, and pregnant and lactating women (WHO, 2012). MDA : mass drug administration
Contact with contaminated water can cause infection with schistosomiasis. Photo: Esther Havens, The Sabin Vaccine Institute / Global Network for Neglected Tropical Diseases Discourage contact with contaminated surface water, including using it for activities such as clothes washing, bathing and swimming, in areas where communitywide coverage of improved sanitation is low. Patient with schistosomiasis Photo: www. path. cam. ac. uk
Odgen S. , Gallo K. , Davis S. , et al. , WASH and the Negleted Tropical Disease : A Manual for WASH Implementers Indonesia (2013). Sightsavers ; Department for International Development The International Trachoma Initiative ; Children Without Worms ; Water. Aid. WASH Advocates ; Center for Global Safe Water, Emory University ; CARE USA.
Neglected Virus Infection • Beginning in 1968, dengue emerged in Indonesia where it has remained a major public health threat. Today, all four serotypes are present, and the number of dengue cases reported annually to the WHO ranks Indonesia as having the second largest number of cases worldwide • Chikungunya and Japanese encephalitis are also found in Indonesia, although no disease burden or economic estimates for these diseases are available
Neglected Bacterial Infections • major neglected bacterial infections in Indonesia are leprosy, leptospirosis, and rickettsia infections
Leprosy • leprosy has been eliminated at the national level (as defined by less than one case per 10, 000 people), there are several provinces, especially in Java (East, Central, and West Java), where, locally, those elimination targets have not yet been met
• the first breakthrough occurred in the 1940 s with the development of the medicine dapsone. In the 1960 s, M. leprae started to develop resistance to dapsone, the world’s only known anti-leprosy medicine at that time. In the early 1960 s, rifampicin and Clofazimine were discovered and subsequently added to the treatment regimen, which was later labelled as multidrug therapy (MDT). • In 1981, a WHO Study Group recommended MDT consists of 2 or 3 medicines: dapsone and rifampicin for all patients, with Clofazimine added for multi-bacillary disease. This latter combination kills the pathogen and cures the patient.
Leptospirosis & Rickettsia • there are no disease burden data for these two infections • 2007 and 2009 as well as in 2010 and 2011 Indonesia experienced an outbreak of leptospirosis, mostly in the Central Java and Jogyakarta areas, association with Mount Merapi eruptions as well as in paddy field areas, forest and flood areas; most of the affected individuals were farmers and forest workers
Albendazole •
Mebendazole •
Praziquantel •
DEC •
Ivermectin •
Dose for children under 10 years of age Dapsone : 2 mg per kilogram body weight daily Rifampicin : 10 mg per kilogram body weight Clofazimine : 1 mg per kilogram per body weight daily 6 mg per kilogram monthly
Kementerian Kesehatan RI memprioritaskan aspek promotif dan preventif kesehatan menjadi kebijakan dalam melaksanakan pembangunan kesehatan, sehingga masyarakat memiliki pengetahuan dan sikap untuk mendukung dalam pencegahan dan pengendalian penyakit menular, termasuk pencegahan dan pengendalian vektor penyakit.
Water, Sanitation, and Hygiene (WASH) Odgen S. , Gallo K. , Davis S. , et al. , WASH and the Negleted Tropical Disease : A Manual for WASH Implementers Indonesia (2013). Sightsavers ; Department for International Development The International Trachoma Initiative ; Children Without Worms ; Water. Aid. WASH Advocates ; Center for Global Safe Water, Emory University ; CARE USA.
Water, Sanitation, and Hygiene (WASH) Odgen S. , Gallo K. , Davis S. , et al. , WASH and the Negleted Tropical Disease : A Manual for WASH Implementers Indonesia (2013). Sightsavers ; Department for International Development The International Trachoma Initiative ; Children Without Worms ; Water. Aid. WASH Advocates ; Center for Global Safe Water, Emory University ; CARE USA.
References Tan M, Kusriastuti R, Savioli L, Hotez PJ (2014) Indonesia: An Emerging Market Economy Beset by Neglected Tropical Diseases (NTDs). PLo. S Negl Trop Dis 8(2): e 2449. doi: 10. 1371/journal. pntd. 0002449 Odgen S. , Gallo K. , Davis S. , et al. , (2013). WASH and the Negleted Tropical Disease : A Manual for WASH Implementers Indonesia. Sightsavers ; Department for International Development The International Trachoma Initiative ; Children Without Worms ; Water. Aid. WASH Advocates ; Center for Global Safe Water, Emory University ; CARE USA. PATH (2015). Diagnostic for NTDs. Seattle, USA.
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