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JAKARTA - A virulent outbreak of dengue fever has claimed 632 victims out of 53,744 reported cases so far this year which is still below the death toll from the mosquito-borne disease in 2003, health officials said on Monday. Last year there were 52,011 reported cases of dengue in Indonesia of whom 792 died, or a mortality rate of 1.5 percent, said Rita Kusriastuti, a dengue expert at the ministry of health. "The dengue outbreak this year should be pretty similar to last year's" said Kusriastuti.
Dengue usually has a virulent outbreak every five to six years, when a new generation of children and new migrant workers enter the urban population with no immunity to the virus and its spreads swiftly between hosts and mosquitoes. Indonesia's last major outbreak of dengue was in 1998, when 72,133 cases were reported with 1,414 deaths, according to data from the ministry of health. Cases dropped off in 1999, and have been increasing gradually since.
Usually, after a major outbreak, people's immunity builds up against the disease and there are several years of low level occurrence among the populace before another major outbreak occurs five to six years later, when immunity is down and themosquito-borne virus is transmitted quickly between infected human hosts. This is the normal pattern for the disease, said Kusriastuti.
The disease, common throughout Southeast Asia, is particularly prevalent in urban areas where there are many man-made containers such as potted plants and discarded cans and cartons which make perfect breeding grounds in the rainy season for the aedesaegypty mosquito, the carrier of dengue, a day-time feeder that lays its eggs in small pockets of fresh water. What is unusual about the current outbreak in Indonesia is it appears to have lasted for two years in a row, a phenomenon that some health experts are now attributing to the appearance of several dengue strains spreading among the populace at the sametime.
"For the past 30 years most Indonesians were infected by sero-type 3, or D-3," said Kusriastuti. "Now, although our samples arevery small, we have found three victims of the D-4 serotype, which used to be very rare." There are four known strains of dengue worldwide, each of which has several sub-strains. A victim of one dengue strain does not build up immunity to the other three strains, and in fact will have a severer reaction to each new strain he or she contracts, experts said.
"For this outbreak in 2004 we have found all four strains, even in one person we found he had all four strains," said Kusriastuti. She complained that the Ministry of Health had insufficient funds to do proper research on the spread of new dengue strains in the country. Instead, it has concentrated its programs on providing treatment for dengue patients and community education activities. While 53,744 dengue patients have been recorded already since Jan. 1, this year, only 632 have died, or 1.2 percent. "We feel its a good performance, because many countries have 5 percent or higher case to fatality rate," said Stephen Bjorge, a dengue expert at the World Health Organization (WHO) office in Jakarta.
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