Indonesia

00000000The first outbreak of DHF occurred in Jakarta and Surabaya in 1968, with 58 cases and 24 deaths (case fatality rate of 41.5 per cent)(20). The following year, DHF spread to other parts of the country and the number of reported clinical cases has since increased each year. Outbreaks of the disease have involved most major urban areas as well a some rural areas. There were 10 189 reported cases with 470 deaths in 1973, and the most severe outbreak occurred in Semarang, Central Java, with 6225 reported cases. The following year, the number of patients declined. Since 1977, the disease has prevailed in 21 of 27 provinces (162 out of 300 regencies and municipalities). Forty-four per cent of the 130 million population lives in endemic areas, but there has been no report of DHF from the eastern-most parts of the country, i.e., West Irian and East Nusattengara(21,22). The average number of cases per year between 1968 and 1972 was 474, with a case fatality rate of 13.8 per cent. A total of 6342 cases and a case fatality rate of 4.8 per cent was reported between 1973 and 1977 while 5178 cases and a case fatality rate of 4.6 per cent between 1978 and 1980(23). In 1983, about 84 per cent of 13 875 cases were reported from Java, which is the most populated area (60 per cent of the whole population). The morbidity rate for the whole country in 1983 was approximately 8 per 100 000 population. In 1987, the highest case record was reported (22 765 cases with 1039 deaths; CFR 4.6 per cent).

00000000Except for the year 1974, when the peak of the outbreak occurred in July, the highest incidence of DHF has usually been found during the rainy months. October to April(22). In 1983 the rainy season was extremely long and DHF cases occurred until June and July(23).

00000000More than 90 per cent of DHF case have occurred in children under 15 years of age(22). The median age of patients reported in 1979 was four-five years, but it appeared to be shifting in later epidemics with more andmore cases occurring in the six-seven year age group. There was no difference in the number of males and females affected(24).

00000000In 1976, two isolated of dengue virus were recovered from patients in Meduin, and were identified as type 1 and type 3. Forty-five isolates irom Bantul in 1976 were identified as type 1 (eight strains), type 3 (28 strains), and type 4 (nine strains), with the rest unidentifiable. Between 1975 and 1977, 150 strains of dengue virus were isolated from the endemic area of Jakarta. All four serotypes were present with type 3 predominant (23 strains of type 1, 38 strains of type 2, 59 strains of type 3, nine strains of type 4, with the rest unidentifiable)(25-27). Aedes aegypti mosquitoes, the principal vectors, are distributed widely throughout the country(28-30).