ZOONOSISPenyakit yang secara alami dapat dipindahkan dari hewan vertebrata ke manusia atau sebaliknya.

Ada 150 penyakit zoonosa di dunia. Di Indonesia terdapat lebih dari 50 zoonosis antara lain: rabies, pes, anthrax, taeniasis/cysticercosis, JE, leptospirosis, hanta, toxoplasmosis, schistosomiasis, dsb

LEPTOSPIROSISWEIL,S DISEASECANICOLA FEVERHAEMORRHAGIC JAUNDICETRENCH FEVERSWINEHERD,S DISEASEMUD FEVERRICE FIELD FEVERFLOOD FEVER

LEPTOSPIROSISAdalah penyakit infeksi yang disebabkan oleh kuman Leptospira sp. karena kontak dengan urine tikus yg mengandung Leptospira atau air, lumpur yg terkontaminasi kuman ini dg menembus kulit lecet atau mukosa.

DISTRIBUSI LEPTOSPIROSISDi dunia :Rusia, Argentina, Inggris, Brazilia, Australia, Israel, Spanyol, Amerika Serikat, Afganistan, Malaysia, Indonesia dsb.

INTRODUCTION LEPTOSPIROSISWorldwide zoonosisOCCUPATIONAL DISEASECost for medical treatment and Decrease of productivity and income

INTRODUCTION INFECTED DOMESTIC ANIMALSCost for treatment and control, Economic losses due to reproductive failures, and Reduced milk yield.WORLDWIDE UNDERESTIMATION OF LEPTOSPIROSIS Difficulty to diagnose : Clinic and Laboratory

INTRODUCTION 180 serotype has been isolatedIn Indonesia the research on Leptospirois has been started very long time (L.medanensis, L.javanica, L.hardjo, L.sentot, L.mankarso, etc).Contact directly and indirectlyRelated to Occupation

Situasi Leptospirosis di Indonesia,th 2003 - 2008

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Situasi Leptospirosis Menurut Lokasi

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DKI1386578625147037

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Jateng012403435707

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Kasus Leptospirosis dilaporkan dari:DKI Jakarta: Jaktim, Jaksel, Jakbar, JakpusJawa Barat : BekasiBanten: TangerangJawa Tengah: Demak, Purworejo, Klaten, Semarang, PatiDIY: Sleman, BantulJawa Timur: Gresik , Surabaya, Malang (kota dan kabupaten)Sulawesi Selatan: Makassar

PENYEBARAN DI INDONESIAJawa Barat Sulawesi UtaraJawa Tengah Sulawesi SelatanDI Yogyakarta Kalimantan BaratLampung Kalimantan TimurDKI JakartaSumatera SelatanBengkuluRiauSumatera BaratSumatera UtaraBaliNTB

KLB LEPTOSPIROSIS1986, KLB di Kuala Cinaku, Riau : transmigrasi pasang surut). 2002 KLB di DKI Jakarta (Febr-Apr) pasca banjir : dari 138 spesimens serum, 61 positif (44,2%), hasil sero survey.103 orang dirawat di RS, kematian 21 orang (20%).

Gambar 1Leptospira dilihat dengan mikroskop lapangan gelap (Dark microscoup).

Gambar 2. Leptospira interrogans dilihat dengan Elektron Mikroskop.

CARA PENULARANKontak dg air, tanah/lumpur, tanaman yg tercemar air seni hewan penderita leptospirosis. Masuk ke dlm tubuh melalui selaput lendir/mukosa (mata, hidung, atau kulit yg lecet).Melalui saluran pencernaan dari makanan yang terkontaminasi oleh urine tikus yang terinfeksi Leptospira, tetapi jarang terjadi

AGENT PENYEBABBakteri berbentuk spiral dari genus Leptospira, ordo Spirochaetales, famili Trepanometaceae.Sumber penularan : Tikus, babi, sapi, kambing, domba, kuda, anjing, kucing, burung, landak, kelelawar, tupai dan rubah. Reservoir : tikus

SUMBER TRANSMISI LEPTOSPIRADikutip dari Faine S, et al, 1999; Leptospira and Leptospirosis.

Walking through flooded area is a risk factor for leptospirosis Semarang, downtown district, January 2003

GEJALA KLINISMasa inkubasi : 419 hari, rata-rata 10 hari

GAMBARAN KLINIS : Leptospirosis ringan (an-ikterik) Leptospirosis berat (ikterik)

Leptospirosis ringan (an-ikterik) :Paling banyak di masyarakat 90% dari seluruh kasus leptospirosis.Demam ringan/berat, nyeri kepala, menggigil, myalgia.Nyeri otot terutama di daerah betis, punggung, dan paha.Conjuctival suffusion (mata merah)Penderita dapat sembuh sendiri (self limited disease), 2-3 minggu.

CLINICAL ASPECT Main symptom and Signs : acute febrile illness and chills, severe headache, body pains is severe : lower limbs (the calves and thighs), anorexia, vomiting, The most characteristic finding : conjuntival suffusion and severe myalgia)

Conjunctivalsuffusion

LEPTOSPIROSIS BERAT (IKTERIC)Biasanya penderita datang terlambat, angka kematian 30 50%.Demam tinggi, nyeri kepala, myalgia, gagal ginjal, hipotensi, manifestasi perdarahan, pneumonitis haomorrhagiae.Penderita ikterik.Komplikasi leptospirosis berat (ikterik) :Acute renal failure (gagal ginjal akut = GGA)Uveitis pada mata.Hepatomegali terjadi pada hari ke 4 6 disertai jaundice (mata kuning)Paru-paru haemorrhagic pneumonitis dg batuk darah, nyeri dada, ARDS (acute respiratory distress syndrome). Jantung aritmia, dilatasi jantung, gagal jantung.Perdarahan saluran pernafasan, pencernaan, ginjal, dan saluran genitalia, ini o.k vascular damage.Abortus dsb.

PATOGENESISMasuk mll luka di kulit, kunjungtiva, Selaput mukosa utuhMultiplikasi bakteriDan menyebar mllAliran darahKerusakan endotel Pembuluh darah kecil :Ekstravasasi sel danperdarahanPerubahan patologi di organ & jaringan :Ginjal- hati- paru- otot lurikjantung

Diagnosis klinisAnamnesisPemeriksaan fisik ( gejala klinik menonjol conjungtival suffusion dan mialgia)Pemeriksaan lab (umum :darah,fungsi ginjal, fungsi hati ; khusus :kultur, inukulasi hewan)Pemeriksaan tdk langsung: MAT, ELISAMolekuler : PCR

TEST DIAGNOSTIC (penyaring)Lepto Tek Dri-Dot 1 menitLepto Tek lateral Flow 10 menitLepto Dupstick assay 2,5 smp 3 jam

Hasil postif / negatif

PENGOBATANPengobatan dilakukan kepada semua penderita / tersangka penderita yang ditemukan pada pengamatan.Obat pilihan (drug of choice) Penicillin Dapat diberikan derivatnya al ampicillin, amoxicillin, dan bila alergi penicilline dapat diberikan erythromicin, doxycyclin, tetracyclin, cephalosporin, cyprofloxacin.

PENCATATAN DAN PELAPORANUntuk daerah endemis, sesuai dengan sistem yang berlaku.Bila terjadi KLB Laporan 24 jam (format W1).Laporan khusus mingguan (W2)Laporan penanggulangan KLB

SITUASI LEPTOSPIROSISDI JAWA TENGAH

D.I.YKAB/KOTA ENDEMIS LEPTOSPIROSISDI JAWA TENGAHREMBANGWONOGIRIKUDUSKOTA SMGKab. SemarangBLORAPKLONGANJEPARAPATITEGALPEMALANGKENDALBoyolaliSKHJGROBOGANDEMAKSRAGENKRANYARBATANGBREBESCILACAPBANYUMASKEBUMENPWREJOMglTMGPBLGWNSBBjngrKLATEN

SITUASI KASUS LEPTOSPIROSISTAHUN 2005-2008 (JUNI)

Kab/KotaTahun2005200620072008Kt Smg19 / 326 / 714 / 135 / 1Demak9 / 28 / 230 / 671 / 6Klaten2 / 10 / 021 / 01 / 1Purworejo4 / 40 / 01 / 00 / 0Pati0 / 00 / 00 / 06 / 0Kab Smg0 / 01 / 01 / 00 / 0Total34 / 1035 / 967 / 7113 / 8

Hasil pengendalian faktor risiko Leptospirosisdi Kabupaten Demak, September 2008Hasil penangkapan tikus per mingguDesa Karangmlati, kec. DemakDesa Moro, kec. Bonang

Chart2

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6843

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mM TaromSudarnoMadekanMuhlisinDjuremiMudawanPriyo UM Kadir

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*

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TIKUS11231121481011

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MG 2

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TIKUS3106152494

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MG 3

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MG 4

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TIKUS2162170816

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MG 1 - 4

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CECURUT30326150

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TIKUS2162170816

CECURUT145125522

MG 1 - 4

12345678

TIKUS2259274516482222

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HASIL TANGKAPAN TOTAL PERMINGGU

1234

TIKUS99624852

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6220

4825

5236

TIKUS

CECURUT

MINGGU

HSL TANGKAPAN

MORO DMK

REKAPAN HARIAN PFR LEPTO DESA MORO DEMAK KEC BONANG KAB DEMAK

NONAMAMINGGU IMINGGU IIMINGGU IIIMINGGU IV

JUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPAN

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REKAPAN HARIAN PFR LEPTO DESA KARANGMLATI KEC DEMAK KAB DEMAK

NONAMAMINGGU IMINGGU IIMINGGU IIIMINGGU IV

JUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPANJUMLAHPEMASANGAN PERANGKAPUMPAN

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Hasil penangkapan tikus berdasarkan tempat pemasangan perangkapDesa Karangmlati, kec. DemakDesa Moro, kec. Bonang

Hasil penangkapan tikus berdasarkan jenis umpanDesa Karangmlati, kec. DemakDesa Moro, kec. Bonang

Mandi dan mencuci di sungaiKebersihan dapur belum dikelola baikBecekSisa makanan

TH 2006TH 2007TH 2008STRATA ENDEMISITAS LEPTOSPIROSIS PERKEC DI KAB. DEMAK

NoTahun Lokasi Kasus Wil Pusk Kec Desa 1200657522007823133200812447

TH 2006TH 2007TH 2008STRATA ENDEMISITAS LEPTOSPIROSIS PERDESA DI KAB. DEMAK

TH 2006TH 2007TH 2008DISTRIBUSI KASUS LEPTOSPIROSIS DI KAB. DEMAK

KASUS LEPTOSPIROSIS KOMULATIF TH 2006-2008DI KABUPATEN DEMAK : SUNGAI: JALAN

Kasus Leptospirosis berdasarkanKelompok umur dan Jenis kelaminJumlah kasus meninggalTH 2006 s/d 2008

TH 2006TH 2007TH 2008

CURAH HUJAN DAN KASUS LEPTOSPIROSISTH 2006 S/D 2008

FAKTOR RESIKO KASUS LEPTOSPIROSISDI KABUPATEN DEMAK Lingkungan tempat tinggal becekLokasi Daerah RobKebiasaan mandi disungaiPemukiman dekat pembuangan sampahMempunyai lukaKerja di sawah yang banyak airPerumahan dekat sawah

PROGRAM PENANGGULANGAN LEPTOSPIROSIS

TUJUANMenurunkan angka kesakitan dan kematianMencegah penularan di daerah endemis dari hewan ke manusia.Menjadikan lingkungan sehat, terbebas dari penularan Leptospira, krn habitat /sarang2 tikus dapat dihilangkan.

KEGIATAN POKOKPencegahan penularan Leptospirosis ke manusia.Surveillance pada manusia.Pengobatan penderita di Puskesmas/RSPenyelidikan epidemiologi (KLB)Penyuluhan Kepada masyarakat.Koordinasi LS/LP terkait dlm penanggulangan Leptospirosis.Pencatatan dan Laporan.

SURVEILANS (PENGAMATAN PENYAKIT)SURVEILANS PADA MANUSIA DI DAERAH ENDEMIS :Daerah rawan banjir/sering banjir aktif & pasifPenampungan para pengungsi aktif & pasifDaerah persawahan & pertambangan pasifDaerah rawa / lahan gambut pasif

SURVEILANS AKTIFPencarian tersangka/penderita dari rumah ke rumah (dengan gejala demam, nyeri otot terutama di betis atau persendian, mata merah, icterus, dsb)Skrining penderita dengan mengambil darah 3-5 ml, kemudian diambil serumnya utk pemeriksaan lab untuk pemeriksaan serologis.

SURVEILANS PASIFDilakukan di RS, Puskesmas, Pustu, Pukesmas Keliling, & sarana yan kes lainnya, bila ditemukan tersangka / penderita, maka dilakukan pengambilan darah 3-5 ml, kmd diambil serumnya.

SISTEM KEWASPADAAN DINI (SKD)Untuk daerah endemis, khususnya musim hujan (banjir dan pasca banjir), tikus2 keluar dari sarangnya berkeliaran, urinnya mencemari air dan lingkungan. Jadi perlu peningkatan kewaspadaan dan kebersihan lingkungan serta individu.Pengamatan intensif di daerah endemis pada musim penghujan di puskesmas dan RS.Bila ditemukan kasus leptospirosis di RS/puskesmas segera melaporkan ke Dinas Kes setempat.

TINDAKAN PENANGGULANGAN KLB LEPTOSPIROSISPE PADA MANUSIAPenemuan penderita aktif dan pasif. Bila ditemukan suspect / kasus -> ambil darah 3-5 ml kmd serum dipisahkan u/ diperiksa lab.Berikan pengobatan.Penyuluhan kesehatan kepada masyarakat.

PE PADA RODENT DAN HEWAN LAINNYA Di desa yang ada kasus dilakukan penangkapan rodent bersamaan waktunya dg pencarian penderita tambahan.Rodent / tikus diidentifikasi, kemudian diambil darah/serumnya untuk pemeriksaan lab. Untuk hewan peliharaan/ternak LS.Intervensi lingkungan dilakukan atas partisipasi masy dan LS terkait.Dianjurkan vaksinasi hewan peliharaan

INTERVENSI LINGKUNGANPengaturan Kebersihan lingkungan :Selokan, saluran air, stagnant waterTempat air dan kolam renangTempat-tempat yg dapat menjadi sarang tikusHealth education tentang personal hygiene. Rodent control, bila kondisi memungkinkan

PENATALAKSANAAN PENANGGULANGAN KASUS / TERSANGKA LEPTOSPIROSIS DI PUSKESMAS

KASUS TERSANGKA

- Demam akut < 9 hr, suhu 39oC atau lebih

- Nyeri kepala mendadak

- Myalgia

(terutama nyeri otot betis & pinggang)

- Conjungtiva suffusion

IKTERUS

YA

TIDAK

DD/ - Leptospirosis berat

DD/ - Leptospirosis ringan

- Hepatitis

- Viral hemoraghic fever

- Malaria (berat)

(dengue,chikungunya, hantaan)

- Demam tifoid

- Influenza

( Faktor risiko

( Faktor risiko

(lingkungan, pekerjaan, olahraga/

(lingkungan, pekerjaan, olahraga/

aktivitas lain, riwayat bepergian)

aktivitas lain, riwayat bepergian)

( Daerah endemis leptospirosis

( Daerah endemis leptospirosis

- Diobati di Puskesmas

- Ambil spesimen darah

- Diobati di Puskesmas

Rujuk ke RS

Pemeriksaan Lab.

Positif Leptospirosis

Lapor ke DINKES. KAB.

Penyelidikan Epidemiologi :

- Pencarian kasus tersangka leptospirosis lainnya

- Pengobatan selektif

- Pengambilan spesimen serum darah tersangka

- Penyuluhan kpd masyarakat

KLB

BUKAN KLB

PENANGANAN KEJADIAN LUAR BIASA

LEPTOSPIROSIS

KLB LEPTOSPIROSIS

- Hasil PE ditemukan peningkatan kasus

Leptosiprosis

- Ditemukan kasus leptospirosis di daerah

bebas

Dinkes. Kab.

PUSKESMAS

Rumah Sakit

- Pengobatan penderita

- Pengambilan spesimen

Dinkes. Prop.

Dit.Jen. PPM&PL

Penanggulangan KLB

Mencari tersangka lainnya

Pengambilan spesimen

Traping Rodent

serum darah tersangka

Pengobatan selektif

Penyuluhan intensif

PSM dgn membersihkan sarang

- Identifikasi Rodent

tikus (sampah, got, dsb)

- Pengambilan spesimen

Serum darah

Pemeriksaan spesimen

Pemeriksaan spesimen

RS / BLK

Balitvet, Bogor

Balitvet, Bogor

(Rapid Test)

(MAT, Isolasi)

(MAT, Isolasi)

SISTEM KEWASPADAAN DINI (SKD) LEPTOSPIROSIS

DI PUSKESMAS

Variabel penunjang penularan Leptospirosis :

Musim hujan yang disertai dengan banjir

Pada saat air pasang di daerah pantai

Daerah rawa / lahan gambut

Kebersihan lingkungan secara umum menurun

Pengamatan kasus leptospirosis di Puskesmas & RS

lebih intensif dengan pemeriksaan klinis yang mengarah

ke Leptospirosis.

Bila ditemukan tersangka

penderita Leptospirosis

- Diobati di Puskesmas

- Ambil spesimen

Pemeriksaan spesimen

Di RS / BLK / Balitvet

Negatif leptospirosis

Positif leptospirosis

Lapor ke DINKES KAB.

Penyelidikan epidemiologi

- Mencari faktor risiko

- Pencarian tersangka lainnya

- Pengambilan spesimen

serum darah

- Pengobatan selektif

- Penyuluhan

PENCEGAHANPengendalian tikus di dalam rumahPengendalian tikus di luar rumahMelaksanakan safety precaution

Pengendalian Tikus di Dalam Rumah Usahakan rumah selalu bersih (dapur) Makanan ditutup Tempat sampah tertutup rapat Perangkap tikus Racun tikus Tutup lubang

Pengendalian Tikus di Luar Rumah Bersihkan semak-semak Perangkap / racun tikus Natural predator

Melaksanakan safety precautionMembersihkan tempat yg sering dilewati tikusPenanganan tikus matiTindakan keselamatan utk petugas yg masuk rumah orang yg sudah dikonfirmasi menderita infeksi hantavirus atau rumah penuh dg tikusTindakan keselamatan bagi pekerja yg sering terpajandgn rodensia5.Tindakan keselamatan bagi yg berkemah, pejalan kaki

APA PERAN KITA ????

PRINSIP PENANGGULANGANPenemuan dini dan pengobatan cepatSurveilansPemberantasan reservoirPenanggulangan KLBPenyuluhan / promosi kesehatan termasuk sanitasi lingkungan

TINDAK LANJUT - 1DIAGNOSA DINI DAN PENGOBATAN CEPAT & TEPATKenali gejala klinisSegera tegakkan diagnosaBeri pengobatan : Drug of choiceSURVEILANSCari sumber penularan, FR -> utk putus rantai penularanCari kasus tambahan -> kontak lingkunganAnalisis data epidemiologi

TINDAK LANJUT - 2PEMBERANTASAN RESERVOIRPenyuluhan kepada masyarakat ttg pencegahan.Pembasmian tikus koordinasi dg Kepala Wilayah.PENANGGULANGAN KLBAnalisis epidemiologiRencana tindakan penanggulangan sesuai hasil analisisPengobatanGerakan sanitasi lingkungan

TINDAK LANJUT - 3PROMOSI KESEHATANKoordinasi dengan Kepala WilayahSebarkan leaflet, siaran radio dll

TERIMAKASIH

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