The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance.
BACKGROUND
In preparation of vaccines trials to estimate protection against shigellosis and cholera we conducted a two-year community-based surveillance study in an impoverished area of North Jakarta which provided updated information on the disease burden in the area.


METHODS
We conducted a two-year community-based surveillance study from August 2001 to July 2003 in an impoverished area of North Jakarta to assess the burden of diarrhoea, shigellosis, and cholera. At participating health care providers, a case report form was completed and stool sample collected from cases presenting with diarrhoea.


RESULTS
Infants had the highest incidences of diarrhoea (759/1,000/year) and cholera (4/1,000/year). Diarrhea incidence was significantly higher in boys under 5 years (387/1,000/year) than girls under 5 years (309/1,000/year; p < 0.001). Children aged 1 to 2 years had the highest incidence of shigellosis (32/1,000/year). Shigella flexneri was the most common Shigella species isolated and 73% to 95% of these isolates were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline but remain susceptible to nalidixic acid, ciprofloxacin, and ceftriaxone. We found an overall incidence of cholera of 0.5/1,000/year. Cholera was most common in children, with the highest incidence at 4/1,000/year in those less than 1 year of age. Of the 154 V. cholerae O1 isolates, 89 (58%) were of the El Tor Ogawa serotype and 65 (42%) were El Tor Inaba. Thirty-four percent of patients with cholera were intravenously rehydrated and 22% required hospitalization. V. parahaemolyticus infections were detected sporadically but increased from July 2002 onwards.


CONCLUSIONS
Diarrhoea causes a heavy public health burden in Jakarta particularly in young children. The impact of shigellosis is exacerbated by the threat of antimicrobial resistance, whereas that of cholera is aggravated by its severe manifestations.
Agtini
Magdarina D
MD
National Institute of Health Research and Development, Jakarta Indonesia, Ministry of Health, Jakarta, Indonesia. magdarina@yahoo.com
Soeharno
Rooswanti
R
Lesmana
Murad
M
Punjabi
Narain H
NH
Simanjuntak
Cyrus
C
Wangsasaputra
Ferry
F
Nurdin
Dazwir
D
Pulungsih
Sri Pandam
SP
Rofiq
Ainur
A
Santoso
Hari
H
Pujarwoto
H
H
Sjahrurachman
Agus
A
Sudarmono
Pratiwi
P
von Seidlein
Lorenz
L
Deen
Jacqueline L
JL
Ali
Mohammad
M
Lee
Hyejon
H
Kim
Deok Ryun
DR
Han
Oakpil
O
Park
Jin Kyung
JK
Suwandono
Agus
A
Ingerani
Oyofo
Buhari A
BA
Campbell
James R
JR
Beecham
H James
HJ
Corwin
Andrew L
AL
Clemens
John D
JD
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology*; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012621:Seasons; D013997:Time Factors