MAKALAH ITMIAH

EPIDEMIOLOGI PENYAKIT POLIO

DR. Drg. Andi Zulkifli, M.Kes
Nip. ! "#" $%
&'kul()s Kese*)()n M)s+)r)k'(
, ni-ersi()s H)s)nuddin
.AA$
/A/ I
PENDAII,L,AN
0.nr ini k1sus p)li) 2en31di isu krusi1l
4 r5(646, p7rk)(11n, 81*k1n 2en+e81r
d1n ()pik
per8in91ng1n pu8lik,
,i646r6'isn:r1 81gi k1l1ng1n pe2er*1(i kese*1(1n p1d1 1n1k usi1 81li(1. Tid1k *1n+1
di
8e8er1p1 d1er1* pedes11n. M1r1kn+1
4,96+:4i(i4 p)li) 2e28u1( 21s+1r1k1( 2en31di res1*, 2enging1( pen+1ki( 2enul1r
4)4,r41;rp1k neg1(if p1d1 1n1k usi1 81li(1. Ole* se818 i(u 2e28u(u*k1n per*1(i1n
,4;4 4 i<,ng1( serius.
p 6,64,66r 1(1u p)ii)2+eli(is 2erup1k1n pen+1ki( 2enul1r 1ku( +1ng dise818k1n
=
,44 :, inrs deng1n predileksi p1d1 sel 1n(eri)r 21s1 kel18u su2su2 (ul1ng
>i1n 1ki81( kerus1k1n 81gi1n susun1n s1r1f
45;r6n44(g d1n in(i 2)()rik 81(1ng )(1k
6644607r444 1k1n (er31di kelu2pu*1n d1n 1(r)fi )()(
i(:n,lenr,))d p1d1 (1*un $%$ 2engungk1pk1n p)li)2+eli(is se81g1i
4(rl r6.i( p1r1l+sis 1ku( p1d1 1n1k. P1d1 181d ?I?, Kuss21ul 2en121i pen+1ki(
44 .ur81g1i p)li)2eili(is 1ku(.
ileini @"A#B, se)r1ng 1*li 8ed1* (ul1ng d1ri <er21n per(121 k1li
5,n<64/rn81rk1n ge31l1 klinis p)li) d1n p1d1 (1*un %"# Medin d1ri CDedi1
44e6=4,.rrk1n g1281rk1rr epide2i)l)gi pen+1ki( ini, se*ingg1 pen+1ki( ini sering di
;iff,54 4enE.1ki( Heini d1n Nedin. T1*un "#", l,1ns(einer
F1n P)pper 8er*1sil
ren6r.l1*k1n pen+e818 p)li)2eili(is ke )(1k )r1ng deng1n 91r1 in)kul1si.
(614=r4i1n Enders dkk @"A"B, 8er*1sil 2e28i1kk1n -irus p)li) ke d1l12 sel
6K<ri64 inr i-). Pene2u1n ini 2erup1k1n 1D1l perke281ng1n -ir)l)gi se*ingg1
l4r4/iGn epide2i)l)gi d1n p1()genesis pen+1ki( ini se21kin 3el1s.
T1*un "%%, Org1nis1si Kese*1(1n Duni1 1(1u HHO 2ens1*k1n res)lusi
rn,5 nneng*1pus
p)li) se8elu2 (1*un .###. P1d1 s11( i(u 21si* (erd1p1( seki(1r
;46 38u k1sus p)li) di seluru* duni1. Meskipun p1d1(1*un .###, p)li) 8elu2
4.42er2ri6 (e(1pi 3u2l1* k1susn+1 (el1* 8erkur1ng *ingg1 di 81D1* I##. P)li)
5 J
d
f
l1gi di Asi1 Ti2ur, A2erik1 L1(in, Ti2ur Teng1* 1(1u Er)p1, (e(1pi
(erd1p1(
di se3u2l1* ke9il di Indi1 d1n P1kis(1n sed1ngk1n di Nigeri1,
G(r.K.i( ini 21si* (erus 8er31ngki( k1ren1 pe2erin(1* +1ng 2en9urig1i -1ksin
Cnrg di8erik1n d1p1( 2engur1ngi fer(ili(1s d1n 2en+e81rk1n HIL. T1*un
' perrerin(1* Nigeri1
2e2in(1 HHO un(uk 2el1kuk1n -1ksin1si l1gi se(el1*
r+(ii p)li) ke281li 2en+e81r ke seluru* Nigeri1 d1n l# neg1r1 (e(1ngg1n+1.
ffiin(e21l d1n per1ng s1ud1r1 di Cud1n d1n P1n(1i G1ding 3ug1
'l9r'di( pe28eri1n -1ksin p)li).
(Kip)n 81n+1k us1*1 (el1* dil1kuk1n, p1d1 (1*un .##A 1ngk1 infeksi p)li)
5e(r 2en31di .%I di $ neg1r1 d1ri $%A di I neg1r1 p1d1 (1*un .##!.
sl&l6r penderi(1 8er1d1 di Asi1 d1n .#!$ 1d1 di Afrik1. Nigeri1 2e2iliki $M!
pfEiA lndi1 l.",d1n Cud1n I ..
* (1ngg1l $ sep(e28er .##M di(e2uk1n k1sus li1r p)ii)-irus (ipe I di
f'g n1d1 s11( i(u di(e2uk1n .M k1sus +1ng di81D1 )le* pend1(1ng d1ri
He 2g 2erup1k1n neg1r1 (e(1ngg1 d1ri Ken+1.
II *d)nesi1 perke281ng1n KL/ P)li) se31k di(e2uk1nn+1 k1sus p)li)
flre NuO1r9( .##I l1lu se(el1* # (1*un @""I6.##IB (id1k di(e2uk1nn+1 l1gi
lp)l8. N12un pen+1ki( p)li) ini ke281li 2eD181* di ind)nesi1 (1*un .A#I=
r *gg1l . n)-e28er .AAI, di(e2uk1n ."I k1sus p)li) +1ng (erd1p1( di
l,fp5en +1ng 1d1 di # pr)pinsi +1kni /1n(en, <1D1 /1r10 L12pung, <1D1
k;6, sunu(, <1D1 Ti2ur, Cu21(er1 Cel1(1n, DKI, Ri1u, d1n A9e*.
fPi( p)li) u2u2n+1 2en+er1ng 1n1k61n1k 81li(1, k1ren1 i(u i2unis1si
lrli Edr1 s1ng1( pen(ing un(uk 2e28erik1n perlindung1n (er*1d1p 1n9121n
*drd1n kelu2pu*1n. Te(1pi (id1k se2u1 kelu2pu*1n dise818k1n )le* -irus
Ifr Ad 81(i(1 +1ng sud1* di i2unis1si p)li) se91r1 8erul1ng6ul1ng 2ini21l M
HJ 2en31di ke81l (er*1d1p -irus6
/A/ II
TIN<A,AN P,CTAKA
II,,
ITEEGERTIAN POLIO
P)li) 1(1u p)li)2+eli(is 1d1l1* pen+1ki( p1r1lisis 1(1u lu2pu* +1ng
4 ,;4n8k1n )le* -irus. Agen pe281D1 pen+1ki(
Tr.
r6T
6::,
ini, se8u1* -irus +1ng din121k1n
irus @PLB, 21suk ke (u8u* 2el1lui 2ulu( , 2enginfeksi s1lur1n usus. Lirus
(rl41r 2e21suki 1lir1n d1r1* d1n 2eng1lir ke sis(e2 s1r1f pus1( 2en+e818k1n
.i6...3i+1 )()( d1n k1d1ng kelu2pu*1n @ p1r1lisis B. nr
fl. IT?OLOGI
; i4us p)li) (er21suk f12ili Pi9)rn1-irus d1n genus En(er)-irus 2erup1k1n
=41il
deng1n di12e(er .#6!. n2, 8er8en(uk sferis deng1n ukur1n u(121n+1
6.4.ng (erdiri d1ri $.A!! nukle)(id1, (1*1n p1d1 pH !6#, se*ingg1 d1p1(
ll4rir,ir6 4ei*1d1p 1s12 l128ung d1n e2pedu. Lirus (id1k rus1k 8e8er1p1 *1ri d1l12
rr:4r.:4rQ6rr .=6%)F, (1*1n (er*1d1p gliser)l, e(er, fen)l lR) d1n 8er21912621912
rr5
i,
45r;4=. (e(1pi 21(i p1d1 su*u I#)6II)9 sel121 !# 2eni(, 81*1n )ksid1(9r,
S491r1 ser)l)gi 21k1 -irus p)li) di81gi ! (ipe +1i(u4
r:6i6,,, 4=. ki)rin d1n sin1r ul(r1-i)le(.
:
4
4
Tipe I /run*ilde
Tipe II L1nsing d1n
. ipe III Le)n
Tipe
I +1ng sering 2eni28ulk1n epide2i
Di Neg1r1 (r)pis d1n su8(r)pis
+1ng lu1s d1n g1n1s, (ipe ll
k1d1ng6k1d1ng 2en+e818k1n k1sus +1ng sp)r1dik d1n (ipe
III 2en+e818k1n
epide2i ring1n.
ke81n+1k1n dise818k1n )l9*
iipe II d1n III d1n -irus ini (id1k 2eni28ulk1n i2uni(1s sil1ng.
PATOLOGI
T1nd1 klinis +1ng 8er-1ri1si 1ki81( inf)ksi -irus p)li), 2en9er2ink1n
ge281r1n p1()l)gi +1ng 8er1nek1 r1g12 d1n sesu1i deng1n lesi +1ng ken1, (e(1pi
4id1k se2u1 kerus1k1n d1p1( 2e281ik d1l12 !6A 2inggu se(el1* (i28uln+1
4e6i1l1.
N1er1* +1ng 8i1s1n+1 (erken1 i1l1*4
l.
..
<.
Medul1 spin1lis (eru(121 k)2u 1n(eri)r
/1(1ng )(1k p1d1 nukleus -es(i8ul1ris, in(i6in(i s1r1f kr1ni1l d1n
f)r21(i) re(ikul1ris +1ng 2eng1ndung pus1( -i(1l
Cere8ellu2 (eru(121 in(i6in(i p1d1 -er2is
A.
Mid8r1in p1d1 21s1 kel18u, su8s(1nsi1 nigr1 d1n k1d1ng6k1d1ng
nukleus ru8r1
I. T1l12us d1n *ip)(1l12us
M. P1lidu2
$. K)r(eks 9ere8ri d1er1* 2)()ris.
%. Medul1 spin1lis +1ng sering ken1 i1l1* seg2en 9er-i91lis d1n lu281lis.
G1281r1n p1()l)gi i1l1* kerus1k1n 2)()r neur)n, p1d1 1D1rn+1
44e2per*1(ik1n p1r(ikel *1lus +1ng 2en+e81r d1n 8u(ir1n k1s1r +1ng dise8u(
45=ng1n 81d1n681d1n Nissl @sel neur)n 2eng1l12i kr)21()lisis d1n
4en:r8engk1k1n si()pl1s21B. P1d1 ke1d11n ini neur)n 21si* d1p1( 2e281ik. p1d1
rQ;iu2 l1n3u(,
81d1n681d1n Nissl (id1k 1d1 d1n si()pl1s21 31di *)2)gen
d1n
:=rk 81s)filik, in(i sel 2engeru(,
4 i1l12 in(i sel.
k1d1ng6k1d1ng did1p1(i infil(r1si e)sin)filik
P1d1 kerus1k1n le8i* l1n3u(, 8il1 (er31di ke21(i1n neur)n, 21k1 se3u2l1*
'gMi(
2engelilingi sel, in(i sel *il1ng d1n si()pl1s21 2engerus se*ingg1 81(1s
d (i(1k 3el1s d1n 1ks)n (erpu(us. P1d1 1u()psi (erli*1( 1d1n+1 ser8uk1n li2f)si(,
'i kd11n 1ku(, f16se per(121 (erli*1( infil(r1si sel PMN. Ce(el1* f1se 1ku(
Hrir, sel neur)n +1ng 21(i dig1n(i )le* 31ring1n ik1(, se*ingg1 2edul1
'l8lis
+1ng (erken1 2en31di ke9il. Ter31din+1 p1r1lisis 1si2e(ris d1n 1(r)fi )()(
rnd
deng1n pers1r1f1n 2edul1 spin1lis +1ng (erken1.
F6ern81r1n 2ikr)sk)pis ini (id1k p1()gn)2)nis un(uk p)li)2ei(is,
k1ren1
C6*r2
fu..-irus
lesi ini s121 deng1n g1281r1n 2ikr)sk)pis +1ng dise818k1n )le*
neur)(r)pik +1ng l1in.
.M<ENIC
L
POLIO
*(8N)n6P1r1lisis
P)li) n)n6p1r1lisis 2en+e818k1n de212, 2un(1*, s1ki peruf lesu d1n
2ri(if.
I1erllrr*6
Ter31di kr12 )()( p1d1 le*er d1n punggung, )()( (er1s1 le28ek 3ik1
0. ffi) P1r1lisis Cpin1l
fuTrin p)li)-irus ini 2en+er1ng s1r1f (ul1ng 8el1k1ng, 2eng*1n9urk1n
ld 6 (r:k 1n(eri)r +1ng 2eng)n(r)l perger1k1n p1d1 81(1ng (u8u* d1n )()(
r6dk6i Meskipun s(r1in ini d1p1( 2en+e818k1n kelu2pu*1n perrn1nen,
8g d1ri s1(u penderi(1 d1ri .## penderi(1 1k1n 2eng1l12i kelu2pu*1n.
r6*rPu*1n p1ling sering di(e2uk1n (er31di p1d1 k1ki. Ce(el1* p)li)-irus
E6&1ng usus, -irus ini 1k1n diser1p )le* k1piler d1r1* p1d1 dinding usus
fu fi2gku( seluru* (u8u*. P)li)-irus rnen+er1ng s1r1f (ul1ng 8el1k1ng d1n
2 5)MM6+.1ng62eng)n(r)l ger1k fisik. P1d1 peri)de inil1* 2un9ul
lde r+7r(i flu6 N12un, p1d1 penderi(1 +1ng (id1k 2e2iliki keke81l1n 1(1u
81(1ng8elu2 di-1ksin1si, -irus ini 8i1s1n+1 1k1n 2en+er1ng
seluru* 81gi1n
sis(e2s1r1f (ul1ng 8el1k1ng d1n 81(1ng )(1k. Inf8ksi ini 1k1n
2e2peng1ru*i
8erke281ngs1r1f pus1( 66 2en+e81r sep1n31ng ser18u( s1r1f. seiring
deng1n
d1l12 sis(e2 s1r1f pus1(, -irus 1k1n 2eng*1n9urk1n neur)n 8i1kn+1 -irus
+1ng2)()r. Neur)n 2)()r (id1k 2e2iliki ke212pu1n
regener1si d1n )()(
sis(e28er*u8ung1n deng1nn+1 (id1k 1k1n 8ere1ksi (er*1d1p
perin(1* d1ri
le21s 66s1r1f pus1(. Kelu2pu*1n p1d1 k1ki 2en+e818k1n
(ungk1i 2en31di
p1r1l+sis @A&PB. Infeksi p1r1* p1d1 sis(e2
k)ndisi ini dise8u( 19u(e
fl199id
)()( p1d1s1r1f pus1( d1p1( 2en+e818k1n kelu2pu*1n p1d1 81(1ng
(u8u* d1n
()r1ks @d1d1B d1n 18d)2en @peru(B, dise8u( 'u1driplegi1:
!. P)li) /ul81r
p)li) 3enis ini dise818k1n )le* (id1k 1d1n+1 keke81l1n 1l12i se*ingg1
+1ng81(1ng )(1k iku( (erser1ng. /1(1ng )(1k 2eng1ndung
neur)n 2)()r
)()(2eng1(ur pern1p1s1n d1n s1r1f kr1ni1l, +1ng2engiri2
sin+1l ke 8er81g1i
+1ng+1ng 2eng)n(r)l perger1k1n 8)l1 21(1; s1r1f (rige2in1l d1n
s1r1f 2uk1
8er*u8ung1n deng1n pipi, kelen3 1r 1ir 21(A
gusi, d1n )()( 2uk1; s1r1f
1udi()ri +1ng 2eng1(ur pendeng1r1n; s1r1f gl)ss)f1ringe1l +1ng 2e281n(u
pr)ses 2enel1n d1n 8er8g1i fungsi di ker)ngk)ng1n; perger1k1n lid1* d1l(
r1s1; d1n s1r1f +1ng rnengiri2 sin+1l ke 31n(ung, usus: p1ru6p1ru, d1n s1r1f
(1281*1n +1ng 2eng1(ur perger1k1n le*er.
T1np1 1l1( 81n(u pe21p1s1n, p)li) 8ul81r d1p1( 2en+e818k1n ke21(i1n:
Li21 *ingg1 sepulu* persen pender(1 +1ng 2enderi(1 p)li) 8ul81r 1k1n
2eningg1l ke(ik1 )()( pern1p1s1n 2erek1 (id1k d1p1( 8eker31. Ke21(i1n
8i1s1n+1 (er31di se(el1* (er31di kerus1k1n p1d1 s1r1f kr1ni1l +1ng 8er(ug1s
2engirirn :perin(1* 8ern1p1s: ke p1ru6p1ru. Penderi(1 3ug1 d1p1( 2eningg1l
k1ren1 kerus1k1n p1d1 fungsi penel1n1n; k)r81n d1p1( :(enggel12: d1l1rn
M
4ekresin+1 sendiri ke9u1li dil1kuk1n pen+ed)(1n 1(1u di8eri perl1ku1n
(r1ke)s()2i un(uk 2en+ed)( 91ir1n +1ng disekresik1n se8elu2 21suk ke
d1l12 p1ru6p1ru. N12un (r1kes)()2i 3ug1 suli( dil1kuk1n 1p18il1 penderi(1
(el1* 2enggun1k1n :p1ru6p1ru 8esi: @ir)n lungE. Al1( ini 2e281n(u p1ru6p1ru
di d1l12;61ng le21* deng1n 91r1 2en1281* d1n 2engur1ngi
(ek1n1n ud1r1
K1l1u (ek1n1n ud1r1 di(1281*, p1ru6p1ru 1k1n 2enge2pis, k1l1u
Q8ung.
46i1n1n ud1r1 dikur1ngi, p1ru6p1ru 1k1n 2enge281ng. Deng1n de2iki1n
;.d1r1 (erp)2p1 kelu1r 21suk p1ru6p1ru. Infeksi +1ng 31u* le8i* p1r1* p1d1
46,4i: d1p1( 2en+e818k1n k)21 d1n ke21(i1n.
Tingk1( ke21(i1n k1ren1 p)li) 8ul81r 8erkis1r .I6$IR (erg1n(ung usi1
4=44d4i(1. Hingg1
444r
s11( ini, 2erek1 +1ng 8er(1*1n *idup d1ri p)li) 3enis ini
4.4r..rs *idup deng1n p1ru6p1ru 8esi 1(1u 1l1( 81n(u pern1p1s1n. P)li) 8ul81r
spin1l sering 2en+er1ng 8ers1211n d1n 2erup1k1n su8 kel1s d1ri p)li)
se28u* 491iisis. P)li) p1r1lisis (id1k 8ersif1( perrn1nen. Penderi(1 +1ng
4Q4.u 2e2iliki fungsi (u8u* +1ng 2endek1(i n)r21l.
s6 r.
Pffi6fi,OEf KLINIC
T1nd1 klinik pen+1ki( p)li) p1d1 21nusi1 s1ng1( 3el1s se*ingg1 pen+1ki( in(
rs;r
96ken1l se31k A.### se8elu2 M1se*i d1ri p1*1(1n d1n lukis1n dinding di
1k1n 4rrur44644. EOesir. Ce81gi1n (er8es1r @"# persenB infeksi -irus p)li)
ri;rr4r666.4 *fe9(i)n,
u=
rn2,i4:418k1n in1pp1ren( infe9(i)n, sed1ngk1n I persen 1k1n 2en12pilk1n ge31l1
I
persen n)n6p1r1l+(i9, sed1ngk1n sis1n+1 2enun3ukk1n (1nd1
4454464r1ii(ik.
G2deri(1 +1ng 2enun3ukk1n (1nd1 klinik p1r1li(ik, !# persen 1k1n se28u*,
6i
4rg6s2l 2enun3ukk1n kelu2pu*1n ring1n, !# persen 2enun3ukk1n kelu2pu*1n
4;4i # persen 2enun3ukk1n ge31l1 +1ng 8er1( d1n 8is1 2eni28ulk1n
di,5r2i.E i4: Ef1s1 inku81si 8i1s1n+1 8erkis1r !6!I *1ri. Penderi(1 se8elu2 21s1
Td6ru.=
di(e2uk1nn+1 -1ksin, (eru(121 8erusi1 di 81D1* I(1*un. Ce(el1* 1d1n+1
per81ik1n s1ni(1si ser(1 pene2u1n -1ksin, penderi(1 8ergeserusi1n+1 p1d1
kel)2p)k 1n1k 8erusi1 di 1(1s I (1*un.
P1d1 s(1diu2 1kur @se31k 1d1n+1 ge31r1 krinis *ingg1 . 2ingguBdi(1nd1i
deng1n su*u (u8u* +1ng 2eningk1(, 31r1ng le8i* d1ri l#*1ri, k1d1ng disef(1i
41ki( kep1l1 d1n 2un(1*.
Kelu2pu*1n (er31di d1l12 se2inggu d1ri per2ul11n s1ki(. Kelu2pu*1nini
(er31di se81g1i 1ki81( d1ri kerus1k1n sel6sel 2)()r neur)ndi Medul1 spin1lis
rrul1ng 8el1k1ngB +1ng dise818k1n k1ren1 in-1si -irus.Kelu2pu*1n
ini 8ersif1(
1si2e(ris se*ingg1 9enderung 2enirn8ulk1n def)r2i(1s @g1nggu1n
8en(uk (u8u*B
l1ng 9enderung 2ene(1p 1(1u 81*k1n 2en31di le8i* 8er1(. Ce81gi1n (er8es1r
kelu2pu*1n 1k1n 2engen1i (ungk1i @$g,M persenB, sed1ngk1nA$,A persen 1k1n
2engen1i leng1n. Kelu2pu*1n ini 1k1n 8er31l1n 8er(1*1p
d1n 2e21k1n D1k(u .
*1ri sUd . 8ul1nB.
P1d1 s(1diu2 su861ku(
@.
2inggu sUd . 8ul1.B di(1nd1i deng1n
2eng*il1ngn+1 de212 d1l12 D1k(u .A 3121(1u k1d1ng
su*u (id1k (erl1lu (inggi.
K1d1ng diser(1i kek1ku1n )()( d1n n+eri )()( ring1n.
Kelu2pu*1n 1ngg)(1 ger1k
i:1ng l1+u* d1n 8i1s1n+1 p1d1s1l1* s1(u sisi.
C(1diu2 K)n-1les9en( @. 8ul1n sUd . (1*unB di(1nd1i deng1npuli*n+1
keku1(1n )()( +1ng le21*. seki(1r I#6$# persen d1rifungsi )()( puli* d1l12
r-1k(u M6" 8ul1n se(el1* f1se 1ku(. Cel1n3u(n+1,
sesud1* usi1 . (1*un
diperkir1k1n
(id1k (er31di l1gi per81ik1n keku1(1n )()(. s(1diu2 kr)nik
1(1u le8i* . (1*un d1ri
ge31l1 1D1l pen+1ki( 8i1s1n+1 2enun3ukk1n keku1(1n
)()( +1ng 2en91p1i (ingk1(
2ene(1p d1n kelu2pu*1n )()( +1ng 1d1 8ersif1( perrn1nen.
:..:
i:(.4;i=6.r..i
.:.= 5:,:6.4
I
I
r N,lLO5'.O INK,/ACI
EO1s1 inku81si pen+1ki( p)li) !6M *1ri d1n kelu2pu*1n (er31di d1l12 D1k(u
66l 6 n1ri.
6
P1p1r1n -irus p)li) p1d1 sese)r1ng d1p1( 2eni28ulk1n 8en(uk klinik4
= In1pp1ren( infe9(i)n, (1np1 ge31l1 klini@ +1ng (er81n+1k (er31di @$.RB
4. Infeksi klinik ring1n, sering (er31di @.ARB deng1n ge31l1 p1n1s, le21s,
21l1ise, pusing, 2un(1*, (engg)r1k1n s1ki( d1n ge31l1n k)28in1si.
21l1ise, pusing, 2un(1*, d1n s1ki( peru(.
P1r1l+i9 P)li)2+eli(is, di2ul1i d1ri ge31l1 seper(i p1d1 infeksi klinlk
ring1n, disel1ng deng1n peri)de 6! *1ri (1np1 ge31l1 l1lu disusul deng1n
n-eri )()(, k1ku )()( d1n de212.
4 &)s( p)li) s+ndr)2e @PPCB +1i(u 8en(uk 21nifes(1si l1281( @I6A# (1*unB
4e(el1* infeksi p)li) deng1n ge31l1 klinik p)li) p1r1li(ik +1ng 1ku(. Ge31l1
='1ns 2un9ul 1d1l1* n+eri
)()( lu1r 8i1s1, p1r1lisis 81ru. P1()genesis
neiu2 3el1s n12un 8uk1n 1ki81( infeksi I,1ng persis(en.
"
G. PENYE/ARAN PENYAKIT
Lirus di(ul1rk1n )le* infeksi dr)ple( d1ri )r)6f1ring @2ulu( d1n (engg)r)kB
1(1u d1ri (in31 penderi(1 +1ng infeksius. Penul1r1n (eru(121 (er31di penul1r1n
l1ngsung d1ri 21nusi1 ke 21nusi1 2el1lui fek1l6)r1l @d1ri (in31 ke 2ulu(B 1(1u
+1ng 1g1k 31r1ng l1inn+1 2el1lui )r1l6)r1l @d1ri 2ulu( ke 2ulu(B6
&ek1l6)r1l 1r(in+1 2inu21n 1(1u 21k1n1n +1ng (er9721r -irus p)li) +1ng
8er1s1l d1ri (in31 penderi(1 21suk ke rnulu( 21nusi1 se*1( l1inn+1. Ced1ngk1n
d1ri )r1l6)r1l 1d1l1* pen+e81r1n d1ri 1ir liur penderi(1 +1ng 21suk ke 2ulu(
21nusi1 se*1( l1inn-1.
Lirus p)li) s1ng1( (1*1n (er*1d1p 1lk)*)l d1n lis)l, n1rnun pek1 (er*1d1p
f)r21lde*ide d1n l1ru(1n kl)r. Cu*u +1ng (inggi 9ep1( 2e21(ik1n -irus, (e(1pi
p1d1 ke1d11n 8eku d1p1( 8er(1*un6(1*un. Ke(1*1n1n -irus di T1n1*
(erg1n(ung kele28181n su*u d1n 1d1n+1 2ikr)81 l1inn+1.
Air s1ng1(
Lirus ini d1p1( 8er(1*1n l121 p1d1 1ir li281* d1n 1ir per2uk11n, 81*k1n
dr+1( s12p1i 8erkil)6kil)2e(er d1ri su28er penul1r1n. Meskipun
infeksius, n12un -irus ini *idup
penul1r1n
(eru(121 1ki81( (er9e21rn+1 lingkung1n )le* -irus p)li) d1ri penderi(1 +1ng
di lingkung1n (er81(1s. C1l1* s1(u in1ng 1(1u
21l5rluk *idup per1n(1r1 +1ng d1p1( di8uk(ik1n s12p1i kini 1d1l1* 21nusi1.
f,6 DLAGNOCO
D1ri ge31l1 klinis d1n kel1in1n fisik +1ng di(e2uk1n, sud1* d1p1( didug1
p9n+1ki( p)li)2+eli(is. N12un, diperluk1n pul1 pe2eriks11n l18)r1()riu2 d1r1*
sf,(1 pe2eriks11n 91ir1n )(1k @9ere8r) spin1l fluidB +1ng di128il d1ri (ul1ng
8el1k1ng p1sieA un(uk 2eli*1( 3enis d1n 3u2l1* seln+1. Pe2eriks11n ser)l)gis
ffi k1d1ng diperluk1n un(uk 2enen(uk1n ser)(+pe -irus. Di1gn)s1 di(eg1kk1n
(#
1L1s d1s1r g1281r1n klinis, ke1d11n epide2i)l)gis,
pe2eriks11n 91ir1n
9ere8r)pin1lis, is)l1si -irus, d1n 2eningk1(nl:1 (i(er 1n(i8)di d1l12 d1r1*. ,n(uk
rle21s(ik1n di1gn)s1 diperluk1n pe2eriks11n -ir)l)g+ gun1 2engiden(ifik1si
-irusn+1.
L PEEGO/ATAN
/elu2 1d1 peng)81(1n 1n(i-irus +1ng spesifik un(uk pen+1ki( p)li) s12p1i
,.9r ini. Ple9)n1lir, s1iu 1n(i-irus +1ng 1k(if
=s* di9)81
se91r1 in-i(r) (er*1d1p pi9)rn1-irus
di
gi 3u2l1*1n di8e8er1p1 pus1( peneli(i1n di duni1.
,n(uk 2engur1ngi 3u2
:6.446rs ser(1 2eningk1(k1n d1+1 (1*1n (u8u* p1sien, d1p1( di8erik1n T1(
4446rr=l)elO8uline6
P1d1 prinsipn+1 di(u3uk1n p1d1 pen9eg1*1n (er31din+1 9191(1g1r 1n1k d1p1(
4 46i4r,u6(r sen)r21l 2ungkin
16 P)li)2ieli(ris 18)r(if
6 Fukup di8erik1n 1n1lge(ik1 d1n sed1(if1
5
Die( 1deku1(
se81likn+1 6Isir1*1( s12p1i su*u n)r21l un8(uk 8e8er1p1 *1ri,
:<iperiks1 neur)skle(1l se91r1 (eli(i.
*6 P)li)2ieli(is n)n
63i9ee1*1ki-i(1s +1ng 8erle8i*1n sel121 . 8ul1n d1n . 8ul1n ke2udi1n
p1r1li(ik4
seper(i (ipe 18)r(if
Ce(1in di8eri 1n1lge(ik1 d1n sed1(if d1p1( dik)28in1si deng1n3 k)2pers
rsng1( sel121 I 6 !# 2eni(, se(i1p .6A 312.
l
9. P)li)2ieli(is p1r1li(ik
6 Me28u(u*k1n per1D1(1n di ru21* s1ki(
6 Is(ir1*1( ()(1l 2ini21l $ *1ri 1(1u sediki(n+1 f1se 1ku( dil12p1ui
6 Cel12 f1se 1ku( ke8ersi*1n 2ulu( di31g1
6 Peru81*1n p)sisi penderi(1 dil1kuk1n deng1n pen+1ngg1 perseDndi1n
(1np1 2en+en(u* )()( d1n *ind1ri ger1k1n 2e2eluk punggung
6
&isi)(er1pi, dil1kuk1n sedini 2ingkin sesuF1* f1se 1ku(, 2ul1i deng1n
l1(i*1n p1sif deng1n 21ksud un(uk 2en9eg1* (er31din+1 def)r2i(1s
6 Akupun(ur dil1kuk1n sedini 2ungkin
6ln(erfer)n dil1kuk1n sedini 2ungkin, un(uk 2en9eg1* (er31din+1 p1r1li(ik
pr)gresif
d6 P)li)2ieli(is 8en(uk 8ul81r
6 Per1D1(1n k*usus (er*1d1p p1r1lisis p1l1(52, seper(i pe28eri1n in1ken1V
,l1l12 8en(uk )1d1( 1(1u se2is)lid
6 Cel121 f1se 1ku( d1n 8er1(, dil1kuk1n dr1in1sep)s(ur1l deng1n p)sisi k1ki
le8ilr (inggi @.# 6.I B%, 2uk1 p1d1 s1(u p)sisi un(uk 2en9eg1* (er31din+1
espir1si, pengis1p1n lendirdil1kuk1n se91r1 (er1(ur d1n *1(i
perlu (r1ke)s()2i.
6 *1(, k1l1u
T.
PENFEGAHAN
D1l12 H)rld He1l(* Asse28l+ (1*un ""% +1ng diiku(i )le* se81gi1n 8es1r
neg1r1 di pen3uru duni1 di8u1( kesep1k1(1n un(uk 2el1kuk1n Er1dik1si P)li)
@Er1p)B (1*un .###, 1r(in+1 duni1 8e81s p)li) (1*un .###. Pr)gr12 Er)p1
p7r(121 +1ng dil1kuk1n 1d1l1* deng1n 2el1kuk1n 91kup1n i2unis1si +1ng (inggi
d1n 2en+eluru*. Ke2udi1n diiku(i deng1n Pek1n I2unis1si N1si)n1l +1ng (el1*
dil1kuk1n Depkes (1*un ""I, ""M, d1n ""$. Pe28eri1n irnunis1si p)li) +1ng
sesu1i deng1n rek)2end1si HHO 1d1l1* di8erik1n se31k l1*ir se81n+1k A k1li
deng1n in(er-1l M6% 2inggu. Ke2udi1n diul1ng usi1 I Y, (1*un,I (1*un, d1n usi1
I (1*un
,p1+1 ke(ig1 1d1l1* Cur-1il1n9e A9u(e &l199id P1r1l+sis 1(1u pene2u1n
penderi(1 +1ng di9urig1i lu2pu* l1+u* p1d1 usi1
di 81D1* I (1*un *1rus
diperiks1 (in31n+1 un(uk 2e21s(ik1n k1ren1 p)li) 1(1u 8uk1n.
Tind1k1n l1inn+1 1d1l1* 2el1kuk1n M)pping O<p, 1r(in+1 pe28eri1n
-1ksin1si 21ss1l di d1er1* +1ng di(e2uk1n penderi(1 p)li) (er*1d1p 1n1k di
81D1* I (1*un l1np1 2eli*1( s(1(us i2unis1si p)li) se8elu2n+1.
(!
T12p1kn+1 deng1n er1 gl)*1lis1si
di 21n1 2)8ili(1s penduduk duni1
1n(1rneg1r1 s1ng1( (inggi d1n 9ep1( 2eng1ki81(k1n kesuli(1n 2engend1lik1n
pen+e81r1n -irus ini.
Cel1in
pen9eg1*1n deng1n -1ksin1si
p)li), *1rus diser(1i
deng1n
6ningk1(1n
s1ni(1si lingkung1n d1n *igienis s1ni(1si per)r1ng1n un(uk
2engur1ngi pen+e81r1n -irus +1ng ke281li 2engk*1D1(irk1n ini.
Ad1pun l1ngk1*
444*1d1p p)li) +1i(u
.
4
6
l1ngk1* +1ng *1rus dil1kuk1n d1l12 pen9eg1*1n >iini
=
<1ng1n 21suk ke d1er1* D181*
6 Di d1er1* D181* se81ikn+1 di*ind1ri f1k()r
6
f1kr)r predisp)sisi seperfi
()nsilekl)2i, sun(ik d1n l1in
6
l1in
E len gur1n gi 1k(i-i(1s 3 1s2 1ni +1n g 8erle8 i *1n
Pe28eri1n i2unis1si 1k(if seper(i 4 &)r21rin In19(i-1(ed -irus @ s1lk +1ng
B
di8erik1n 2el1lui sun(ik1n d1n Li-e A((enus(ed -irus -199ine @ s18in +1ng
B
:l i8erik1n 2el1lui )r1l
O440un keun(ung1n d1n kerugi1n d1ri i2unis1si (erse8u(
4
. I2unis1si deng1n r(enggun1k1n -1ksin s18in
Keun(ung1n 4
. Le8i* efek(if d1ri -1ksin s1lk
46 -e28erik1n i2uni(1s l)k1r d1n *u2)r1r p)1d1 dinding usus
;. Pe28eri1nn+1 2ud1* d1n *1rg1n+1 2ur1*
;. I2uni(1s 9ukup l121 +1kni % (1*un
;= Ti28ul T1(1n(i s1ng1( 9ep1(
4. D1p1( dip1k1i di l1p1ng1n d1n (id1k 2e2erluk1n pers+1r1(1n su*u 8eku
1 EE:1k(u epide2i pe28en(uk1n T1( 1n(i (id1k s131 9ep1( (1pi 3ug1
2er1ngs1ng usus d1n 2en9eg1* pen+e81r1n -irus
D1p1( di8u1( d1l12 sel 21nusi1 d1n (id1k (erg1n(ung d1ri 8in1(1ng
(A
Kerugi1n4
1. K1ren1 -irus *idup, su1(u s11( 2ungkin 2en31di g1n1s
8. Lirus -1ksin d1p1( 2en91p1i se2u1 peng*uni ru21*
9. Der1* p1n1s -1ksin 2e2erluk1n r1n(1i dingin +1ng 81ik
d. Ad1n+1 k)n(r1dik1si 81gi penderi(1 deng1n defisisensi i2un d1n penderi(1
+1n g sed1n g d i8eri k)r(ik)s(er)
i dU i2 un)supres i
f
se818
<enis -1ksin ini digun1k1n
di ind)nesi1. L1ksin ini pen(ing
i3Ve2pun+1i du1 fungsi pen(ing
; per(121, 2eni28ul1k1n ken1i1k1n 1n()8)di
kedu1, 4urn)r1l +1ng d1p1( 2eng*1281( 21sukn+1 -irus p)l) ke )(1k
nerTrngs1ng (i28uln+1 1n(i8)di l)k1l uisus +1ng d1p1( 2en9eg1* (rer31din+1
4ene2pel1n -irus p)li) p1d1 dignding usul. Ce2en(1r1 -1ksin s1l1k *1n+1
4erniliki ken1i1k1n 1n(i8)di *u2)r1l.
I2unis1si d1s1r di8erik1n ke(ik1 1n1k 8erusi1 . 8ul1n, di8eri1k1n
in(er-1l pe28eri1n A 6M 2inggu, 8))s(er di8erik1nQr1n-1k1 . 6 ! k1li deng1n
4,;9i1 usi1 ,I . (1*un d1n 2en3el1ng usi1 I (1*un d1n # (1*un.L1ksin ini
46,ernpunl1i d1+1 i2un)l)gi +1ng (inggi. Ce(i1p d)sis 2eng1ndung -irus (+pe
: rn(:ek(if:uni(, (ipe II l#s infek(if uni( d1n III # s:s infek(if uni(.
I l#
nr2unis1si deng1n -1ksin s1lk
L1ksin1si d1s1r di2ul1i p1d1 usi1 ! 8ul1n , di8erik1n ! k1lideng1n
4;en:1lA6M 2inggu. Cun(ik1n ul1ng1n di8erik1n se(ip1 6. (1*u.
ffef(ung1n4
L
4
4
I
4
Deng1n d)sis +1ng 9ukup, d1p1( 2e28erik1n i2uni(1s *u2)r1l +1ng 81ik
K1re1n1 (id1k 1d1 -irus +1ng *idup, ke2ungklin1n -irus g1n1s (id1k 1d1
D1p1( di8erik1n kep1d1 1n1k
6
1n1k
E61ng sed1ng 2end1p1(k1n k)r(ik)s(er)id 1(1u kel1in1n i2uni(1s
C1ng1( 8erf1ed1* di d1er1* (r)pis. di21n1 -1ksin +1ng 2eng1ndung -irus
nidupU le21* 2ud1* rus1k
(I
Kerugi1n4
16 Pe28en(uk1n T1( 1n(i kur1ng 81ik
8. Me2erluk1n 8e8er1p1 u1l1ng1n sun(ik1n
9. Tid1k 2eni28ul1k1n i2uni(1s l)k1ldi usus
d.
e.
M1*1l
Pe28u1(1n suli(
D1p1( (er31di ke9el1k11n (erk)n(12in1si deng1n -irus *idup +1ng 21si* g1n1s
f.
TM
/A/ III
TTN<A,AN EPTDEMIGT,OGIC
O. AGENT
Agen( pen+1ki( p)li) 1d1l1* p)li)-irus @PLB:
/. DICTRI/,CI
Eli2in1si -irus p)li) (el1* dil1ks1n1k1n pulu*1n (1*un +1ng i1lu di seluru*
duni1 2el1lui pr)gr12 er1dik1si +1ng (el1* 2enurunk1n 1ngk1 ke31di1n p)li)
se91r1 dr1s(is. N12un, *ingg1 s11(
ini (erd1p1( M neg1r1 di seluru* duni1 +1ng
ende2is p)li) +1kni Afg1nis(1n, Indi1, Cud1n, Nigeri1, P1kis(1n, d1n /1ngl1des*:
Terd1p1( k1sus li1r p)li)-irus (ipe I
>ii Ken+1, p1d1 s11( i(u di(e2uk1n .M
iesus +1ng di81D1 )le* pend1(1ng d1ri C)21li1 +1ng 2erup1k1n neg1r1 (e(1ngg1
41ri Ken+1.
Di Ind)nesi1 sendiri pen+1ki( ini 2un9ul ke281li se(el1* d1l12 kurun D1k(u
iirrr1 (1*un (el1* din+1(1k1n (er8e81s d1ri p)li), di(e2uk1n ."I k1sus se91r1
nen+e81r
6:i1r16
di pr)pinsi
/1n(en, <1D1 /1r1(, L12pung, <1D1 Teng1*, Cu21(r1
<1D1 Ti2ur, Cu21(er1 Cel1(1n, DKI <1k1r(1 Ri1u, d1n N1nggr)e A9e*
B4russ1l12.
Pen+1ki( ini 8i1s1n+1 2un9ul di d1er1*
6
d1er1* +1ng 2e2ilik6i s1ni(1si3elek,
66rukung1n +1ng (er9ern1r )le* (in31, ke1d11n d1er1* +1ng kekur1ng1n 1k1n 1ir
4,ersi*, d1n d1er1* +1ng 2e2iliki kep1d1(1n penduduk +1ng (inggi: -irus ini d1p1(
46ri1 *idup di Dil1+1* (r)pis d1n di(e2uk1n sep1n31ng (1*un. Di d1er1* +1ng
rerikli2 sed1ng, -irus ini d1p1( dide(eksi p1d1 2usi2 *u31n6
Pen+1ki( p)li) u2u2n+1 (er31di p1d1 2usi2 (er(en(u d1ri 2usi2 *u31n ke
44isi2 p1n1s d1n se81likn+1. Di
d1er1* ende2is k1sus p)li) 2un9ul se91r1
.4=rr1dis 1(1upun ei1i12 8en(uk KL/= <urnl1* penderi(1 2eningk1( p1d1 1k*ir
($
2usi2 p1n1s d1n p1d1 s11( 2usi2 gugur di d1er1* 8erikli2 dingin. Di neg1r16
neg1r1 (r)pis, pun91k 2usi21n (er31di p1d1 s11( 2usi2 p1n1s d1n 2usi2 *u31n.
P)li) 21si* 2erup1k1n pen+1ki( +1ng 2en+er1ng 81+i d1n 1n1k61n1k: $#
/#
6
=
penderi(1 p)li) 8erusi1 di81D1* ! (1*un, d1n %#
6
"# )U= 8erusi1 di81D1* I
(1*un. Merek1 +1ng 2e2pun+1i resik) (inggi (er(ul1ri 1d1l1* kel)2p)k ren(1n
p1r1seper(i kel)2p)k6kel)2p)k +1ng 2en)l1k i2unis1si,
kel)2p)k 2in)ri(1s,
2igr1n 2usi21n, 1n1k61n1k +1ng (id1k (erd1f(1r, k1u2 n)21den: pengungsi d1n
21s+1r1k1(
2 iskin Perk)(11n
6
Pene2u1n k1sus
p)li) 8er81nding (er81lik deng1n u2ur d1n pre-1lensi
1n(i8)di spesifik 8er81nding lurus deng1n u2ur. Insidensi infeksi d1n pre-1lensi
1n(i8)di spesifik dil1p)rk1n (id1k 8er8ed1 1n(1r1 l1ki 6 l1ki d1n pere2pu1n, (e(1pi
pen+1ki( +1ng 8er1( le8i* sering p1d1 l1ki
6
l1ki:
F. &REK,ENCI
Menuru( d1(1 d1ri HHO 2en+1(1k1n 81*D1 *ingg1 s11( ini 21si* 1d1
8e8er1p1 neg1r1 +1ng ende2is p)li). Ad1pun uru(1n neg1r1 +1ng 2erniliki
frekuensi pen+1ki( p)li) (er81n+1k +1kni Nigeri1 @IM# )r1ngB, Y121n @A$#
)r1ngB, lnd)nesi1 @."I )r1ngB d1n di ken+1 se81n+1k .M k1sus.
k1sus, <1D1 /1r1( I" k1sus, L12pung .I
Di Ind)nesi1, /1n(en 8er3u2l1* M
k1sus, <1D1 Teng1* .# k1sus, Cu21(r1 ,(1r1 # k1sus, <1D1 Ti2ur I k1sus,
Cu21(er1 Cel1(1n I k1sus, DKI <1k1r(1 A k1sus, Ri1u ! k1sus, d1n N1nggr)e A9e*
D1russ1l12 se81n+1k ! k1sus6
D. DETERMINAIO
Lirus p)li) (er81gi 1(1s ! sr1in,+1i(u
1. Tipe I /run*ilde
4
8. Tipe lI L1nsing d1n
9. Tipe III Le)n
%
Tipe I +1ng sering 2eni28ulk1n epide2i +1ng lu1s d1n g1n1s, (ipe II k1d1ng6
k1d1ng 2en+e818k1n k1sus +1ng sp)r1dik d1n (ipe lll
2en+e818k1n epide2i
ring1n. DiNeg1r1 (r)pis d1n su8(r)pis ke81n+1k1n dise818k1n )le* (ipe II d1n
d1n -irus ini (id1k 2eni28ulk1n i2uni(1s sil1ng6
Ill
("
/A/ IL
PEM/AHACAN
Pen+1ki( p)li) 2erup1k1n se8u1* 21s1l1* kese*1(1n +1ng 2enggl)81l +1ng
(id1k *1n+1 (er31di di Ind)nesi1 n12un di 8er81g1i neg1r1
6
neg1r1 di duni1. Menuru(
d1(1 HHO 2en+1(1k1n 81*D1 1d1 8e8er1p1 neg1r1 ende2is p)li) +1kni Afg1nis(1n,
Indi1, Cud1n, Nigeri1, P1kis(1n, d1n /1ngl1des*.
I
i. (
Ad1pun uru(1n neg1r16neg1r1 +1ng 2e2iliki frekuensi pen+1ki( p)li)
(er81n+1k di duni1 +1kni Nigeri1 @IM# )r1ngB, Y121n @A$A )r1ngB, Ind)nesi1 @."I
)r1ngB di (1*un .#AI. sed1ngk1n p1d1 (1*un .##M (er31di k1sus p)li) di Ken+1 +1kni
.M k1sus.
.#
I
i.,,
K1sus p)li) +1ng (er31di di Ind)nesi1 ke281li 2un9ul di (1*un .##I se(el1*
li21 (1*un ke21rin +1ng din+1(1k1n 8e81s p)li). N12un *ingg1 kini (el1* 81n+1k
di(e2uk1n k1sus p)li) +1ng 8er2un9ul1n di 8er81g1i d1er1* 81ik di pedes11n
21upun
pr)pinsi=
di perk)(11n. Ad1 ."I k1sus p)li)
d1n A# k18up1(en +1ng 1d1 di V#
.
Dis(ri8nsi Pen+e81r1n P9n+1ki( P)li) Menuru( Te2p1( di Ind)nesi1
T1*un .##I
Pr)pinsi
/1n(en
<1D1 /1r1(
<u2l1* K1sus
M
Persen(1se @R=B
IA.I$
"." I"
.I L12pung
<1D1 Teng1*
Cu21(er1 ,(1r1
<1D1
%.A$
.# M.$%
!.!"
.M"
.M"
.!I
.#.
l#
I Ti2ur
Cu21(er1 Cel1(1n I
DKI <1k1r(1
Ri1u
A
6
N1nggr)e A9e* D1russ1l12 < (.#.
## <u2l1*
Cu28er 4 Depkes RI,.##I
."I k1sus
D1ri (18el di 1(1s, 2enu3ukk1n dis(ri8usi pen+e81r1n pen+1ki( p)li) di
Ind)nesi1 (1*un .##I, (er81n+1k (erd1p1( di Pr)pinsi /1n(en se81n+1k M k1sus
@IA,I$RB d1n (erend1*
Ced1ngk1n
di d1er1* Ri1u d1n NAD se81n+1k ! k1sus @,#.RB.
di Cul1Desi Cel1(1n 8elu2 1d1 di (e2uk1n k1sus se818 pe2erin(1* (el1*
2el1kuk1n d1n 21si* (erus 8erl1ngsung i2unis1si gr1(is. T1*un .##A ke21rin
(er91(1( IM.I!# 81li(1 d1ri %M.#.% 3u2l1* s1s1r1n (el1* 2eneri21 i2unis1si.
se*ingg1 pen+1ki( p)li) ini d1p1( (er1(1si.
/1n+1kn+1 21s1l1* p)li) di Ind)nesi1 *ingg1 s11( ini dise818k1n )le* k1ren1
pel1ks1n11n i2unis1si +1ng di31l1nk1n )le* pe2erin(1* (id1k 8er*1sil 2en91p1i
91kup1n sesu1i (1rge( +1ng (el1* di(e(1pk1n, +1i(u 2ini2u2 "# Y). /er81g1i kend1l1
+1ng 2eng*1d1ng, seper(i d1n1 l)gis(ik, (eru(121 9*)ld 9*1in un(uk 2en31g1
..
l1in 6 l1(n:efek(i-i(1s -1ksin, kend1l1 ge)gr1fis d1er1*
(erpen9il, super-isi, d1n
)U) d1ri seluru* des1 pen91p1i1nn+1 di
Ceper(i di1kui Men(eri Kese*1(1n, seki(1r .
81D1* g# R. /e8er1p1, 81*k1n *1n+1 seki(1r I#
R s131. Cel1in i(u,
kes1d1r1n
21si* kur1ng21s+1r1k1( un(uk 2e281D1 1n1kn+1 ke puskes21s 1(1u
p)s+1ndu
se*ingg1 se81gi1n 1n1k (id1k 2e2per)le* -1ksin (erse8u(.
.!
/A/ L
P/N,T,P
A= Kesi2pul1n
+1ngl. P)li) 1(1u p)li)2+eli(is 1d1l1* pen+1ki( p1r1lisis 1(1u
lu2pu*
(u8u* 2el1lui 2ulu(:dise818k1n )le* -irus p)li-irus +1ng 21suk ke
d1r1* d1n 2eng1lir ke2enginfeksi s1lur1n usus ser(1 d1p1( 2e21suki
1lir1n
sis(e2 s1r1fPus1(
6
..
<enis63enis P)li)
16 P)li) N)n6P1r1lisis
8. P)li) P1r1lisis CPin1l
9. P)li) /ul81r
!.
(er31di d1l12 D1k(u $6
M1s1 inku81si pen+1ki( p)li) !6M *1ri d1n kelu2pu*1n
.l *1ri.P1p1r1n -irus p)li) p1d1 sese)r1ng d1p1( 2eni28ulk1n 8en(uk klinik4
1. In1PP1ren(infe9(i)n,
8. A8)r(i-e P)li)2Yeli(is,
9. P1r1lY(i9 P)li)2Yeli(is,
d. P)s( P)li) sYndr)2e @PPCB
A.
dr)ple( d1ri )r)6Pen+e81r1n pen+1ki( p)li) +1kni-irus di(ul1rk1n
)le* infeksi
d1n (engg)r)kB 1(1u d1ri (in31 penderi(1 +1ng infeksius: f1ring @2ulu(
ke 21nusi1Penul1r1n (eru(121 (er31di penul1r1n
l1ngsung d1ri 21nusi1
31r1ng l1inn+1 2el1lui2el1lui fek1l6)r1l @d1ri (in31 ke 2ulu(B 1(1u
+1ng 1g1k
)r1l6)r1l @d1ri 2ulu( ke 2ulu(B:
.A
I. Pen9eg1*1n pen+1ki( p)li) d1p1( dil1kuk1n 2el1lui
4
1. <1ng1n 21suk ke d1er1* D181*
8. Di d1er1* D181* se81ikn+1 di*ind1ri
()nsilek()2i, sun(ik d1n l1in
f1k()r
6
f1kr)r predisp)sisi seper(i
6
l1in
96 Meningk1(k1n *+giene per)r1ng1n, s1ni(1si lingkung1n d1n per81ik1n
d. Mengur1ngi 1k(i-i(1s 31s21ni +1ng 8erle8i*1n
e=
Pe28eri1n i2unis1si 1k(if seper(i
giTi
4 &)r2)lin In19(i-1(ed -irus @ s1lk B
+1ng di8erik1n 2el1lui sun(ik1n d1n L*,e A((enu1(ed Lirus -199ine @
s18in B +1ng di8erik1n 2el1lui )r1l
/. C1r1n
l6 Kep1d1 pe2erin(1* di*1r1pk1n 2engg1l1kk1n k1nnp1n+e PH/C, peningk1(1n
pr)gr12 s1ni(1si d1s1r, k*ususn+1 pr)gr12 +1ng 8er*u8ung1n deng1n
pen1ng1n1n (in31.
.. Kep1d1 21s+1r1k1( di*1r1pk1n iku( 8erper1n ser(1 1k(if d1l12 pener1p1n
pr)gr12 pen1nggul1ng1n pen+1ki( p)li) d1n le8i* k*usus 2e2per*1(ik1nd1n
2el1ks1n1k1n p)l1 *idup 8ersi* d1n se*1( (eru(1rn1 p1d1 *igiene s1ni(1si
per)r1ng1n
!. Perlu di(ingk1(k1n ker31 s121 lin(1s sekl)r1l d1l12 r1ngk1 pen1ng1n1i.0
pen+1ki( p)li)2+eili(is ini
.I
DA&TAR P,CTAIFA
/uku ru3uk1n,.##., Er1diknsi p)li) di Ind)nesi1, Dep. Kese*1(1n RI d1n HHO
D KK G i 1( kn n K12p1n+ e I2uni s 1s i P ) I i ). * ((p U,:,r5-D. sll1r1 2erdek1. 9)2
4
I2unis1si C1(u
6 C1(un+1 F1r1 Men9eg1* Penul1r1n
Lrus P)li). *((p4UUUDDD.rsud.
ke8u2en.g).id
Ind) n es i1 N ) 21r Tig' di D un i 1.*((p4UUU D,r-r-. k ) nl p1s. 9) nl
P)li) Didug1 Cer1ng Culsel, IA P1sien Di(e2uk1n Lu2pu* L1+u. *((p4UUDDD.2edi1ind).9)rn
L1(if , Y enusi 6 Me ng1p 1 P ) I i ) MeD 18 1* Ke 2 81I i G . *(lp 4 UUU
p(ki r1n r1n+1(. 9)2
Lu8is, &ir21n. P)li) d1n 21s1l1* kese*1(1n ki(1. *((p 4UUDDD.k)2p1s.9)26
M)p ,p P)li) di Tig1 Pr)pinsi /eresikn Tinggi *((p4Ulu,nr-.repu8lik1.9)2
PurD1. Indr1. Pu(us Ceger) M1(1 R1n(1i P)li) di Ind)nesi1.*((p4UUUDDD. Pikir1n R1k+1(.9)2
D K K Gi 1 ( k1n K1 2p 1n+ e I 2uni s 1s i P ) I i ) . lr((p 4 UUiu:r-u,. s u1r1 2erdek1.9)2
H1l id, A8dul. F e g1* P ) I i), P e r *1( i k1n P ) s+ 1ndu.*((p4U U I su1ru
2erdek19)2