We are IntechOpen,

the world’s leading publisher of

Open Access books
Built by scientists, for scientists

4,200
Open access books available
116,000
International authors and editors
125M
Downloads

Our authors are among the

154
Countries delivered to
TOP 1%
most cited scientists
12.2%
Contributors from top 500 universities

Selection of our books indexed in the Book Citation Index

in Web of Science™ Core Collection (BKCI)

Interested in publishing with us?

Contact [email protected]
Numbers displayed above are based on latest data collected.
For more information visit www.intechopen.com
 Chapter 5

Indonesia Dengue Fever: Status, Vulnerability, and

Challenges

Budi Haryanto
Budi Haryanto
Additional
Additional information is available
information is available at
at the
the end
end of
of the
the chapter
chapter

http://dx.doi.org/10.5772/intechopen.82290

Abstract

In Indonesia, the incidence rate (IR) of dengue fever reported increase almost in every
year since the first cases were found in 1968, from 0.05 to ~35–40 per 100,000 population
in 2013, with superimposed epidemics demonstrating a similar increasing trend with
the highest epidemic occurring in 2010 (IR 85.7). Most currently, about 80% of regencies/
cities had been infected and posed as very high vulnerability of spreading the disease.
Increased incidence of dengue fever is associated with the increase of rainfall and tem-
perature in particular years. Up to the year of 2038, a climate model of Meteorological,
Climatological, and Geophysical Agency shows increasing trend of rainfall and tem-
perature. Along with its unsuccessful of Indonesia dengue fever control program will
lead challenges to reduce dengue fever endemic in the future. Revitalization of dengue
disease control program in every single stage with close monitoring implementation is
urgently needed. Socialization, community capacity building, and participation could
also be a joint sectoral action to enhance the dengue fever control program.

Keywords: Indonesia dengue fever, climate vulnerability, eradication challenges

1. Introduction

Dengue fever is a mosquito-borne disease caused by any one of four closely related dengue
viruses (DenV-1, DenV-2, DenV-3, and DenV-4). Dengue fever is transmitted by the bite of an
Aedes mosquito infected with a dengue virus. The female mosquito becomes infected when it
bites a person with dengue virus in their blood both indoors and outdoors during the daytime
(from dawn to dusk). Aedes aegypti is particularly involved, as it prefers to lay its eggs in
artificial water containers, to live in close proximity to humans, and to feed on people rather
than other vertebrates.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons
© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative
Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
distribution, and reproduction in any medium, provided the original work is properly cited.
82 Current Topics in Tropical Emerging Diseases and Travel Medicine

Dengue infection is the most rapidly spreading mosquito-borne viral disease in the world.
Infections are most commonly acquired in the urban environment. In recent decades, the
expansion of villages, towns, and cities in the areas in which it is common and the increased
mobility of people have increased the number of epidemics and circulating viruses. Dengue
fever, which was once confined to Southeast Asia, has now spread to Southern China, coun-
tries in the Pacific Ocean and America, and might pose a threat to Europe. In the last 50 years,
dengue virus infections had expanded to many other countries with significant increasing
cases [1] up to 2.5 billion people living in endemic countries where about 1.8 billion (more
than 70%) in Southeast Asia and the Western Pacific Region [1–4]. About 50 million dengue
infections occur every year [2, 3], and approximately 500,000 patients are hospitalized of
whom dominated by children [2–7]. The increasing incidence and geographical spread of den-
gue virus were more likely driven by demographic and societal changes such as population
growth, urbanization, and modern transportation [8]. The traveler movement also contrib-
uted to the risk of contracting dengue disease from nonendemic countries to endemic dengue
areas to nonendemic regions where competent mosquito vectors are currently found [9–12].
Indonesia, with 257.5 million inhabitants and 17,500 islands spread across the equator,
poses as the largest archipelago country in the world [13], comprising 3.1 million km2 of
ocean (62% of the total area) with a coastline of 81,000 km and approximately 2 million km2
of land (38% of the total area). Its tropical climate and subsequent relative high humidity
makes Indonesia favorable conditions for vector-borne disease transmission. The increasing
trend of dengue infections over the current decades putting Indonesia as one of endemic
area for dengue fever and tread both the people as well as travelers visiting the archipelago
[14]. Its burden is a result of a constant ground of established infections in the past period,
combined with epidemics of emerging infectious diseases (EID) [15]. This chapter describes
the dengue fever status or situation in Indonesia, its vulnerability among population, the
future challenges, and the disease prevention and control.

2. Dengue fever status in Indonesia

Indonesia is reported as the second largest with dengue fever cases among 30 endemic coun-
tries. The number of cases of dengue fever is most prevalent in the provinces of East Java,
West Java, and Central Java. However, there are a number of provinces that are vulnerable
with its high incidence rate of dengue fever. In 1968, the first 58 dengue cases were reported in
Indonesia from the city of Jakarta (DKI Jakarta) and Surabaya (East Java) [16–19]. Since then,
the sharp increasing numbers of cases and spreading to many other geographical locations
have been reported [16, 17, 20–25]. The epidemiology of dengue fever in Indonesia has been
described mostly in the form of case series, reporting on single outbreaks, or clinical and
virological studies in confined geographical locations and selected years [26].

A study in 2014 reported that the annual dengue fever incidence increased from 0.05/100,000 in
1968 to ~35–40/100,000 in 2013. The highest epidemic occurred in 2010 with the incidence of
85.7/100,000 population. The data revealed declining of case fatality rate (CFR) from 41% in
1968 to 0.73% in 2013. Dengue cases increased among ages during the observation period up
to 1998 with the highest incidence of aged 5–14 years. From 1999 onward, the trend of dengue
incidence increased among those aged 15 years or over. This study indicates incidence of
 Indonesia Dengue Fever: Status, Vulnerability, and Challenges 83
http://dx.doi.org/10.5772/intechopen.82290

dengue fever increased rapidly over the past 45 years in Indonesia with peak incidence shift-
ing from young children to older age groups [27].
The threat of dengue fever among children was emphasized clearly on a recently published
study among 3194 children aged 1 through 18 years who lived in 30 different urban neigh-
borhoods. Children blood samples were drawn for antibodies to dengue, an indication that
someone has been infected with the virus in the past, and found that 69.4% of all children
tested positive for dengue antibodies. Among the age groups, positive antibodies found
33.8% at the group of 1–4 year olds, 65.4% at the group of 5–9 year olds, 83.1% at the group
of 10–14 year olds, and 89% at the group of 15–18 year olds. The first time to become infected
with dengue was at the age of 4.8 years as the median, and in addition, 13.1% of children on
average get their first dengue infection each year. It was also found that the more people in
a household who had been diagnosed with dengue since a child’s birth, the more likely the
child were to test positive for dengue antibodies [28].
The incidence rate (IR) for every 100,000 population in seven provinces were found over 100
or are prone to dengue cases. The seven provinces are Bali (484), East Kalimantan (306), DKI
Jakarta (198.7), DI Yogyakarta (167.9), North Kalimantan (158.3), Southeast Sulawesi (123.3),
and South Kalimantan (101.1). The lowest IR is achieved by Papua province (11.8) and West
Kalimantan (12.1) (Figure 1). The whole of Indonesia is high (IR is 78.0). In general, the
increasing number of dengue fever cases is more likely followed by the spread of the cities

Figure 1. Incidence rate (IR) of dengue fever per 100,000 population by province in Indonesia 2016 (source: DG of CDC
MOH 2017).
84 Current Topics in Tropical Emerging Diseases and Travel Medicine

Figure 2. Incidence rate (IR) of dengue disease per 100,000 population and number of cities/districts infected in Indonesia
1968–2016.

and districts infected in all of 34 provinces in Indonesia (Figure 2). From the total of 497 cities
and districts in Indonesia, about 80% have reported the dengue fever cases in 2017.

In the context of dengue fever mortality, as many as 1229 people died in 2015 from the disease
caused by this dengue virus. Throughout the history of dengue fever in Indonesia, the highest
death rate occurred when first time the disease was discovered in 1968 in Surabaya. Of the
58 people infected, 24 lives were lost. In 2016, the highest percentage of CFR was obtained in
Maluku Province (6.0%), Gorontalo (6.1%), and West Papua (4.6%). Provinces with the lowest
CFR were achieved by Papua (0%), DKI Jakarta (0.1%), and NTT (0.2%). In some provinces,
dengue disease was an outbreak in 1998 and 2004 that caused 79,480 people and 800 more
deaths. In subsequent years, there has been reported a decrease in the case of death but note
that the number of cases continues to increase. In 2008, there were 137,469 cases and 1187
deaths. In 2009, there were 154,855 cases and 1384 deaths [29].

3. Dengue fever vulnerability

Studies on Indonesian vulnerability to climate change were mostly focused on mitiga-

tion aspects, such as water scarcity, reduction emission from deforestation and degradation
(REDD), the forest conservations, disasters, land drought, floods, and others. Meanwhile, the
vulnerability study on adaptation is still rare, especially to human health. In 2013, Research
Center for Climate Change—University of Indonesia (RCCC-UI) initiated a study on vulner-
ability of dengue disease to climate change/variability in collaboration with the Directorate of
Environmental Health of the Ministry of Health and supported by Indonesia Climate Change
Trust Fund (ICCTF). The study involved 20 districts/cities in 5 provinces namely West Sumatra,
 Indonesia Dengue Fever: Status, Vulnerability, and Challenges 85
http://dx.doi.org/10.5772/intechopen.82290

Jakarta, East Java, Bali, and Central Kalimantan which were selected based on the availability
of monitoring station of the Indonesian Agency for Meteorology, Climatology, and Geophysics
(BMKG). The dengue disease vulnerability components were generated based on bionomic
mosquito and habitat, pathology dengue disease, and factors related to dengue disease occur-
rence. The exposure variables include land use (settlement, offices, business, schools, etc.) and
population density. The sensitivity variables include breeding places and resting areas of Aedes
mosquitoes, pupa and adult density, incidence of dengue fever, and population mobility. The
adaptive capacity variables include availability of health services (number of hospitals, clin-
ics, and public health centers), treatment management and skilled providers, implementation
of dengue fever intervention program, community participation and involvement on dengue
fever prevention program, and personal protection behavior. The Intergovernmental Panel
Convention for Climate Change (IPCC) vulnerability analysis was implemented to gain the
coping range index of DF for each city/district [31]. The coping range index (CRI) = 1 (blue)
indicates the people vulnerability of having dengue fever is very low and located at quadrant
between low exposure and sensitivity index and high adaptive capacity index; CRI = 2 (green)
indicates the people vulnerability of having dengue fever is low and located at quadrant
between high exposure and sensitivity index and high adaptive capacity index; CRI = 3 (yellow)
indicates the people vulnerability of having dengue fever is medium and located at quadrant
between medium exposure and sensitivity index and medium adaptive capacity index; CRI = 4
(brown) indicates the people vulnerability of having dengue fever is high and located at quad-
rant between low exposure and sensitivity index and low adaptive capacity index; and CRI = 5
(red) indicates the people vulnerability of having DF is very high and located at quadrant
between high exposure and sensitivity index and low adaptive capacity index (Figure 3) [30].

A study of Research Center for Climate Change—Universitas Indonesia 2013–2014 reported that
in almost all districts/municipalities under study (in 17 out of 20 regencies/cities) indicated a
very serious vulnerability condition of very high coping range index (CRI) (red = 5) since 2005.

Figure 3. The coping range index (CRI) of dengue disease vulnerability.

86 Current Topics in Tropical Emerging Diseases and Travel Medicine

Very high CRI was found in 75% of regencies/cities in West Sumatra province (City of Padang
in 2005, 2007, 2008, 2009, and 2012; Padang Pariaman Regency in 2008, 2011, and 2012; and City
of Padang Panjang in 2007 and 2008), all of regencies/cities in Bali province (City of Denpasar in
2006, 2009, and 2010; Jembrana Regency in 2007; City of Badung in 2007, 2009, and 2010), 80%
of regencies/cities in East Java province (City of Surabaya in 2007, 2008, 2009, 2011, and 2012;
Malang Regency in 2007, 2008, 2009, 2011, and 2012; City of Pasuruan in 2007, 2008, 2009, 2010,
and 2011; Sumenep Regency in 2007, 2008, 2009, 2011, and 2012), all of cities in Jakarta province
(City of Central Jakarta in 2005, 2006, 2007, 2008, 2009, and 2012; City of North Jakarta in the year
2006–2012), half of cities in Banten province (City of Tangerang in 2007–2012), all of regencies/cit-
ies in Central Kalimantan province (City of Palangkaraya in 2006, 2008, and 2012; Kotawaringin
Barat Regency in 2005–2008 and in 2012; Kotawaringin Timur Regency in 2008, 2010, and 2011;
Barito Utara Regency in 2008). High CRI (brown = 4) was also happened more often before
and following the years of the very high CRIs occurrences in the regencies/cities [30]. Thus, this
concluded that dengue fever is in the level of seriously vulnerable to people living in the regen-
cies/cities under study in Indonesia. Figures 4 and 5 show the dengue fever vulnerability among
cities/districts in 2012 in the provinces of Jakarta/Banten, Bali, Central Kalimantan, and East Java.

Figure 4. Map of CRI of dengue fever vulnerability in Jakarta/Banten and West Sumatra in 2012.

Figure 5. Map of CRI of dengue fever vulnerability in Bali, Central Kalimantan, and East Java in 2012.
 Indonesia Dengue Fever: Status, Vulnerability, and Challenges 87
http://dx.doi.org/10.5772/intechopen.82290

4. Dengue fever challenges

Dengue emerged as a public health burden and has become increasingly important, with
progressively longer and more cyclical epidemics of dengue including cases of dengue with
alarm signs and severe dengue. In Indonesia, although some programs and control efforts
have been performed, both the incidence and case fatality rate are still high and not showing
significant changes. There are still some challenges that need to be handled, such as sur-
veillance system, availability adequate laboratory, community knowledge, awareness, and
involvement against dengue, many new cases reported from new city or district, high mobil-
ity of dengue fever’s carrier, density of community in the city/district central, access to health
centers, and the availability of drugs and vaccines.
Surveillance for this vector-borne viral disease remains largely passive and based on the hos-
pital report which is the estimation of real cases still underreported. It was also reported
that many health centers and clinics were without adequate laboratory support. This will
lead increasing of referral activities to hospitals with the consequences of time spent and
transportation challenges in rural areas. Some studies found about one-third adult popula-
tion with sufficient knowledge about dengue fever and its fast spreading to other people.
However, only about 17% of them aware and clearly know the way for prevention [31, 32]. In
addition, the high number of dengue fever incidence can also be caused by increasing Aedes
aegypti mosquito breeding places, mosquito habitat, more effective mode of transmission,
more frequent dengue fever course, shorten dengue fever symptoms, access for dengue fever
treatment. Home conditions such as governance and the layout of goods at home can also
affect the high number of dengue fever incidence.
Indonesia is a country with a vast region, varied geographic and biodiversity, populated den-
sity, and characteristics of various populations. In the last decade, several new administration
districts developed with the newly reporting and recording management systems. This will
lead underreporting of dengue fever both from the passive surveillance and the number of
real cases estimation. The increasing number of people and the area of dengue fever spread
in Indonesia is due to the high population mobility, the development of urban areas, cli-
mate change, increasing population density, and changes in population distribution. Climate
change causes changes in rainfall, temperature, humidity, and air direction thus affecting the
breeding of Aedes aegypti mosquitoes.
The last and most important thing of the challenges is community participation. The participa-
tion of the community to participate consistently to keep the environment from dengue is still
difficult. Various breakthroughs by government such as 3 M plus (draining, covering, burying
or utilizing/recycling and all forms of prevention, such as to apply powder of larvae-killers in
water tanks, to use mosquito repellents, to keep fish predators to consume mosquito larvae,
etc.) movement, Jumantik (volunteer or student who periodically monitor Aedes larvae on
water storages at home) and so have long been circulated. But people who forget and bored
easily become a problem. For example, after some time, there was no extraordinary incident,
the community considered it safe and careless, consequently when the case exploded, people
just reacted [33].

Among other challenges, passive surveillance systems tend to underestimate the burden of
communicable diseases such as dengue. By utilizing the data from the Indonesian surveillance
88 Current Topics in Tropical Emerging Diseases and Travel Medicine

Figure 6. Estimated annual number of dengue cases and hospitalizations in Indonesia following adjustment of
surveillance reports with EFs, and their 95% confidence intervals (CIs), 2006–2015.

system and associated health system parameters, a study to estimate the proportion of dengue
was conducted by Delphi panel in 2017. The iterative estimation was generated by calculat-
ing the expansion factors (EF), the ratio of total and reported cases during the presentation
of medical and epidemiological data and subsequent discussions. The data revealed that
from all of symptomatic Indonesian dengue episodes, 57.8% enter healthcare facilities to
seek treatment but only 39.3% of them are diagnosed as dengue. Furthermore, only 20.3% of
them are subsequently reported in the surveillance system. Public sector found dominating
occurrence of hospitalizations and followed by private sector for ambulatory episodes (∼55%).
Therefore, estimations gave an overall EF of 5.00; hospitalized EF of 1.66; and ambulatory EF
of 34.01 which, when combined with passive surveillance data, equates to an annual average
(2006–2015) of 612,005 dengue cases, and 183,297 hospitalizations (Figure 6.). The findings are
lower than those similar estimations published elsewhere, perhaps due to case definitions,
local clinical perceptions, and treatment-seeking behavior [34].

5. Dengue fever prevention and control

The goal of WHO Global Strategy is to reduce the burden of dengue. Its specific objectives
are: (1) to reduce dengue mortality by at least 50% by 2020, (2) to reduce dengue morbidity
by at least 25% by 2020, and (3) to estimate true burden of the disease by 2015 (the year 2010
is used as the baseline). The implementing strategy is expected to pave the way for reduc-
ing dengue morbidity and mortality nationwide through strengthening local and national
capabilities, as well as regional coordination. National Dengue Control Program in Indonesia
 Indonesia Dengue Fever: Status, Vulnerability, and Challenges 89
http://dx.doi.org/10.5772/intechopen.82290

is currently implementing WHO Global Strategy 2012–2020 that promotes coordination and
collaboration among multisectoral partners, an integrated vector management approach and
sustained control measures at all levels. Dengue is an ecological disease, therefore coordi-
nation and collaboration by all sectors within the government, communities, civil societ-
ies, private sectors, and media need to be strengthened. All sectors should harmonize the
prevention, surveillance (entomological and epidemiological), and case management with
the existing health systems, in order to make the program sustainable, cost-effective, and
ecologically sound.

It has long been believed that preventing and reducing dengue virus transmission was very
depended upon vectors control (Aedes sp.) or interrupt the human-vector contact. Activities
to control transmission should target Ae. aegypti (the main vector) in the habitats of its adult
stages as well as the immature. The high death toll from dengue fever demands people to
stay alert to possible outbreaks of this disease in their neighborhoods [35]. Therefore, it is
important for the community to collectively jointly create a healthy environment free of larvae
to suppress the incidence of dengue disease. The prevention and control programs need to
be undertaken with specific commitments from stakeholders from the top to the bottom lev-
els. Currently, the Ministry of Health has launched a program of Nest Mosquito Eradication
Program (PSN) through 3 M plus way.

6. Conclusion

Given the wide area in the tropical temperature, high population density in urban area, and
various geographic and biodiversity, putting Indonesia as a natural potential for the habitat
of dengue viruses. The number of dengue fever cases reported dramatically increases since
it was firstly found in 1968 and spread out almost in 80% cities and districts in Indonesia in
2016. Many of those cities and districts were very vulnerable and putting million people at
risk to the disease in 2012. Some challenges are still heading in the front of the prevention and
control implementation actions. However, keeping spirit for struggling to combat dengue
fever in Indonesia along with full commitment and involvement of community are urgently
needed as well as to revitalize dengue disease eradication programs at every stage with close
monitoring implementation.

In addition, technical guidance and increased skills of health officers are indispensable.
Socialization of a hands-on program activities in particular and increased capacity and active
participation of community on the action could be a joint action in preventing the increase in
dengue disease associated to climate change.

Conflict of interest

The author declares no competing financial interests.

90 Current Topics in Tropical Emerging Diseases and Travel Medicine

Author details

Budi Haryanto1,2*
1 Research Center for Climate Change, University of Indonesia, Indonesia

2 Department of Environmental Health, University of Indonesia, Indonesia

*Address all correspondence to: [email protected]

References

[1] Ferreira GL. Global dengue epidemiology trends. Revista do Instituto de Medicina
Tropical de São Paulo. 2012;54:5-6

[2] Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, et al. Dengue: A
continuing global threat. Nature Reviews. Microbiology. 2010;2460:7-14

[3] Simmons CP, Farrar JJ, Chau NV, Wills B. Dengue. The New England Journal of Medicine.
2012;366:1423-1432

[4] Halstead SB. Dengue: Overview and history. In: Halstead SB, Pasvol G, Hoffman L, edi-
tors. Dengue. 1st ed. Vol. 5. Singapore: Imperial College Press; 2008. pp. 1-28

[5] Anderson KB, Chunsuttiwat S, Nisalak A, Mammen MP, Libraty DH, Rothman AL, et al.
Burden of symptomatic dengue infection in children at primary school in Thailand: A
prospective study. Lancet. 2007;369:1452-1459
[6] Kabra SK, Jain Y, Pandey RM, Madhulika, Singhal T, Tripathi P, et al. Dengue haemor-
rhagic fever in children in the 1996 Delhi epidemic. Transactions of the Royal Society of
Tropical Medicine and Hygiene. 1999;93:294-298

[7] Chan YC, Salahuddin NI, Khan J, Tan HC, Seah CLK, Li J, et al. Dengue haemorrhagic
fever outbreak in Karachi, Pakistan, 1994. Transactions of the Royal Society of Tropical
Medicine and Hygiene. 1995;89:619-620

[8] Gubler DJ. Epidemic dengue/dengue hemorrhagic fever as a public health, social and
economic problem in the 21st century. Trends in Microbiology. 2002;10:100-103

[9] Calisher CH. Persistent emergence of dengue. Emerging Infectious Diseases. 2005;11:737-739

[10] Halstead SB. More dengue, more questions. Emerging Infectious Diseases. 2005;11:740-741

[11] Smith AW. Dengue infections in travellers. Paediatrics and International Child Health.
2012;32:28-32

[12] Bulungahapitiya U, Siyambalapitiya S, Seneviratene SL, Fernando DJS. Dengue fever in

travellers: A challenge for European physicians. European Journal of Internal Medicine.
2007;18:185-192
 Indonesia Dengue Fever: Status, Vulnerability, and Challenges 91
http://dx.doi.org/10.5772/intechopen.82290

[13] World Bank Indonesia Data. 2016. http://data.worldbank.org/country/indonesia [Accessed:

2016]

[14] WHO. The Top 10 Causes of Death. Geneva (Switzerland): WHO; 2014. http://www.
who.int/mediacentre/factsheets/fs310/en/ [Accessed: 2014]

[15] Morens DM, Folkers GK, Fauci AS. The challenge of emerging and re-emerging infec-
tious diseases. Nature. 2004;430:242-249

[16] Saroso JS. Dengue haemorrhagic fever in Indonesia (1978). Asian Journal of Infectious
Diseases. 1978;2:7-8

[17] Gubler DJ, Soeharyono, Nalim S, Saroso JS. Epidemic dengue haemorrhagic fever in
rural Indonesia. Asian Journal of Infectious Diseases. 1978;2:152-155

[18] Nathin MA, Harun SR, Sumarmo. Dengue haemorrhagic fever and Japanese B encepha-
litis in Indonesia. The Southeast Asian Journal of Tropical Medicine and Public Health.
1988;19:475-481

[19] Ismangun, Wahab AS, Sutrisno R, Surjono A. Dengue haemorrhagic fever in Jogjakarta,
Central Java. Paediatrica Indonesiana. 1972;12:49-54

[20] Malavige GN, Fernando S, Fernando DJ, Seneviratne SL. Dengue viral infection. Postgradu-
ate Medical Journal. 2004;80:588-601

[21] Porter KR, Beckett CG, Kosasih H, Tan RI, Alisjahbana B, Rudiman PI, et al. Epidemio-
logy of dengue and dengue haemorrhagic fever in a cohort of adults living in Bandung,
West Java, Indonesia. The American Journal of Tropical Medicine and Hygiene. 2005;72:
60-66

[22] Suwandono A, Kosasih H, Nurhayati, Kusriastuti R, Harun S, Ma’roef C, et al. Four den-
gue virus serotypes found circulating during an outbreak of dengue fever and dengue
haemorrhagic fever in Jakarta, Indonesia, during 2004. Transactions of the Royal Society
of Tropical Medicine and Hygiene. 2006;100:855-862

[23] Beckett CG, Kosasih H, Faisal I, Nurhayati, Tan R, Widjaja S, et al. Early detection of
dengue infections using cluster sampling around index cases. The American Journal of
Tropical Medicine and Hygiene. 2005;72:777-782

[24] Bandyopadhyay S, Lum LC, Kroeger A. Classifying dengue: Review of the difficulties in
using the WHO case classification for dengue haemorrhagic fever. Tropical Medicine &
International Health. 2006;11:1238-1253
[25] Rivai A, Hamzah S, Rahman O, Thaib S. Dengue and dengue haemorrhagic fever in
Bandung. Paediatrica Indonesiana. 1972;12:40-48
[26] Setiati TE, Wagenaar JF, Kruit MD, Mairuhu AT, Gorp EC, Soemantri A. Changing epi-
demiology of dengue hemorrhagic fever in Indonesia. Dengue Bulletin. 2006;30:1-14
[27] Karyanti et al. The changing incidence of dengue haemorrhagic fever in Indonesia: A
45-year registry-based analysis. BMC Infectious Diseases. 2014;14:412
92 Current Topics in Tropical Emerging Diseases and Travel Medicine

[28] Prayitno A, Taurel A-F, Nealon J, Satari HI, Karyanti MR, Sekartini R, et al. Dengue
seroprevalence and force of primary infection in a representative population of urban
dwelling Indonesian children. PLoS Neglected Tropical Diseases. 2017;11(6):e0005621.
DOI: 10.1371/journal.pntd.0005621
[29] Kusriastuti R. Data Kasus Demam Berdarah Dengue di Indonesia 2008 dan 2009. Jakarta:
Ditjen PP & PL Depkes RI; 2010
[30] Haryanto B. Health adaptation scenario and dengue fever vulnerability in Indonesia. In:
Akhtar R, editor. Climate Change and Human Health Scenario in South and Southeast
Asia. Switzerland: Springer; 2016. pp. 221-236. ISSN 1879-7180

[31] Itrat A, Khan A, Javaid S, Kamal M, Khan H, et al. Knowledge, awareness and practices
regarding dengue fever among the adult population of dengue hit cosmopolitan. PLoS
One. 2008;3(7):e2620. DOI: 10.1371/journal.pone.0002620
[32] Malhotra G, Yadav A, Dudeja P. Knowledge, awareness and practices of dengue in a
city. International Journal of Medical Science and Public Health. 2014;3(3):295-299
[33] Simanjuntak R, Farchanny. 1 House 1 Jumantik: Movement a Call for Action. E-Health
Bulletin. Issue No. 11, Jan-June 2017
[34] Wahyono TYM, Nealon J, Beucher S, Prayitno A, Meureau A, Nawawi S, et al. Indonesian
dengue burden estimates: Review of evidence by an expert panel. Epidemiology and
Infection. 2017;145:2324-2329. United Kingdom: © Cambridge University Press. DOI:
10.1017/S0950268817001030

[35] Saputra M, Oktaviannoor H. One health approach to dengue haemorrhagic fever con-
trol in Indonesia: A systematic review. In: The 1st International Conference on Global
Health, KnE Life Sciences. 2017. pp. 201-221. DOI: 10.18502/kls.v4i1.1382