Dengue haemorrhagic fever and Japanese B encephalitis in Indonesia.

Dengue haemorrhagic fever (DHF) was first recognized in Indonesia in the cities of Jakarta and Surabaya in 1968, 15 years after its recognition in the Philippines. During the 1968 outbreak, a total of 58 clinical cases with 24 deaths were reported. The number of reported cases since then has increased sharply, with the highest number of cases recorded in the years 1973 (10,189 cases), 1983 (13,668 cases), and 1985 (13,588 cases). Outbreaks of the disease have spread to involve most of the major urban areas, as well as some of the rural areas. In 1985, the disease had spread to 26 of 27 Provinces and 160 of 300 regencies of municipalities. At present, the disease is endemic in many large cities and small towns. Interestingly, DHF has not been reported in some cities, even though dengue virus transmission rates in those cities are high. The epidemic pattern of DHF for the country as a whole has become irregular. Since 1982, the intensity and spread of DHF has created an increasing public health problem in Indonesia, particularly in Java where 60% of the total population of the country resides. Java contributed about 71% of all cases occurring in the country in 1982, 84% in 1983, and 91% in 1984. The peak monthly incidence of DHF was frequently reported during October through April, months which coincide with the rainy season. The morbidity rate for Indonesia, estimated from reported cases over five years (1981-1985), ranged between 3.39 to 8.65 per 100,000 population. The overall case fatality rate has steadily declined from 41.3% in 1968 to 3% in 1984.(ABSTRACT TRUNCATED AT 250 WORDS)

Dengue haemorrhagic fever in Indonesia.

Dengue haemorrhagic fever (DHF) was first recognized in Indonesia in the cities of Jakarta and Surabaya in 1968, 15 years after its recognition in the Philippines. During the 1968 outbreak, a total of 58 clinical cases with 24 deaths were reported. The number of reported cases since then has increased sharply, with the highest number of cases recorded in the years 1973 (10, 189 cases), 1983 (13,668 cases), and 1985 (13,588 cases). Outbreaks of the disease have spread to involve most of the major urban areas, as well as some of the rural areas. In 1985, the disease had spread to 26 of 27 Provinces and 160 of 300 regencies or municipalities. At present, the disease is endemic in many large cities and small towns. Interestingly, DHF has not been reported in some cities, even though dengue virus transmission rates in those cities are high. The epidemic pattern of DHF for the country as a whole has become irregular. Since 1982, the intensity and spread of DHF has created an increasing public health problem in Indonesia, particularly in Java where 60% of the total population of the country resides. Java contributed about 71% of all cases occurring in the country in 1982, 84% in 1983, and 91% in 1984. The peak monthly incidence of DHF was frequently reported during October through April, months which coincide with the rainy season. The morbidity rate for Indonesia, estimated from reported cases over five years (1981-1985), ranged between 3.39 to 8.65 per 100,000 population.

DHF characterized by acute type DIC with increased vascular permeability.

Decreases in platelet count, fibrinogen concentration, factor VIII, antithrombin III and alpha 2-antiplasmin activities, increase in FDP-D fraction, and pleural effusion were observed transiently at early fever stage of DHF at grade II, indicating DHF patients had manifestations of the acute type of DIC with increased permeability of vascular wall.

Protection against marked plasma leakage in dengue haemorrhagic fever by infusion of carbazochrome sodium sulfonate (AC-17).

Patients diagnosed clinically as having grade II dengue haemorrhagic fever, and confirmed serologically to have been recently infected by dengue virus were randomly assigned to two groups, to assess suppression of plasma leakage by intravenous administration of carbazochrome sodium sulfonate(AC-17). The double-blind prospective study over three successive epidemic periods included 39 patients in the placebo group, and 38 in the AC-17 group. The effects of the administration were evaluated with respect to pleural effusion of the chest X-ray films. A clear difference between the two groups was found in the numbers of patients with pleural effusion and severity of the pleural effusion thus the administration of AC-17 may be useful in eliminating the risk factors of severe bleeding and shock in dengue haemorrhagic fever.

Immunological changes and recovery in patients with dengue haemorrhagic fever.

In studying the immunological changes in dengue haemorrhagic fever, three phases of investigations had been carried out. During the earlier phase of investigation, significant immunological findings were obtained, namely the elevation of immunoglobulins, activation of complements, formation of circulating-immune-complexes and diminished number of T lymphocytes. The changes tended to recover during the convalescent phase. During the second phase of investigation, the extended studies revealed further confirmation of T cell impairment during the acute phase which tended to recover during the convalescent phase. Elevated number of Fc-receptor- and C3-receptor-bearing cells was also observed in some patients, variedly occurred during the acute or the convalescent phase. Elevated number of B cells was only found in small proportion. Significantly high number of activated RNA-rich lymphocytes was found in almost the half of patients. The virus-lymphocyte interaction has been demonstrated by the detection of viral antigen on the surface of lymphocytes in a proportion of patients. The circulating-immune-complexes was shown to contain viral (DEN-1) antigen. During the third phase of investigation, the impairment of T cells was further analyzed on their regulatory T populations. Impairment of total T lymphocytes, helper-T and suppressor-T was detected during the acute phase and tended to recover during the convalescent phase. The reversed changes occurred on B cells, The immunological changes and recovery are considered to be related to the stimulatory and suppressive effects of the dengue virus and regulatory mechanism.

Dengue hemorrhagic fever accompanied by encephalopathy in Jakarta.

Forty one cases of dengue hemorrhagic fever, confirmed by viral isolation, accompanied by neurological signs compatible to the diagnosis of acute encephalopathy were observed in 3 University Hospitals in Jakarta during the period November 1975 to December 1977. Two of these children showed typical signs and symptoms of Reye's syndrome confirmed by liver biopsy.

Dengue with haemorrhage and shock in Jakarta, Indonesia.

Pediatric patients with fever and haemorrhage were studied in Jakarta, Indonesia between May 1973 and January 1974. Eighty-one of 104 demonstrated unequivocable evidence of dengue with clinical findings similar to those reported associated with dengue haemorrhagic fever in Thailand. The majority of patients had extremely high antibody titers against dengue measured by both hemagglutination-inhibition and by plaque reduction neutralization tests and all four types of dengue virus were isolated. Eight of the patients died.