Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01
Entomological investigation during dengue outbreak in Kudus and
Jepara Districts, Central Java, Indonesia
1,2* 3 4 1 1 Muhammad Choirul Hidajat ,Eddi Dharmana ,Martini Martini ,Widiarti Widiarti ,Triwibowo Ambar Garjito
1Institute for Vector and Reservoir Control Research and Development, National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia 2Doctoral Program on Medicine and Health Science, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia 3Faculty Of Medicine, Universitas Diponegoro, Semarang, Indonesia 4Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
*Corresponding author: Muhammad Choirul Hidajat Perum Sehati D137, Blotongan Sidorejo, Kota Salatiga Phone numbers: +62895627237877 Facsimile numbers:+ (0298) 312107 E-mail address: [email protected]
Abstract
Background: Between January to July 2014, dengue outbreak occurred in Kudus and Jepara Districts, Central Java Province. We conducted an entomological investigation of the dengue vectors in 6 selected villages with the most impact on the outbreak. Aims: This study aimed to investigate the risk factor of dengue transmission based on entomology data and to identifies the most appropriate vector control measure. Methods and materials: Larvae collection was conducted in 6 selected endemic villages using the single larvae method. The survey used a cross-sectional method. We used Breteau Indices (BI) and Density Figure (DI) to assess the risk transmission. The resistance assay was carried out using the WHO standard impregnated paper. The Odd Ratio test was carried out to determine the risk factor of potential breeding places. Results: The dengue risk transmission in this study varies between low, medium, and high, with an average BI rate above 5 and DI between 2-7. The main breeding places were water tanks in bathrooms. There was no difference in risk between covered and uncovered containers becoming breeding sites, and varied risk between drained and non-drained containers. Aedes aegypti from all villages were resistant against all insecticides classes. Conclusion: Outbreaks occurred in all villages, although the risk of transmission was low. Due to the resistance to insecticides, vector control approaches should be introduced, such as mechanical and bio-insecticide methods. It is necessary to develop alternative entomological parameters to predict risk transmission more accurately.
Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24120 Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01
Keywords: Dengue Outbreak, entomological investigation, Kudus, Jepara
How to cite this article: Hidajat MC, Dharmana E, et al (2021): Entomological investigation during dengue outbreak in Kudus and Jepara district, Central Java , Ann Trop Med & Public Health; 22(S01): SP24120. DOI: http://doi.org/10.36295/ASRO.2021.24120
Introduction
Dengue is a vector-borne disease that has become one of the major public health problems in Central Java Province, Indonesia. The circulation of four distinct serotype of Dengue virus (DENV-1, DENV- 2, DENV-3, and DENV-4) have also been reported in this area. This disease was reported to have spread to all districts with the incidence rate (IR) has increased from 15.27 per 100,000 population in 2011 to 19.29 and 45.52 in 2012 and 2013 respectively. In the same period, the case fatality rate (CFR) was also high, i.e., 0.95 (2011), 1.52 (2012), and 1.21 (2013). In the end of 2013, the IR in 27 districts was more than 20 per 100,000 population, and only 8 of 35 districts had an incidence rate of less than 20 per 100,000 population1. Currently, Central Java continuously noted as an important province in Indonesia that serves as a center for DENV transmission.
Jepara and Kudus, two districts in the Central Java region, have long been known as dengue endemic areas. In Jepara, total of 154 confirmed cases of dengue were reported in 2011, with 1among them fatal in Jepara. . In 2012, the number of dengue infection increased to 415 cases with 11 fatal cases.The significant outbreaks of was confirmed in this district in 2013, which the confirmed cases reached up to 411 cases. As of July 2014, there were 480 cases of DHF reported2. In Kudus, the number of DHF cases was 148 in 2011. However, in 2012 and 2013, there were 162 and 501 cases of DHF reported, respectively, in all villages3.
While vaccines and effective drugs for dengue are not yet available, entomological surveillance and vector control are the main efforts to prevent and control dengue outbreaks. Based on the outbreak situation in these two districts, an investigation and entomological study of DHF outbreaks was carried out.
Subjects and Methods
This observational study was conducted in the districts of Jepara and Kudus, Central Java Province. The survey was conducted by collecting Ae. aegypti larvae in 3 selected dengue-endemic villages from 2 districts using single larvae methods. In Jepara District, the survey was carried out in the villages of Demaan, Ujung Batu, and Bandengan, while in Kudus district it was carried out in the villages of Tanjung Rejo, Undaan, and Pasuruan Lor. All containers inspected were recorded: presence/absence of larvae, type of container, house, or village in which the larva was found.
Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24120 Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01
All larvae obtained were identified using the identification keys from Stojanovich and Scott5and Mahadevan and Cheong6. Population Ae. aegypti larvae were assessed based on the results of the larvae survey. The level of risk of transmission was analyzed using the stegomyia index and free larvae survey7. The measured stegomyia index includes the container index (CI: percentage of positive water reservoirs with Ae. aegypti larvae), the house index (HI: the percentage of positive houses with Ae. aegypti larvae), and the breteau index (BI: positive container with Ae. Aegypti larvae per 100 houses) and Density figure (DI).
Resistance tests were carried out on Aedes aegypti mosquitoes in 5 villages, namely Ujung Batu and Bandengan, at Jepara District and TanjungRejo, Pasuruan Lor, and Undaan in Kudus District. The test was carried out using the WHO Standard Impregnated paper method, and the resistance status was determined after 24 hours of observation. The types of insecticides used for the test were Malathion (Organophosphate), etofenprox, and Bendiocarb (Carbamate), Cypermethrin, Permethrin, Deltamethrin, and Lambda-cyhalothrin (Pyretrhoid).
Results
Three Villages the Kudus Regency area were surveyed. The complete results of this survey can be seen in Table 1.
Table 1. Larva Index of Aedes aegypti in 3 villages of Kudus District, 2014
No. Villages Number of Density Index (%) Risk of House Figure Transmission* HI CI BI FLI 1. Tanjungrejo 110 17.3 10 19.1 92.7 2 Low 2. Undaan 100 31.8 22.8 31.8 68.2 5 Medium 3. Pasuruan lor 96 43.8 39.9 55.2 53 7 High
* Based on WHO8 & Brown9 criteria
The larva index shows that 3 villages in Kudus district have various levels of Transmission Risk. Based on the House Index and Density figure, the assessment of risk transmission was carried out. Tanjungrejo is a village with low dengue transmission potential, while Undaan village has a moderate dengue transmission potential. Pasuruan lor village has a high potential for dengue transmission. This can be seen from the BI indicator, which is above 35% and DI = 7, which is a high potential area for transmission based on WHO criteria (1994) 8
Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24120
Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01
Table 2. Types of breeding sites and the number of positive containers containing Aedes larvae in Tanjungrejo, Undaan, and Pasuruan Lor Villages in November 2014
Tanjungrejo Undaan Pasuruan lor
No. Types of kontainer No. of Positive No. of Positive No. of Positive Container Container Container 1. Tanks for bathroom 93 14 73 29 74 41 2. Toilet Tub 6 1 9 3 4 2 3. Crock 11 1 2 0 5 1 4. Bucket 61 1 61 0 34 4 5. Used Cans 1 1 0 0 0 0 6. Used Pot 1 1 0 0 0 0 7. Aquarium 5 0 2 0 0 0 8. Bird drinking places 3 0 0 0 0 0 9. Coconut Shell 1 0 0 0 0 0 10. drum 0 0 0 0 4 0 11. Tree Hole 0 0 0 0 2 2 12. Jerry Cans 0 0 0 0 1 0 13. Refrigerator 0 0 0 0 8 0 14. Others 29 2 2 2 134 50
211 21 149 34 265 98
Bathroom water tanks are dominant breeding places for Aedes spp in 3 villages in Kudus, followed by WC, buckets and jars, and others.
In Jepara Regency, an Aedes spp larvae survey was conducted in three villages, namely Demaan, Ujungbatu, and Bandengan Villages. The results of the survey activities carried out in September 2014 can be seen in Table 3.
Table 3 Larva Index of Aedes aegypti in 3 villages of Jepara District, 2014 No. Villages Number of Density Risk of Index (%) House Figure Transmission* HI CI BI FLI 1. Demaan 100 14 9,3 16 86 2 Low 2. Ujungbatu 100 28 21,1 16 72 3 Low 3. Bandengan 100 5 4,1 7 95 3 Low * Based on WHO8 & Brown9 criteria
Three villages in Jepara District have low potential for transmission. Density figures range from 2-3, with FLI between 75-95 and BI below 20%. The number of DHF cases in the three villages shows an increase in 3 consecutive years. Although the potential for transmission is low, these three urban villages are endemic areas for DHF. In 3 consecutive years (2011 - 2013), Demaan village reported an increase in the number of cases. The number of reported cases in 2011 was 2. In 2012 and 2013, it increased to 11 and 40 people. However, the risk of transmission in the 3 villages was low.
Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24120
Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01 In Ujungbatu Village, the number of cases in 2011-2013 period also increased to 1, 6, and 10 cases, respectively.
Table 4. Types of breeding sites and the number of positive containers containing Aedes aegypti larvae in Demaan, Ujung Batu, and Bandengan Villages, collected in September 2014
Demaan Ujungbatu Kel. Bandengan
No. Types of Container No. of Positive No. of Positive No. of Positive Container Container Container 1. Tanks for Bathroom 50 13 79 20 48 5 2. Toilet Tub 2 0 12 4 13 1 3. Crock 7 1 0 0 23 0 4. Bucket 99 2 35 3 75 0 5. Used Can 0 0 0 0 0 0 6. Used Pan 0 0 0 0 0 0 7. Aquarium 1 0 2 0 0 0 8. Bird drinking place 0 0 0 0 0 0 9. Coconut shell 0 0 0 0 0 0 10. drum 3 0 5 2 3 1 11. Tree Hole 0 0 0 0 0 0 12. Jerry can 0 0 0 0 0 0 13. refrigerator 0 0 0 0 0 0 14. Dispenser 4 0 7 1 8 0 15. Others 0 0 0 0 0 0 172 16 147 31 170 7
Based on the survey, water tanks for the bathroom were the most dominant breeding places for Aedes aegypti in the 3 study villages in Jepara, followed by a bucket and a toilet tub.
Table 5. Covered and drained containers as risk factors for the absence of Aedes aegypti larvae
Villages Drained container Covered container OR 95% CI OR 95% CI No Kudus District 1 Tanjungrejo 0.447* 0.242-0.827 O.798 0.302-2.109 2 Undaan 0.065* 0.025-0.167 1.493 0.364-6.117 3 Pasuruan Lor 0.801 0.386-1.661 0.498 0.223-1.115
Jepara District 1 Demaan 0.759 0.314-1.834 0.384* 0.148-0.999 2 Ujung batu 0.280* 0.136-0.578 1.310 0.394-4.349 3 Bandengan 0.173* 0.050-0.601 1.080 0.421-2.769 * Statistically significant
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Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01 Data in 4 villages (Tanjungrejo, Undaan Ujung Batu, and Bandengan) show that containers drained in the last week appear to have a lower risk of containing larvae than if they were not drained. In the other 2 villages, there is no difference in risk. For breeding places that are covered and not covered, there is no difference in terms of risk of finding larvae in almost all villages.
In all villages, there are no residents who use larvicides for mosquito control.
Table 6: Resistance status of Aedes aegypti from Jepara and Kudus District, 2014.
% Death Organo Carbamate Cypermethrin No Villages phosphate Malathion Bendio Etophen Perme Lambda Delta Cyper 0.8% carb prox thrine cyhalothrin methrin methrin 0.1% 0.5% 0.75% e 0.05% e e 0.05% 0.05% 1 Ujungbatu 28.3 23.3 3.3 15 30 33.3 5 2 Bandengan 20 68.3 13.3 43.3 35 35 15 3 Tanjung Rejo 4 43 29 5 42 36 6 4 Pasuruan Lor 21 15 12 29 83 51 7 5 Undaan 5 12.5 5 5 35 32.5 10
The resistance tests carried out on Aedes aegypti mosquitoes in 5 study locations have revealed that almost all study areas were resistant to all types of insecticides. Mosquitoes are declared resistant if the 24-hour mortality test results are less than 90% (WHO). The highest mortality rate from insecticides varied in all villages. In Ujung Batu and Undaan the highest was Deltamethrin. In Bandengan village, the highest was Bendiocarb and in Pasuruan Lor village, it was Lamda Cyhalothrine.
Discussion
The entomological survey in 6 dengue-endemic villages from Jepara and Kudus districts showed various results of transmission risk. Three villages in Kudus District have low, medium, and high dengue transmission risks respectively, while in Jepara District, all 3 selected endemic villages have low transmission risk. This result indicated that the larval index cannot reflect the dengue transmission during outbreak in Jepara and Kudus Districts. Previous study that has been done in Palu, Central Sulawesi has shown contradictory results. The study in Tondo Village, Palu City has revealed a high transmission rate according stegomyia indices, i.e. BI = 36 and DI = 6. Even though Tondo village has a high risk of transmission, the number of dengue case was very low10. Another report covering 57 locations from 29
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Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01
provinces in Indonesia during 2015-2018 shows there is no correlation between stegomyia indices and the case of dengue11.
According to WHO vector surveillance standard8, an area with BI = 2 or less was considered as safe dengue area, while an area with BI = 5 or more is potential (at risk). There will be a risk of dengue transmission. Thus, if it is stratified based on the BI, then BI = 5-20 is considered low risk, BI = 20-35 is considered medium risk, while BI = 35-50 is considered high risk. By using the Density figure (DI) and the House index (HI), according to Brown (1977)9, the potential for transmission can be predicted. According to Brown, effective DHF transmission occurs when HI> 5 and DI> 3.38, 39
Inconsistencies in the relationship between stegomyia index and DHF cases have also been reported worldwide. Studies showing a significant relationship were reported in Havana, Cuba12, Trinidad13, Vietnam14, and Venezuela15. Studies showing no association were reported in Malaysia16, Fortaleza, Brazil17, and Columbia18. Inconclusive relationships are reported in Studies in Taiwan19, Peru20. This study indicates that covered and uncovered containers have the same risk of becoming breeding places. For drained and non-drained Containers, in 4 villages draining containers one week earlier reduced the risk of containers becoming an Aedes aegypti breeding place, while in 2 villages there were no differences in risk between drained and non-drained containers. These results may be due to the improper way of closing the container and improperly draining the container. The program to eradicate mosquito breeding places through burying, draining, and closing containers, known as 3M movement (menutup=covering, mengubur=burrying, menguras=draining) has been a national program for many years. Since 1992 the eradication of mosquito breeding place has been driven by the following strategies:(i) health education using mass media, women’s groups, and schoolchildren; (ii) implementing 3M by door-to-door visits by PKK volunteers (women empowerment welfare group); and (iii) source reduction using community participation and intersectoral coordination21.Based on the findings, 3M's strategy must be given more attention, especially in the technical aspects of adequately draining and closing containers. Improperly draining and closing will cause the container to remain a breeding place for Aedes aegypti.
Widiarti reported that transovarial transmission of dengue in Ae. aegypti was occurred in 6 sub-district of Central Java with infection rate among them between 0.48% - 8.77%22. The transovarial transmission of the dengue virus also increases the potential for dengue transmission in various dengue- endemic areas in Indonesia. Another study conducted by Joshi et al. showed a low percentage (2.4%) of positive viral antigenin the first generation (F1), but the percentage increased until the 7th generation and after that were stable23. Insecticide resistance tests carried out in 5 villages in the study location showed that the dengue vector in the area was resistant to 7 of the 3 insecticide classes, i.e. pyrethroids, organophosphates and carbamates. These results show the same results as several previous studies that have been reported by
Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24120 Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01
Widiarti (2011), Sayono (2016), and Widiastuti (2016) in Central Java. Martini (2019) also reported the activity of the enzyme monooxygenase in the Aedes aegypti mosquito in Semarang25. This enzyme is known to play a role in the metabolism of the pyrethroid insecticides. The susceptibility test conducted in Semarang in 2019 also showed that the Aedes aegypti mosquito was still resistant to pyrethroids but susceptible to organophosphates26. The last use of organophosphates in the Aedes aegypti control program was carried out in Semarang in 2016. The results of Martini's research (2019) show the activity of the enzyme monooxygenase in the Aedes aegypti mosquito in Semarang25.This enzyme is known to play a role in the metabolism of the pyrethroid insecticides. The susceptibility test conducted in Semarang in 2019 also showed that the Aedes aegypti mosquito was still resistant to pyrethroids but susceptible to organophosphates26. The last use of organophosphates in the Aedes aegypti control program was carried out in Semarang in 2016. Resistance occurs due to continuous contact between mosquito vectors and insecticides. Wigati (2012) and Kusumastuti (2014) have reported that household insecticides are widely used because of their low cost and easy access27,28. Gray reported that household spray insecticides reduced Aedes aegypti mortality from 99% to 44%, and increased the risk of mutations in the VGSC gene responsible for target site resistance to pyrethoid26.
In this study, the low FLI is supported by the large number of water reservoirs (TPA). Ae. aegypti is found predominantly in various water storage tanks in the form of bathrooms, jars, buckets, toilet tubs, and other containers (broken glass, solids, plastic containers in landfills, etc.). Breteau Index (BI) and House Index (HI) are generally used to determine priority areas to be controlled. According to Suroso et al. (2003), BI is the best index because it shows the relationship between positive containers and the number of houses.
If the transovarial transmission is proven to occur in an area and mosquitoes are mosquitoes' status resistant to insecticides, to prevent outbreaks, massive PSN needs to be done correctly and adequately. The proper and correct eradication of mosquito breeding places is by draining, covering, and hoarding (3M +). Also, brushing of container wall needs that the eggs can be damaged Other controls can be done by focusing on the larval stage with larvacides or living bodies (biolarvicide).
In the case of an outbreak where fast action is needed to reduce vector mosquitoes' density, space spraying (fogging) can be done using an insecticide with the highest mortality rate. Fogging is carried out in two (2) cycles with 1-week intervals, which will be very effective when an outbreak occurs to kill adult mosquitoes that contain the virus, or when the transmission is in progress (cycle I). The second cycle is carried out to kill the larvae that become adult mosquitoes in the following week.
Conclusion
1. Outbreaks occur in areas with low, medium, and high potential for transmission.
Annals of Tropical Medicine & Public Health http://doi.org/10.36295/ASRO.2021.24120 Hidajat et al (2021): Entomological investigation during dengue outbreak, Jan 2021 Vol. 24 Issue 01
2. Aedes aegypti in all research areas has been resistant to insecticides from the pyrethroid, organophosphate and carbamate groups. 3. Aedes aegypti in all research areas has been resistant to insecticides from the pyrethroid,
organophosphate and carbamate groups.
4. It should be considered to introduce other vector control approaches, such as mechanical and bio- insecticide methods. 5. It is necessary to develop alternative entomological parameters to predict risk transmission more accurately.
Acknowledgment
The authors would like to thank and appreciate the Director of IVRCRD, NIHRD-MoH, Salatiga. We also thank all staff of IVRCRD, NIHRD-MoH, for their great support during this study.
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