{:en}The Coronavirus Disease (COVID-19) pandemic had a significant impact on the health systems around the world. Since it was discovered in Wuhan, Hubei Province, China on December 31, 2019, COVID-19 has spread to 219 countries in the world, and infected 126,890,643 people, and caused 2,778,619 deaths as of March 29, 2021. Indonesia is a country with the highest cases in Southeast Asia, with 1,476,452 cases and 39,893 deaths.

Before the COVID-19 pandemic. The World Health Organization has classified several diseases as Neglected Tropical Diseases (NTDs). There are 20 diseases that are grouped into NTDs, named Chagas disease, dengue, chikungunya, yaws, dracunculiasis, trypanosomiasis, leprosy, onchocerciasis, leishmaniasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminths, trachoma, buruli ulcers, echinococci taeniasis, cutaneous leishmaniasis, mycetoma, chromoblastomycosis, and snake bites.

Neglected tropical diseases in Indonesia that controlled by the Ministry of Health are leprosy, filariasis, yaws, soil-transmitted helminths / STHs, and schistosomiasis. Based on the five diseases, there are some challenges and hopes in controlling each of these diseases. The management of leprosy in the era of the COVID-19 pandemic in Indonesia including: 1) co-infection between COVID-19 and leprosy which has been reported in several countries in the world, but has not been reported in Indonesia; 2) increasing bad stigma against patients with leprosy co-infection and COVID-19; 3) access to the health system is still limited due to the priorities for COVID-19 patients; 4) poverty and limited practice of clean and healthy living habits. The Indian Dermatological Association provides several recommendations regarding leprosy management in the pandemic era, which are: 1) advocacy by health workers for leprosy patients to adopt clean and healthy living habits (PHBS); 2) leprosy patients still adhere to the therapeutic rules as recommended; 3) leprosy patients are registered for multi-drug therapy; 4) some patients with leprosy are at risk of being infected with COVID-19, including those who are undergoing treatment with corticosteroids; 5) damage to the nervous system in leprosy patients can lead to the formation of lesions (especially in the eyes, feet, and hands), dry and deformed skin.

Filariasis is a group of diseases caused by roundworms / nematodes, of the species Wuchereria bancrofti¸ Brugia malayi, and Brugia timori and transmitted through mosquito bites of the genus Culex. Mosquitoes from the genus Culex are the main vectors, but there are also reports of the transmission of filariasis by mosquitoes from other genera, namely Aedes, Anopheles, and Mansonia. Data from the Indonesian Health Profile in 2019 shows that there are still cases of filariasis, which are as many as 592 new cases. The highest number of cases was found in Papua, followed by the provinces of East Nusa Tenggara, East Java, West Papua, and Aceh. The main method to control filariasis is mass drug administration in communities at risk. When the COVID-19 pandemic, several mass treatment agendas were postponed, so the achievement of the target set by the Global Program to Eliminate Lymphatic Filariasis was delayed, MDA evaluation studies in Indonesia were also still limited, some community groups at risk were also reluctant to carry out continuous treatment because of discomfort, so that the elimination program has not been maximum. Campaigns related to the use of insecticide-treated bed nets to prevent mosquito bites are also being carried out by health workers in risky areas.

Yaws / yaws is a contagious disease caused by Treponema pallidum subspecies pertenue. This bacterial infection can cause damage to the bones and skin. The group that is susceptible to this infection is the age group of 15 years, and mostly found in the age range of 6 to 10 years. There are 18 provinces that report cases of yaws, which are scattered in Papua, Maluku, East Nusa Tenggara, and Sulawesi. The prevalence of yaws in 2019 is 0.9 per 10,000 population. The challenges for yaws control in Indonesia are the lack of surveillance and case tracking, late reporting of cases, and unsustainable surveillance systems.

Soil-transmitted helminths are infectious diseases that are still a burden for several countries in the Southeast Asian region. The challenges for controlling STHs in Indonesia are 1) inconsistency in monitoring the control program; 2) expanding the coverage of chemotherapy in risk groups; 3) possible emergence of drug resistance; 4) and weak diagnostic methods. During the COVID-19 pandemic era, there was a possibility of co-infection of STHs patients with COVID-19 so that it required special treatment. Mass treatment for communities at risk also experiences delays, due to disrupted drug distribution.

Schistosomiasis is a parasitic infectious disease caused by trematode worms of the genus Schistosoma. There are two types of schistosomiasis; intestinal and urogenital schistosomiasis, caused by the species Schistosoma haematobium, Schistosoma mansoni, and Schistosoma japonicum. Schistosomiasis in Indonesia is caused by Schistosoma japonicum which is spread in Asian countries, such as China, Japan, Philippines, Vietnam, Laos, Thailand, and Cambodia. Schistosomiasis eradication in Indonesia requires the collaboration of various sectors such as health workers, government, and society, especially in the COVID-19 pandemic, where access to the health system is limited.

Based on the description above, Indonesia still has several problems related to NTDs control, especially in COVID-19 pandemic. The literature review in this article concludes that Indonesian government can strengthen efforts to control NTDs in various ways, including collaboration with the community for the discovery of new cases, introducing gadger-based applications for detecting and monitoring of patient progress. Increasing testing, tracing, and treatment for COVID-19 also needs to be done, so that the transmission of COVID-19 in the community can be minimized. If the transmission of COVID-19 can be minimized, then detection and control of NTDs can be optimized.

Author : Shifa Fauziyah, Teguh Hari Sucipto, etc.
Source : news.unair.ac.id

Translator : Ausie{:}{:id}Pandemi Coronavirus Disease (COVID-19) telah membawa dampak yang signifikan bagi tatanan sistem kesehatan di seluruh dunia. Sejak ditemukan di Wuhan, Provinsi Hubei, China pada tanggal 31 Desember 2019, COVID-19 telah menyebar ke 219 negara di dunia, dan menginfeksi sebanyak 126.890.643 orang dan menyebabkan kematian sebanyak 2.778.619 per tanggal 29 Maret 2021. Indonesia merupakan Negara dengan kasus tertinggi di kawasan Asia Tenggara, yaitu sebanyak 1.476.452 kasus dan 39.893 kematian.

Sebelum adanya pandemi COVID-19. Badan Kesehatan Dunia/ World Health Organization telah mengelompokkan beberapa penyakit yang tergolong sebagai penyakit tropis terabaikan atau Neglected Tropical Diseases(NTDs). Terdapat 20 penyakit yang dikelompokkan dalam NTDs yaitu penyakit Chagas, dengue, chikungunya, frambusia, dracunculiasis, tripanosomiasis, leprosy, onkoserkiasis, leishmaniasis, filariasis limfatik, skistosomiasis, penyakit infeksi cacing tanah/soil transmitted helminths, trachoma, buruli ulcer, ekinokokosis, trematodiasis, taeniasis, leishmaniasis kutaneus, misetoma, kromoblastomikosis, dan gigitan ular.

Penyakit tropis terabaikan yang terdapat di Indonesia yang menjadi focus pengendalian oleh Kementerian Kesehatan yaitu leprosi, filariasis, frambusia, soil-transmitted helminths/STHs, dan skistosomiasis. Berdasarkan kelima penyakit tersebut, terdapat tantangan dan harapan di setiap pengendalian penyakit tersebut. Manajemen leprosy di era pandemic COVID-19 di Indonesia diantaranya meliputi 1) koinfeksi antara COVID-19 dan leprosi yang telah dilaporkan di beberapa Negara di dunia, namun belum dilaporkan di Indonesia; 2) peningkatan stigma buruk terhadap pasien koinfeksi leprosy dan COVID-19; 3) akses ke sistem kesehatan yang masih terbatas dikarenakan prioritas bagi pasien COVID-19; 4) kemiskinan dan praktik perilaku hidup bersih dan sehat yang masih terbatas. Organisasi Perhimpunan Dermatologis India memberikan beberapa rekomendasi terkait manajemen leprosy di era pandemi, yaitu: 1) advokasi oleh petugas kesehatan pada pasien leprosy untuk menerapkan perilaku hidup bersih dan sehat (PHBS); 2) pasien leprosy tetap mentaati peraturan terapi sesuai dengan anjuran; 3) pasien leprosy teregistrasi untuk mendapatkan multidrug therapy; 4) beberapa pasien dengan leprosy memiliki risiko terinfeksi COVID-19, diantaranya yang menjalani pengobatan dengan kortikosteroid; 5) kerusakan sistem saraf pada pasien leprosy dapat menyebabkan terbentuknya lesi (terutama pada mata, kaki, dan tangan), kulit menjadi kering dan kecacatan.

Filariasis adalah kelompok penyakit yang disebabkan oleh cacing gilig/nematoda, dari spesies Wuchereria bancrofti¸Brugia malayi, dan Brugia timori serta ditularkan melalui gigitan nyamuk dari genus Culex. Nyamuk dari genus Culex merupakan vektor utama, namun ada juga laporan penularan filariasis oleh nyamuk dari genus lain yaitu Aedes, Anopheles, dan Mansonia. Data dari Profil Kesehatan Indonesia tahun 2019 menunjukkan masih ditemukannya kasus filariasis, yaitu sebanyak 592 kasus baru. Jumlah kasus tertinggi ditemukan di Papua, kemudian diikuti oleh provinsi Nusa Tenggara Timur, Jawa Timur, Papua Barat, dan Aceh. Metode utama bagi pengendalian filariasis adalah pengobatan masal (mass drug administration) pada komunitas berisiko. Saat pandemi COVID-19 beberapa agenda pengobatan masal ditunda, sehingga capaian target yang dicanangkan oleh Global Program to Eliminate Lymphatic Filariasis menjadi tertunda, Studi evaluasi MDA di Indonesia juga masih terbatas, beberapa kelompok masyarakat berisiko juga enggan melakukan pengobatan secara kontinyu karena adanya rasa ketidaknyamanan, sehingga program eliminasi belum maksimal. Kampanye terkait penggunaan kelambu berinsektisida untuk menghindari gigitan nyamuk juga terus dilakukan oleh petugas kesehatan di kawasan yang berisiko.

Frambusia/yaws adalah penyakit menular yang disebabkan oleh Treponema pallidum subspecies pertenue. Infeksi bakteri ini dapat mengakibatkan keruskan pada tulang maupun kulit. Kelompok yang rentan terinfeksi adalah kelompok usia 15 tahun, dan paling banyak ditemukan pada usia rentang 6 hingga 10 tahun. Terdapat 18 provinsi yang melaporkan adanya kasus frambusia, yang tersebar di wilayah Papua, Maluku, Nusa Tenggara Timur, dan Sulawesi. Prevalensi frambusia pada tahun 2019 adalah sebanyak 0,9 per 10.000 penduduk. Tantangan bagi pengendalian frambusia di Indonesia adalah kurangnya surveilans dan pelacakan kasus, telatnya pelaporan kasus, dan sistem surveilans yang tidak kontinyu dilakukan.

Penyakit infeksi cacing tanah/soil-transmitted helminths merupakan penyakit menular yang masih menjadi beban bagi beberapa Negara di kawasan Asia Tenggara. Tantangan bagi pengendalian STHs di Indonesia adalah 1) inkonsistensi pemantauan program pengendalian; 2) perluasan cakupan kemoterapi pada kelompok beresiko; 3) kemungkinan munculnya resistensi obat; 4) dan metode diagnosis yang lemah. Saat era pandemic COVID-19, terdapat kemungkinan adanya koinfeksi pasien STHs dengan COVID-19 sehingga membutuhkan perlakuan yang khusus. Pengobatan massal bagi komunitas yang berisiko juga mengalami keterlambatan, karena distribusi obat yang terganggu.

Skistosomiasis adalah penyakit infeksi parasite yang diseababkan oleh cacing trematoda dari genus Schistosoma. Terdapat dua jenis skistosomiassi yaitu skistosomiasis usus dan urogenital, yang disebabkan oleh spesies Schistosoma haematobium, Schistosoma mansoni, dan Schistosoma japonicum. Skistosomiasis di Indonesia disebabkan oleh Schistosoma japonicum yang tersebar di Negara Asia, seperti China, Jepang, Filiphina, Vietnam, Laos, Thailand, dan Kamboja. Eradikasi skistosomiasis di Indonesia memerlukan kolaborasi berbagai sektor seperti petugas kesehatan, pemerintah, dan masyarakatm terutama di era pandemi COVID-19, dimana akses ke sistem kesehatan terbatas.

Berdasarkan uraian di atas, Indonesia masih memiliki beberapa problem/permasalahan terkait pengendalian NTDs terutama di era pandemi COVID-19. Kajian literatur pada artikel ini menyimpulkan bahwa pemerintah Indonesia dapat memperkuat upaya pengendalian NTDs melalui berbagai cara, diantaranya adalah kolaborasi antara masyarakat untuk penemuan kasus baru, mengenalkan aplikasi berbasis gadger untuk deteksi dan monitoring progress pasien. Peningkatan testing, tracing, dan treatment COVID-19 juga perlu dilakukan, sehingga transmisi COVID-19 di masyarakat dapat diminimalisir. Apabila transmisi COVID-19 dapat diminimalisir, maka deteksi dan kontrol NTD dapat dioptimalkan.

Penulis: Shifa Fauziyah, Teguh Hari Sucipto, dkk.

Sumber : news.unair.ac.id

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