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Gastrointestinal Infection and Typhoid - Hepatitis A vaccination


Overview

Gastrointestinal infections remain a significant health challenge in Indonesia, which pose a public health concern due to factors such as waterborne pathogens, inadequate sanitation, and limited access to healthcare in certain regions. The condition is influenced by various socio-economic factors and health system capabilities. Typhoid and Hepatitis A are the diseases among most common gastrointestinal infection in Indonesia.

Statistic

According to the Ministry of Health, gastrointestinal diseases are prevalent across the country, with a substantial number of cases reported annually.

The Indonesian archipelago’s tropical climate and high population density contribute to the spread of infectious diseases, including those affecting the gastrointestinal tract. Rural areas, in particular, are more susceptible due to less developed sanitation infrastructure and clean water access.

The Health Statistics Profile 2023 published by BPS-Statistics Indonesia report from a surveillance study found that among acute diarrhea cases, a significant percentage of patient stools were positive for bacteria. The most prevalent pathogen isolated was Shigella flexneri, followed by Salmonella sp. and Vibrio sp.
Diarrhea is an endemic disease in Indonesia potential to cause an outbreak and remain contributor for mortality statistic, especially in children. Health Research in 2018 stated the prevalence across age is 8%, children 1-5 years 12.3% and baby 0-12 months 10.6%.

Diarrhea causing 5.8% cause of death for children 1-5 years.

Typhoid fever necessitates prompt antibiotic therapy to effectively eradicate the Salmonella Typhi bacteria, while management of Hepatitis A primarily involves supportive care, as the body’s immune system typically clears the virus without the need for antiviral medications.”

At other side, Indonesia is facing a burden of antimicrobial resistance (AMR). The report published from Institute for Health Metrics and Evaluation, the AMR burden in Indonesia in 2019, there were 34,500 deaths attributable to AMR and 133,800 deaths associated with AMR. Indonesia has the 78th highest age-standardized mortality rate per 100,000 population associated with AMR across 204 countries worldwide, and the 5th highest across 13 countries the Southeast Asia.

Background

Historically, gastrointestinal infections in Indonesia have been linked to several factors:

  • Unsafe water sources: Many communities rely on water sources that are not adequately treated, leading to contamination.
  • Inadequate sanitation: A lack of proper waste disposal systems and toilets facilitates the spread of infections.
  • Cultural practices: Certain local customs and food preparation methods may increase the risk of transmission.
    Most Common Cases
    The most common gastrointestinal infections in Indonesia include:
  • Typhoid fever: Caused by Salmonella Typhi, transmitted through contaminated food and water.
  • Cholera: An acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.
  • Hepatitis A: A viral liver disease that can cause mild to severe illness, spread through the consumption of contaminated food or water.

Recommendations

The Indonesian government, through the Ministry of Health, has issued several recommendations to combat gastrointestinal infections:

  • Improve water and sanitation facilities: Ensuring access to clean water and promoting the construction of adequate sanitation facilities.
  • Public health education: Educating the public on proper hygiene practices, such as handwashing and safe food preparation.
  • Vaccination programs: Implementing vaccination drives for preventable diseases like typhoid and hepatitis A.
  • Strengthening healthcare systems: Enhancing the capacity of healthcare facilities to manage and treat infections effectively.

Vaccination Strategy

Hepatitis A and Typhoid vaccinations are crucial tool in the health strategy, offering protection against two significant causes of gastrointestinal infection. The Hepatitis A vaccine is a safe and effective means to prevent a virus that can cause debilitating liver disease, while the Typhoid vaccine guards against a bacterial infection that can lead to severe systemic illness.
Hepatitis A and Typhoid are both transmitted through the oral-fecal route. This means they can enter the body when an individual ingests food or water that has been contaminated with the feces of an infected person.

Hepatitis A: The virus is primarily spread by ingesting food or water contaminated with feces from an infected person. It can also spread through direct contact with an infectious person. The virus is robust and can survive in the environment for extended periods, making it highly transmissible in poor hygiene and sanitation condition.

Typhoid Fever: Caused by the bacterium Salmonella Typhi, typhoid is also spread through contaminated food and water. It can be contracted by eating food handled by someone who is infected or if sewage contaminated with the bacteria gets into the water used for drinking or washing food.

Vaccines for Hepatitis A and Typhoid are recommended by Indonesian Pediatric Society (IDAI) and Indonesian Internal Medicine Society (PAPDI), for travelers as well as people living in Indonesia and general population, especially in areas where the diseases are more prevalent.

The World Health Organization (WHO) recommends Typhoid vaccination in the endemic areas, which can include food handlers as a targeted group to prevent the spread of typhoid fever. While the WHO does not specifically mandate Hepatitis A vaccination for food handlers globally, it is strongly recommended in regions experiencing outbreaks or where there are other risk factors. Centers for Disease Controls and Prevention (CDC) in the United States has noted the role of food handlers in Hepatitis A virus transmission and suggests that vaccination efforts should be prioritized in situations where the risk of secondary transmission is high. It is generally advisable for food handlers to be vaccinated against diseases they may transmit through food.

Typhoid vaccination can prevent typhoid disease because it prepares the body’s immune system to recognize and fight off the bacteria that cause typhoid fever, Salmonella Typhi. The vaccine does this by stimulating the production of antibodies, which are proteins that can specifically target and neutralize the bacteria. There are two main types of typhoid vaccines available:

  1. Inactivated Vaccine: This type uses a killed version of the bacteria to stimulate the immune response without causing the disease. It is administered as an injection.
  2. Live Attenuated Vaccine: This oral vaccine uses a weakened form of the bacteria that is still alive but cannot cause illness in healthy individuals.

    Both vaccines are effective in preventing typhoid fever, which is characterized by symptoms such as prolonged high fever, weakness, stomach pain, headache, and sometimes a rash.

In Indonesia, Hepatitis A vaccines are available and recommended for travelers and high-risk group due to the country’s moderate endemicity of the disease. Research has shown it is safe and effective. Since the vaccine introduction, there has been a significant decline in Hepatitis A cases.

The Hepatitis A vaccination is administered in two doses administered as an injection for effective long-term protection:
Research has shown that Hepatitis A vaccines are safe and effective. Since their introduction, there has been a significant decline in Hepatitis A cases.

Below picture are the vaccine schedule for children and adult refer to IDAI and PAPDI recommendation,

https://www.idai.or.id/artikel/klinik/imunisasi/jadwal-imunisasi-anak-idai

https://imuni.id/jadwal-vaksinasi-dewasa-papdi-terbaru-2023/

Conclusion

Gastrointestinal infections pose a significant health burden in Indonesia. While the government has made strides in addressing these issues, ongoing efforts are required to improve public health infrastructure and awareness, through a combination of improved infrastructure, public health education, vaccination, and effective surveillance.

Hepatitis A and Typhoid vaccinations are crucial tool in the health strategy, offering protection against two significant causes of gastrointestinal infection. The Hepatitis A vaccine is a safe and effective means to prevent a virus that can cause debilitating liver disease, while the Typhoid vaccine guards against a bacterial infection that can lead to severe systemic illness.

For almost 40 years in Indonesia, SOS MEDIKA provides round-the-clock services of family physicians, specialists and emergency support, as well as in-house pharmacy, imaging and laboratory. We place a strong focus on building relationships with patients to provide holistic care and disease prevention, which include wide range of vaccinations such as Hepatitis A, Typhoid, Influenza, Yellow Fever, and more.

Let’s get vaccinated!

For any medical assistance, call our clinic. We are committed to providing prompt care for 24/7.

SOS MEDIKA CIPETE
Jl. Puri Sakti no. 10, Cipete Selatan - Antasari
Jakarta Selatan 12410
Tel: +62 (0)21 750 5980
Email: Cipete.Pro@sosmedika.id
Operating hours: 24 hours including Public Holidays

SOS MEDIKA KUNINGAN

Menara Prima 2nd Floor
Jl. DR Ide Anak Agung Gde Agung, blok 6.2, Kawasan Mega Kuningan, Jakarta 12950
Tel: +62 (0)21 5794 8600
Email: Pro.Kuningan@sosmedika.id
Operating hours: Mon-Fri: 8AM to 5PM
Saturday: 8AM to 2PM

We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.

Our appreciation to the Coordinating Doctors of International SOS, an AEA Company who have contributed this article in response to a health threat faced by expatriates in Indonesia.

Updated June 10, 2024