Diphteri outbreak investigation in restricted islamic boarding school Boyolali district, Central Java province, Indonesia 2018


Rido Illahi Ayef Eka Putra(1*), Teguh Tri Kuncoro(2), Dibyo Pramono(3)

(1) Departemen Biostatistik, Epidemiologi, dan Kesehatan Populasi, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(2) Dinas Kesehatan Boyolali
(3) Departemen Biostatistik, Epidemiologi, dan Kesehatan Populasi, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(*) Corresponding Author


Background: On May 13, 2018 at 10.08 a.m, Boyolali District Surveillance Officer (DSO) was informed by the Head of the Boyolali Health Office Disease Control  Division via the WhatsApp group (WA), that there was found one diphtheria-suspected patient from El-Abror Islamic Boarding School in Candi,  Ampel sub-district. Suspected patien was referred from Sumber Waras Health Clinic to Pandan Arang Public Hospital (RSUPA) in Boyolali district, Central Java province to be isolated in an isolation room. Investigation aims to explore  the information regarding the spread of risk factors of diphtheria in the El-Abror Islamic boarding school. Methods: Data were collected through interviews and field observations to all male students, female students, teachers and residents living in the El-Abror Islamic boarding school 147 in total. The criteria for the cases used are those diagnosed with fever of more than 37C who live in the El-Abror boarding school from April 10, 2018 to May 24, 2018. Results: The index case in this diphtheria outbreak was 2 female students who were diagnosed with symptoms of fever, tonsillitis, pseudomembrane who treated at the Pandan Arang Hospital (RSPA) in Boyolali district. during the investigation had found 20 diphtheria-suspect in total. Attack rate (AR) based on sex,female group (55%) was higher in comparing to  male group (31.03%). Attack rate (AR) based on age, most suspects were found in the 11-15 year age group (63.15%). There were no cases of death in this diphtheria outbreak (CFR = 0%). Risk factors for transmission are immunization status and lighting conditions and ventilation that did not meet the healthy home criteria. Conclusions: ORI (Outbreak Response Immunization) has done as intervention for tackling this outbreak. Sustainability of surveilance system should be developed for primary health worker to monitor and evaluate immunization program. DSO (District Surveilance Officer) should engange community to develop immunization program by increasing health promotion in Islamic Boarding School.


diphteri outbreak, investigation, islamic boarding school, ORI

Full Text:



  1. RI Kemenkes, Kesehatan DSdK, Penyakit DPdP. Pedoman Pencegahan dan Pengendalian Difteri. Jakarta: Kementerian Kesehatan RI; 2017.
  2. RI Kemenkes. Buku Pedoman Penyelidikan dan Penanggulangan Kejadian Luar Biasa Penyakit Menular dan Keracunan Pangan (Pedoman Epidemiologi Penyakit) Edisi Revisi Tahun 2011. Jakarta: Kemenkes RI. 2012.
  3. Guilfoile P. Deadly diseases and epidemics: Diphtheria. Chelsea House, New York; 2009.
  4. de Mattos Guaraldi AL, Hirata R, de Carvalho Azevedo VA. Corynebacterium diphtheriae, Corynebacterium ulcerans and Corynebacterium pseudotuberculosis—general aspects. Corynebacterium diphtheriae and Related Toxigenic Species: Springer; 2014. p. 15-37.
  5. Burkovski A. Corynebacterium diphtheriae and related toxigenic species: Springer; 2016.
  6. Nursyamsi-Agustina N, Wahyutomo R, Hapsari MMDEAH WH. Tonsilopharingitis diphtheriae complicated with diphtheritic myocarditis in 13 years old girl at DR Kariadi Hospital Semarang-Indonesia. J Clin Microbiol Infect Dis. 2014;1:6-16.
  7. Burkovski A. Diphtheria and its etiological agents. Corynebacterium diphtheriae and related toxigenic species: Springer; 2014. p. 1-14.
  8. Patil N, Gawade N, Gaidhane A, Syed ZQ. Investigating diphtheria outbreak: a qualitative study in rural area. Int J Med Sci Public Health. 2014;3(4):513-6.
  9. Galazka A, Dittmann S. The changing epidemiology of diphtheria in the vaccine era. Journal of Infectious Diseases. 2000;181(Supplement_1):S2-S9.
  10. SARI PMM. Pengaruh kondisi sanitasi rumah, status imunisasi, dan pengetahuan ibu terhadap kejadian difteri pada bayi di kota Surabaya. Swara Bhumi. 2012;1(2).
  11. Kartono B, Purwana R, Djaja IM. Hubungan lingkungan rumah dengan Kejadian Luar Biasa (KLB) difteri di Kabupaten Tasikmalaya (2005-2006) dan Garut Januari 2007, Jawa Barat. Metode. 2008;51:6.

DOI: https://doi.org/10.22146/bkm.45154

Article Metrics

Abstract views : 139 | views : 112


  • There are currently no refbacks.

Copyright (c) 2019 Berita Kedokteran Masyarakat

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Berita Kedokteran Masyarakat ISSN 0215-1936 (PRINT), ISSN: 2614-8412 (ONLINE).

Indexed by:

Analytics Visitor Counter