Diarrhoea is still one of the major causes of morbidity and mortality among children under five in many countries, including Indonesia. Nearly half of the diarrhoea cases are caused by rotavirus. That severe diarrhoea can only be prevented by vaccination.
Professor of the Faculty of Medicine, University of Gadjah Mada, Yogyakarta, Sri Suparyati Soenarto, on Friday (20/1), in Jakarta, said that surveillance over eight provinces during 2009-2015 revealed that half of children under five who suffered diarrhoea and needed hospitalisation, were due to rotavirus. However, people generally do not regard diarrhoea as a serious matter. There are not many people who know about diarrhoea caused by rotavirus.
Diarrhoea is still considered as treatable and not lethal. In fact, diarrhoea caused by rotavirus if not properly handled can cause death. "Rotavirus diarrhoea cannot be solved simply by washing hands or maintaining hygiene," said Suparyati.
Rotavirus causes gastroenteritis, inflammation of the stomach and intestines. In general, rotavirus infects the small intestine and destroys the tissue surface so that absorption of nutrients from food become disrupted.
Symptoms of this rotavirus diarrhoea include severe watery diarrhoea, often with vomiting, fever, and abdominal pain. Because of vomiting, oral rehydration using ORS (oral rehydration salts) may not be effective and the rotavirus diarrhoea patients can become more dehydrated, which may lead to death.
Cause of death
Rotavirus diarrhoea is the cause of death of nearly half a million children under five every year worldwide. The disease also causes millions of children under five hospitalised. About 95% of the rotavirus cases occur in the lower middle income countries in Asia and Africa who have not included rotavirus vaccine into their national immunisation program.
While in Indonesia, according to a research done in 2009, rotavirus patients reached approximately 700,000 or one-fifth of total clinic visitors and approximately 200,000 were hospitalised, which accounted for half of the total in-patient case. Rotavirus also caused 10,000 or 4 out of 5 deaths of children under five in the country.
So far, rotavirus diarrhoea can only be prevented by vaccination. Two vaccines were recommended by the World Health Organisation (WHO) in 2009 and since then, they have been used widely in various countries all over the world. However, up to now, the use of these vaccines in Indonesia is still low. The vaccines are expensive and not yet included in the national immunisation program.
Research on Vaccines
Currently, PT Bio Farma (Persero) in collaboration with the Faculty of Medicine of UGM and the Murdoch Children Research Institute in Australia are developing rotavirus vaccine. According to the Director of Health Surveillance and Quarantine of the Ministry of Health, Elizabeth Jane Soepardi, rotavirus diarrhoea has become a major cause of death.
"Patients suffering diarrhoea due to rotavirus are vomiting, thus ORS cannot be given. They should be immediately taken to hospital," she said. Jane added that if clinical trials on the vaccine are successful, rotavirus vaccination will be gradually given starting in 2018. Because it will be domestically produced, procurement of rotavirus vaccine will not overburden the national budget.
The plan to give rotavirus vaccine is part of the plan of giving new vaccines in the next five years. Before the rotavirus vaccine in 2018, this year four vaccines will be given in stages through demonstrative test program. The four vaccines include human papilloma virus, pneumococcal, rubella or German measles, and Japanese encephalitis.
Text by Denistya Sagita
Stock photos from Advanced Paediatric Associates
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