CHAPTER I

PRELIMINARY

A. BACKGROUND
Today the epidemic of disease has become a global problem, the main
concern in the determination of public health policy. Foodborne disease and
other outbreaks occur not only in developing countries where sanitation and
hygiene are generally poor, but also in developed countries. Therefore,
epidemiological discipline seeks to analyze the nature and spread of various
health problems in a particular population and to study the causes of the
problems and health disorders for the purpose of prevention and control.
Incidence of an increase in sufferer or death caused by a disease in a
particular area can sometimes be a shocking event and alarming people in the
region. In general this incident we call the Extraordinary Events (KLB),
whereas the meaning of disease is all infectious diseases that can cause
outbreaks, diseases caused by food poisoning and other poisoning. Patients or
those at risk of illness may cause outbreaks to be observed if observations are
made of all activities carried out regularly, thoroughly and continuously,
including collection, processing, analysis / interpretation, presentation of data
and reporting. If the observation results indicate the presence of the outbreak
suspect, it is necessary to investigate the epidemiology of all activities
undertaken to recognize the nature of the cause and the factors that may
influence the occurrence and dissemination of the outbreak in addition to the
appropriate countermeasures. The result of epidemiological inquiry leads the
steps that must be taken in the effort to control the outbreak. These
countermeasures include prevention of outbreaks, including monitoring of
prevention efforts and the eradication of the disease. A carefully planned
outbreak of the planned outbreak and implemented by all relevant parties in a
coordinated manner may stop or limit the dissemination of outbreaks so that it
does not develop into an outbreak. (Efendy Ferry, 2009)

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 The confusion of news, opinions or opinions about Extraordinary Events
can basically be neutralized well if we all have the same understanding and
perception of the Extraordinary Events. Therefore this paper is expected to
lead us to see, what is the definition of Extraordinary Events (KLB)? How is
the criterion of a disease that called Extraordinary Events (KLB)? How are
Extraordinary Events (KLB) classified? How are the Prevention and
Investigation of Epidemiological Outbreaks and Epidemiological Response
and Examination activities occur? as well as many things related to it.

B. FORMULATION OF THE PROBLEM

1. What is the definition of Extraordinary Events (KLB)?
2. What are the criteria of Extraordinary Events (KLB)?
3. What are the factors that influence the occurrence of Extraordinary Events
(KLB)?
4. What are some diseases that can cause Extraordinary Events (KLB)?
5. What are the measures of prevention of Extraordinary Events (KLB)?

C. PURPOSE
1. To know the definition of Extraordinary Events (KLB)
2. To know the criteria of Extraordinary Events (KLB)
3. To know the factors that influence the occurrence of Extraordinary Events
(KLB)
4. To know the various diseases that can cause Extraordinary Events (KLB)
5. To know the steps of prevention of the Extraordinary Events (KLB)

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 CHAPTER II

DISCUSSION

A. THE DEFINITION OF EXTRAORDINARY EVENTS (KLB)

According to the Minister of Health of Republic of Indonesia Regulation
No.1501/MENKES/PER/X/2010, the extraordinary events is the events or
incidence of epidemiologic morbidity and/or death occurrence in an area
within a certain time period and is a condition that can lead to an outbreak.
In addition, the Minister of Health of the Republic of Indonesia (2010)
limits the notion of outbreaks as follows: "The incidence of an outbreak of an
infectious disease in a society whose number of sufferer increases
significantly exceeds that of the prevalent state at a particular time and region
and can cause catastrophe."
Extraordinary Events: Perception of Health Risks. The government
determines the status of the affected areas by disease outbreaks based on
morbidity and mortality rates. If in an area found the number of patients
exceeds the number of patients in the same month last year in the area or the
death rate has exceeded 1%, the status of the region is stated to have happened
as an Extraordinary Events. (Sinaga, 2015)

B. THE CRITERIA OF EXTRAORDINARY EVENTS (KLB)

An occurrence of disease or poisoning can be said to outbreak if it meets
the following criteria:
1. The emergence of an infectious disease that was previously absent or
unknown.
2. Increased incidence of sickness or death continuously for successive
periods according to the type of illness.
3. Increase in incidence or death ≥ 2 times compared to previous period.
4. Number of new patients in one month showed an increase of ≥ 2 times
when compared with the average number of previous month.

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 5. The monthly average for one year shows an increase of ≥ 2 times
compared to the monthly average of the previous year.
6. CFR of a particular ailment shows an increase of 50% or more in the CFR
of the previous period.
7. Proposal Rate of new patient from a certain period shows increase ≥ 2
times compared to same period and previous period or year.
8. Specific diseases: Cholera, DHF/DSS endemic areas (any increase in
cases from previous period) and there are one or more new patients where
in the previous 4 weeks period the area is declared free of the disease.
9. Some illnesses experienced by one or more people: food poisoning,
pesticides, tetanus, malnutrition, diphtheria.
(Umaroh, 2015).

C. THE FACTORS THAT INFLUENCE THE OCCURRENCE OF

EXTRAORDINARY EVENTS (KLB)

a. Low Herd Immunity

One of the factors that can influence the outbreak is Herd
Immunity. In general it can be said that herd immunity is immunity owned
by some residents that can block the spread. This can be likened to the
level of individual immunity that the higher the level of a person's
immunity, the more difficult the disease. Similarly, with herd immunity,
the more proportion of the immune population means the higher the rate of
herd immunity until the spread of the disease becomes increasingly
difficult.
The ability to stretch or high herd immunity to avoid the
occurrence of varied epidemics for each disease depends on:

1) Proportion of immune population,

2) Ability to spread disease by case or career, and
3) The living habits of the population.

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 Knowledge of herd immunity is useful to know that avoiding the
occurrence of epidemics is not necessary for all vulnerable populations to
be uncertain, but depending on the type of illness, for example variola
needs 90%-95% of immune populations.
b. Pathogenic
The ability of disease seeds to cause reaction to the host so that the
pain arises.
c. Bad Environment
All conditions that exist around the organism but affect the life or
development of the organism .
(Notoatmojo, 2003).

D. Miscellaneous Diseases That Cause Occurrences of Outbreaks

According to the Permenkes 560 / MENKES / PER / VIII / 1989, 16
potential diseases of the epidemic have been identified, namely: Kholera, Pes,
Yellow Fever, Back Fever, Typhoid Spare Spot, DHF, Measles, Polio,
Diphtheria, Pertussis, Rabies, Malaria , Influenza, Hepatitis, Typhus Stomach,
Meningitis, Encephalitis, Anthrax. (Umaroh, 2015).

a. Dengue Hemorrhagic Fever (DHF)

Dengue Hemorrhagic Fever is one of the contagious diseases that

until now is still a public health problem and often appears as the
Extraordinary Events (KLB). Dengue disease often causes panic in the
community, because of its rapid spread and potentially cause death. The
disease is caused by the Dengue virus that is transmitted through the bite
of Aedes aegypti mosquito and Aedes albopictus that live in clean water
around the house. Generally this case began to increase during the rainy
season.

In 2011 the number of cases reported and tested positive was 199
cases and 4 people died (CFR: 2.0%). Thus seen from the CFR indicator,

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 the CFR Sambas is slightly above the national indicator (<1%). DHF cases
spread almost equally in all districts in Sambas District, but when
compared with 2010 the number of cases of dengue has decreased
significantly with the incidence rate of dengue fever in 2010 39.3 per
100,000 population.

In the handling of dengue cases need to involve and support all

sectors, both government, community and private parties, with the
movement of mosquito nest eradication that is 3 M (drain - bury - close the
water reservoir). Another effort is to monitor the house / buildings free of
larvae and do early recognition of symptoms of DHF and handling at
home.

b. Diarrhea

Diarrhea is one of the most environmentally-based diseases,

where clean water and unhealthy latrines and unhealthy human behavior
are the dominant factors of the disease. Cases of diarrhea can cause death
especially during Extraordinary Occasions (KLB).

In 2011 there were 11,532 cases in Sambas District and an

increase compared to 2010. The percentage of diarrhea found and handled
in 2011 was 22.75%.

Thus the program of environmental sanitation and personal

hygiene becomes very important to reduce diarrheal diseases. Diarrheal
disease can be correlated with improvement of sanitary hygiene and clean
and healthy life behavior (PHBS) in everyday life and involving cadres in
the management of diarrhea because with proper and fast handling at
household level, it is expected to prevent the occurrence of severe
dehydration case which can lead to Dead.

c. Filariasis (Elephant Foot Disease)

Filariasis (elephantiasis disease) is a chronic (chronic) infectious

disease caused by microfilaria worms. This disease is transmitted by

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 various types of mosquitoes that attack the channel and lymph nodes that
can cause permanent disability (lifetime) in the form of enlargement of the
legs, arms and genitals, which can lead to social stigma.

In Indonesia approximately 10 million people have been infected

with this disease with the number of chronic sufferers (elephantiasis)
approximately 6,500 people. In Sambas district the number of chronic
cases filariasis based on the report there are 82 cases spread across 16
districts. The most sufferers in Sejangkung sub district are 24 people,
Tekarang 15 people and Sebawi 17 people. The morbidity rate of filariasis
disease in 2011 was 16 per 100,000 population.

Prevention and eradication efforts are done by breaking the chain

of transmission and treating patients to prevent secondary infection. In
order to achieve eradication of Filariasis in 2020 (WHO), sensitive devices
/ means are needed for diagnosis, so that patients can be found in the early
stages and not to cause disability

E. Countermeasures Measures of Outbreak Occurrences

Efforts to control outbreaks under the Outbreak Act include:

1). Epidemiological investigation

Epidemiological investigation is to investigate to identify the nature of the

cause and factors that may affect the occurrence of outbreaks. With such
an inquiry, the most effective and effective actions of the countermeasures
by the authorities and or authorities. Thus the epidemic can be overcome
in the shortest time, so that the spread of outbreaks can be prevented and
the number of victims can be reduced as low as possible.

Epidemiological inquiries in the response to outbreaks are intended to:

• Know the causes of disease outbreaks

• Determining factors causing outbreaks

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 • Find out which community groups are threatened by outbreaks

• Determine how KLBS countermeasures

2). Examination, treatment, care, and isolation of the patient, including

quarantine measures. Aim :

• Provide medical help to patients to recover and prevent them from

becoming a source of transmission

• Find and treat people who appear to be healthy, but contain the cause of
the disease so that it can potentially transmit the disease (carrier)

3). Prevention and thickening

Prevention and thickening are measures taken to provide protection to

people who have not yet been ill but are at risk for disease.

4). Destruction of causes of disease

The cause of disease is the seeds of disease ie bacteria, viruses, and others
that cause disease. In the destruction of the cause of the disease,
occasionally the destruction of objects, places and other things that contain
the life of the cause of the disease, such as the breeding grounds for
mosquitoes, rat nests and others.

5). Treatment of corpses due to outbreaks

The handling of the corpse if the death is caused by a disease that causes
the outbreak or the body is a source of disease that can cause the outbreak
should be done specifically according to the type of illness without
abandoning the norms of religion and human dignity.

6). Counseling to the community

Counseling to the community is an educational activity that is persuasive

educative about the disease that can cause the outbreak so that they
understand the nature of the disease, so that it can protect themselves from
the disease and if exposed, not transmitted to others. In addition,

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 counseling is conducted so that the community can participate actively in
tackling the outbreak

7) .Other countermeasures

Other countermeasures are measures undertaken in the context of

prevention of outbreaks, namely that for each disease special actions are
taken.

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 CHAPTER III

CLOSING

A. Conclusion

An extraordinary event is an increase in the frequency of the disease

so that the number of patients goes beyond the normal predicted
circumstances, at a particular time and place. There are 9 criteria of
exceptional work according to Kep.Dirjen PPM and PLP. 451 I / PD.03.04 /
1997. Factors that affect extraordinary events are low Herd Immunity,
pathogenesis, and bad environments.

According to the Permenkes 560 / MENKES / PER / VIII / 1989, 16

potential diseases of the epidemic have been identified, namely: Kholera, Pes,
Yellow Fever, Back Fever, Typhoid Spare Spot, DHF, Measles, Polio,
Diphtheria, Pertussis, Rabies, Malaria , Influenza, Hepatitis, Typhus Stomach,
Meningitis, Encephalitis, Anthrax (Umaroh, 2015).

B. Suggestions

Based on the above discussion we have been able to see that the
disease arises due to unhealthy lifestyles, so from that, so that our bodies are
not attacked by disease we must apply a healthy lifestyle and conduct regular
checks.

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