I have had several parents contact me with concerns about the current Diptheria outbreak here in Indonesia. Schools are also sending home letters with warnings about this disease. But should you be worried?


What is Diptheria?

Diphtheria is a life-threatening communicable disease that spreads through air containing Corynebacterium diphtheriae. The bacteria attack the upper respiratory system, leading to symptoms such as high fever, sore throat, difficulties in swallowing, and shortness of breath.

The bacteria can also spread through spits and coughs and contaminated objects. When they enter the body, they release toxins. The toxins spread through the blood and can cause damage in the body system, especially the heart and nervous system. This can lead to death.


Why the Worry?

The diphtheria outbreak has become a major problem in Indonesia since 2011. East Java, with a 35 million population, is the most severely affected area contributing approximately 80% of the total cases in the country. Indonesia has among the world’s highest rates of diphtheria – along with India and sub-Saharan African countries – even though vaccinations have helped minimize global cases over the past 30 years.

The World Health Organization recorded about 7,000 cases around the world last year. In 1980, the figure was 100,000.

Between January and November 2017, the Indonesian government has recorded 593 diphtheria cases, spread across 95 regencies in 20 provinces. The death toll has reached 32. The World Health Organization data on diphtheria shows that the number of cases in Indonesia has fluctuated since the 1980s.

As a vaccine preventable disease, these deaths should not be occurring, however none of those affected in Indonesia had been vaccinated against the disease…why?


Medical Factors

Several medical factors have contributed to the outbreak of diptheria:

  1. No or Incomplete immunization – According to data the diphtheria, pertussis, and tetanus (DPT) immunisation coverage for children between 2 and 6 year old in Indonesia is only 75.6%. The ideal coverage is above 90%.
  2. Vaccine distribution and storage – Distribution of vaccines from the central government to the regions has logistical problems of storage temperature and transportation conditions. Once the vaccines lose their potency, it is irreversible; the vaccines are no longer effective. Vaccines are very sensitive to heat, and some also to freezing temperature.
  3. Fake vaccines – In 2016 a huge fake vaccine scandal was uncovered where the perpetrators were refilling original vials with water and reselling them. This has created a huge population of children that may not actually have received any valid vaccines at all.
  4. Vaccines are not always 100% effective. The DTaP (Diptheria, Tetanus & Pertussis or Whooping Cough) has about 95% efficacy at the completion of the initial course, however this will decrease over time which is why this vaccine needs to be boosted every 10 years after the childhood program is complete.


Non-Medical Factors and People’s View of Vaccines

Apart from medical factors, there are others causing the increase of incidence:

  1. Many parents do not want to deal with side effects of DPT immunization, including the fever.
  2. Densely populated neighborhoods and houses allow for faster spread of the disease.
  3. The news about fake vaccines in June 2016 still affect some parents trust on vaccines even though the government has taken measures by conducting re-immunization.
  4. Some parents who have lower education level sometimes neglect the importance of good sanitation and immunization schedule
  5. Lack of healthy lifestyle education in schools makes students vulnerable to diphtheria infection.
  6. Some parents believe that vaccines are prohibited under Islamic law (haram). The Indonesian Ulama Council (MUI) has countered this, saying that vaccines are not haram.
  7. Some believe that vaccines are not necessary as immunity is present in every one, and that the important thing is to maintain a healthy lifestyle.


If you really want to avoid having you or your family exposed to this or other vaccine preventable diseases, check your vaccine records, and update them as necessary (adults as well as children).

Naturally adopt a healthy lifestyle, and report any severe symptoms to your doctor immediately.


Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her Community Health Care office in Sanur.

Kim is happy to discuss any health concerns that you have and may be contacted via email at balikim2000@gmail.com, or office phone 085105-775666 or https://www.facebook.com/CHC Bali



Copyright © 2018 Kim Patra

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