The Current Taenia Solium Taeniasis/cysticercosis Situation in Indonesia

The first Taenia solium taeniasis/cysticercosis case in Indonesia has not been clearly recognized or recorded. There has been no regular report of this disease. On a very few occasions, cysticercosis cellulosae cases were reported among post-mortem examinations of slaughtered pigs, particularly in Medan, North Sumatra Province, and Denpasar, Bali Province. Since 1972, the Directorate General of Communicable Disease Control and Environmental Health, Ministry of Health, collaborating with the Directorate General of Livestock, Ministry of Agriculture, conducted some surveillance work through data collection from hospitals and animal slaughterhouses, and collected data from surveys. During the period 1987-2002, 11/30 Indonesian provinces were found endemic. Christian and Hindu groups populate some areas of all 11 endemic provinces. These groups used to breed pigs with small-scale backyard farming, and there were very few large-scale breeding farms. In 10/ 11 endemic areas where stool surveys were conducted and worms examined after treatment, it was found that the positive rates were around 0.0-3.1%, except in Papua Province, where the positive rate was 10.5%. The positive rate for cysticercosis/brain cysticercosis cases, which is confirmed by isolation of the nodule by counterimmunoelectrophoresis (CIEP) test, and by recognition of epileptic symptoms, was around 0.0-1.8%, except in Papua Province (about 25.0%). During the early 1970s, atebrine and yomesan were used to de-worm humans, and praziquantel was used for victims of cysticercosis/brain cysticercosis. Since 1998, praziquantel with albendazole and mebendazole have been used to treat Taenia solium taeniasis/cysticercosis. The T. solium taeniasis/ cysticercosis situation in Papua Province, particularly among the 120,000 population of Baliem Valley, in Jayawijaya district, has become the worst, especially when the cysticercosis rate of 25.0% is projected onto the 120,000 population at risk. Control measures have been conducted with very minimal success. Sumatra, Riau, Bangka Belitung, Central Java, and Bali provinces. The problem of Taenia solium taeniasis/ cysticercosis used to be found around traditional pig farms. Some factors are related to the T. solium taeniasis/cysticercosis problem, such as the way farmers take care of their pigs, whether the pigs are kept inside a fence all day or just let roam around freely outside the fence, the availability of a family latrine, how the pork is cooked, and how the farmers take care of their personal hygiene to prevent T. solium taeniasis/ cysticercosis. The first Taenia solium taeniasis/cysticercosis case in Indonesia is not clearly recognized or recorded. Before 1972, this disease was not included among the notifiable diseases, since reported cases were very rare and were received from a few hospitals in North Sumatra, West Kalimantan, and Bali. Porcine cysticercosis cases were recorded frequently and reported annually from 1952 from slaughterhouses in Bali and North Sumatra. All of these infected pig carcasses, according to veterinary policy, were discarded. The first human cysticercosis cellulosae case was reported in Bali in 1963, where the cyst was taken from subcutaneous nodules in the upper arm and the larvae were confirmed by clinical laboratory examination. From then until 1972, there were nine Correspondence: GM Simanjuntak, Centers for Health Ecology Research and Development, NIHR&D, MOH, Jl Pereetakan Nagara No. 29, Jakarta, Indonesia. Tel: 021-4261088 Ext 268 E-mail: [email protected] INTRODUCTION The Indonesian archipelago has a population of 220 million, and consists of about 21,000 islands, of which about 17,600 are named, while only about 8,000 are inhabited. About 85.0% of the Indonesian population is Moslem while another 15% are Christians, Hindu, Buddhists and animists, and these communities can be found predominantly in some locations. Wild boar can be found on every island of Indonesia. Some Christian, Hindu, Buddhist and animist communities breed pigs, but mostly by smallscale backyard farming. This type of traditional farming can be found in the provinces of Aceh, North Sumatra, Riau, Bangka Belitung, Lampung, Central Java, Bali, East Nusatenggara, Central Kalimantan, East Kalimantan, South Sulawesi, Central Sulawesi, North Sulawesi, Maluku, and Papua. Industrial pig farms, where the number of pigs may be up to 700,000 head, are small in number and can be found in North