ASPEK PERTAHANAN BIOLOGI (BIODEFENSE) PADA PENUGASAN OPERASI PRAJURIT TNI DI LUAR NEGERI

HERIDADI, Prof. dr. Hari Kusnanto, SU, Dr.PH.

2013 | Disertasi | S3 Kedokteran Umum

Latar belakang. Pertahanan biologi (biodefense) pada tugas operasi militer adalah upaya pertahanan terhadap agen biologi yang digunakan sebagai senjata oleh pihak yang konflik serta terhadap penyakit infeksi endemis. Kontingen Garuda XXIII bertugas di Lebanon sejak tahun 2005 dan Kontingen Garuda XX di Republik Demokratik Kongo (RDK) sejak tahun 2003. Penyakit Hepatitis B di Lebanon dan Malaria di RDK merupakan penyakit infeksi yang tinggi prevalensinya. Tujuan. Mengkaji dampak pajanan penyakit infeksi endemis dan agen biologi lain terhadap status kesehatan anggota, serta efektifitas upaya penyiapan dan pencegahan. Metoda. Studi kohor pada 275 anggota Tim Lebanon dan 175 anggota Tim RDK. Data pra tugas diperoleh dari hasil pemeriksaan saat seleksi kesehatan, data selama tugas diperoleh dari catatan medis selama penugasan, data pasca tugas diambil pada saat pemeriksaan kesehatan purna tugas. Analisis statistik status kesehatan menggunakan teknik Kai kuadrat dan analisis multivariat serta dilakukan analisis molekul terhadap DNA virus hepatitis B dan Plasmodium malaria. Hasil. Terdapat penurunan status kesehatan pasca tugas secara bermakna (p=0,000) pada anggota dari kedua lokasi tugas dan didapatkan penurunan status kesehatan secara bermakna (p=0,032) pada anggota yang selama tugas terinfeksi penyakit endemis. Pada pasca tugas Tim Lebanon terdapat 8 orang ( 2,9%) dengan hepatitis B positif berdasarkan pemeriksaan rapid test yang kemudian dikonfirmasi dengan pemeriksaan serologi dan molekul (PCR dan genotiping). Hasil pemeriksaan menunjukkan bahwa semua spesimen sesuai dengan cluster hepatitis B genotip B (HBV/B) sehingga sangat mungkin infeksi hepatitis B bukan didapat di Lebanon tapi di Indonesia sebelum berangkat tugas. Pada 4 orang dari Tim RDK yang selama tugas di diagnosis terinfeksi P.vivax dilakukan pemeriksaan mikroskopis dan PCR dengan hasil tidak didapati adanya DNA Plasmodium. Pemeriksaan fisik pada kasus penyakit infeksi selama dan pasca tugas tidak didapatkan adanya gejala klinis infeksi agen biologi yang mungkin digunakan sebagai senjata. Kesimpulan. Pajanan penyakit endemis berdampak pada penurunan status kesehatan pasca tugas. Dari pemeriksaan fisik tidak didapatkan bukti adanya pajanan agen biologi yang mungkin digunakan sebagai senjata.

Background. Biodefense in military operation assignments is an efforts to defend against biological agents that used as weapons by the sides involved in a conflict, as well as against endemic infectious diseases. The Garuda XXIII Contingent has been on assignment in Lebanon since 2005, and the Garuda XX Contingent in the Democratic Republic of Congo (DRC) since 2003. Hepatitis B in Lebanon and Malaria in DRC are endemic infectious diseases that are highly prevalent in each respective area. Objective. To assess how exposure towards endemic infectious diseases and other biological agents affect personnel health status, as well as the effectiveness of preparation and precautionary measures. Method. Cohort study was performed on 275 Lebanon Team members and 175 DRC team members. Pre-deployment data was obtained from health selection examination results, on-deployment data from medical records taken throughout the deployment period, post-deployment data from the post-deployment health examination. Statistical analysis was carried out using the Chi-square and multivariat technique, molecular analysis was carried out on hepatitis B virus and malarial Plasmodium DNA. Result. There was a significant decline (p=0.000) in the post deployment health status of personnel from both deployment areas, as well as significant health status decline (p=0.032) among members infected by endemic diseases during their deployment. 8 members (2.9%) of the Lebanon team were found as hepatitis B positive based on rapid test examination, confirmed through serology and molecular (PCR and genotyping) methods. These methods show all specimens are consistent with the hepatitis B genotype B (HBV/B) cluster, thus it is highly likely that infection occurred not in Lebanon, but in Indonesia prior to deployment. Microscope and PCR analysis were carried out for 4 members of the DRC team who were diagnosed with P. vivax infection during deployment, results show no Plasmodium DNA. Physical examination on infectious disease cases during and after deployments did not yield any clinical symptoms of biological agent infections that might have been used as weapons. Conclusion. Exposure of endemic diseases results in a decline in post-deployment health conditions. Physical examinations do not show any evidence of exposure from biological agents that may be used as weapons. Keywords: Biodefense, infectious endemic diseases and other biological agents, health status.

Kata Kunci : Pertahanan biologi, penyakit infeksi endemis dan agen biologi lain, status kesehatan