SEROEPIDEMIOLOGI DAN FAKTOR RISIKO KEJADIAN LEPTOSPIROSIS DI DAERAH ENDEMIS KABUPATEN SLEMAN YOGYAKARTA

NUR SUBAGYO, Prof.drh. Setyawan Budiharta, MPH, PhD ; dr Doni Priambodo, Sp.PD.

2015 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang : Leptospirosis adalah penyakit zoonosis yang disebabkan oleh bakteri Leptospira. Manusia terinfeksi lewat kontak dengan air atau tanah yang terpapar urin atau cairan tubuh binatang yang terinfeksi. Kasus leptospirosis di Kabupaten Sleman Yogyakarta sejak tahun 2008 meningkat. Penentuan jenis serovar dan faktor risiko sangat penting untuk memperkirakan sumber penularan potensial serta rencana penanggulangannya. Tujuan: Mengetahui jenis serovar leptospira pada manusia dan faktor risiko utama kejadian leptospirosis. Metode Penelitian: Rancangan penelitian case-control. Lokasi penelitian di daerah endemis leptospirosis Kabupaten Sleman Yogyakarta. Penentuan sampel secara purposive sampling dan kriteria inklusi, jumlah responden kasus = 56 dan kontrol = 56. Penentuan kasus dan kontrol menggunakan Rapid Leptospirosis-WB dan kriteria Faine modifikasi Shivakumar. Pemeriksaan serovar menggunakan MAT. Analisis data secara univariat, bivariat dan multivariat dengan metode regresi logistik. Pengolahan data menggunakan Microsoft Office Excel 2007, SPSS for Windows Release 17.0 dan perhitungan statistik. Hasil Penelitian: Faktor risiko leptospirosis adalah: lingkungan (OR: 12,906, p:0,000, 95 % CI: 3,741-44,523), kepemilikan hewan ternak (OR: 6,519, p:0,010, 95 % CI: 1,569-27,085), perilaku (OR: 6,048, p:0,004, 95 % CI: 1,770-20,660) dan pekerjaan (OR: 4,711, p:0,013, 95 % CI: 1,385-16,022). Hasil pemeriksaan MAT: 56 sampel dan 23 positif. Jenis serovar : bataviae (4,35 %), hardjo (17,39 %), icterohaemorrhagiae (13,04 %), patoc (26,09%), rachmati (17,39 %) dan semaranga (21,74 %). Serovar patogenik adalah bataviae, hardjo, icterohaemorrhagiae dan rachmati. Serovar nonpatogenik adalah patoc dan semaranga. Kesimpulan: Dinamika penularan leptospirosis adalah adanya interaksi manusia (risiko kerja dan perilaku) dengan lingkungan yang terkontaminasi. Serovar patoc dan semaranga menunjukkan reaksi silang dengan serovar patogenik lain yang tidak terdapat pada panel pemeriksaan MAT.

Background: Leptospirosis is a zoonotic disease caused by leptospire. Humans usually become infected through contact with water or soil that is exposed to urine or other body fluids of infected animals. Since 2008 cases of leptospirosis in Sleman District have increased. Determination of serovars and risk factors are very important to estimate a potential source of transmission and mitigation plan. Objective: : This study aims to determine the serovars and the main risk factors for leptospirosis in the area. Method: A case-control study design. Study sites are endemic areas in Sleman District of Yogyakarta. This study used a purposive sampling and inclusion criteria. The respondents consisted of 56 cases and 56 controls. The cases and controls were determined by using Faine criteria modified by Shivakumar and serology using Rapid Leptospirosis-WB. Serovars were detected with MAT. Data analysis was performed by using univariate, bivariate, and multivariate. Data processing by using Microsoft Office 2007 and statistical calculations.using univariate, bivariate and multivariate logistic regression methods, using Microsoft Office 2007, SPSS for Windows release 17.0 and statistical calculations. Result: Risk factors associated with leptospirosis were : environmental risk (OR: 12.906, p:0.000, 95 % CI: 3/741-44.523), having livestock (OR: 6.519, p:0.010, 95 % CI: 1.569-27.085), behavioral risk (OR: 6.048, p:0.004, 95 % CI: 1.770-20.660) and occupational risk (OR: 4.711, p:0.013, 95 % CI: 1.385-16.022). Serological test (MAT) from 56 serum showed that 23 (41.07%) were positive. Serovars found were bataviae (4.35 %), hardjo (17.39%), icterohaemorrhagiae (13.04%), patoc (26.09%), rachmati (17.39%) and semaranga (21.74%). Serovar bataviae, hardjo, icterohaemorrhagiae and rachmat are pathogenic Leptospira. Serovar patoc and semaranga are non pathogenic Leptospira. Conclusion: The dynamics of transmission of leptospirosis is interaction between human (occupational and behavior risks) and contaminated environment. Serovar patoc and semaranga usually showed cross reaction with many leptospire pathogenic bacteria, but probably from strain that not available in "batteray antigen test MAT" in laboratory diagnosis.

Kata Kunci : Leptospirosis, Serovar, Faine Criteria, MAT