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Tuesday, August 02, 2005

Implikasi Flu Burung pada Manusia

IMPLIKASI FLU BURUNG PADA MANUSIA

Dr Widodo Judarwanto SpA, Rumah Sakit Bunda Jakarta,

Departemen Kesehatan Indonesia telah mengidentifikasi adanya infeksi flu burung pada seorang penderita di kota Tangerang. Penemuan ini telah dikuatkan oleh pemeriksaan laboratorium resmi WHO di Hongkong. Hal ini merupakan penemuan penderita flu burung pada manusia yang pertama kali di Indonesia. Setahun sebelumnya, tepatnya tanggal 25 Januari 2004 Departemen Pertanian telah mengumumkan secara resmi, terjadi pertama kali kasus avian influenza menyerang unggas di Indonesia.

Flu burung atau flu unggas juga sering dikenal sebagai avian influenza, pada umumnya tidak menyerang manusia. Beberapa tipe terbukti dapat menyerang manusia atau suatu tipe tertentu dapat mengalami mutasi lebih ganas dan menyerang manusia. Penyakit mematikan ini telah menjadi pandemi di dunia. Mulai timbul kepanikan di beberapa negara ketika wabah tersebut menyebabkan kematian yang sangat cepat dengan tingkat kematian (Case Fatality Rate) lebih dari 80% .

Penyakit flu burung tercatat pertama kali diidentifikasi di Italia lebih dari 100 tahun lalu. Pada mulanya, penyakit ini adalah penyakit hewan yang menyerang bangsa unggas. Flu burung atau sampar unggas (fowl plaque) adalah penyakit virus yang menyerang berbagai jenis unggas, meliputi ayam, kalkun, merpati, unggas air, burung-burung piaraan, hingga ke burung-burung liar. Virus ini juga didapatkan pada babi, kuda, dan binatang laut menyusui seperti ikan paus dan anjing laut. Terakhir terungkap virus H5N1 ini telah diidentifikasi pada harimau, kucing dan macan tutul. Sebelumnya binatang ini tidak dianggap sebagai bianatang yang dapat dicemari virus flu burung. Babi juga dapat tertular dan sebagai perantara penularan ke manusia. Belakangan terungkap virus bukan hanya menempel di kulit, tetapi dibiakkan dan bermutasi di peredaran darah binatang babi.

Penyebab dan Cara Penularan pada Manusia

Penyebab burung pada bangsa unggas itu adalah virus influenza tipe A. Virus menakutkan ini adalah termasuk family Orthomyxoviridae dari genus Influenza. Ukuran diameter Virions adalah 80 hingga 120 nm yang berbentuk filament. Susunan virus terdiri dari 8 segmen berbeda dari “negative-stranded RNA”. Subtipe H5 dan H7 virus flu burung adalah yang menyebabkan wabah dengan tingkat kematian tinggi (patogenik). Hanya ada satu galur dari virus flu burung yang tingkat kemampuan mematikannya tinggi atau high-pathogenic avian influenza (HPAI) H5N1 yang dapat menginfeksi manusia (zoonosis). Menurut beberapa ahli flu burung lebih berbahaya dari SARS. Karena kemampuan virus yang mampu membangkitkan hampir keseluruhan respon bunuh diri dalam sistem imunitas tubuh manusia.

Dari hasil studi yang ada menunjukkan, unggas yang sakit oleh Influenza A atau virus H5N1 dapat mengeluarkan virus dengan jumlah besar dalam kotorannya. Virus itu dapat bertahan hidup di air sampai empat hari pada suhu 22 derajad celcius dan lebih dari 30 hari pada nol derajad celcius. Di dalam kotoran dan tubuh unggas yang sakit, virus dapat bertahan lebih lama. Virus ini mati pada pemanasan 56 derajat Celcius dalam 3 jam atau 60 derajad celcius selama 30 menit. Bahan disinfektan fomalin dan iodine dapat membunuh virus menakutrkan ini.

Virus flu burung hidup di dalam saluran pencernaan unggas. Burung yang terinfeksi virus akan mengeluarkan virus ini melalui saliva (air liur), cairan hidung, dan kotoran. Avian Virus influenza avian dapat ditularkan terhadap manusia dengan 2 jalan. Pertama kontaminasi langsung dari lingkungan burung terinfeksi yang mengandung virus kepada manusia. Cara lain adalah lewat perantara binatang babi. Penularan diduga terjadi dari kotoran secara oral atau melalui saluran pernapasan. Flu burung dapat menyebar dengan cepat diantara populasi unggas dengan kematian yang tinggi. Penyakit ini dapat juga menyerang manusia, lewat udara yang tercemar virus itu. Belum ada bukti terjadinya penularan dari manusia ke manusia. Juga belum terbukti adanya penularan pada manusia lewat daging yang dikonsumsi. Orang yang mempunyai resiko besar untuk terserang flu burung adalah pekerja peternakan unggas, penjual dan penjamah unggas. Sebagian besar kasus manusia telah ditelusuri pada kontak langsung dengan ayam yang sakit

Manifestasi Klinis

Tampilan klinis manusia yang terinfeksi flu burung menunjukkan gejala seperti terkena flu biasa. Diawali dengan demam, nyeri otot, sakit tenggorokan, batuk dan sesak napas. Adanya kontak dalam 7 hari terakhir dengan unggas di peternakan terutama jika unggas tersebut menderita sakit atau mati. Dalam perkembangannya kondisi tubuh sangat cepat menurun drastis. Bila tidak segera ditolong, korban bisa meninggal karena berbagai komplikasi. Komplikasi yang mengancam jiwa adalah mengakibatkan gagal napas dan gangguan fungsi tubuh lainnya.

Flu burung banyak menyerang anak-anak di bawah usia 12 tahun. Hampir separuh kasus flu burung pada manusia menimpa anak-anak, karena sistem kekebalan tubuh anak-anak belum begitu kuat. Masa inkubasi penyakit, dimana saat mulai terpapar virus hingga mulai timbul gejala sekitar 3 hari. Sebagian besar penderita mengalami produksi dahak yang meningkat, di antaranya dahak bercampur darah. Diare dialami oleh sebagian besar penderita. Semua penderita mengalami kelainan pada pemeriksaan hasil foto roentgen saat pertama kali masuk Rumah Sakit. Semua penderita menunjukkan limpopenia dan sebagian besar penderita mengalami trombositopeni..

Diagnosis ditegakkan dengan melakukan pemeriksaan laboratorium. Dikatakan diduga mengalami infeksi virus influenza A(H5N1) atau Probable Case, bila didapatkan antibodi spesifik spesimen serum. Diagnosis Pasti bila hasil biakan virus positif Influenza A (H5N1) atau hasil pemeriksaan PCR positif untuk influenza H5. Peningkatan titer antibodi spesifik H5 sebesar > 4 kali dan hasil dengan IFA positif untuk antigen H5 juga merupakan petanda diagnosis pasti. Menurut kesepakatan internasional, serangan virus flu burung baru dipastikan setelah ada hasil pemeriksaan dari laboratorium rujukan WHO

Pengobatan dan Pencegahan
Seperti penyakit virus lainnya, sebenarnya penyakit ini belum ada obat yang efektif. Penderita hanya akan diberi untuk meredakan gejala yang menyertai penyakit flu itu, seperti demam, batuk atau pusing. Obat-obatan itu hanya meredam gejalanya, tapi tidak mengobati. Tetapi Food and Drug Administration (FDA) Amerika Serikat telah merekomendasikan 4 jenis obat antiviral untuk pengobatan dan pencegahan influenza A. Jenis obat tersebut diantaranya adalah M2 inhibitors (amantadine and rimantadine) dan neuraminidase inhibitors (oseltamivir and zanimivir). Kadangkala beberapa galur virus influenza menjadi resisten terhadap satu atau lebih jenis obat tersebut. Misalnya, virus influenza A (H5N1) yang berhasil diidentifikasi dari penderita di Asia tahun 2004 – 2005 ternyata resisten terhadap obat amantadine dan rimantadine.

Orang yang berisiko mendapat flu burung atau yang terpajan harus mendapat pencegahan dengan oseltamivir 75 mg dosis tunggal selama 1 minggu.
Jika vaksin untuk flu burung ini telah tersedia, dapat diberikan pada semua orang yang diduga kontak dengan unggas atau peternakan unggas yang terinfeksi dengan avian influenza (H5N1). Orang yang diindikasikan kontak khususnya orang yang bertugas memisahkan unggas yang sakit atau yang terlibat dalam pemusnahan unggas dan orang yang hidup dan bekerja di peternakan unggas dimana telah dilaporkan terdapat/dugaan H5N. Tenaga kesehatan yang menangani kasus influenza H5N1 pada manusia dan tenaga kesehatan yang bekerja pada sarana pelayanan darurat di daerah terjadinya influenza H5N1 pada burung juga dianggap orang yang beresiko.
Sejauh ini belum ditemukan vaksin yang dapat mencegah penyakit flu burung galur H5N1 pada manusia. Beberapa ahli di berbagai negara maju telah melakukan penelitian untuk menemukan vaksin untuk tersebut. WHO bersama Global Influenza Surveillance Network saat ini mengembangkan prototip virus H5N1 untuk mengungkap lebih jauh penemuan vaksin tersebut. Hingga sekarang belum ada vaksin yang tepat untuk influenza, termasuk avian influenza. Karena waktu perubahan mutasi virus sangat singkat yakni dalam kurun waktu tiga tahun. Perubahan cepat model virus inilah yang menyebabkan para peneliti kesulitan untuk menemukan antiviral yang efektif jangka panjang. Vaksin prototip virus yang telah ditemukan dan dikembangkan tahun 2003 ternyata tidak dapat digunakan lagi. Pada evaluasi awal tahun 2004 ternyata virus telah bermutasi secara bermakna.
Pencegahan umum penyakit ini adalah mengurangi kontaminasi dengan binatang, bahan dan alat yang dicurigai tercemar virus. Tahapan Kewaspadaan Universal Standar perlu dilakukan untuk tindakan tersebut. Diantaranya adalah cuci tangan dilakukan di bawah air mengalir dengan menggunakan sabun dan sikat selama kurang lebih 5 menit, yaitu dengan menyikat seluruh permukaan telapak tangan maupun punggung tangan. Hal ini dilakukan sebelum dan sesudah memeriksa penderita atau kontak dengan unggas yang dicurigai terinfeksi. Pakaian yang digunakan adalah pakaian bedah atau pakaian sekali pakai. Memakai masker N95 atau minimal masker bedah.Menggunakan pelindung wajah/kaca mata goggle, apron/gaun pelindung, sarung tangan, pelindung kaki atau sepatu boot.

Menghadapi masalah timbulnya flu burung di Indonesia, sebaiknya masyarakat tidak terlalu panik. Masyarakat dalam beberapa tahun terakhir ini telah menghadapi banyak cobaan masalah kesehatan yang tidak kalah ganasnya , seperti DBD, SARS dan Poliomielitis. Berbekal pengalaman itu, dengan kewaspadaan, tawakal dan berusaha keras menggunakan pola hidup sehat, ternyata keadaan yang mengkawatirkan itu akhirnya dapat dilalui.

Daftar Pustaka

1. Henzler DJ, Kradel DC, Davison S, Ziegler AF, Singletary D, DeBok P, Castro AE, Lu H, Eckroade R, Swayne D, Lagoda W, Schmucker B, Nesselrodt A. 2003. Epidemiology, production losses, and control measures associated with an outbreak of avian influenza subtype H7N2 in Pennsylvania (1996–98). Avian Diseases 47(Suppl 3):1022–1036.

2. Kobasa D, Takada A, Shinya K, Hatta M, Halfmann P, Theriault S, Suzuki H, Nishimura H, Mitamura K, Sugaya N, Usui T, Murata T, Maeda Y, Watanabe S, Suresh M, Suzuki T, Suzuki Y, Feldmann H, Kawaoka Y. 2004. Enhanced virulence of influenza A viruses with the haemagglutinin of the 1918 pandemic virus. Nature 431(7009):703–707.

3. Neuraminidase Inhibitor Susceptibility Network. 2004. NISN statement on antiviral resistance in influenza viruses. Weekly Epidemiological Record 79(33):306–308.

4. Simonsen L, Fukuda K, Schonberger LB, Cox NJ. 2000. The impact of influenza epidemics on hospitalizations. Journal of Infectious Diseases 181(3):831–837.

5. Snacken R, Kendal AP, Haaheim LR, Wood JM. 1999. The next influenza pandemic: Lessons from Hong Kong, 1997. Emerging Infectious Diseases 5(2):195–203.

6. Stevens J, Corper AL, Basler CF, Taubenberger JK, Palese P, Wilson IA. 2004. Structure of the uncleaved human H1 hemagglutinin from the extinct 1918 influenza virus. Science 303(5665):1866–1870.

7. Kuiken T et al (2004), Avian H5N1 Influenza in Cats, Science 2004 306: 241 ()

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7:17 PM

 
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8:45 PM

 
Blogger alex said...

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10:33 PM

 
Blogger alex said...

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1:00 AM

 
Blogger alex said...

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3:30 AM

 
Blogger ade trilistya said...

salam kenal.. visit blog aku ya

http://adelikeoriflame.blogspot.com/

6:00 AM

 
Blogger Blogku said...

Terima kasih infonya. Tapi kok jarang diupdate ya blog ini???

9:14 AM

 
Blogger Indonesia said...

Banyaknya masalah yang timbul di masyarakat baik tentang virus seperti flu burung atau yg lain. akan meningkatkan kualitas dari masyarakat itu sendiri jika mampu mengatasinya. semoga indonesia ke depan akan menjadi negara yg berkualitas dari segi apapun amin.
Luthfi

9:22 PM

 
Blogger uii profile said...

Terimakasih Infonya
sangat bermanfaat..
Perkenalkan saya mahasiswa Fakultas Kedokteran di UNIVERSITAS ISLAM INDONESIA Yogyakarta
:)

10:18 PM

 
Blogger Ghina Yunika said...

This comment has been removed by the author.

8:05 AM

 
Blogger Ghina Yunika said...

nice info, lumayan untuk menambah wawasan seputar flu burung :)
Ulasan Seputar Anak

8:12 AM

 

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