Antitoksin Mampu Lawan

Sakit kerongkong atau difteria adalah penyakit lazim yang mengancam nyawa kanak-kanak kerana ia menjejaskan sistem pernafasan.

Penyakit berjangkit ini pernah berleluasa di seluruh dunia dan menjadi punca utama kepada penyakit serta kematian dalam kalangan kanak-kanak.

Pada 1921, sebanyak 206,000 kes difteria dengan 15,520 kematian direkodkan di Amerika Syarikat sehingga banyak keluarga membuat keputusan untuk berkurung di rumah masing-masing bagi memastikan anak mereka selamat.

Malah penyakit ini juga merebak di negara Eropah sehingga menimbulkan kebimbangan kerana mengakibatkan ribuan kematian setiap tahun. Di Barat, difteria juga digelar Malaikat Melemaskan (The Strangling Angel) disebabkan oleh pembentukan membran berwarna kelabu keputihan yang berbentuk sayap pada tonsil kanak-kanak yang menghidap penyakit ini.

Selaput ini akan memenuhi dan menyekat tekak, peti suara dan paru-paru lalu mengakibatkan mangsa sesak nafas. Vaksin melawan difteria mengurangkan kadar kematian dan morbiditi penyakit ini secara mendadak, bagaimanapun difteria masih menjadi masalah kesihatan kanak-kanak yang ketara di negara dengan liputan program lanjutan imunisasi (EPI) terendah.

Di negara endemik untuk difteria, penyakit ini berlaku kebanyakannya sebagai kes sporadik atau wabak kecil. Difteria mengakibatkan kematian dalam lima hingga 10 peratus kes dengan kematian tertinggi membabitkan kanak-kanak. Rawatan pula membabitkan antitoksin difteria bagi meneutralkan kesan toksin difteria sebagaimana antibiotik membunuh bakteria.

Ketua Pengarah Kesihatan, Datuk Dr Noor Hisham Abdullah berkata, difteria disebabkan oleh jangkitan bakteria Corynebacterium diphtheria dan disebarkan daripada pesakit kepada individu lain melalui titisan cecair pernafasan apabila seseorang yang dijangkiti itu batuk, bersin atau bercakap.

Individu yang dijangkiti boleh menyebarkan penyakit dalam masa dua hingga tiga minggu selepas pendedahan awal kepada bakteria terbabit. Namun individu yang dijangkiti mungkin tidak menunjukkan apa-apa simptom jangkitan sebelum menyebarkan penyakit ini kepada orang lain tanpa diketahuinya.

Bakteria ini kemudian akan menjangkiti tekak iaitu bahagian tonsil, farinks, larinks dan hidung. Kadangkala ia turut menjangkiti selaput mukus lain, kulit, konjunktiva dan kemaluan.

Ia menghasilkan toksin yang menyebabkan keradangan di sekitar tekak dan bengkak leher yang boleh menyebabkan pesakit sukar bernafas. Toksin ini juga boleh menyerap ke dalam darah, melumpuhkan saraf dan menyebabkan keradangan jantung (miokarditis).

“Di Malaysia, pesakit yang disyaki menghidap difteria akan diberi antitoksin dengan segera tanpa menunggu keputusan ujian makmal kerana sebaran toksin ke seluruh tubuh boleh mengancam nyawa.

“Lazimnya seorang kes difteria memerlukan tujuh hingga lapan vial antitoksin dengan kos RM500 setiap vial berbanding dengan kos vaksin hanya RM34 satu dos dan dapat melindungi daripada lima jenis penyakit,” katanya di Putrajaya, baru-baru ini.

Menurutnya, sejak pelalian difteria dimasukkan ke dalam Program Imunisasi Kanak-kanak Kebangsaan pada 1972, kejadian penyakit difteria menurun dengan sangat drastik.

Dalam tempoh lima tahun kebelakangan ini, bilangan kes difteria yang paling tinggi di Malaysia dicatatkan pada 2013 membabitkan empat kes termasuk dua kematian dilaporkan dengan kadar insiden 0.01 kes per 100,000 populasi penduduk.

“Namun, pada awal November lalu, satu kes difteria dilaporkan berlaku di Kampung Bukit Malut, Langkawi, Kedah. Kes membabitkan pesakit kanak-kanak berumur lapan tahun dan tidak menerima imunisasi difteria.

“Mangsa meninggal dunia kerana komplikasi jangkitan dan sebagai langkah berjaga-jaga, semua anggota keluarga terdekat termasuk individu lain yang rapat diperiksa. Hasil pemeriksaan didapati hanya seorang mengalami gejala yang disahkan dijangkiti difteria.

“Kedah juga pernah melaporkan satu kes kematian difteria yang berlaku di Kampung Bikan, Kulim pada Disember 2014 dan kes ini juga disebabkan mangsa tidak mendapat suntikan lengkap imunisasi difteria,” katanya.

Beliau berkata, pada masa kini, imunisasi difteria terkandung dalam vaksin lima serangkai dikenali DTaP-IPV/Hib untuk penyakit difteria, pertusis, tetanus, polio dan Haemophilus Influenza Jenis B.

Ia diberikan pada bayi umur dua, tiga dan lima bulan sebagai dos utama dan umur 18 bulan sebagai dos tambahan. Liputan imunisasi yang melebihi 95 peratus dalam komuniti akan memberi imuniti kelompok dan melindungi kanak-kanak daripada dijangkiti bakteria ini. Kanak-kanak yang menerima imunisasi lengkap hanya akan mengalami gejala ringan.

“Jangkitan difteria mempunyai kadar kematian yang sangat tinggi. Ia menunjukkan betapa bahayanya penyakit ini dan betapa mustahaknya kanak-kanak diberi imunisasi difteria.

“Oleh itu, ibu bapa disarankan untuk memastikan anak mereka mendapat imunisasi lima serangkai dos utama yang lengkap. Tindakan bijak kita akan menyelamatkan anak daripada komplikasi jangkitan difteria ini,” katanya.

Vaksin difteria adalah toksin bakteria yang tahap ketoksikannya sudah dimatikan. Pelalian ini biasanya diberi dalam kombinasi dengan vaksin lain seperti DTP. Bagi remaja dan dewasa, toksin tidak aktif difteria biasanya diberi bersama toksin tetanus tidak aktif dalam kepekatan rendah.

Antara penyakit yang boleh dicegah menerusi pemberian vaksin ialah Haemophilus Influenza Jenis B (Hib) yang menyebabkan meningitis dan pneumonia, hepatitis B yang menyerang hati, human papillomavirus (HPV) yang menyebabkan kanser serviks dan jangkitan seks, demam campak menyebabkan buta dan encefalitis, meningitis A iaitu jangkitan pada otak, beguk, pneumococcal, polio, rotavirus yang menyebabkan cirit-birit, rubella, kancing gigi dan demam kuning.

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