Dream - The 30-year-old man came to a health facility in DKI Jakarta on Thursday, October 12th. He complained of fever. In addition, he claimed to have 10 spots or lesions all over his body. The lesions resembled chickenpox. Eventually, he was admitted to the hospital. Later, on Friday afternoon, October 13th, 2023, the laboratory examination results revealed that the patient was infected with monkeypox (Mpox). He is the second patient with monkeypox in Indonesia. The first case of monkeypox in Indonesia was detected a year ago, in August 2022, in a 27-year-old man. He also experienced lesions on his body and genitals.

It is the second case of monkeypox or Mpox. The first case of monkeypox in Indonesia was detected a year ago, in August 2022, in a 27-year-old man. He also had lesions on his body and genitals. The difference between the first and second cases is that the first patient had a history of traveling abroad to one of the countries that was experiencing a Mpox outbreak at that time. Meanwhile, the second patient had no history of traveling abroad. This means that transmission occurred locally.

A week later, on Thursday, October 19, 2023, a 28-year-old man returned to the healthcare facility in DKI. He also complained of fever and rash or lesions. What's worse, lesions also appeared in his genital area. He was immediately admitted to the hospital. The second and third patients did not have a history of travel from abroad. Surveillance is still being conducted to determine if the patients have had close contact with travelers from abroad.

Although it has been a year, these three cases of monkeypox cannot be taken lightly. Globally, the World Health Organization (WHO) paid attention to this disease last year. WHO declared a global health emergency status for the monkeypox outbreak in July 2022. At that time, a total of 87,000 cases and 140 deaths were reported in 111 countries related to monkeypox transmission.

And, several months later, now monkeypox has appeared on the doorstep of Indonesia: DKI Jakarta...***Until October 22, 2023, there have been eight reported cases of monkeypox. All of them occurred in DKI Jakarta. The Ministry of Health of the Republic of Indonesia (Kemenkes RI) stated that based on their investigation, seven individuals have been confirmed to have monkeypox or Mpox in DKI Jakarta as of October 22, 2023.

With this addition, the accumulation is that there have been eight cases of Mpox in Indonesia since the first case was found in 2022. One person who tested positive for Mpox in August 2022 has recovered. They recovered after self-isolating for three weeks at home. After a year, one person was found positive for Mpox again on October 13, 2023. Followed by one case on October 19, 2023, and five cases at once on October 21, 2023.

"Based on the results of laboratory examinations, up to now we have found 7 confirmed cases of Monkeypox in Indonesia this year. All confirmed cases were found in the DKI Jakarta region," said the Director General of Disease Prevention and Control at the Ministry of Health, Maxi Rein Rondonuwu, on Monday, October 23, 2023. Maxi stated that all currently confirmed Mpox patients are productive-age males. The majority, or about 71%, are males aged 25-29 years old. Meanwhile, the remaining 29% are males aged 30-39 years old."

Maxi also mentioned, from the results of the investigation, it is known that six Monkeypox patients are also People with HIV (ODHIV). They have a bisexual orientation (liking both men and women). It is known that people with HIV have a low immune system, making them vulnerable to Monkeypox infection. Based on data from the Ministry of Health, here are the details of the domicile origin of the seven Monkeypox patients: 1 case from Jatinegara (East Jakarta), 1 case from Mampang, 1 case from Kebayoran Lama, 2 cases from Setiabudi (South Jakarta), 1 case from Grogol Petamburan, and 1 case from Kembangan (West Jakarta).

The following is the translation of the given 'Bahasa' text to 'English' while preserving any html tags: Kemenkes will vaccinate 500 people who are at risk in Jakarta for the next week, with each person receiving two doses within a four-week injection interval. This is because there are still 1,000 doses of Monkeypox vaccine stock available in Indonesia. The Monkeypox vaccination is planned to be carried out starting from October 24, 2023, targeting approximately 447 individuals.

Vaccination will be held at health service facilities designated by the Jakarta Health Office, namely Carlo Clinic and Community Health Centers located in South Jakarta, Central Jakarta, East Jakarta, and West Jakarta. This vaccine is administered in 2 doses with a 4-week interval. The type of Monkeypox vaccine to be used is an imported vaccine produced by Bavarian Nordic. The vaccine has obtained Vaccine Approval Certificate from the Indonesian Food and Drug Authority on March 17, 2023.

"Monkeypox vaccine stock is safe. Currently, a total of 991 vials of Monkeypox vaccine have been distributed to the Jakarta Provincial Health Office to meet the needs of the Monkeypox vaccination program, which will begin in October," said Maxi. Monkeypox was previously designated by the World Health Organization (WHO) as a disease that posed a global health emergency (PHEIC) before this emergency status was lifted on May 11, 2023. However, WHO still urges all countries to carry out prevention, early detection, surveillance, and treatment."

Globally, the cumulative number of cases from January 1, 2022, to September 26, 2023, is 90,618 cases with 157 reported deaths from 115 countries. The two regions reporting the highest number of cases in September are the Western Pacific (51.9 percent) and Southeast Asia (18.1 percent). WHO data shows that 96.3 percent are males with an average age of 34 years. Other data reveals that based on sexual orientation, approximately 83.2 percent occur among males who have sex with males, while 7.4 percent of cases are identified as bisexual males.

Then, around 52.7 percent of cases have a positive HIV status. About 82.5 percent of cases are reported to be transmitted through sexual intercourse. For Indonesia itself, initially only one case of monkeypox was confirmed in August 2022. However, on October 12, 2023, monkeypox cases were detected again. Furthermore, the positive confirmation has now developed into 7 cases.

"“On August 20, 2022, there was 1 case, then on October 12, 2023, at the Puskesmas in DKI, a suspicious case was found and followed up with specimen collection. On October 13th afternoon, the result was positive for Mpox,” said Director of Surveillance and Quarantine of the Ministry of Health of the Republic of Indonesia, Achmad Farchanny Tri Adryanto, in the webinar "Preparedness for Mpox Case Handling." "Since then, until October 21st, there have been 7 positive cases, 3 suspects, 1 probable, 1 discarded or negative," he said."

However, the number of Mpox patients in DKI continues to increase two days later. The Indonesian Ministry of Health (Kemenkes RI) reported an increase in cases of monkeypox or Mpox in DKI Jakarta on Tuesday, October 24, 2023. The number of monkeypox cases in Jakarta on that Tuesday was reported to continue to increase and now totals 10 people who have tested positive, with 11 suspects. All positive monkeypox patients have been recorded since October 13, 2023.

Until Tuesday, October 24, 2023, the detected cases of monkeypox positive patients are as follows: 1 case in August 2022 (recovered), 1 case on October 13, 2023 (hospital isolation), 1 case on October 19, 2023 (hospital isolation), 5 cases on October 21, 2023 (hospital isolation), and 2 positive cases on October 23, 2023 (hospital isolation). The last two cases resulted from close sexual contact with the previous positive cases. And on Friday, October 27, 2023, the monkeypox or Monkeypox (Mpox) cases in the capital city have increased to 17 cases. All patients are males aged 25-50 years. They all contracted the virus through sexual contact. ***

Not only Indonesia is overwhelmed by monkeypox virus. China is also currently struggling with the rising number of cases within the country. China plans to handle monkeypox or Mpox in the same way as dealing with infectious diseases like COVID-19, after detecting a spike of around 500 virus infection cases in August 2023. In August, China reported 501 new Mpox infections, without any severe cases or deaths.

The National Health Commission (NHC) of China stated that Mpox will be managed based on Category B protocols, starting from September 20, 2023. Currently, Category B infectious diseases include COVID-19, AIDS, and SARS. Under this category, China can take emergency measures such as limiting gatherings, suspending work and school, or closing areas when there is a disease outbreak.

"More than 20 provinces have reported cases of monkeypox in China since the first imported case in September 2022 and the early locally transmitted cases in June 2023, triggering a sustained outbreak and 'hidden' transmission," said the NHC. The World Health Organization said in its latest comprehensive report that 10 countries reported an increase in the number of weekly cases, with the highest increase reported in China."

The translation of the given 'Bahasa' text to 'English' while preserving any html tags is: "hina mengklasifikasikan penyakit menular ke dalam tiga kelas, dengan Kategori A sebagai tingkat tertinggi yang memberi wewenang kepada pihak berwenang untuk mengkarantina pasien dan kontak dekat mereka. China menurunkan peringkat penanganan COVID-19 ke Kategori B dari Kategori A pada akhir tahun 2022, setelah hampir tiga tahun menerapkan pembatasan ketat yang mencakup penutupan seluruh kota." Translated text: "hina classifies infectious diseases into three classes, with Category A as the highest level that authorizes authorities to quarantine patients and their close contacts. China downgraded the handling of COVID-19 from Category A to Category B at the end of 2022, after nearly three years of implementing strict restrictions that included the closure of entire cities."

"In August 2023, China reported 501 new cases of Mpox infection, with no severe cases or deaths, according to the China Center for Disease Control and Prevention (CDC) on September 8. First identified in monkeys, this virus is primarily transmitted through close contact with infected individuals. In May 2023, the World Health Organization declared that Mpox is no longer a global public health emergency."

The increasing number of monkeypox cases or Mpox in Jakarta raises questions and concerns about the potential for a new pandemic. As of October 21, 2023, there have been a total of seven confirmed cases of monkeypox by the Ministry of Health of the Republic of Indonesia (Kemenkes RI). "With at least seven reported cases of monkeypox in Jakarta, many are wondering if this could trigger another pandemic. There are at least three explanations for this," said Former Director of Communicable Diseases of WHO Southeast Asia, Prof. Tjandra Yoga Aditama.

The three things that can explain the potential of monkeypox pandemic according to Tjandra are: monkeypox is not a new disease. According to Tjandra, monkeypox is not a new disease. The latest data from the World Health Organization (WHO) on October 20, 2023, shows that there have been 91,123 cases of monkeypox worldwide. These cases have spread to 115 countries around the world. "Of course, we do not know whether the data from Jakarta is included in these calculations. Out of the more than 90 thousand cases, WHO recorded 157 deaths. Clearly, monkeypox cases still exist in the world, and it seems that they are also present in our country," said Tjandra.

The second thing that can explain the potential pandemic according to Tjandra is the need for knowledge about the stages that a disease will go through before becoming a global pandemic. The first stage, if there is a potentially contagious disease between countries, then WHO will include it in the Disease Outbreak News (DONs). For example, polio in Aceh a few months ago has already been included in the WHO DONs. Since August 2023 until today, there have been various diseases that need to be alerted and included in the WHO DONs.

"And there is no monkeypox disease in it, although there is an increase in reported cases in Jakarta. So, in the current situation, monkeypox is not included in the WHO DONs. Meaning, globally, it is not yet classified as a disease with the potential to spread widely between countries. In the second phase, after being included in the DONs and continuing to develop, WHO will declare it as a global health emergency or Public Health Emergency of International Concern (PHEIC). Monkeypox was previously declared as a PHEIC on July 23, 2022."

After almost a year of intensive handling worldwide, the public health situation is well under control. Therefore, on May 11, 2023, it was declared that monkeypox is no longer a PHEIC (Public Health Emergency of International Concern). "Specifically, the global health emergency of monkeypox has been declared over," he said. The third point regarding the potential monkeypox pandemic is that, although the global health emergency status has been lifted, Tjandra urges the public to remain vigilant.

"\u201cAlthough no longer classified as a global health emergency, we still need to remain cautious about monkeypox. Just like we are cautious about other contagious diseases,\u201d he said. Furthermore, Tjandra explained that the symptoms of monkeypox infection are abnormalities in the skin and mucous membranes that can occur two to four weeks later. Followed by fever, headache, muscle pain, weakness, and swollen lymph nodes."

What is clear: monkeypox is no longer only found in Africa, its place of origin. But it is now present in Indonesia: DKI Jakarta. So it is not wrong for everyone to always remain vigilant. Learning from China, monkeypox can easily spread throughout the archipelago. Because monkeypox is already among us. It can be transmitted through sexual contact. Terrifying. (eha)Source: Liputan6, BBC, ABC News, WION.