**1. Introduction**

Dengue fever is a mosquito-borne disease caused by any one of four closely related dengue viruses (DenV-1, DenV-2, DenV-3, and DenV-4). Dengue fever is transmitted by the bite of an *Aedes* mosquito infected with a dengue virus. The female mosquito becomes infected when it bites a person with dengue virus in their blood both indoors and outdoors during the daytime (from dawn to dusk). *Aedes aegypti* is particularly involved, as it prefers to lay its eggs in artificial water containers, to live in close proximity to humans, and to feed on people rather than other vertebrates.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dengue infection is the most rapidly spreading mosquito-borne viral disease in the world. Infections are most commonly acquired in the urban environment. In recent decades, the expansion of villages, towns, and cities in the areas in which it is common and the increased mobility of people have increased the number of epidemics and circulating viruses. Dengue fever, which was once confined to Southeast Asia, has now spread to Southern China, countries in the Pacific Ocean and America, and might pose a threat to Europe. In the last 50 years, dengue virus infections had expanded to many other countries with significant increasing cases [1] up to 2.5 billion people living in endemic countries where about 1.8 billion (more than 70%) in Southeast Asia and the Western Pacific Region [1–4]. About 50 million dengue infections occur every year [2, 3], and approximately 500,000 patients are hospitalized of whom dominated by children [2–7]. The increasing incidence and geographical spread of dengue virus were more likely driven by demographic and societal changes such as population growth, urbanization, and modern transportation [8]. The traveler movement also contributed to the risk of contracting dengue disease from nonendemic countries to endemic dengue areas to nonendemic regions where competent mosquito vectors are currently found [9–12].

dengue fever increased rapidly over the past 45 years in Indonesia with peak incidence shift-

Indonesia Dengue Fever: Status, Vulnerability, and Challenges

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The threat of dengue fever among children was emphasized clearly on a recently published study among 3194 children aged 1 through 18 years who lived in 30 different urban neighborhoods. Children blood samples were drawn for antibodies to dengue, an indication that someone has been infected with the virus in the past, and found that 69.4% of all children tested positive for dengue antibodies. Among the age groups, positive antibodies found 33.8% at the group of 1–4 year olds, 65.4% at the group of 5–9 year olds, 83.1% at the group of 10–14 year olds, and 89% at the group of 15–18 year olds. The first time to become infected with dengue was at the age of 4.8 years as the median, and in addition, 13.1% of children on average get their first dengue infection each year. It was also found that the more people in a household who had been diagnosed with dengue since a child's birth, the more likely the

The incidence rate (IR) for every 100,000 population in seven provinces were found over 100 or are prone to dengue cases. The seven provinces are Bali (484), East Kalimantan (306), DKI Jakarta (198.7), DI Yogyakarta (167.9), North Kalimantan (158.3), Southeast Sulawesi (123.3), and South Kalimantan (101.1). The lowest IR is achieved by Papua province (11.8) and West Kalimantan (12.1) (**Figure 1**). The whole of Indonesia is high (IR is 78.0). In general, the increasing number of dengue fever cases is more likely followed by the spread of the cities

**Figure 1.** Incidence rate (IR) of dengue fever per 100,000 population by province in Indonesia 2016 (source: DG of CDC

ing from young children to older age groups [27].

child were to test positive for dengue antibodies [28].

MOH 2017).

Indonesia, with 257.5 million inhabitants and 17,500 islands spread across the equator, poses as the largest archipelago country in the world [13], comprising 3.1 million km<sup>2</sup> of ocean (62% of the total area) with a coastline of 81,000 km and approximately 2 million km<sup>2</sup> of land (38% of the total area). Its tropical climate and subsequent relative high humidity makes Indonesia favorable conditions for vector-borne disease transmission. The increasing trend of dengue infections over the current decades putting Indonesia as one of endemic area for dengue fever and tread both the people as well as travelers visiting the archipelago [14]. Its burden is a result of a constant ground of established infections in the past period, combined with epidemics of emerging infectious diseases (EID) [15]. This chapter describes the dengue fever status or situation in Indonesia, its vulnerability among population, the future challenges, and the disease prevention and control.
