Abstrak

Difteri masih menjadi masalah kesehatan masyarakat di Kabupaten Garut terdapat 100 kasus difteri dengan CFR sebesar 17,2%. Penelitian ini bertujuan mengetahui hubungan status imunisasi dan riwayat kontak dengan kejadian difteri di Kabupaten Garut tahun 2023–2024. Penelitian ini menggunakan pendekatan mix-method. Penelitian kuantitatif menggunakan desain case control (1:2) dengan matching individu berdasarkan usia dan tempat tinggal. Jumlah responden sebanyak 141 anak (47 kasus dan 94 kontrol) yang dipilih menggunakan teknik total sampling dari data KLB. Analisis kondisional regresi logistik dilakukan untuk menghitung odds ratio (OR) dan 95% Confidence Interval (CI). Pendekatan kualitatif dilakukan melalui wawancara mendalam dengan informan terkait menggunakan pendekatan fenomenologi. Sebagian besar anak pada kelompok kasus tidak diimunisasi (74,47%) dan memiliki riwayat kontak dengan penderita difteri (76,6%). anak yang tidak diimunisasi dan memiliki riwayat kontak berisiko 9 kali untuk terkena difteri dibandingkan dengan yang imunisasi lengkap (95%CI: 2,67-31,79). Hasil analisis menunjukkan terdapat hubungan signifikan antara status imunisasi dan kejadian difteri (OR=5,82; 95% CI: 2,17–15,61; p=0,0001) sebelum mengontrol kovariat. Setelah mengontrol kovariat, terdapat hubungan antara status imunisasi dan kejadian difteri (OR=3,08; 95% CI: 1,40–23,79; p=0,008). Hasil kualitatif menunjukkan bahwa faktor sosial-budaya, agama, penolakan imunisasi, serta sistem surveilans yang belum optimal sebelum KLB turut memengaruhi kejadian. Diperlukan peningkatan cakupan imunisasi, edukasi masyarakat, serta penguatan sistem surveilans untuk pencegahan difteri di wilayah berisiko tinggi.

Keywords: difteri, status imunisasi, riwayat kontak, mix-method, Kab. Garut

Background: Diphtheria remains a public health problem in Garut District, with 100 reported cases and a case fatality rate (CFR) of 17.2%. This study aimed to determine the relationship between immunization status with the incidence of diphtheria in Garut District in 2023–2024. Methods: A mixed-method approach was used. The quantitative component employed a case-control design (1:2) with individual matching based on age and residence. A total of 141 children (47 cases and 94 controls) were selected using total sampling from outbreak data. Conditional logistic regression analysis was conducted to calculate odds ratios (OR) and 95% confidence intervals (CI). The qualitative approach was carried out through in-depth interviews with key informants using a phenomenological method. Result: Most children in the case group were not immunized (74.47%) and had a history of contact with diphtheria patients (76.6%). Children who were not immunized and had contact history were 9 times more likely to contract diphtheria compared to those who were fully immunized (95% CI: 2.67–31.79). A significant association was found between immunization status and diphtheria incidence (OR=5.82; 95% CI: 2.17–15.61; p=0.0001), and remained significant after controlling for covariates (OR=3.08; 95% CI: 1.40–23.79; p=0.008). The qualitative findings revealed that socio-cultural and religious factors, vaccine refusal, and a suboptimal surveillance system prior to the outbreak contributed to the cases. Conclusion: Strengthening immunization coverage, community education, and surveillance systems is needed to prevent diphtheria in high-risk areas.