Progress in Diarrheal Disease Research at Namru-2 in Collaboration with Badan Litbangkes and Rspi

Penyakit diare termasuk kolera masih merupakan masalah kesehatan yang penting untuk Indonesia. Kejadian luar biasa (KLB) "muntah-berak" masih terus dilaporkan dari berbagai daerah di Indonesia. Salah satu upaya yang dilakukan untuk mengatasi keadaan ini adalah menemukan suatu vaksin yang aman, praktis dan terjangkau harganya. CVD-103 adalah strain V. cholerae yang sebagian besar gen penyebab diare, toksin subunit A, telah dibuang. Pada penelitian dengan peserta anak-anak di Jakarta, CVD 103-HgR ternyata memberikan kenaikan antibodi dan dapat diterima baik oleh anak-anak Indonesia berusia 5-9 tahun dan 25-59 bulan. Di samping itu pemeriksaan sampel bakteriologik dari lingkungan dekat tempat kediaman peserta dengan menggunakan teknik yang peka untuk mendeteksi V. cholerae, tidak menemukan adanya strain vaksin. Suatu penelitian lapangan dengan tujuan untuk menilai kemanjuran dosis tunggal vaksin oral kolera CVD 103-HgR untuk pencegahan kolera secara klinis selama tiga tahun, telah dimulai didaerah Jakarta Utara pada tahun 1993. Selain itu penelitian ini juga bertujuan untuk menetapkan kemanjuran vaksin terhadap berbagai kelompok umur, terhadap kolera berat, serta membandingkan kemanjurannya pada peserta dengan golongan darah O. Jumlah penduduk yang ikut dalam penilaian vaksin ini adalah 67.000 peserta sukarela. Hasil penelitian ini diharapkan dapat diketahui pada akhir tahun 1996.Di samping penelitian tentang vaksin kolera, NAMRU dan Badan Litbangkes juga telah ikut serta dalam berbagai penelitian WHO, misalnya tentang larutan garam oralit (ORS) yang dilakukan di RS Karantina/RS Penyakit Infeksi Prof. Dr. Sulianti Saroso. Salah satu penelitian terakhir adalah manfaat larutan ORS dengan osmolaritas rendah pada tahun 1994. Hasil penelitian ini telah mendorong WHO untuk melaksanakan penelitian dengan larutan yang sama di berbagai pusat penelitian (multicenter) pada tahun 1995 sebelum mengusulkan suatu Perubahan formulasi larutan ORS secara global

P. Falciparum Resisten Terhadap Chloroquine Di Kabupaten Jepara, Jawa Tengah

Twenty indigenous falciparum cases were subjected to either an in vivo and/or in-vitro (macro and micro) test, held during a WHO assisted training activity in Jepara, Central Jawa, in May 1981, to assess its susceptibility to chloroquine. Result showed that all cases were resistant to chloroquine. Ten cases underwent in-vivo test, revealing 9 resistant at RI and 1 resistant at RII level. This is the first report of falciparum found in Jawa

Etiologi Mikribiologis Penyakit Diare Akut

As in other developing countries, diarrhoea is a major cause of morbidity and mortality in Indo­nesia. It is estimated that at least 4-5 million deaths per year in the world are caused by acute di­arrhoea. In Indonesia, 40% of deaths in the first 2 years of life is caused by acute diarrhoea. This study is to assess the microbial agents of diarrhoea! disease, from patients of 2 hospitals in Ja­karta. Rectal swabs for bacteriological examination were collected from patients at the admission using Cary & Blair as a transport media. Stools for Rota virus examination were collected in a tube container and kept at 4- 6°C before further processing. Conventional bacteriological procedures were performed for isolation and identification of bacterial agents. Enterotoxigenic E. Coli (E T E Cj was examined by ELISA for LT and by intragastric inocula­tion of suckling mice for ST. Campylobacter was incubated at 42°C in a candle jar using desiccator as a jar. The isolation results from 1937 specimens collected were V. cholera 01 50,2%, Rota virus 31,0%, ETEC 6,8%, Campylobacter sp 4,8%, Salmonella sp 4,3%, V. parahaemolyticus 1,6%, NAG 0,9%, Shi­gella sp 0,8%, Y. enterocolytica 0,2% and mixed infection of 2 or 3 different agent 5%. Most of the V. cholera isolated were of the Ogawa sero-type (98,9%). ETEC consisted of 69,2% LT alone, 21,4% ST alone and 8,9% both LT and ST. The most prevalent among 10 Salmonella species isolated were S. oranienberg 34,9% and S. kreveld 21,7%. The most prevalent among 4 species of Shigella isolated were Sh. flexneri 43,8% and Sh. dysen-triae 31,3%. Diarrhoeal diseases were continuously found through the year with 2 peaks; one high peak in May, June and July and the other lower peak in December and January

The Impact of Water Supply on Diarrheal Disease in Several Villages, Nusa Tenggara Timur

Dampak penyediaan air bersih terhadap penyakit diare telah dipelajari di dua kecamatan endemis Malaka Tengah dan Malaka Barat, Kabupaten Belu, Propinsi Nusa Tenggara Timur dalam bulan No-pember 1987. Prevalensi diare di 15 desa berkisar antara 73,9 - 634,2 per 1000 penduduk dengan rata-rata 2692 per 1000 penduduk. Prevalensi di desa yang menggunakan sarana baik (safe) 166 per 1000 penduduk, sarana kurang baik (less safe) 184 per 1000 penduduk dan sarana jelek (unsafe) 315 per 1000 penduduk. Sarana penyediaan air mempengaruhi prevalensi diare. Prevalensi diare relatif rendah di desa yang sebagian besar penduduknya menggunakan sarana baik. Sebaliknya prevalensi lebih tinggi di desa yang menggunakan sarana kurang baik atau jelek

20 Years of Progress in Typhoid Research

In 1981, the reported number of cases of typhoid fever in Indonesia was 19,596, increasing to 26,606 m 1986, most of the increase was due to improved detection and recognition of the pathogen. A more realistic estimate of incidence for this underreported and underdiagnosed disease would be from 540,000 to 1,210,000 cases per year. This was based on results of a household survey done by Budiarso R. et al. in 1980 and 1986, and on result of a community surveillance done by Ruwido and Simanjuntak et al. from 1983-1988. These studies were done in Plaju, South Sumatera, representing an urban area and Paseh, West Java, representing a semi-rural area. The results showed that the incidence rate of typhoid fever in the semi rural area was 358/100,000 population/year, and between 760-810/100,000 population/year in the urban area. These studies also indicated that the high risk group in the population was school age children between ages of 3-19 years. From other observations, it is also noted that the case fatality in urbanized and growing areas of Indonesia, may be higher than it is reported in other areas of the worl

Safety, Immunogenicity, and Transmissibility of Single-Dose Live Oral Cholera Vaccine Strain CVD l03-HgR in 24- to 59-Month-Old Indonesian Children

Recombinant A-B+ Vibrio cholerae O1 strain CVD 103-HgR is a safe, highly immunogenic, single-dose live oral vaccine in adults in industrialized countries, Safety, excretion, immunogenicity, vaccine transmissibility, and environmental introduction ofCVD 103-HgR were investigated among 24- to 59-month-old children in Jakarta. In 81 households, 1 child was randomly allocated a single dose of vaccine (5 x 109 cfu) and another, placebo. Additionally, 139 unpaired children were randomly allocated vaccine or placebo. During 9 days of follow-up, diarrhea or vomiting did not occur more often among vaccinees than controls. Vaccine was minimally excreted and was isolated from no controls and from 1 (0.6%) of 177 unvaccinated family contacts. A 4-fold or higher rise in serum vibriocidal antibody was observed in 75% of vaccinees (10-fold rise in geometric mean titer over baseline). Of 135 paired placebo recipients or household contacts, 5 had vibriocidal seroconversions. Moore swabs placed in sewers and latrines near 97 households failed to detect vaccine. These observations pave the way for a large-scale field trial of efficac

Standard WHO-ORS Versus Reduced-osmolarity ORS in the Management of Cholera Patients

The study compared the safety and efficacy of an oral rehydration salts (ORS) solution, containing 75 mmol/L of sodium and glucose each, with the standard World Health Organization (WHO)-ORS solution in the management of ongoing fluid losses, after initial intravenous rehydration to correct dehydration. The study was conducted among patients aged 12-60 years hospitalized with diarrhoea due to cholera. One hundred seventy-six patients who were hospitalized with acute diarrhoea and signs of severe dehydration were rehydrated intravenously and then randomly assigned to receive either standard ORS solution (311 mmol/L) or reduced-osmolarity ORS solution (245 mmol/L). Intakes and outputs were measured every six hours until the cessation of diarrhoea. During maintenance therapy, stool output, intake of ORS solution, duration of diarrhoea, and the need for unscheduled administration of intravenous fluids were similar in the two treatment groups. The type of ORS solution that the patients received did not affect the mean serum sodium concentration at 24 hours after randomization and the relative risk of development of hyponatraemia. However, patients treated with reduced-osmolarity ORS solution had a significantly lower volume of vomiting and significantly higher urine output than those treated with standard WHO-ORS solution. Reduced-osmolarity ORS solution was as efficacious as standard WHO-ORS solution in the management of cholera patients. The results indicate that reduced-osmolarity ORS solution is also as safe as standard WHO-ORS solution. However, because of the limited sample size in the study, the results will have to be confirmed in trials, involving a larger number of patients

20 Years of Progress in Diarrheal Disease Research

When NAMRU started its collaboration work with the National Institute of Health, Research and Development (NIHRD), it became apparent that diarrheal disease was one of the most important causes of morbidity and mortality in Indonesia, especially in children. Many of the most important etiologic agents of diarrhea were not known and the percentage of diarrheas with an identifiable etiologic agent was very low. Since these early times NAMRU and NIHRD have worked together in all aspects of diarrheal disease research. Increased capabilities for the identification of bac­tériologie, parasitic and viral enteropathogens, new vaccines, and better treatment via oral rehydration solutions are some of the results of this collaboration

The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance

BACKGROUND: In preparation of vaccines trials to estimate protection against shigellosis and cholera we conducted a two-year community-based surveillance study in an impoverished area of North Jakarta which provided updated information on the disease burden in the area. METHODS: We conducted a two-year community-based surveillance study from August 2001 to July 2003 in an impoverished area of North Jakarta to assess the burden of diarrhoea, shigellosis, and cholera. At participating health care providers, a case report form was completed and stool sample collected from cases presenting with diarrhoea. RESULTS: Infants had the highest incidences of diarrhoea (759/1 000/year) and cholera (4/1 000/year). Diarrhea incidence was significantly higher in boys under 5 years (387/1 000/year) than girls under 5 years (309/1 000/year; p < 0.001). Children aged 1 to 2 years had the highest incidence of shigellosis (32/1 000/year). Shigella flexneri was the most common Shigella species isolated and 73% to 95% of these isolates were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline but remain susceptible to nalidixic acid, ciprofloxacin, and ceftriaxone. We found an overall incidence of cholera of 0.5/1 000/year. Cholera was most common in children, with the highest incidence at 4/1 000/year in those less than 1 year of age. Of the 154 V. cholerae O1 isolates, 89 (58%) were of the El Tor Ogawa serotype and 65 (42%) were El Tor Inaba. Thirty-four percent of patients with cholera were intravenously rehydrated and 22% required hospitalization. V. parahaemolyticus infections were detected sporadically but increased from July 2002 onwards. CONCLUSION: Diarrhoea causes a heavy public health burden in Jakarta particularly in young children. The impact of shigellosis is exacerbated by the threat of antimicrobial resistance, whereas that of cholera is aggravated by its severe manifestations