Studi Hepatitis B pada Anak-Anak yang Lahir di Era Program Imunisasi Nasional Hepatitis B di Indonesia

lndonesia termasuk negara dengan prevalensi infeksi hepatitis B sedang sampai tinggi. Persentasi Infeksi hepatitis B menjadi khronik adalah 90-95% pada mereka yang tertular waktu lahir dari ibu yang positif, dan hanya sekitar 5% pada mereka yang tertular setelah dewasa. Hepatitis B khronik kemungkinan besar berujung pada sirosis dan atau kanker hati. Oleh sebab itu vaksinasi hepatitis B pada bayi baru lahir sangatlah penting. Program vaksinasi massal pada semua bayi baru lahir di seluruh Indonesia dimulai sejak tahun 1997. Hingga saat ini belum ada evaluasi tentang ke rhasilan vaksinasi massal tersebut. Pada penelitian ini akan dicari data vaksinasi dan dilakukan pemeriksaan serologis, hep titis B surface-antigen (HBsAg) dan antibody terhadap HBsAg (HBsAb), pada anak usia 1- 13 tahun di berbagai daerah representatif genotipe dan subtipe virus hepatitis B (HBV) di Indonesia, yakni Kabupaten Kotawaringin Barat Kalimantan Tengah dan Kota Kupang, Nusa Tenggara Timur. Di Kab Kotawaringin Barat Kalimantan Tengah, diperoleh hasil prevalensi HbsAg positif sejumlah 3 dari 258 anak (1.2%), angka keberhasilan imunisasi Hepatitis B dengan status anti HBs saja yang positif sebesar 108 anak (41.9%) dan angka anti HBc sebesar 4.3%. Di Kota Kupang Nusa Tenggara Timur, prevalensi status HbsAg positif sejumlah 6 dari 177 nak (3.4%) angka keberhasilan imunisasi Hepatitis B dengan status anti HBs saja yang positif sebesar 85 anak (48.0%) dan angka anti HBc sebesar 5.1%. Jumlah HBV DNA positif dari sampel dengan HbsAg dan atau anti HBc positif di Kab Kotawaringin Barat dan Kota Kupang NTT masing masing sebanyak 8 (3.1%) dan 9 (5.1%). Seluruh sampel dari Kab Kotawaringin Barat-Kalimantan Tengah merupakan genotipe B dan subtipe adw. Sedangkan distribusi strain HBV pada anak di Kota Kupang NTT yakni HBV genotipe B (5 sampel) dan C (4 sampel), serta jenis subtipe adw, ayw dan adr masing masing 4, 3, dan 2 sampel. Mutasi M133L diduga berperan dalam HBV vaccine escape mutant yang diidentifikasi pada 1 sampel dari Kab Kotawaringin Barat Kalimantan Tengah

The model of supervision for impermanent food sellers by women volunteer in Kendari City Indonesia

Objectives: Many fast food sellers emerged in Kendari city of Southeast Sulawesi Province Indonesia. The number of staff in Environmental division in Primary Health Services was limit, so they could not supervise for all fast food sellers in that area. Therefore, involving of women volunteer in the villages of Kendari City was necessary. Therefore, this study aimed to find out the model of supervision for impermanent food sellers by the women volunteers in Kendari City, Southeast Sulawesi Province in Indonesia. Method: This study used Quasy Experiment with the One-Group Pre-test-Post-test Design. The study was conducted in 3 villages in Kendari City. This study recruited 17 women volunteers and 39 fast food sellers. The statistical analysis used linier regression. Results: The model of supervision under the women volunteers could be found in this study. The characteristic of women volunteers which involved and be active to supervise were they who have be active in social activities in their village. They have also been involved in Primary Health Services in the village for more than 6 years, they were above 41 years old. They were married and had 3 children in average. Each village involve about 4-10 women. Each village was organized by 1 person as a village coordinator. The village coordinator had responsibility to communicate or mediate to primary health services, especiallay to environmental division. Every month the coordinator reports the results of women’s supervision for the fast food sellers. The time of reaching the fast food sellers was found to be significant relation with the seller’s behavioural change and fast quality improvement. Conclusion: Women volunteers can supervise to the fast food sellers in kendari City in southeast Sulawesi Province, Indonesia. They have closed with the food sellers and with sanitation and environmental staff in primary health service

Viral hepatitis and human immunodeficiency virus co-infections in Asia

Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) affect many people in Asian countries, although there are geographic differences. Both HBV and HIV (HBV/HIV) and HCV/HIV co-infections are highly prevalent in Asia. Hetero- and homosexual, injection drug use, and geographic area are strong predictors of HBV, HCV, and HIV serostatus. In HBV endemic regions, the prevalence and genotype distribution of HBV/HIV co-infection is almost comparable with that in the general population. In Japan, where HBV has low endemicity, the prevalence of HBV/HIV co-infection is approximately 10-fold higher than that in the general population, and HBV Ae is the most common subgenotype among HIV infected individuals. Highly active antiretroviral therapy (HAART) is an effective treatment for HIV/Acquired Immune Deficiency Syndrome. Lamivudine, a component of HAART, is an effective treatment for HBV, HIV, and HBV/HIV co-infection; however, cost, emerging drug resistance, antiretroviral-associated liver toxicity and liver-related morbidity due to HCV progression are particular concerns. HCV/HIV co-infection may accelerate the clinical progression of both HCV and HIV. The high prevalence of HBV/HIV and HCV/HIV co-infections in Asia underscores the need to improve prevention and control measures, as fewer evidence-based prevention strategies are available (compared with Western countries). In this review, the most recent publications on the prevalence of HBV/HIV and HCV/HIV co-infections and related issues, such as therapy and problems in Asia, are updated and summarized

Current hepatitis B virus infection situation in Indonesia and its genetic diversity

Indonesia has a moderate to high endemicity of hepatitis B virus (HBV) infection. The risk for chronic HBV infection is highest among those infected during infancy. Since 1997, hepatitis B (HepB) vaccination of newborns has been fully integrated into the National Immunization Program. Although HBV infection has been reduced by the universal newborn HepB immunization program, it continues to occur in Indonesia. The low birth dose coverage and the presence of vaccine escape mutants might contribute to this endemicity among children. Although limited information is available for an analysis of occult HBV infection (OBI), several variations and substitutions in the pre-S/S region have been detected in Indonesian HBV strains. Additionally, persistent infection and disease progression of chronic hepatitis B are related to not only viral factors but also the host genome. Indonesia is one of the most ethnically heterogeneous nations, with Javanese and Sundanese as the two highest ethnic groups. This multi-ethnicity makes genomic research in Indonesia difficult. In this article, we focused on and reviewed the following aspects: the current hepatitis B immunization program and its efficacy, OBI, HBV infection among high-risk patients, such as hemodialysis patients, and research regarding the host genome in Indonesia

Hepatitis B virus infection in Indonesia

Approximately 240 million people are chronically infected with hepatitis B virus (HBV), 75% of whom reside in Asia. Approximately 600000 of infected patients die each year due to HBV-related diseases or hepatocellular carcinoma (HCC). The endemicity of hepatitis surface antigen in Indonesia is intermediate to high with a geographical difference. The risk of HBV infection is high in hemodialysis (HD) patients, men having sex with men, and health care workers. Occult HBV infection has been detected in various groups such as blood donors, HD patients, and HIV-infected individuals and children. The most common HBV subgenotype in Indonesia is B3 followed by C1. Various novel subgenotypes of HBV have been identified throughout Indonesia, with the novel HBV subgenotypes C6-C16 and D6 being successfully isolated. Although a number of HBV subgenotypes have been discovered in Indonesia, genotype-related pathogenicity has not yet been elucidated in detail. Therefore, genotype-related differences in the prognosis of liver disease and their effects on treatments need to be determined. A previous study conducted in Indonesia revealed that hepatic steatosis was associated with disease progression. Pre-S2 mutations and mutations at C1638T and T1753V in HBV/B3 have been associated with advanced liver diseases including HCC. However, drug resistance to lamivudine, which is prominent in Indonesia, remains obscure. Although the number of studies on HBV in Indonesia has been increasing, adequate databases on HBV infection are limited. We herein provided an overview of the epidemiology and clinical characteristics of HBV infection in Indonesia

Studi hepatitis B pada anak-anak yang lahir di era program imunisasi nasional hepatitis B di Indonesia

Indonesia termasuk negara dengan prevalensi infeksi hepatitis B sedang sampai tinggi Persentasi Infeksi hepatitis B menjadi khronik adalah 90-95% pada mereka yang tertular waktu lahir dari ibu yang positif, dan hanya sekitar 5% pada mereka yang tertular setelah dewasa. Hepatitis B khronik kemungkinan besar berujung pada sirosis dan atau kanker hati. Oleh sebab itu vaksinasi hepatitis B pad a bayi baru lahir sangatlah penting. Program vaksinasi massai pada semua bayi baru lahir di seluruh Indonesia dimulai sejak tahun 1997. Hingga saat ini belum ada evaluasi tentang keberhasilan vaksinasi massal tersebut. Pada penelitian ini akan dicari data vaksinasi dan dilakukan pemeriksaan serologis, hepatitis B surface-antigen (HBsAg) dan antibody terhadap HBsAg (HBsAb). pada anak usia 1-13 tahun di berbagai daerah representatif genotipe dan subtipe virus hepatitis B (HBV) di Indonesia, yakni Kabupaten Kotawaringin Barat Kalimantan Tengah dan Kota Kupang, Nusa Tenggara Tlmur. Di Kab Kotawaringin Barat Kalimantan Tengah diperoleh hasil prevalensi HbsAg positif sejumlah 3 dari 258 anak (1.2%), angka keberhasilan imunisasi Hepatitis B dengan status anti HBs saja yang positif sebesar 108 anak (41.9%) dan angka anti HBc sebesar 4.3%. Di Kota Kupang Nusa Tenggara Timur, prevalensi status HbsAg positif sejumlah 6 dari 177 anak (3.4%) angka keberhasilan imunisasi Hepatitis B dengan status anti HBs saja yang positif sebesar 85 anak (48.0%) dan angka anti HBc sebesar 5.1 %. Jumlah HBV DNA posit if dari sampel dengan HbsAg dan atau anti HBc positif di Kab Kotawaringin Barat dan Kota Kupang NTT masing masing sebanyak 8 (3.1 %) dan 9 (5.1%). Seluruh sampel dari Kab Kotawaringin Barat-Kalimantan Tengah merupakan HBV genotipe B dan subtipe adw. Sedangkan distribusi strain HBV pada anak di Kota Kupang NTT yakni HBV genotipe B (5 sampel) dan C (4 sampel), serta jenis subtipe adw, ayw dan adr masing masing 4, 3, dan 2 sampel. Mutasi M133L diduga berperan dalam HBV vaccine escape mutant yang diidentifikasi pada 1 sampel dari Kab Kotawaringin Barat Kalimantan Tengah

Phylogenetic Molecular Analysis Human Immunodeficiency Virus (HIV) Patients in Surabaya, East Java

The Human Immunodeficiency Virus Type 1 (HIV-1) isolates are classified in three main groups: group M (main), group O (outlier) as well as group N (non-M/non-O). The HIV-1 M group, responsible for the majority of infections in the HIV-1 worldwide epidemic, can be further subdivided into 10 recognized phylogenetic subtypes or clades, A�D and F-K. HIV-1 phylogenetic classifications are currently based on nucleotide sequences derived from such as gag p17 region of the same isolates or on full-length genome sequence analysis. We do not know HIV subtype distribution in HIV suspected patients, in Surabaya, East Java. The aims of this study was to do molecular analysis HIV in patients with HIV infection, in Surabaya, East Java. Antibody to HIV were detected using 3 methods, paper and EIA (Acon) and ELISA (Axion) techniques from 51 plasma obtained from the patients suspected HIV infection, in Surabaya, Indonesia All of the samples were subjected to Polymerase Chain Reaction (PCR) using pairs of primers based on HIV gag p17 genes. The PCR positive samples were sequenced and analysed to identify the HIV subtype using Genetic Version 9 program. Fourty nine (96,08%) HIV antibody were detected from 51 patients suspected HIV infection and 57,14% (28/49) HIV RNA determination positives. All of 21 positives HIV DNA except one sample that have been analyzed was CRFs of HIV with mayority CRF01-AE subtype similar with HIV CRF01-AE subtype in Asia countries, e.g. Thailand, Japan, Malaysia, Cina and Hongkong. Those one sample has 18 nucleotides insertion look like a HIV new subtype but it is needed to confirm further. From gag p7 HIV gene in this study, one HIV has and CRF01-AE is majority HIV subtype in Surabaya, East Java which is located in the same branch with HIV common CRF01-AEHIV subtype in Asia

Comparation of Phenotypic and Genotypic Profile of Carbapenemase Producing Escherichia coli

Carbapenemase-producing Escherichia coli (E. coli) has caused trouble in therapeutic antibiotic selection. Carbapenemase screening procedure in laboratories is usually based on inacurate semi-automatic system. Confirmation and classification of carbapenemases according to Ambler can be done with combination of phenotypic methods, i.e., Modified Hodge Test (MHT), Sodium Mercaptoacetic Acid (SMA), and 3-Aminophenylboronic Acid (PBA). This study aimed to compare profiles of carbapenemase-producing E. coli which were confirmed and classified phenotypically with the genotypic profiles. E. coli isolates from urine specimens which were potential as carbapenemase-producers according to semi-automatic system BD Phoenix were phenotypically tested with MHT, SMA, and PBA. Isolates were grouped as carbapenemase-producers and non carbapenemase-producers. Phenotypic carbapenemase-producer isolates were classified based on Ambler criteria. All isolates were then tested with Polymerase Chain Reaction (PCR) for the presence of OXA-48, IMP1, IMP2, GES, VIM, NDM, KPC genes. Out of 30 isolates, 6 isolates (20.0%) were MHT positive, and 25 isolates (83.3%) were SMA positive, which indicated that most isolates produced were carbapenemase Ambler B. PCR confirmed 12 isolates (40.0%) had VIM gene which were classified as carbapenemase Ambler B. Phenotypic confirmatory test had 100% sensitivity and 22.2% specificity. Classification with phenotypic confirmatory test had 91.7% match with PCR. Phenotypic confirmatory test detected more carbapenemase than PCR. This low specificity may be caused by inappropriate use of diagnostic gold standard. PCR should not be used for routine carbapenemase confirmation because of vast diversity of carbapenemases. Phenotypic confirmatory test can classify carbapenemase according to Ambler classification

DETECTION OF HUMAN HERPESVIRUS-8 ANTIGEN IN HIV-INFECTED PATIENTS IN EAST JAVA, INDONESIA

Background: Co-infection of human herpesvirus-8 (HHV-8) in HIV-positive people might cause Kaposi's sarcoma. Early detection of HHV-8 may prevent the onset of clinical manifestations. In Indonesia, detection of HHV-8 antigen in HIVpositive patients has yet to be reported. The intention of this research was to examine the presence of HHV-8 antigen in HIV-positive patients in East Java, Indonesia. Material and Methods: 103 serum samples were collected from HIV-positive patients in Surabaya and Tulungagung, East Java, Indonesia. Serums were then tested for the presence of HHV-8 antigen by using sandwich ELISA. Results: Human Herpesvirus-8 antigen was detected in 15 samples (14.5%). The presence of HHV-8 infection in HIVpositive patients did not present differently in males and females and among different age groups. Human immunodeficiency virus-positive serum samples were collected from 23 homosexual men, 25 intravenous drug users (IVDUs) and 52 heterosexuals. In the male homosexual group, HHV-8 antigen was detected in 21.7% (5/23) of the samples, while in the intravenous drug user group (IVDUs), 16% (4/25) of the samples were found to have HHV-8 antigen. Conclusion: This research found the presence of HHV-8 antigen in 14.5% of patients in East Java, Indonesia. It is recommended that patients with a positive result should receive further examination to detect any clinical manifestations related to HHV-8 infection, especially in the form of Kaposi’s sarcoma lesions, so that the illness can be appropriately managed

Another novel subgenotype of hepatitis B virus genotype C from papuans of Highland origin

Hepatitis B virus (HBV) genotypes and subtypes have been identified worldwide. As HBV genotypes/subtypes, the HBV subgenotypes seem to be associated with their geographical distribution and ethnic origin. A previous study showed the novel HBV subgenotype C6 based on the complete genome sequences of isolates in Papua, Indonesia. In the present study, further characterization of HBV in Jayapura (capital of Papua Province), particularly from native people of Papua originating from the highland (highland Papuans) and those from the lowland (lowland Papuans) were examined. Of 32 HBV isolates from both highland and lowland Papuan blood donors with HBsAg positive, part of the S gene and the core gene sequences were analyzed. Analyses of some isolates from highland Papuans were confirmed by the complete genome sequences. Most HBV isolates were classified into genotype C (78.1%), followed by genotype B (18.8%), and genotype D (3.1%). The subtype adr was predominant (71.9%), followed by adw2 (25.1%), and ayw2 (3.1%). As with previous findings, phylogenetic analyses revealed that most HBV isolates from Papuans, C/adr, belonged to subgenotype C6. Interestingly, some C/adr isolates from highland Papuans formed a distinct cluster from all reported subgenotypes of HBV/C, and they differed from HBV/C1‐C10 by 4.2–7.2% over the complete genome. SimPlot analysis showed no evidence of recombination with HBV/C1–C10. The isolated life and closed social systems of highland Papuans, even though some have been moving to Jayapura, likely contribute to the formation of this unique cluster of infection with a novel subgenotype of HBV, named C11