Plasmodium vivax Malaria Endemicity in Indonesia in 2010

BACKGROUND: Plasmodium vivax imposes substantial morbidity and mortality burdens in endemic zones. Detailed understanding of the contemporary spatial distribution of this parasite is needed to combat it. We used model based geostatistics (MBG) techniques to generate a contemporary map of risk of Plasmodium vivax malaria in Indonesia in 2010. METHODS: Plasmodium vivax Annual Parasite Incidence data (2006-2008) and temperature masks were used to map P. vivax transmission limits. A total of 4,658 community surveys of P. vivax parasite rate (PvPR) were identified (1985-2010) for mapping quantitative estimates of contemporary endemicity within those limits. After error-checking a total of 4,457 points were included into a national database of age-standardized 1-99 year old PvPR data. A Bayesian MBG procedure created a predicted PvPR(1-99) endemicity surface with uncertainty estimates. Population at risk estimates were derived with reference to a 2010 human population surface. RESULTS: We estimated 129.6 million people in Indonesia lived at risk of P. vivax transmission in 2010. Among these, 79.3% inhabited unstable transmission areas and 20.7% resided in stable transmission areas. In western Indonesia, the predicted P. vivax prevalence was uniformly low. Over 70% of the population at risk in this region lived on Java and Bali islands, where little malaria transmission occurs. High predicted prevalence areas were observed in the Lesser Sundas, Maluku and Papua. In general, prediction uncertainty was relatively low in the west and high in the east. CONCLUSION: Most Indonesians living with endemic P. vivax experience relatively low risk of infection. However, blood surveys for this parasite are likely relatively insensitive and certainly do not detect the dormant liver stage reservoir of infection. The prospects for P. vivax elimination would be improved with deeper understanding of glucose-6-phosphate dehydrogenase deficiency (G6PDd) distribution, anti-relapse therapy practices and manageability of P. vivax importation risk, especially in Java and Bali

Роль православної церкви у формуванні та функціонуванні політичної системи України в 90-і роки ХХ ст.

У статті зроблено спробу аналізу місця та ролі православної церкви у процесах формування та функціонування політичної системи України у 90-і роки ХХ ст. Доведено, що українські православні церкви відігравали значну роль у політичному житті країни, не тільки агітуючи віруючих за певну політичну силу, а й балотуючи своїх представників до місцевих органів влади. Українські політики використовували церкву заради досягнення власних цілей, що ще більше загострювало міжконфесійні взаємини і посилювало політизацію церковного життя.В статье сделана попытка анализа места и роли православной церкви в процессе формирования и функционирования политической системы Украины в 90-е годы ХХ ст. Доказано, что украинские православные церкви играли значительную роль в политической жизни страны, не только агитируя верующих за определенную политическую силу, но и баллотируя своих представителей в местные органы власти. Украинские политики использовали церковь ради достижения собственных целей, что еще больше обостряло межконфессиональные отношения и усиливало политизацию церковной жизни.In the article the attempt of analysis of place and role of orthodox church in the process of forming and functioning of the political system of Ukraine in the 90 th ys of the XX ct is done. It is proved, that the Ukrainian orthodox churches acted considerable part in the political life of country, not only agitating believers for definite political force, but also voting the representatives in local authorities. The Ukrainian politicians used a church for achievement of own purposes, that yet more intensified the interconfession relations reinforced the political impact on the church life

Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation.

BACKGROUND: Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world's highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes. METHODS: Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival. RESULTS: Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p < 0.0001). We found substantial variability in the time to viral testing (p = 0.04) by type of medical care provider. Antivirals were started promptly after diagnosis (median 0 days). CONCLUSIONS: Delays in the delivery of appropriate care to human cases of avian influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007

Mosquitoes Put the Brake on Arbovirus Evolution: Experimental Evolution Reveals Slower Mutation Accumulation in Mosquito Than Vertebrate Cells

Like other arthropod-borne viruses (arboviruses), mosquito-borne dengue virus (DENV) is maintained in an alternating cycle of replication in arthropod and vertebrate hosts. The trade-off hypothesis suggests that this alternation constrains DENV evolution because a fitness increase in one host usually diminishes fitness in the other. Moreover, the hypothesis predicts that releasing DENV from host alternation should facilitate adaptation. To test this prediction, DENV was serially passaged in either a single human cell line (Huh-7), a single mosquito cell line (C6/36), or in alternating passages between Huh-7 and C6/36 cells. After 10 passages, consensus mutations were identified and fitness was assayed by evaluating replication kinetics in both cell types as well as in a novel cell type (Vero) that was not utilized in any of the passage series. Viruses allowed to specialize in single host cell types exhibited fitness gains in the cell type in which they were passaged, but fitness losses in the bypassed cell type, and most alternating passages, exhibited fitness gains in both cell types. Interestingly, fitness gains were observed in the alternately passaged, cloned viruses, an observation that may be attributed to the acquisition of both host cell–specific and amphi-cell-specific adaptations or to recovery from the fitness losses due to the genetic bottleneck of biological cloning. Amino acid changes common to both passage series suggested convergent evolution to replication in cell culture via positive selection. However, intriguingly, mutations accumulated more rapidly in viruses passed in Huh-7 cells than in those passed in C6/36 cells or in alternation. These results support the hypothesis that releasing DENV from host alternation facilitates adaptation, but there is limited support for the hypothesis that such alternation necessitates a fitness trade-off. Moreover, these findings suggest that patterns of genetic evolution may differ between viruses replicating in mammalian and mosquito cells

Plasmodium falciparum Malaria Endemicity in Indonesia in 2010

BACKGROUND: Malaria control programs require a detailed understanding of the contemporary spatial distribution of infection risk to efficiently allocate resources. We used model based geostatistics (MBG) techniques to generate a contemporary map of Plasmodium falciparum malaria risk in Indonesia in 2010. METHODS: Plasmodium falciparum Annual Parasite Incidence (PfAPI) data (2006-2008) were used to map limits of P. falciparum transmission. A total of 2,581 community blood surveys of P. falciparum parasite rate (PfPR) were identified (1985-2009). After quality control, 2,516 were included into a national database of age-standardized 2-10 year old PfPR data (PfPR(2-10)) for endemicity mapping. A Bayesian MBG procedure was used to create a predicted surface of PfPR(2-10) endemicity with uncertainty estimates. Population at risk estimates were derived with reference to a 2010 human population count surface. RESULTS: We estimate 132.8 million people in Indonesia, lived at risk of P. falciparum transmission in 2010. Of these, 70.3% inhabited areas of unstable transmission and 29.7% in stable transmission. Among those exposed to stable risk, the vast majority were at low risk (93.39%) with the reminder at intermediate (6.6%) and high risk (0.01%). More people in western Indonesia lived in unstable rather than stable transmission zones. In contrast, fewer people in eastern Indonesia lived in unstable versus stable transmission areas. CONCLUSION: While further feasibility assessments will be required, the immediate prospects for sustained control are good across much of the archipelago and medium term plans to transition to the pre-elimination phase are not unrealistic for P. falciparum. Endemicity in areas of Papua will clearly present the greatest challenge. This P. falciparum endemicity map allows malaria control agencies and their partners to comprehensively assess the region-specific prospects for reaching pre-elimination, monitor and evaluate the effectiveness of future strategies against this 2010 baseline and ultimately improve their evidence-based malaria control strategies

Knowledge, attitude, and practice regarding dengue virus infection among inhabitants of Aceh, Indonesia: A cross-sectional study

Background: The Indonesian region of Aceh was the area most severely affected by the earthquake and tsunami of 26 December 2004. Department of Health data reveal an upward trend of dengue cases in Aceh since the events of the tsunami. Despite the increasing incidence of dengue in the region, there is limited understanding of dengue among the general population of Aceh. The aim of this study was to assess the knowledge, attitude, and practice (KAP) regarding dengue among the people of Aceh, Indonesia in order to design intervention strategies for an effective dengue prevention program. Methods: A community-based cross-sectional study was conducted in Aceh between November 2014 and March 2015 with a total of 609 participants living in seven regencies and two municipalities. Information on the socio-demographic characteristics of participants and their KAP regarding dengue was collected using a pre-tested structured questionnaire. The KAP status (good vs. poor) of participants with different socio-demographic characteristics was compared using Chi Square-test, ANOVA or Fisher's exact test as appropriate. Logistic regression analysis was used to determine the predictors of each KAP domain. Results: We found that 45% of participants had good knowledge regarding dengue and only 32% had good attitudes and good dengue preventive practices. There was a significant positive correlation between knowledge and attitudes, knowledge and practice, and attitudes and practice. In addition, people who had good knowledge were 2.7 times more likely to have good attitudes, and people who had good attitudes were 2.2 times more likely to have good practices regarding dengue. The level of education, occupation, marital status, monthly income, socioeconomic status (SES) and living in the city were associated with the knowledge level. Occupation, SES, and having experienced dengue fever were associated with attitudes. Education, occupation, SES and type of residence were associated with preventive practices. Conclusion: Our study suggests that dengue prevention programs are required to increase KAP levels regarding dengue in the communities of Aceh

The changing incidence of Dengue Haemorrhagic Fever in Indonesia: a 45-year registry-based analysis

Contains fulltext : 136987.pdf (publisher's version ) (Open Access)BACKGROUND: Increases in human population size, dengue vector-density and human mobility cause rapid spread of dengue virus in Indonesia. We investigated the changes in dengue haemorrhagic fever (DHF) incidence in Indonesia over a 45-year period and determined age-specific trends in annual DHF incidence. METHODS: Using an on-going nationwide dengue surveillance program starting in 1968, we evaluated all DHF cases and related deaths longitudinally up to 2013. Population demographics were used to calculate annual incidence and case fatality ratios (CFRs). Age-specific data on DHF available from 1993 onwards were used to assess trends in DHF age-distribution. Time-dependency of DHF incidence and CFRs was assessed using the Cochrane-Armitage trend test. RESULTS: The annual DHF incidence increased from 0.05/100,000 in 1968 to ~ 35-40/100,000 in 2013, with superimposed epidemics demonstrating a similar increasing trend with the highest epidemic occurring in 2010 (85.70/100,000; p < 0.01). The CFR declined from 41% in 1968 to 0.73% in 2013 (p < 0.01). Mean age of DHF cases increased during the observation period. Highest incidence of DHF was observed among children aged 5 to 14 years up to 1998, but declined thereafter (p < 0.01). In those aged 15 years or over, DHF incidence increased (p < 0.01) and surpassed that of 5 to 14 year olds from 1999 onwards. CONCLUSIONS: Incidence of DHF over the past 45 years in Indonesia increased rapidly with peak incidence shifting from young children to older age groups. The shifting age pattern should have consequences for targeted surveillance and prevention

Situasi Vektor Demam Berdarah Saat Kejadian Luar Biasa (Klb) Di Kecamatan Pasarrebo, Jakarta Timur

Kejadian luar biasa (KLB) penyakit Demam berdarah dengue (DBD) sering terjadi sejak dilaporkan tahun 1968. Pemberantasannya dengan penemuan penderita, pengobatan dan pengendalian vektor. Karena obat dan vaksin belum ditemukan maka sampai saat ini pemberantasan dan pencegahannya masih mengandalkan pada pengendalian vektor. Tujuan dari penelitian vektor ini adalah untuk mendapatkan informasi tentang habitat perkembangbiakan, kepadatan larva dan nyamuk penular DBD pada waktu terjadi KLB serta tipe virus yang dikandung vektornya. Penelitian dilakukan di Kecamatan Pasar Rebo, Jakarta Timur selama tiga bulan yaitu Juni sampai dengan Agustus 2003. Penelitian entomologi dilakukan merujuk kepada alamat penderita rawat inap yang bertempat tinggal di Kecamatan Pasar Rebo. Diagnosa penderita dilakukan dengan uji Hemagglutination inhibition (HI) terhadap 24 akut konvalesen sera penderita yang diambil dari Rumah Sakit Pasar Rebo. Basil penelitian menunjukkan bahwa index larva sebagai berikut House index (HI) 22,6%; Container index (Cl) 11,4% dan Breuteau index (Bl) 30,3. Kontainer yang positif larva yang berada di dalam rumah 12, 7% dari 387 kontainer. Sementara yang berada di luar rumah 3,1% dari 65 kontainer. Angka bebas jentik (ABJ) di daerah KLB kurang dari 95%. Hasil uji HI sera penderita menunjukkan 70,8% dari pasangan sera yang diperiksa, terinfeksi oleh virus dengue

The distribution and bionomics of anopheles malaria vector mosquitoes in Indonesia.

Malaria remains one of the greatest human health burdens in Indonesia. Although Indonesia has a long and renowned history in the early research and discoveries of malaria and subsequently in the successful use of environmental control methods to combat the vector, much remains unknown about many of these mosquito species. There are also significant gaps in the existing knowledge on the transmission epidemiology of malaria, most notably in the highly malarious eastern half of the archipelago. These compound the difficulty of developing targeted and effective control measures. The sheer complexity and number of malaria vectors in the country are daunting. The difficult task of summarizing the available information for each species and/or species complex is compounded by the patchiness of the data: while relatively plentiful in one area or region, it can also be completely lacking in others. Compared to many other countries in the Oriental and Australasian biogeographical regions, only scant information on vector bionomics and response to chemical measures is available in Indonesia. That information is often either decades old, geographically patchy or completely lacking. Additionally, a large number of information sources are published in Dutch or Indonesian language and therefore less accessible. This review aims to present an updated overview of the known distribution and bionomics of the 20 confirmed malaria vector species or species complexes regarded as either primary or secondary (incidental) malaria vectors within Indonesia. This chapter is not an exhaustive review of each of these species. No attempt is made to specifically discuss or resolve the taxonomic record of listed species in this document, while recognizing the ever evolving revisions in the systematics of species groups and complexes. A review of past and current status of insecticide susceptibility of eight vector species of malaria is also provided