Detection of SARS-CoV-2 Post COVID-19 Vaccination in Health Workers in the COVID-19 Isolation Room

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a type of virus that causes COVID-19 and is a global health problem that has a significant impact on the health of people around the world, including Indonesia. Health workers (nakes) as the frontline have a higher risk of exposure, especially health workers who work in the COVID-19 isolation room in hospitals. Health workers are the main priority for COVID-19 vaccine recipients, but post-vaccine infection does not rule out the possibility of COVID-19 infection due to health workers as health service providers who interact with other health workers or patients, or in patients who are not on transmission-based alert. Detection of SARS-CoV-2 should continue to be investigated and further action to reduce the risk of infection to health workers. This community service activity was carried out to help facilitate health workers during the post-vaccination SARS-CoV-2 examination (I, II and booster III). Of the 73 health workers, nurses are the health workers who mostly work in the COVID-19 isolation room 56 (77%), doctors 11 (15%), midwives 4 (5%) and laboratory assistants 2 (3%). Based on the results of the COVID-19 examination using the RT-PCR method from the nasopharyngeal swab sample, it showed that there were 19 health workers who were infected with COVID-19 before vaccination, namely 1 (1.3%) doctors and 18 (24.6%) nurses. The decrease in infection with health workers decreased after health workers received the first vaccination, where only 1 (1.3%) doctors and 2 (2.7) nurses were reinfected, the increase in the number of health workers infected with SARS-CoV-2 after vaccination II was 3 (4.1%) doctors, 12 (16.4%) and 2 (2.7%) midwives. The results of the detection of SARS-CoV-2 in 73 health workers who had been vaccinated with booster III (moderna) did not find any SARS-CoV-2 infection, indicating that vaccine III increases self-protection against SARS-CoV-2 infection

Performance of Xpert MTB/RIF and sputum microscopy compared to sputum culture for diagnosis of tuberculosis in seven hospitals in Indonesia

IntroductionTuberculosis (TB) is a major public health concern in Indonesia, where the incidence was 301 cases per 100,000 inhabitants in 2020 and the prevalence of multi-drug resistant (MDR) TB is increasing. Diagnostic testing approaches vary across Indonesia due to resource limitations. Acid-fast bacilli (AFB) smear is widely used, though Xpert MTB/RIF has been the preferred assay for detecting TB and rifampicin resistance since 2012 due to higher sensitivity and ability to rapidly identify rifampicin resistance. However, <1,000 Xpert instruments were available in Indonesia as of 2020 and the Xpert supply chain has suffered interruptions.MethodsWe compared the performance of Xpert MTB/RIF and AFB smear to facilitate optimization of TB case identification. We analyzed baseline data from a cohort study of adults with pulmonary TB conducted at seven hospitals across Indonesia. We evaluated sensitivity and specificity of AFB smear and Xpert MTB/RIF using Mycobacterium tuberculosis (Mtb) culture as the gold standard, factors associated with assay results, and consistency of Xpert MTB/RIF with drug susceptibility test (DST) in detecting rifampicin resistance.ResultsSensitivity of AFB smear was significantly lower than Xpert MTB/RIF (86.2 vs. 97.4%, p-value <0.001), but specificity was significantly better (86.7 vs. 73.3%, p-value <0.001). Performance varied by hospital. Positivity rate for AFB smear and Mtb culture was higher in subjects with pulmonary cavities and in morning sputum samples. Consistency of Xpert MTB/RIF with DST was lower in those with rifampicin- sensitive TB by DST.DiscussionAdditional evaluation using sputa from primary and secondary Indonesian health centers will increase the generalizability of the assessment of AFB smear and Xpert MTB/RIF performance, and better inform health policy.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT027 58236]

Multidrug-resistant Tuberculosis in a Tertiary Hospital in North Sumatera, Indonesia : Clinical Predictors and Molecular Investigation

Thesis (Ph.D., Epidemiology (International Program))--Prince of Songkla University, 201

Training On Improving Training On Improving Health Cadres Capacity In Eradication of Tuberculosis Disease In Communities

Tuberculosis (TB) is an important issue in public health, where Indonesia ranks second in the world after India and China. The discovery of TB suspects and cases through health facilities is very important, this makes the role of health cadres in the community in the discovery of TB suspects in their area. The purpose of this community service activity is to train health cadres in an effort to increase the capacity of knowledge about tuberculosis (TB). Health cadres in the PKK area of ​​Medan Tuntung District have not been exposed to special training in tuberculosis infectious diseases. The results of the training show that there is a significant difference between the knowledge of tuberculosis infectious disease before training (pre-test) compared to after training (post-test) (p value <0.05). The results of the pre-test scores showed that cadre knowledge before training was categorized as good as 12/30 (40%) and cadre knowledge increased after receiving special training on Tuberculosis which was categorized as good at 26/30 (87%)

Diversity of <em>Spa</em> gene between methicillin-resistant and methicillin-sensitive <em>Staphylococcus aureus</em> bacteria in a tertiary referral hospital, Indonesia

BACKGROUND Spa typing is an effective and fast technique to identify the prevalence and spread of Staphylococcus aureus strains based on their spa gene profiles. The distribution of spa types will contribute to control the spread of S. aureus. Little is known regarding the spa types of S. aureus in Indonesia. This study aimed to investigate the diversity of spa gene among S. aureus carriage isolates in North Sumatra Province, Indonesia. METHODS 79 S. aureus isolates consisting of 39 methicillin-resistant S. aureus (MRSA) and 40 methicillin-susceptible S. aureus (MSSA) carriage isolates were identified by VITEK2 Compact (Biomerieux, Indonesia) to detect mecA gene. All samples underwent spa typing and sequencing. RESULTS Spa gene was detected among 31/39 (79%) of the MRSA isolates and 24/40 (60%) of the MSSA isolates. Most spa typing genes were identified between 350 and 400 base pair (bp). t258 and t852 were the most prevalence spa types among MRSA and MSSA isolates, respectively. CONCLUSIONS Many MRSA and MSSA isolates encoded spa gene. The most genes detected were t258 and t852, identified in Germany and Portugal, respectively; while t18977 was initially identified in Malaysia. This indicated a global spread of MRSA according to spa typing

Missing Cases of Bacteriologically Confirmed TB/DR-TB from the National Treatment Registers in West and North Sumatra Provinces, Indonesia

This study aimed to assess the percentage of confirmed drug-sensitive (DS) TB and drug-resistant (DR) TB patients who were missing in the national treatment registration in North Sumatra and West Sumatra, where treatment services for DR-TB in North Sumatra are relatively well established compared with West Sumatra, where the system recently started. Confirmed DS/DR-TB records in the laboratory register at 40 government health facilities in 2017 and 2018 were traced to determine whether they were in the treatment register databases. A Jaro–Winkler soundexed string distance analysis enhanced by socio-demographic information matching had sensitivity and specificity over 98% in identifying the same person in the same or different databases. The laboratory data contained 5885 newly diagnosed records of bacteriologically confirmed TB cases. Of the 5885 cases, 1424 of 5353 (26.6%) DS-TB cases and 133 of 532 (25.0%) DR-TB cases were missing in the treatment notification database. The odds of missing treatment for DS-TB was similar for both provinces (AOR = 1.0 (0.9, 1.2), but for DR-TB, North Sumatra had a significantly lower missing odds ratio (AOR = 0.4 (0.2, 0.7). The system must be improved to reduce this missing rate, especially for DR-TB in West Sumatra

Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: A cross-sectional study

Objective To assess the test characteristics of a urine dipstick test in predicting a positive urine culture in an outpatient setting in Indonesia. Design Cross-sectional study. Setting Two outpatient clinics in Medan, Indonesia. Participants 616 consecutively enrolled participants suspected of having a urinary tract infection. Outcome measures The primary outcome is the estimates of accuracy (sensitivity, specificity, predictive values) where urine culture is the reference test. The secondary outcome is the post-test probability of a positive urine culture. Results The optimal test characteristics were obtained when index test positivity was defined as any leucocyte esterase reaction and/or a nitrite reaction and reference test positivity was defined as a urine culture with a growth of at least 10 3 colony-forming units/mL (sensitivity: 88.2% (95% CI 81.6 to 93.1), negative predictive value: 93.0% (95% CI 88.9 to 95.9)). The post-test probability of a positive urine culture after a negative urinary dipstick test was 7% in the obstetric/gynaecology clinic and 8% in the internal medicine clinic. Conclusion The use of a urine dipstick test in a rule-out strategy can reduce the need for urine culture and avoid the prescription of (ineffective) antibiotics in a non-urology outpatient setting

Laboratory-based versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia.

Surveillance of antimicrobial resistance (AMR) enables monitoring of trends in AMR prevalence. WHO recommends laboratory-based surveillance to obtain actionable AMR data at local or national level. However, laboratory-based surveillance may lead to overestimation of the prevalence of AMR due to bias. The objective of this study is to assess the difference in resistance prevalence between laboratory-based and population-based surveillance (PBS) among uropathogens in Indonesia. We included all urine samples submitted to the laboratory growing Escherichia coli and Klebsiella pneumoniae in the laboratory-based surveillance. Population-based surveillance data were collected in a cross-sectional survey of AMR in E. coli and K. pneumoniae isolated from urine samples among consecutive patients with symptoms of UTI, attending outpatient clinics and hospital wards. Data were collected between 1 April 2014 until 31 May 2015. The difference in percentage resistance (95% confidence intervals) between laboratory- and population-based surveillance was calculated for relevant antibiotics. A difference larger than +/- 5 percent points was defined as a biased result, precluding laboratory-based surveillance for guiding empirical treatment. We observed high prevalence of AMR ranging between 63.1% (piperacillin-tazobactam) and 85% (ceftriaxone) in laboratory-based surveillance and 41.3% (piperacillin-tazobactam) and 74.2% (ceftriaxone) in population-based surveillance, except for amikacin and meropenem (5.7%/9.8%; 10.8%/5.9%; [laboratory-/population-based surveillance], respectively). Laboratory-based surveillance yielded significantly higher AMR prevalence estimates than population-based surveillance. This difference was much larger when comparing surveillance data from outpatients than from inpatients. All point estimates of the difference between the two surveillance systems were larger than 5 percent points, except for amikacin and meropenem. Laboratory-based AMR surveillance of uropathogens, is not adequate to guide empirical treatment for community-based settings in Indonesia

Rethinking Antimicrobial Resistance Surveillance: A Role for Lot Quality Assurance Sampling

Global surveillance of antimicrobial resistance (AMR) is a key component of the 68th World Health Assembly Global Action Plan on AMR. Laboratory-based surveillance is inherently biased and lacks local relevance due to aggregation of data. We assessed the feasibility, sensitivity, and affordability of a population-based AMR survey using lot quality assurance sampling (LQAS), which classifies a population as having a high or low prevalence of AMR based on a priori defined criteria. Three studies were carried out in Medan and Bandung, Indonesia, between April 2014 and June 2017. LQAS classifications for 15 antibiotics were compared with AMR estimates from a conventional population-based survey, with an assessment of the cost of a single LQAS classification using microcosting methodology, among patients suspected of urinary tract infection at 11 sites in Indonesia. The sensitivity of LQAS was above 98%. The approach detected local variation in the prevalence of AMR across sites. Time to reach LQAS results ranged from 47 to 138 days. The average cost of an LQAS classification in a single facility was US$466. The findings indicate that LQAS-based AMR survey is a feasible, sensitive, and affordable strategy for population-based AMR surveys, providing essential data to inform local empirical treatment guidelines and antimicrobial stewardship efforts