Profil Kekebalan Terhadap Difteri, Pertusis dan Tetanus pada Anak Umur di Bawah Lima Tahun, Hasil Riskesdas 2013

Children under five years are a vulnerable group for diseases infection, therefore immunity to vaccine preventable diseases are essential, such as diphtheria, pertussis and tetanus. Those mentioned diseases, immunization is the most effective effort to reduce the mortality and morbidity. As a part of Basic Health Research analysis for samples collected in 2013, sera of 368 children under five years (aged 12-59 months) were tested for IgG to diphtheria, pertussis toxin and tetanus by ELISA method. The proportion of protective antibody associated with DPT immunization status obtained by univariate analysis. Based on health record and questionnaire, only 72% children under five years received a complete 3-dose of DPT vaccine. Fully protective immunity to diphtheria and tetanus (titer ≥ 0.1 IU / ml) were only found 70% and 83% of children under five years with a complete DPT immunization status, respectively. Very small proportion (0.27%) of children without immunity to diphtheria and tetanus (titer <0.01 IU / ml) were observed. Results showed less than 10% children under five years had immunity to pertussis toxin, indicated that the pertussis exposure occurred within 12 months. Incomplete immunization status and high proportion of negative titers especially for pertussis toxin, should have attention exclusively for the completeness of recording and immunization card and also the vaccine storage. Furthermore, the immunization booster should be administered to provide long protective immunity. Keywords: immunity, DPT, under five years, ELISA Abstrak Balita merupakan kelompok rentan yang perlu mendapatkan perhatian, terutama kekebalan terhadap penyakit yang dapat dicegah dengan imunisasi, antara lain difteri, pertussis dan tetanus. Imunisasi merupakan upaya yang paling efektif untuk menurunkan angka kematian dan kesakitan karena penyakit tersebut. Sebanyak 368 sampel darah balita (umur 12- 59 bulan), bagian dari sampel Riset Kesehatan Dasar tahun 2013 telah diperiksa kekebalan terhadap difteri, pertusis toksin dan tetanus dengan metode ELISA. Analisis data secara deskriptif berupa proporsi kekebalan protektif dari masing-masing parameter dikaitkan dengan status imunisasi DPT. Berdasarkan hasil observasi catatan kesehatan dan wawancara menunjukkan hanya 72% balita yang mendapat imunisasi DPT lengkap 3 dosis. Kekebalan protektif difteri dan tetanus dengan titer ≥ 0,1 IU/ml hanya dimiliki sekitar 70% dan 83% balita dengan status imunisasi DPT lengkap. Walaupun proporsinya sangat kecil (0,27%), masih ditemukan balita yang tidak mempunyai kekebalan terhadap difteri dan tetanus (titer <0,01 IU/ml). Kurang dari 10% balita memiliki kekebalan terhadap pertusis toksin dengan keterpaparan dalam jangka waktu 12 bulan. Ditemukannya balita dengan status imunisasi yang tidak lengkap dan titer negatif yang cukup tinggi terutama terhadap pertussis toksin, perlu mendapat perhatian yang serius, terutama kelengkapan pencatatan dan kartu imunisasi serta penyimpanan vaksin, Pemberian booster imunisasi perlu dilakukan untuk memberikan kekebalan yang penuh dalam jangka panjang. Kata kunci: kekebalan, DPT, balita, ELIS

Karier Meningitis Meningokok Pada Jemaah Haji Indonesia Tahun 1993-2003

Research and routine survey of meningococcal meningitis on Indonesian hajj pilgrims have been conducted since 1993 until now. This paper consists of several research and routine survey of meningococcal meningitis during 1993 and 2003. The objectives of the test were determining the meningococcal meningitis carrier on hajj pilgrims, determining the serogroup of N. meningitidis and knowing sensitivity of bacteria to several antibiotics. The result showed increasing of meningococcal meningitis carrier in 1993 up to 1996, that was 1.3% - 9,4% respectively. This proportion of meningococcal meningitis carrier in the case groups decreased after given of rifampicin in 1994 and cyprofloxacin in 1997 as a chemoprophilactic. The result of the study in 1997 indiciated that the carrier rate of groups with cyprofloxacin (1.4%) was lower than rifampicin group (1.4%). Most of the isolated bacteria of N. meningitidis in 1996 and 1997 were resistant to rifampicin (sensitivity test was 0-33%). Serogroup B of N. meningitidis were found dominantly between 1993 and 1999, it changed to be serogroup W135 from 2000 to 2003. The changes related with the majority cases of meningococcal meningitis in another countries that caused by serogroup W135. Because of that since 2002, immunization program has given a tetravalen (serogroup ACYW135) meningococcal vaccine to all of Indonesian hajj pilgrims. The carrier of meningococcal meningitis is still found in hajj pilgrims and their contact. More attention must be given, caused of meningococcal meningitis serogroup B vaccine is not available. The further researches are needed especially for subtype of N. meningitidis, effectivity of the drug choice and development of meningococcal meningitis vaccine serogroup B

Seroprevalensi Hepatitis C pada Populasi Perkotaan dan Perdesaan di Indonesia Tahun 2013: Kajian Determinan Sosiodemografi, Lingkungan, Pejamu, dan Komorbiditas (Analisis Lanjut Riskesdas 2013)

Hepatitis C is an infectious disease caused by RNA virus that is often asymptomatic and can lead into serious complications such as liver cancer. It remains one of major public health issues in several developing countries. Urban and rural areas have different sociodemographic characteristics but seroprevalence of hepatitis C based on antibody against hepatitis C virus (HCV) shows the same proportion of 1.0% in both areas, suggesting that there is discrepancy of risk factors for HCV infection between the two. This analysis aims to identify such determinants that include sociodemographic factors, neighbourhood, environmental conditions including hygienic behaviour and access to healthcare facilities, host conditions and comorbidities outside major risk factors. The analysis used secondary data of Riskesdas 2013 through complex logistic regression technique and alternative tests. The results showed that the determinants of HCV seroprevalence in urban and rural respondents were: gender, unemployment status, prediabetes, abnormalities of HDL and triglyceride levels, renal impairment and malaria. Hence, hepatitis C management strategies in Indonesia may require different approach to urban populations compared to rural areas

Keragaman Genetik Petanda P. Falciparum dari Specimen Subyek Penelitian Monitoring Dihidroartemisinin-piperakuin di Kalimantan dan Sulawesi

Treatment failure in falciparum malaria may be caused by parasite resistant to antimalarial drug or new infection. Polymorphism genetic marker of P. falciparum namely MSP1, MSP2 and GLURP locus genes in the population should be identified as a baseline to distinguish the cause of treatment failure. A nested Polymerase Chain Reaction (PCR) method was applied to each locus gene separately. A total 121 dried blood spot specimens from subjects infected with P. falciparum in monitoring Dihydroartemisinin-Piperaquine treatment in Kalimantan and Sulawesi Islands were analyzed. Locus genes of MSP1, MSP2 and GLURP were successful identified 82.6%, 96.7% and 81.0% respectively. However, the three (MSP1, MSP2 and GLURP) locus genes were only found in 71.9% (87 of 121) samples. All of MSP1 locus gene had just one allele, two alleles on most of MSP2 (67.5%) and few of GLURP (14.3%). Multi genotype infection was likely dominant than a single genotype infection (65.5% vs. 34.5%). Based on allele length classification, MSP2 locus gene shows more variety of allele class (12 alleles) than GLURP (9 alleles) and MSP1 (7 alleles), with an allele length mostly for MSP1: 440 - 479 bp, MSP2: 480–519 bp and GLURP: 580–639 bp. In this study, falciparum malaria cases were commonly as multi-genotype infection, and MSP2 was a dominant and polymorphic genetic marker of P.falciparum. Keywords: P. falciparum, PCR, MSP1, MSP2, GLURP, allele Abstrak Gagal pengobatan pada malaria falsiparum dapat disebabkan oleh parasit yang resisten terhadap obat antimalaria atau oleh infeksi baru. Keragaman genetik petanda Plasmodium falciparum yaitu lokus gen MSP1, MSP2 dan GLURP dalam suatu populasi perlu diidentifikasi sebagai dasar untuk membedakan penyebab gagal pengobatan. Metode pemeriksaan yang digunakan adalah nested Polymerase Chain Reaction (PCR) terhadap masing-masing lokus gen secara terpisah. Telah dianalisis 121 spesimen resapan darah kering pada kertas filter dari subyek terinfeksi P.falciparum pada studi monitoring pengobatan dengan Dihidroartemisinin-Piperakuin di Kalimantan dan Sulawesi. Masing-masing lokus gen MSP1, MSP2 dan GLURP yang dapat diidentifikasi sebanyak 82,6%, 96,7% and 81,0%. Sedangkan ketiga lokus gen tersebut ditemukan hanya pada 71,9% (87/121) sampel. Lokus gen MSP1 semuanya mempunyai 1 alel, sedangkan dua alel ditemukan pada sebagian besar MSP2 (67,5%) dan sebagian kecil GLURP (14,3%). Infeksi multi-genotip oleh dua atau lebih genotip P.falciparum ditemukan pada 65,5% sampel dan infeksi tunggal hanya 34,5% sampel. Keragaman klas alel paling banyak ditemukan pada lokus gen MSP2 sebanyak 12 klas alel, GLURP sebanyak 9 klas alel, dan MSP1 sebanyak 7 klas alel. Alel pada lokus gen MSP1 sebagian besar pada kisaran 440 - 479 bp, MSP2: 480 – 519 bp, dan GLURP: 580–639 bp. Pada penelitian ini kasus malaria falsiparum umumnya merupakan infeksi multi-geotip, dan MSP2 merupakan petanda gen P.falciparum yang dominan dan beragam. Kata kunci : P. falciparum, PCR, MSP1, MSP2, GLURP, ale

Identifikasi Single Nucleotide Polymorphism (SNP) Gen Pvmdr1 Pada Penderita Malaria Vivaks Di Minahasa Tenggara (Sulawesi Utara)

Parasite resistance to antimalarial drugs is an obstacle to malaria elimination. In Plasmodium vivax, up to now, a marker to distinguish between resistant and susceptible is no available yet. Identify Single Nucleotide Polymorphisms (SNP) in P. vivax for multidrug resistance (pvmdr1)is potential approach due to pvmdr1 gene is orthologous to the pfmdr1 of P.falciparum, have been related to multidrug resistance. The purpose of this study was to identify SNPs/mutations on pvmdr1 gene of malaria vivax patients who came to the Primary Healthe Centers, Touluaan and Tombatu Minahasa Tenggara (North Sulawesi).Blood samples and slide of blood smears were collected from patients who infected with P.vivax or mixed infection of P.vivax and P.falciparum. After the species were cross checked by certified microscopist then confirmed by PCR, SNP identification were performed by sequencing technique. Only 83 of 99 recruited subjects were included inclution criteria. Sequensing result showed that 59 of 83 subjects were analysed to identify the SNP. We found 5 nonsynonymous SNPs, namely at the point G698S, M908L, Y976F, L1076F, and K1261E

Deteksi P.vivax Single Nucleotide Polymorphism (Snp) Y976f dari Sampel Monitoring Pengobatan Dihidroartemisinin-piperakuin di Kalimantan dan Sulawesi

This study was a part of the activity of monitoring Dihydroartemisinin-Piperaquine (DHP) treatment in subjects infected with P.falciparum and P.vivax in Kalimantan and Sulawesi. SNP Y976F had been proved as the mutation in pvmdr1 gene which was related to P. vivax resistance chloroquine in Papua. Data of spreading pvmdr1 SNP Y976F outside Papua is needed for using Dihidroartemisinin-Piperakuin policy in the treatment of vivax malaria in Indonesia. Detection of SNP Y976F was done against 95 day0-samples of subjects confirmed infected with P.vivax or mixed infection of P.vivax and P.falciparum by PCR. The results showed that 88 (93%) of a total 95 samples were positive detected 976F mutant which were distributed in all sentinel sites of West Kalimantan (2of 3), Central Kalimantan (6 of 8), North Sulawesi (63 of 65), and Central Sulawesi (17 of 19). In conclusion, pvmdr1 SNP Y976F has been spreaded in all sentinel sites. Key words: P.vivax, pvmdr1, Single Nucleotide Polymorphism Abstrak Penelitian ini merupakan bagian kegiatan dari monitoring pengobatan Dihidroartemisinin-Piperakuin (DHP) pada subyek yang terinfeksi dengan P.vivax atau infeksi campuran P.falciparum dan P. vivax di Kalimantan dan Sulawesi. SNP Y976F merupakan mutasi pada gen pvmdr1 yang terbukti berhubungan dengan P. vivax resisten klorokuin di Papua. Dalam rangka kebijakan penggunaan Dihidroartemisinin-Piperakuin untuk pengobatan malaria vivaks di seluruh Indonesia, perlu data penyebaran parasit SNP Y976F pada gen pvmdr1 di luar Papua. Deteksi SNP Y976F dilakukan terhadap 95 sampel H0 subyek terinfeksi P. vivax atau infeksi campuran P.vivax dan P.falciparum yang telah dikonfirmasi dengan PCR. Hasil menunjukkan bahwa 88 dari 95 sampel (93%) terdeteksi positif galur mutan 976F yang tersebar di Kalimantan Barat (2 dari 3), Kalimantan Tengah (6 dari 8), Sulawesi Utara (63 dari 65) dan Sulawesi Tengah (17 dari 19). Kesimpulannya bahwa P.vivax galur Y976F sudah tersebar di setiap sentinel penelitian. Kata kunci: P.vivax, pvmdr1, Single Nucleotide Polymorphis

Pengaruh Status Imunisasi Difteri Pertusis dan Tetanus terhadap Respon Kekebalan Difteri dan Tetanus pada Murid Kelas I Sekolah Dasar di Kecamatan Cimandala

A preliminary study has been carried out to investigate the effect of DPT immunization status on immune response against diphtheria and tetanus in the program of School Immunization Month (locally referred to as Bulan Imunisasi Anak Sekolah, BIAS) for children aged 5-6 years old after the immunization with DT 1 dosage. The research involved 92 primary school children of grade 1 in sub-district Cimandala, Bogor district. Objective of the research was to support the BIAS program that was started in 1998. The specific objective was to examine the level of immunity and the average antibody titre against diphtheria and tetanus after the immunization with DT 1 dosage as well as to explore the relationship between titre antibody with DPT 3 immunization status (complete) and DPT < 3 (incomplete). The research findings showed that one year after immunization with DT 1 dosage the percentage of immunity against diphtheria and tetanus in children with DPT 3 status was recorded at 96.5% and 100% with the geometric mean titre (GMT) of 0.3022 IU/ml and 1.5536 IU/ml respectively. The percentage of immunity against diphtheria and tetanus for children with the dosage of DPT < 3 was 100% with the GMT of 0.2862 IU/ml and 1.4306 IU/ml respectively. It may be concluded that there was no significant difference (p<0.05) between children with basic immunization status of DPT 3 and DPT < 3. Considering the fact that coverage qf DPT 3 since 1990 has been more than 80%, and taking into consideration findings of the research, it is suggested that screening of basic immunization status or primary school children of grade 1 can be ignored. Further research is required to explore the immunity originated after immunization with TT 1 dosage for grade 2 and 3 school children, that is after obtaining a complete 5 dosage of TT immunization. There is a need to study anti titre against diphtheria in the long term