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

Response of Falciparum Malaria to a Standard Regimen of Chloroquine in Jayapura, Irian Jaya

Untuk pertama kalinya di Indonesia, resistensi chloroquine terhadap Plasmodium falciparum telah dilaporkan oleh J. Verdrager dan Arwati pada tahun 1974. Distribusi yang pasti tentang adanya resistensi chloroquine terhadap P. falciparum di Asia Tenggara, khususnya di Indonesia, belumlah begitu jelas. Akan tetapi kelihatannya resistensi ini terdapat di daerah-daerah dimana A. balabacensis sebagai vector. Faktor-faktor lain yang mempengaruhi resistensi ini ialah intensitas transmisi dan penggunaan obat-obat anti malaria yang meluas, terutama pada penduduk yang tak mempunyai kekebalan. Keadaan seperti digambarkan diatas terutama tentang intensitas transmisi yang cukup tinggi terdapat di Irian Jaya dimana vector utama adalah A. punctulatus group. Dari 35 penderita yang di-follow-up, diperoleh 7 orang yang resisten tingkat RI. Seorang diantaranya timbul bentuk asexual dari parasit pada hari ke-9, dan ke-enam lainnya pada hari ke-21 setelah makan obat chloroquine dengan dosis sesuai dengan standard WHO

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

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

Carrier Meningitis Meningokok Pada Jemaah Haji Dari Embarkasi Jakarta, Tahun 1994

Meningococcal meningitis is caused by Neisseria meningitidis bacteria. Most clinical infections are caused by group A, B or C. Nasopharyngeal carrier can act as persistent source of infection. Until now the prevalence of meningococcal meningitis in Indonesia is still unknown. The objectives of this study are to obtain data regarding the carrier rate among returning haj pilgrims from Jakarta at embarkation in 1994 and sero groups of N. meningitidis in carriers. Nasopharyngeal swabs were taken from 1548 haj pilgrims from group of contact persons of cases or suspected cases and other groups from each province at Jakarta embarkation. Isolation and serogrouping were carried out for groups A, B, C. In 1994 the number of meningococcal meningitis cases among Indonesian haj pilgrims in 1994 in Arab Saudi were 4, one of them died. Carrier rate of N. meningitidis found from 7 districts was 0.97% (15 carriers ). The percentage of carriers in age group of 30-39 years was 1.96%, groups of 40-49, 50-59, 60-69 and above 70 years were 0,55%, 0.65%, 1.41% and 1.07% respectively. Sero groups of N. meningitidis isolated from carriers were 78.59% of group B, 7.14%> of group C and 14.29% of group A & B. The study of meningococcal serotype and routine sampling of haj pilgrims in group of cases are still continued to obtain more data of prevalence and carriers returning to Indonesia