The Difference of Angiopoietin-2 Levels between Dengue Hemorrhagic Fever Patients with Shock and without Shock

BACKGROUND: Dengue infection is one of the problems in the national health sector in Indonesia because the incidence and mortality in Indonesia due to dengue infection is still very high. In 2005 Indonesia became the highest contributor to dengue infection in Southeast Asia (53%) with 95.270 people and 1.298 deaths. AIM: This study aims to analyse differences in angiopoietin-2 levels in dengue hemorrhagic fever (DHF) with and without shock. METHODS: This study was a consecutive sampling design with the research subject was obtained based on the order of admission to the hospital — the serum Angiopoietin-2 levels using the ELISA method. The statistical test used is the independent t-test. The value of p < 0.05 was said to be statistically significant. RESULT: The result showed that the mean of Angiopoietin-2 levels in DHF patients with shock was higher than in DHF (p < 0.05). CONCLUSION: This study concluded that there was a difference in the average level of Angiopoietin-2 among DHF patients with shock compared to without shock

The Difference of sVE-Cadherin Levels between Dengue Hemorrhagic Fever Patients with Shock and without Shock

BACKGROUND: Dengue virus infection is an infectious disease caused by the dengue virus and transmitted by the Aedes aegypti mosquito. Dengue virus (DEN-V) consists of 4 serotypes, namely DEN-1, DEN-2, DEN-3, and DEN-4. The most feared result of DHF is death. Death in children is caused by hypovolemic shock due to plasma leakage from intravascular to extravascular space due to endothelial dysfunction. AIM: This study aims to analyse difference in sVE-Cadherin levels in Dengue Hemorrhagic Fever (DHF) with and without shock. MATERIAL AND METHODS: The method of taking samples is consecutive sampling, namely the research subjects obtained based on the order of entry in the hospital with a comparative cross-sectional design. From the results of the calculation using the sample formula, the sample size for each group is set at 32 people. So that the total sample size used for both groups is 64 people. The serum sVE-Cadherin levels using the ELISA method. The statistical test used is the independent t-test. The value of p < 0.05 was said to be statistically significant. RESULTS: The result showed that there was no difference in mean sVE-Cadherin levels between DHF patients with shock and without shock (p > 0.05). CONCLUSION: This study concluded that there was no difference in mean of sVE-Cadherin level in DHF patients with shock and without shock

Diphtheria Epidemiology in Indonesia during 2010-2017

Background: in recent years, diphtheria has reemerged in several countries including Venezuela, Yemen, Bangladesh, and Haiti. Similarly, Indonesia also showed an increased number of diphtheria cases in 2010-2017 despite the Diphteria, Tetanus, Pertussis (DTP) immunization program applied in Indonesia for children. This study aimed to evaluate the epidemiology of diphtheria cases which occurred in Indonesia during 2010-2017. Methods: this was a retrospective study of diphtheria cases in Indonesia. The following source of data about diphtheria disease burden and vaccine coverage was obtained from Ministry of Health Republic of Indonesia, Indonesian Pediatric Society and World Health Organization South East Asia Regional Office. Results: the number of diphtheria cases in Indonesia were distributed across 30 provinces with a total of 811 cases in 2011; 1,192 cases in 2012; 296 cases in 2014; and 939 cases in 2017. Based on age group, the highest number of case fatality rate were in age group of 5-9 years old. Diphtheria immunization coverage in Indonesia among children was fluctuated, reported as 67.7 % in 2007, 61.9 % in 2010, 75.6% in 2013 and 61.3% in 2018. In addition to that, the organization of internal medicine has recommend booster of DPT immunization every 10 years for those children that had received complete DPT vaccination during childhood, however this was not applied. As the countermeasure towards this trend, the Ministry of Health implemented three rounds of Outbreak Response Immunization (ORI) targeted for the age group of 0-1-6 months old and 1-18 years old in 2017 and tailor approached for adults that had exposed to cases. Banten, DKI Jakarta and West Java were the first three provinces to implement this program considering their condensed population and high risk of disease transmission. Conclusion: in Indonesia, there was dramatic increase of diphtheria case in 2010-2017, where immunization in children should be reinforced by increasing coverage more than 95% and adult boosted vaccination approaches should be initiated to prevent the spread of these fatal diphtheria diseases in Indonesia

Spatiotemporal variability in dengue transmission intensity in Jakarta, Indonesia.

BACKGROUND: Approximately 70% of the global burden of dengue disease occurs on the Asian continent, where many large urban centres provide optimal environments for sustained endemic transmission and periodic epidemic cycles. Jakarta, the capital of Indonesia, is a densely populated megacity with hyperendemic dengue transmission. Characterization of the spatiotemporal distribution of dengue transmission intensity is of key importance for optimal implementation of novel control and prevention programmes, including vaccination. In this paper we use mathematical models to provide the first detailed description of spatial and temporal variability in dengue transmission intensity in Jakarta. METHODOLOGY/PRINCIPAL FINDINGS: We applied catalytic models in a Bayesian framework to age-stratified dengue case notification data to estimate dengue force of infection and reporting probabilities in 42 subdistricts of Jakarta. The model was fitted to yearly and average annual data covering a 10-year period between 2008 and 2017. We estimated a long-term average annual transmission intensity of 0.130 (95%CrI: 0.129-0.131) per year in Jakarta province, ranging from 0.090 (95%CrI: 0.077-0.103) to 0.164 (95%CrI: 0.153-0.174) across subdistricts. Annual average transmission intensity in Jakarta province during the 10-year period ranged from 0.012 (95%CrI: 0.011-0.013) in 2017 to 0.124 (95%CrI: 0.121-0.128) in 2016. CONCLUSIONS/SIGNIFICANCE: While the absolute number of dengue case notifications cannot be relied upon as a measure of endemicity, the age-distribution of reported dengue cases provides valuable insights into the underlying nature of transmission. Our estimates from yearly and average annual case notification data represent the first detailed estimates of dengue transmission intensity in Jakarta's subdistricts. These will be important to consider when assessing the population-level impact and cost-effectiveness of potential control and prevention programmes in Jakarta province, such as the controlled release of Wolbachia-carrying mosquitoes and vaccination

Cervical cancer prevention in Indonesia:An updated clinical impact, cost-effectiveness and budget impact analysis

Introduction The clinical and economic impact of cervical cancer consistently become a serious burden for all countries, including Indonesia. The implementation of HPV vaccination policy for a big country such as Indonesia requires a strong commitment from several decision-makers. The aim of this study was to provide a comprehensive description on cost-effectiveness and the budget-impact of HPV vaccination policy in Indonesia. Method A cohort Markov model was used to evaluate the cost and the clinical impact of HPV vaccination for 10 years old girls in Indonesia. The researchers consider two doses of all three available HPV vaccines adjusted with the HPV infection profile with 95% vaccination coverage to estimate the national cervical cancer incidence and mortality. The Budget impact analysis explores three different scenarios covering (1) Two districts per year expansion, (2) oneprovince per year expansion and (3) achieving the National Immunization Program in 2024. Results Upon fully vaccinating almost 2.3 million 10-year-old girls, 34,723; 43,414; and 51,522 cervical cancer cases were prevented by Quadrivalent, Bivalent and Nonavalent vaccines, consecutively. Furthermore, the highest (591 cases) and lowest (399 cases) mortality were prevented by Nonavalent and Quadrivalent vaccines, respectively. Most of the vaccines were considerably cost-effective and only the Bivalent vaccine with the GAVI/UNICEF price which will be considered a cost-saving strategy. To provide national coverage of HPV vaccination in Indonesia, the government has to provide an annual budget of about US$49 million and US$22 million using the government contract price and GAVI/UNICEF price, respectively. Conclusion HPV vaccination shows a cost-effective strategy and the budget required to provide this policy is considerably affordable for Indonesia

Kejadian Ikutan Pasca Imunisasi

Dalam era globalisasi, imunisasi merupakan upaya pencegahan penyakit infeksi menuju masa depan anak yang lebih sehat. Peningkatan pemberian imunisasi harus diikuti dengan peningkatan efektifitas dan keamanan vaksin. Walaupun demikian, peningkatan penggunaan vaksin akan meningkatkan pula kejadian ikutan pasca imunisasi (KIPI) yang tidak diinginkan. Guna mengetahui apakah KIPI yang terjadi disebabkan oleh imunisasi, maka diperlukan pelaporan pencatatan dari semua reaksi yang timbul setelah pemberian imunisasi. Reaksi KIPI dapat dipantau melalui sistim surveilans yang baik untuk mendapatkan profil keamanan penggunaan vaksin di lapangan. Untuk mengetahui besaran masalah KIPI di Indonesia diperlukan pelaporan dan pencatatan KIPI dan koordinasi antara pengambil keputusan dengan petugas pelaksana di lapangan, guna menentukan sikap dalam mengatasi KIPI yang terjadi. Diharapkan surveilans KIPI dapat membantu program imunisasi, khususnya untuk memperkuat keyakinan masyarakat akan pentingnya imunisasi sebagai upaya pencegahan penyakit yang paling efektif

Demam pada Pasien Neutropenia

Demam merupakan salah satu gejala terpenting dari penyakit infeksi. Di lain pihak, demam tanpa disertai gejala klinis lain sulit menentukan penyebab. Oleh sebab itu, pemeriksaan penunjang sangatlah diperlukan. Namun, dalam keadaan neutropenia baik disebabkan oleh penyakit utamanya yaitu penyakit keganasan ataupun akibat dari obat sitostatik. Beberapa parameter infeksi seperti jumlah leukosit, laju endap darah, kadar transaminase, dan biakan tidak dapat dipakai untuk membantu menegakkan diagnosis infeksi pada penyakit keganasan tersebut. Atas dasar hal-hal tersebut di atas, maka telah dibuat kesepakatan pemberian antibiotik pada pasien neutropenia yang mengalami demam. Pemilihan jenis antibiotik berdasarkan pada kemungkinan jenis bakteri penyebab yang tersering. Diharapkan dengan mentaati pedoman tersebut pengobatan demam pada neutropenia lebih terarah dan dapat mencegah lebih banyak resistensi bakter

Terapi Asiklovir pada Anak dengan Varisela Tanpa Penyulit

Varisela atau chickenpox atau yang dikenal dengan cacar air adalah infeksi primer virus zoster varicella (VZV) yang umumnya menyerang anak dan merupakan penyakit yang sangat menular. Varisela pada anak tanpa penyulit adalah ringan dan dapat sembuh sendiri. Pengobatan varisela bersifat simtomatik, namun dalam praktek sehari-hari, masih banyak dokter yang memberikan asiklovir oral. Asiklovir sebagai terapi varisela sudah lama digunakan termasuk pada anak sehat tanpa penyulit walaupun sampai saat ini masih kontroversial. Berdasarkan hasil penelusuran didapatkan 8 artikel yang relevan yang dapat disimpulkan bahwa bila asiklovir diberikan dalam 24 jam pertama timbulnya ruam, secara signifikan dapat mengurangi hari lamanya demam, memperpendek lama sakit, mengurangi jumlah lesi, tapi tidak mengurangi komplikasi varisela (level of evidence 1a). Namun asiklovir tidak dianjurkan diberikan secara rutin pada anak varisela tanpa penyulit, karena ada pendapat bahwa kemungkinan terjadinya resistensi terhadap asiklovir dan menganggu imunitas serta masalah biaya yang mahal

Profil Klinis, Laboratorium, dan Serologi Infeksi Virus Dengue pada Bayi

Latar belakang. Kejadian infeksi virus dengue (IVD) meningkat di Sumatera Barat pada beberapa tahun terakhir. Bahkan, terjadi pada anak usia kurang dari satu tahun. Bayi mempunyai karakteristik klinik yang unik dan tidak banyak penelitian mengenai hal ini di Indonesia. Tujuan. Mengetahui profil klinis, laboratorium, dan serologi infeksi virus dengue pada bayi yang dirawat di RSUP Dr. M Djamil Padang dari tahun 2012-2014 Metode. Seri kasus menggunakan data rekam medik bayi yang dirawat di RSUP Dr M Djamil Padang dari 1 Januari 2012 sampai 31 Desember 2014. Data mencakup usia, jenis kelamin, hari demam saat diagnosis, gejala dan tanda klinis, serta laboratorium. Hasil. Duabelas bayi dengan usia termuda 3 bulan dan usia terbanyak 5 bulan (5/12). Muntah merupakan gejala tambahan yang paling banyak ditemukan (9/12), diikuti oleh ptekie dan syok (6/12), serta batuk (5/12). Infeksi primer didapatkan pada 8/12 bayi. Kesimpulan: Rerata usia dan kelompok usia terbanyak 5 bulan. Muntah merupakan gejala yang banyak ditemui, diikuti, petekie, batuk dan syok sebagian besar merupakan infeksi primer