Seroconversion among children with HBsAg-positive mothers in Indonesia and factors affecting the anti-HBs titers

Background and aim

Around 2% of newborns are at risk of hepatitis B virus (HBV) infection from their mothers. To prevent this, infants born to HBsAg-positive mothers are given hepatitis B immune globulin (HBIG) and hepatitis B (HB) vaccine as immunoprophylaxis. This study aims to investigate the efficacy of immunoprophylaxis in infants born to HBsAg-positive mothers and the contributing factors.

Methods

The study was conducted on a group of 87 children, ranging from nine months to under 36 months, born to HBsAg-positive mothers and received immunoprophylaxis within 24 h after birth followed by a national immunization schedule at the Community Health Center (CHC) in three administrative cities of DKI Jakarta. We measured the levels of HBsAg and anti-HBs, and utilized ordinal logistic regression models to identify factors that influence the anti-HBs titers after vaccination.

Results

Out of 87 children, only one child had positive HBsAg results. The data showed that 88.5% of the children had seroprotection with anti-HBs levels ≥10 mIU/mL. Additionally, 48.3% of the children had a high protective response with anti-HBs levels ≥100 mIU/mL, while 11.5% had a non-protective response. Children under one year of age, with a family history of HBV carriers, and who received five doses of the HB vaccine exhibited higher levels of anti-HBs titer category with adjusted OR 3.9 (95%CI: 1.3-11.6), 5.3 (95%CI: 1.1-27.4), and 8.3 (95%CI: 2-34.8), respectively.

Conclusion

The administration of HBIG and HB vaccine successfully prevented vertical transmission, resulting in a high seroprotection rate.

International Care programs for Pediatric Post-COVID Condition (Long COVID) and the way forward

BACKGROUND

Pediatric Post-COVID-Condition (PPCC) clinics treat children despite limited scientific substantiation. By exploring real-life management of children diagnosed with PPCC, the International Post-COVID-Condition in Children Collaboration (IP4C) aimed to provide guidance for future PPCC care.

METHODS

We performed a cross-sectional international, multicenter study on used PPCC definitions; the organization of PPCC care programs and patients characteristics. We compared aggregated data from PPCC cohorts and identified priorities to improve PPCC care.

RESULTS

Ten PPCC care programs and six COVID-19 follow-up research cohorts participated. Aggregated data from 584 PPCC patients was analyzed. The most common symptoms included fatigue (71%), headache (55%), concentration difficulties (53%), and brain fog (48%). Severe limitations in daily life were reported in 31% of patients. Most PPCC care programs organized in-person visits with multidisciplinary teams. Diagnostic testing for respiratory and cardiac morbidity was most frequently performed and seldom abnormal. Treatment was often limited to physical therapy and psychological support.

CONCLUSIONS

We found substantial heterogeneity in both the diagnostics and management of PPCC, possibly explained by scarce scientific evidence and lack of standardized care. We present a list of components which future guidelines should address, and outline priorities concerning PPCC care pathways, research and international collaboration.

IMPACT

Pediatric Post-COVID Condition (PPCC) Care programs have been initiated in many countries. Children with PPCC in different countries are affected by similar symptoms, limiting many to participate in daily life. There is substantial heterogeneity in diagnostic testing. Access to specific diagnostic tests is required to identify some long-term COVID-19 sequelae. Treatments provided were limited to physical therapy and psychological support. This study emphasizes the need for evidence-based diagnostics and treatment of PPCC. The International Post-COVID Collaboration for Children (IP4C) provides guidance for guideline development and introduces a framework of priorities for PPCC care and research, to improve PPCC outcomes.

Safety profile of inactivated COVID-19 in healthy adults aged ≥ 18 years: A passive surveillance in Indonesia

Coronavirus Disease 2019 (COVID-19) vaccination in Indonesia has shown effectiveness in reducing the morbidity and mortality of Covid-19. The study aims to evaluate the incidence rate and severity of Adverse Events Following Immunization (AEFI) of inactivated SARS-CoV-2 vaccine during the first quarter of 2021 until the second quarter of 2022 in Indonesia. More than two hundred million Sinovac/CoronaVac were given from January 13th, 2021, until June 30th, 2022. Data for this study were collected manually and electronically from the national vaccine safety website managed by the National Committee (NC) of AEFI Indonesia and the Ministry of Health Indonesia. The total number of injections observed in the study was 264,311,992 doses consisting of 142,449,795 (first dose), 121,613,324 (second dose), and 248,873 (booster dose). Of the injections given, 301 subjects with Serious AEFIs (SAE) and 10.261 subjects with non-serious AEFIs (AE) reported, with a majority of SAE and AEs found in the first dose. Most of the SAEs were classified as coincidental events by the NC AEFI (IR 0.8/1 million doses on first dose injection; 0.31 on second dose injection). ISRR (immunization stress-related response) is in the second rank of SAEs reported (0.59 IR/1 million doses on the first dose; 0.14 on the second dose). The incidence rate of SAEs and AEs, both in the variable of age, sex, and symptoms per 1 million dose injections in Indonesia, was very rare according to WHO guidelines. Most SAEs were classified as coincidences or unrelated to the vaccine. The result showed that the Sinovac/CoronaVac in Indonesia is safe.

The efficacy and safety of first-line anti-seizure medications as substitution therapy for children with drug-resistant epilepsy: a randomized controlled trial protocol

Although many anti-seizure medications (ASMs) are available, treatment failure, known as drug-resistant epilepsy (DRE), still occurs in around 30% of children with epilepsy. Second-line ASMs are usually used as substitution therapy in DRE to control seizures, although international consensus is not available yet. Previous studies focus on comparing the ASMs, whether as add-on or substitution therapy, mainly conducted in newly diagnosed epilepsy. However, the study that investigated first-line ASMs as substitution therapy compared to second-line ones, particularly among DRE children, is still lacking. A randomized controlled trial (RCT) enrolling 102 participants, aged 1-18, at three referral hospitals in Indonesia will be conducted, dividing them into intervention and control groups. The intervention group will be treated with first-line ASMs as the substitution therapy, while the other in the control group will get second-line ASMs. The primary outcome measure is the proportion difference of responders between groups who get first-line and second-line ASMs in 14 weeks of intervention. Clinical trial registration: ClinicalTrials.gov, identifier NCT05697614.

Safety profile of inactivated COVID-19 vaccine in indonesian adults

Background

Vaccines are urgently needed to handle the morbidity and mortality of the COVID-19 pandemic in Indonesia. The inactivated vaccine is widely used in Indonesia's national immunization program due to its eligibility of stock, easier to transport, and considered to be more established than newer platforms. In this study, we aimed to evaluate the safety profile of the inactivated vaccine and analyze the safety profile between adults and the elderly.

Methods

A prospective analytical study was conducted to evaluate the safety profile of inactivated COVID-19 vaccine among healthy adults aged ≥ 18 years from September 2nd to December 28th, 2021, at ten primary health centers from 5 districts in Jakarta, Indonesia. The participants were instructed to record the symptoms after inactivated COVID-19 vaccine injection in the diary card for 28 days. Chi-square tests were carried out to analyze the relationship between the adverse event following immunization (AEFI) in adults and elderly groups.

Results

Four of 1113 participants were not included in this study due to the lack of follow-up. Out of 1109 participants, there were 1044 adults (18-59 years) and 65 elderly (>59 years). There were no serious AEFI cases reported. Most AEFI cases were mild to moderate and resolved after several days of injection. Local pain, myalgia and fatigue were the most frequent adverse events reported. We found that there was no correlation between the adults and elderly age group with the incidence of AEFI (p = 0.924) for local reactions (p = 0.181) and most of the systemic reactions (p = 0.629). However, there is an increased risk of fever in the elderly group compared to the adult group (OR 4.046, 95 % CI 1.794-9.124, p = 0.003) following immunization.

Conclusions

Our study demonstrated that the inactivated COVID-19 vaccine is safe, considering that all symptoms experienced were mild to moderate and resolved entirely.

Infeksi Tuberkulosis Laten pada Anak: Diagnosis dan Tatalaksana

Infeksi laten tuberkulosis (ILTB) adalah keadaan respons imun persisten terhadap antigen Mycobacterium tuberculosis tanpa bukti manifestasi klinis tuberkulosis aktif. Anak-anak lebih mudah terinfeksi dan menjadi penderita tuberkulosis (TB) aktif dibandingkan orang dewasa setelah kontak erat dengan pasien TB aktif. Masa inkubasi TB bervariasi selama 2-12 minggu, biasanya 4-8 minggu. Investigasi kontak dan penegakan diagnosis ILTB harus dilakukan pada anak yang memiliki risiko tinggi terinfeksi, yaitu memiliki kontak erat dengan penderita TB aktif, dengan HIV, serta dengan kondisi imunokompromais lainnya. Pengobatan pencegahan ILTB bertujuan mencegah anak yang terinfeksi M.tuberculosis berkembang menjadi tuberkulosis aktif. Pedoman WHO yang kemudian diadopsi oleh Petunjuk Teknis Penanganan Infeksi Laten Tuberkulosis Kementerian Kesehatan Republik Indonesia tahun 2020 memberikan rekomendasi pemberian terapi pencegahan tuberkulosis yang terdiri dari beberapa pilihan obat dan durasi pemberian, antara lain isoniazid selama 6 bulan, isoniazid – rifampisin selama 3 bulan, isoniazid -  rifapentin sekali sepekan dalam 3 bulan, atau rifampisin selama 4 bulan. Diagnosis dini dan pemberian terapi pencegahan yang cepat penting untuk menurunkan kejadian TB aktif sehingga visi pemberantasan TB dunia pada tahun 2050 bisa tercapai.

Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: a model-based cost-effectiveness analysis

OBJECTIVES

The WHO currently recommends stool testing using GeneXpert MTB/Rif (Xpert) for the diagnosis of paediatric tuberculosis (TB). The simple one-step (SOS) stool method enables processing for Xpert testing at the primary healthcare (PHC) level. We modelled the impact and cost-effectiveness of implementing the SOS stool method at PHC for the diagnosis of paediatric TB in Ethiopia and Indonesia, compared with the standard of care.

SETTING

All children (age <15 years) presenting with presumptive TB at primary healthcare or hospital level in Ethiopia and Indonesia.

PRIMARY OUTCOME

Cost-effectiveness estimated as incremental costs compared with incremental disability-adjusted life-years (DALYs) saved.

METHODS

Decision tree modelling was used to represent pathways of patient care and referral. We based model parameters on ongoing studies and surveillance, systematic literature review, and expert opinion. We estimated costs using data available publicly and obtained through in-country expert consultations. Health outcomes were based on modelled mortality and discounted life-years lost.

RESULTS

The intervention increased the sensitivity of TB diagnosis by 19-25% in both countries leading to a 14-20% relative reduction in mortality. Under the intervention, fewer children seeking care at PHC were referred (or self-referred) to higher levels of care; the number of children initiating anti-TB treatment (ATT) increased by 18-25%; and more children (85%) initiated ATT at PHC level. Costs increased under the intervention compared with a base case using smear microscopy in the standard of care resulting in incremental cost-effectiveness ratios of US$132 and US$94 per DALY averted in Ethiopia and Indonesia, respectively. At a cost-effectiveness threshold of 0.5×gross domestic product per capita, the projected probability of the intervention being cost-effective in Ethiopia and Indonesia was 87% and 96%, respectively. The intervention remained cost-effective under sensitivity analyses.

CONCLUSIONS

The addition of the SOS stool method to national algorithms for diagnosing TB in children is likely to be cost-effective in both Ethiopia and Indonesia.

Parents' Perspectives Toward School Reopening During COVID-19 Pandemic in Indonesia-A National Survey

Background

All sectors are affected due to COVID-19 pandemic occurring worldwide, including the education industry. School closure had been taking place for more than a year in Indonesia. Despite the controversies, Indonesian government had decided to begin school reopening.

Objectives

This study aims to assess parental readiness for school reopening, and factors affecting parental attitude toward school reopening.

Methods

A cross-sectional study using online questionnaire distributed via official Indonesian Pediatric Society (IPS) official social media account collected between March and April 2021. The questionnaire contained the general characteristics of study participants, parents' knowledge, and perspectives on COVID-19, and health protocols for school reopening.

Results

A total of 17,562 responses were collected, of which 55.7% parents were ready to send their children to school should school reopens. Factors significantly contribute to parental decision to keep their child at home were: presence of vulnerable population at home [OR = 1.18 (1.10–1.27), p < 0.001], children with comorbidities [OR = 2.56 (2.29–2.87), p < 0.001], perception of COVID-19 as a dangerous disease [OR = 28.87 (14.29–58.33), p < 0.001], experience with COVID-19 positive cases in the community [OR = 1.75 (1.61–1.90), p < 0.001], COVID-19 related death in the community [OR = 2.05 (1.90–2.21), P < 0.001], approval for adult COVID-19 vaccination [OR = 1.69 (1.53–1.87), p < 0.001], and ownership of private transportation [OR = 1.46 (1.30–1.66), p <0.001].

Conclusion

We identified several factors affecting parental perception on school reopening during COVID-19 pandemic that should be addressed. This study can be used for policy-maker to make further recommendations and health educations prior to school reopening in Indonesia.

Clinical Features of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 in Indonesia

BACKGROUND

While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia.

METHODS

This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021.

RESULTS

The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors.

CONCLUSIONS

Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Corrigendum on: Pediatric COVID-19: Report from Indonesian pediatric society data registry

[This corrects the article DOI: 10.3389/fped.2021.716898.].

Validation of the vasoactive-inotropic score in predicting pediatric septic shock mortality: A retrospective cohort study

Introduction

Mortality in pediatric septic shock remains very high. Vasoactive-inotropic score (VIS) is widely used to predict prognosis in patients with heart disease. It is a simple method that was initially used as a predictor of morbidity and mortality in postoperative patients with congenital heart diseases. Previous reports showed that high VIS score was associated with high mortality in pediatric sepsis. However, its discriminative value remains unclear. We aim to explore the discriminative value of VIS in predicting mortality in pediatric septic shock patients.

Methods

We conducted a retrospective cohort study on medical records of septic shock patients who received care in the pediatric intensive care unit (PICU). We screened medical records of pediatric patients which were diagnosed with septic shock and admitted to the PICU and received vasoactive/inotropic score for more than 8 h. Other supporting examination results were recorded, such as organ function evaluation for calculation of Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score. The outcome of patients was recorded. The receiver operating curve was constructed to calculate the area under the curve (AUC), sensitivity, and specificity of each cutoff point.

Results

We obtained the optimum cutoff point of VIS > 11 with 78.87% sensitivity and 72.22% specificity. AUC positive was 0.779 (P < 0.001); predictive value and negative predictive value were 91.80% and 46.43%, respectively.

Conclusion

VIS > 11 has a good ability to predict mortality in children with septic shock.

Hubungan Jaringan Parut Bacillus Calmette-Guerin dengan Kejadian Tuberkulosis Ekstraparu pada Anak di Rumah Sakit Cipto Mangunkusumo Kiara tahun 2015-2017

Latar belakang. Meskipun vaksin Bacillus Calmette-Guerin (BCG) telah menjadi program vaksinasi wajib di Indonesia, tuberkulosis (TB) pada anak tetap prevalen. Tujuan. Penelitian ini bertujuan mengevaluasi jaringan parut BCG dan hubungannya dengan kejadian TB ekstraparu (TB-EP) pada anak.Metode. Pengambilan data dilakukan di Rumah Sakit Cipto-Mangunkusumo Kiara dengan metode potong-lintang pada populasi anak terdiagnosis TB berdasarkan kriteria WHO dan konsensus IDAI.Hasil. Dari 246 pasien anak jangkauan usia 2 bulan -18 tahun terdiagnosis TB, 127 (51,6%) anak mengalami TB-EP dengan prevalensi TB tulang, KGB dan abdomen secara berurutan 13%, 10,9%, dan 6,6%. Mayoritas pasien TB EP adalah laki-laki (55,2%) dan berada dalam kelompok usia 6-14 tahun (60%). Riwayat kontak dengan kasus TB-EP ditemukan pada 49 kasus (51,5%). Penyakit komorbid penyerta dengan mayoritas keganasan (25,6%) dan infeksi HIV (23,1%) ditemukan pada 21 kasus TB-EP (35%). Status jaringan parut BCG positif ditemukan pada 140 kasus (56,9%). Dari 106 anak tanpa jaringan parut BCG, 38 (35,8%) anak memiliki TB paru dan 68 (64,2%) memiliki TB-EP. Tidak adanya jaringan parut BCG memiliki hubungan yang bermakna dengan kejadian TB-EP pada anak (p<0,01) dengan OR: 2,457 (IK95%: 1,46 - 4,131).Kesimpulan. Kejadian TB- EP anak yang tinggi pada proporsi tanpa jaringan parut BCG berhubungan signifikan secara statistik.

Mortality in children with positive SARS-CoV-2 polymerase chain reaction test: Lessons learned from a tertiary referral hospital in Indonesia

Background

The incidence of coronavirus disease 2019 (COVID-19) is still increasing rapidly, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aimed to describe the characteristics of children with COVID-19 with fatal outcomes in a tertiary referral hospital in Indonesia.

Methods

This cross-sectional study used data collected from the medical records of patients with COVID-19 admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from March to October 2020.

Results

During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, and 20 (40%) had a fatal outcome. The fatality rate was higher in patients aged ≥10 years, categorized with severe disease upon admission, PaO₂/FiO₂ ratio ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase and presepsin levels were found in all fatal cases. One patient met the criteria of multisystem inflammatory syndrome in children.

Conclusion

Our work highlights the high mortality rate in paediatric patients with positive SARS-CoV-2 polymerase chain reaction test. These findings might be related to or co-incided with COVID-19 infection. Further studies are needed to improve understanding of the role of severe acute respiratory syndrome coronavirus-2 in elaborating the mechanisms leading to death in children with comorbidities.

Imunodiagnosis Tuberkulosis dengan Interferon Gamma Release Assay dan Uji Tuberkulin pada Anak dengan Infeksi Human Immunodeficiency Virus

Latar belakang. Tuberkulosis (TB) dan Human Immunodeficiency Virus (HIV) merupakan salah satu penyebab utama kematian pada anak. Diagnosis dini penting untuk menurunkan angka mortalitas TB pada infeksi HIV. Uji tuberkulin dan interferon gamma release assay [IGRA, QuantiFERON®-TB Gold In-Tube (QFT-GIT)] diharapkan dapat mendeteksi lebih dini adanya infeksi TB pada HIV. Laporan akurasi QFT-GIT dan uji tuberkulin pada anak dengan infeksi HIV bervariasi. Tujuan. Mengetahui akurasi diagnostik dari QFT-GIT dan uji tuberkulin dalam mendiagnosis TB pada anak usia 1 bulan-15 tahun dengan infeksi HIV. Metode. Penelitian potong lintang dilakukan pada 48 pasien HIV tersangka TB usia 1 bulan-15 tahun. Pengambilan data dilakukan melalui anamnesis, pemeriksaan fisis, foto toraks, uji tuberkulin, QFT-GIT, dan pemeriksaan bakteriologis (Xpert MTB/RIF dan biakan MGIT). Hasil. Angka kejadian TB adalah 20,9% (confirmed TB 4,2% dan possible TB 18,7%). Gambaran klinis anak yang terdiagnosis TB adalah batuk lama (90%), penurunan BB (80%), penurunan aktivitas (80%), pembesaran KGB (60%), dan demam lama (50%). Sensitivitas QFT-GIT terhadap possible TB adalah 38% (IK 95%: 12-77%), spesifisitas 100% (IK 95%: 98-100), NDP 100% (IK 95%: 98-100), sedangkan NDN 88% (IK 95%: 76-94). Sensitivitas uji tuberkulin terhadap possible TB adalah 29% (IK 95%: 8-64%), spesifisitas 97% (IK 95%: 87-100), NDP 67% (IK 95%: 21-94), sedangkan NDN 88% (IK 95%: 76-95%). Sensitivitas QFT-GIT terhadap pemeriksaan bakteriologis 50% (IK 95%: 9-91%), spesifisitas 96% (IK 95%: 85-99%), NDP 33% (IK 95%: 6-79%), sedangkan NDN 98% (IK 95%: 88-100%). Hasil akurasi uji tuberkulin terhadap pemeriksaan bakteriologis tidak dapat dinilai. Kesimpulan. Pemeriksaan dengan QFT-GIT untuk mendeteksi TB pada anak dengan infeksi HIV sedikit lebih unggul dibandingkan uji tuberkulin sehingga dalam pelayanan kedua pemeriksaan ini dapat menjadi pilihan sesuai ketersediaan dan kenyamanan pasien. 

Pediatric COVID-19: Report From Indonesian Pediatric Society Data Registry

Background: Indonesia has a high number of COVID-19 cases and mortalities relative to not only among the Asia Pacific region but the world. Children were thought to be less affected by the virus compared to adults. Most of the public data reported combined data between adults and children. The Indonesian Pediatric Society (IPS) was involved in the COVID-19 response, especially in the area of child health. One of IPS's activities is collecting data registries from each of their chapters to provide a better understanding of COVID-19 in children. Objective: The objective of this study was to share the data of suspected and confirmed COVID-19 cases in children from IPS's COVID-19 data registry. Method: This is a retrospective study from the IPS's COVID-19 registry data. We collected the data of COVID-19 in children during March to December 2020 from each of the IPS chapters. We analyzed the prevalence, case fatality rate (CFR), age groups, diagnosis, and comorbidities of the children diagnosed with COVID-19. Result: As of December 21, 2020, there were 35,506 suspected cases of children with COVID-19. In total, there were 522 deaths, with a case fatality ratio (CFR) of 1.4. There were 37,706 confirmed cases with 175 fatalities (CFR 0.46). The highest mortality in confirmed COVID-19 cases was from children ages 10-18 years (42 out of 159 cases: 26%). The most common comorbidity and diagnosis found were malignancy (17.3%) and respiratory failure (54.5%). Conclusion: The CFR of confirmed COVID-19 cases in children in Indonesia is high and should be a major public concern.

Prevalence of tuberculosis infection and its relationship to stunting in children (under five years) household contact with new tuberculosis cases

BACKGROUND

Children who inhabit the same house with tuberculosis (TB) patients are at high risk for infection and illness with TB. Nutritional status (stunting) in children is related to the child's ability to withstand MTB (Mycobacterium Tuberculosis). This study aims to estimated the prevalence of tuberculosis infection and its relationship to stunting in children (under five years) with household contact (HHC) with new TB cases.

METHODS

A cross-sectional design was implemented. Conducted in July 2018-April 2019 at 13 Public Health Center in Makassar City. The sample size was calculated using one sample situation-about precision formula. Samples were children under five who had contact with new diagnosed TB cases. Tuberculosis infection was measured by TST (tuberculin skin test). Logistic regression with causal model to examine TB infection relationship with stunting and covariate variable, analyzed using Stata/MP 13.0 software.

RESULTS

One hundred twenty-six (126) eligible children. Prevalence of tuberculosis infection was 38.10%. Frequency of stunted was 31 children (24.60%). Stunted nutritional status (aPR): 2.36, 95% CI 1.60-3.44), boys (aPR: 1.47, 95% CI 0.96-2.25), not getting BCG immunization (aPR: 1.58, 95%) CI 0.89-2.82), and high contact intensity (aPR: 2.62, 95% CI 1.10-6.22) best predicted the tuberculosis infection in children with TB case household contacts with a model contribution of 64%.

CONCLUSION

Stunted nutritional status (moderate and severe), boys, not getting BCG immunization, and high contact intensity are the determinants of TB infection transmission in children HHC with TB. Children under five years of age who have close contact with TB cases should be targeted for priority interventions to prevent the transmission of TB infection and progressing to TB cases.

The association between plasminogen activator inhibitor type-1 and clinical outcome in paediatric sepsis

: Acute phase protein plasminogen activator inhibitor type-1 (PAI-1) is a key element in fibrinolysis inhibition in sepsis-induced disseminated intravascular coagulation (DIC). Elevated PAI-1 level is related to worse outcome in sepsis. The aim of this study was to investigate the relationship between plasma PAI-1 level and clinical outcome in children with sepsis. A total of 35 children with sepsis were enrolled into this prospective study. Plasma PAI-1 was measured on day-1 and day-4. Systemic coagulation profile was measured on day-4. Individuals were followed up until 28 days. The mean PAI-1 from day-1 to day-4 in overt DIC children was not statistically significant. Contrarily, among nonovert DIC individuals, there was a significant difference (P ≤ 0.001) in PAI-1 levels on day-1 compared with day-4 were 95.25 ± 46.57 vs. 60.36 ± 37.31 ng/ml, respectively. Among survivors, mean PAI-1 level on day-1 was statistically higher than PAI-1 level on day-4 (82.47 ± 44.43 vs. 58.39 ± 32.98 ng/ml), P = 0.021. There was no significant difference between PAI-1 levels on day-1 compared with day-4 in nonsurvivors. PAI-1 was correlated to DIC score with r = 0.606 (P ≤ 0.001). PAI-1 levels significantly decreased on day-4 compared with day-1 among nonovert DIC individuals, and not in overt DIC individuals. Changes in PAI-1 levels in nonsurvivors did not differ. PAI-1 level was positively correlated with DIC score.

Studi Pilot: Peran Heat Shock Protein 60 (Hsp60) dan Kontrol Metabolik terhadap Infeksi Tuberkulosis pada Anak dan Remaja dengan Diabetes Mellitus Tipe-1

Latar belakang. Heat shock protein 60 (Hsp60) ditemukan pada individu dengan Diabetes Mellitus (DM) tipe-1 dan merupakan mimikri molecular Hsp65 pada mycobacterium. Fenomena ini dapat menyebabkan penundaan identifikasi mycobacterium dan memperparah kondisi DM tipe-1. Tujuan. Studi ini bertujuan untuk meneliti peran Hsp60 dalam kontrol metabolik terhadap infeksi tuberkulosis (TB) pada anak dan remaja dengan DM tipe-1.Metode. Penelitian ini merupakan studi potong lintang yang dilaksanakan di Rumah Sakit Cipto Mangunkusumo. Anak dan remaja dengan DM tipe I memenuhi kriteria inklusi. Setelah memperoleh data dasar, dilakukan pemeriksaan HbA1c, Hsp60, dan IGRA. Dilakukan analisis data.Hasil. Sebanyak 32 subjek dengan DM tipe-1 diidentifikasi. Insidens infeksi TB yang terdeteksi dengan IGRA pada anak dan remaja dengan DM tipe-1 adalah 12,5%. Tiga dari empat pasien dengan hasil IGRA positif memiliki nilai HbA1c >9.0. Nilai rerata Hsp60 pada subjek IGRA positif lebih rendah dibandingkan subjek IGRA negatif (1.16 ± 0.59 vs 115.18 ± 364.73), dengan nilai P>0,05.Kesimpulan. Tidak didapatkan hubungan signifikan antara Hsp60 dan control glikemik dengan insidens TB pada anak dan remaja dengan DM tipe-1. Hasil ini mungkin dipengaruhi oleh jumlah subjek yang sedikit, penggunaan IGRA untuk mendiagnosis TB pada anak, dan reaktivitas rendah Hsp60 dengan Hsp65.

Diagnosis and management of latent tuberculosis infection in Asia: Review of current status and challenges

Asia has the highest burden of tuberculosis (TB) and latent TB infection (LTBI) in the world. Optimizing the diagnosis and treatment of LTBI is one of the key strategies for achieving the WHO 'End TB' targets. We report the discussions from the Asia Latent TubERculosis (ALTER) expert panel meeting held in 2018 in Singapore. In this meeting, a group of 13 TB experts from Bangladesh, Cambodia, Hong Kong, India, Indonesia, Malaysia, Myanmar, the Philippines, Singapore, Taiwan, Thailand and Vietnam convened to review the literature, discuss the barriers and propose strategies to improve the management of LTBI in Asia. Strategies for the optimization of risk group prioritization, diagnosis, treatment, and research of LTBI are reported. The perspectives presented herein, may help national programs and professional societies of the respective countries enhance the adoption of the WHO guidelines, scale-up the implementation of national guidelines based on the regional needs, and provide optimal guidance to clinicians for the programmatic management of LTBI.

The Gastroesophageal Reflux Disease Questionnaire in Adolescents: What Is the Best Cutoff Score?

BACKGROUND

A self-assessment questionnaire, the GERD-Questionnaire (GERD-Q) was used to determine the prevalence of GERD in adolescents, describe the related factors, and determine the impact on quality of life (QoL).

METHODS

The incidence of GERD was evaluated using the GERD-Q in adolescents aged 12-18 years. The Pediatric Gastroesophageal Reflux Disease Symptom Questionnaire and Quality of Life Questionnaire (PGSQ-A) for adolescents were additionally administered. Some factors considered related to GERD were also evaluated.

RESULTS

The 520 adolescents were included. The prevalence of suspected GERD, according to a GERD-Q cutoff score of ≥7 was 32.9%, and those drinking soda were 1.7 times more likely to have GERD (95% confidence interval, 1.3-2.2; p<0.001). However, soda consumption was not a risk factor for development of GERD symptoms. Applying a cutoff score of ≥8, only 10.9% of the participants had a positive GERD score, but the association with soda consumption persisted. The median PGSQ-A score in subjects suspected of GERD was 8 (range 0-37) on weekends and 1 (range 0-17) during weekdays (p<0.001) compared to those not suspected of GERD, with a median of 2 (range 0-27) during weekends and 0 (range 0-10) during weekdays. Heartburn, regurgitation, and extraesophageal symptoms correlated significantly with QoL (p<0.001).

CONCLUSION

The prevalence of suspected GERD in adolescents was 32.9% or 10.9%, depending on the cutoff score used. There was a statistically significant difference in PGSQ-A scores between the subjects suspected or not of GERD, indicating an impaired QoL.

Penyakit Respiratorik pada Anak dengan HIV

Latar belakang. Kejadian AIDS pada anak meningkat seiring dengan peningkatan kasusdewasa. Gejala dan manifestasi klinis sering tidak khas, sehingga menyebabkanunderdiagnosis. Anak HIV sering datang dengan keluhan yang berasal dari infeksioportunistik, bahkan infeksi oportunistik banyak ditemukan sebagai penyebab kematian.Salah satu infeksi oportunistik yang sering terjadi adalah infeksi respiratorik.Tujuan penelitian. Penelitian ini bertujuan untuk melihat pola penyakit respiratorikpada anak HIV yang dirawat di Bagian Ilmu Kesehatan RS Dr. Cipto Mangunkusumo(RSCM), Jakarta.Metoda. Data berasal dari rekam medis anak HIV tahun 2002-2005. Penelitiandilakukan dengan desain potong lintang. Kriteria inklusi adalah anak usia 0-13 tahun,dengan HIV positif dan menderita penyakit respiratorik. Data yang dicatat meliputiumur, jenis kelamin, faktor risiko, status gizi, parut BCG, diameter uji tuberkulin, riwayatkontak dengan pasien tuberkolosis, kategori HIV, diagnosis penyakit respiratorik,outcome. Data klinis khusus meliputi batuk kronik berulang, demam lama, sesak nafas,laboratorium rutin, foto torak, dan kadar CD4, PCR.Hasil. Sejak Januari 2002-Desember 2005, telah dirawat 85 anak yang terinfeksi HIV,dengan 13 orang (15,2%) di antaranya meninggal. Tiga belas orang (13/35) didiagnosisHIV berdasarkan serologi dan PCR, 24/35 hanya dengan serologi, dan 1/35 orang denganPCR. Sebanyak 38 (44,7%) orang menderita infeksi respiratorik dengan pola penyakit: TB47,3%, pneumonia 44,7%, pneumocytis corinii pneumonia (PCP) 13,1%. Pada penelitianini, didapatkan bahwa 3/38 (7,8%) anak HIV dengan penyakit paru meninggal karenapneumonia berat, dengan 2/3 di antaranya pada kelompok umur 1-5 tahun. Penyebabkematian lainnya adalah PCP 2/38 pasien (5,2%), dan tersangka sepsis pada 2 pasien (5,2%).Kesimpulan. Pada anak HIV, TB merupakan penyakit respiratorik terbanyak, diikutipneumonia, sedangkan penyebab kematian terbanyak adalah pneumonia. Penyakitrespiratorik pada anak HIV dapat menjadi pembuka jalan untuk diagnosis anak HIV.

Akurasi Polymerase Chain Reaction (PCR) Dibandingkan dengan Uji Tuberkulin untuk Diagnosis Tuberkulosis pada Anak

Latar belakang. Penegakan diagnosis tuberkulosis (TB) pada anak sangat sulit, oleh karena gejalanya yang tidak khas serta sulitnya mendapatkan spesimen untuk pemeriksaan mikrobiologis. Uji tuberkulin telah lama digunakan sebagai salah satu pemeriksaan penunjang yang penting untuk diagnosis TB anak. Beberapa tahun terakhir telah dikembangkan pemeriksaan polymerase chain reaction (PCR) untuk mendeteksi TB.Tujuan. Menilai akurasi pemeriksaan PCR dalam penegakan diagnosis TB anak serta perbandingannya dengan uji tuberkulin.Metode. Penelitian uji diagnosis yang menilai akurasi PCR terhadap baku emas diagnosis TB yaitu basil tahan asam (BTA) dan/atau biakan di RS Cipto Mangunkusumo, RSIA Harapan Kita, RS Budhi Asih, dan RS Persahabatan, tahun 2005-2007. Dilakukan pemeriksaan uji tuberkulin dan pengambilan spesimen dari dahak, bilasan lambung, cairan pleura, aspirasi kelenjar getah bening (dengan jarum halus), atau cairan serebrospinal untuk diperiksa PCR, sediaan langsung basil tahan asam dan biakan Mycobacterium tuberculosis.Hasil. Dari 181 pasien anak tersangka TB (suspected TB), didapatkan 13 pasien yang didiagnosis pasti TB (confirmed TB) sehingga didapatkan prevalens 7,2%. Sensitivitas dan spesifisitas PCR berturut-turut adalah 69% dan 57%, sedangkan sensitivitas dan spesifisitas uji tuberkulin berturut-turut adalah 77% dan 55%. Rasio kemungkinan positif (positive likelihood ratio) PCR dan uji tuberkulin berturut-turut adalah 1,62 dan 1,7.Kesimpulan. Penelitian ini mendapatkan bahwa PCR tidak lebih superior dibandingkan dengan uji tuberkulin untuk mendiagnosis TB pada anak.

Uji Kesahihan dan Keandalan Kuesioner Childhood Asthma Control Test versi Indonesia pada Anak Usia 4-11 Tahun

Latar belakang. Childhood Asthma Control Test (CACT) merupakan kuesioner penilaian terkendalinya asma pada anak yang cepat dan mudah digunakan. Di Indonesia, penggunaan CACT masih terbatas karena kendala bahasa dan budaya. Sampai saat ini, belum ada kuesioner CACT versi Indonesia (terjemahan CACT ke dalam bahasa Indonesia) yang terbukti sahih dan andal.Tujuan. Mengetahui kesahihan (validity) dan keandalan (reliability) kuesioner CACT versi Indonesia.Metode. Menerjemahkan tujuh pertanyaaan kuesioner CACT menjadi kuesioner CACT versi Indonesia. Studi potong lintang dilakukan terhadap 66 subjek usia 4-11 tahun yang dipilih secara konsekutif. Semua subjek menjalani uji fungsi paru dan pemeriksaan peak expiratory flow berkala. Analisis statistik menggunakan uji Cronbach’s α dan uji korelasi Pearson/ Spearman.Hasil. Rerata usia subjek penelitian 7,89 tahun (5,25 -11,83) tahun dengan proporsi jenis kelamin laki-laki lebih tinggi dibandingkan perempuan. Sebagian besar subjek penelitian yaitu 60,4% memiliki status asma tidak terkendali (nilai kuesioner CACT ≤19). Kuesioner CACT versi Indonesia mempunyai keandalan (Cronbach’s α 0,762) dan kesahihan konstruksi (r= 0,384-0,545) yang baik. Tidak terdapat korelasi bermakna antara kuesioner CACT versi Indonesia dengan nilai FEV1 (r=-0,024; p=0,846) dan nilai variabilitas mingguan PEF (r=-0,218; p=0,079).Kesimpulan. Kuesioner CACT versi Indonesia mempunyai kesahihan dan keandalan yang baik untuk menilai terkendalinya asma. Kuesioner ini tidak mempunyai korelasi dengan uji fungsi paru sehingga CACT tidak dapat menggantikan peran uji fungsi paru sebagai salah satu komponen penilaian terkendalinya asma.

Profil Pubertas dan Pertumbuhan Linear pada Hiperplasia Adrenal Kongenital dalam Pengobatan Serial Kasus

Latar belakang. Terapi yang adekuat pada hiperplasia adrenal kongenital (HAK) diharapkan dapatmenghasilkan perkembangan pubertas dan pertumbuhan linear yang optimal. Saat ini, di Indonesia, belumada data profil pubertas dan pertumbuhan linear penderita HAK yang sedang menjalani terapi.Tujuan. Mengetahui profil pubertas dan pertumbuhan linear pada HAK di Indonesia yang sedang menjalaniterapi.Metode. Studi serial kasus terhadap 14 kasus HAK yang memasuki masa pubertas di Departemen IlmuKesehatan Anak Rumah Sakit Cipto Mangunkusumo Jakarta selama bulan November 2012 hingga April2013. Pencatatan data berisi anamnesis, pemeriksaan fisis, pemeriksaan laboratorium, dan radiologi boneage.Hasil. Hasil penelitian ini merupakan riset pendahuluan (preliminary research) terhadap 14 kasus HAK.Mayoritas subjek adalah perempuan, berusia di atas 8 tahun, HAK tipe Salt-Wasting (SW), dan terdiagnosissejak kurang dari satu tahun. Tujuh dari 14 subjek mengalami obesitas. Undertreatment terjadi pada 11/14subjek memiliki bone age accelerated dengan perhitungan tinggi badan dewasa yang pendek. Tiga belas subjeksudah pubertas dan 10/14 subjek mengalami pubertas prekoks. Rekomendasi dosis glukokortikoid yangdiberikan (median 18,12 mg/m2/hari) dengan median durasi terapi 8,1 tahun. Kontrol metabolik denganmenggunakan parameter 17-OHP bervariasi pada rentang 0,2-876 nmol/L (rerata 166,9 nmol/L).Kesimpulan. Sebagian besar subjek mendapatkan undertreatment sehingga memiliki bone age accelerateddengan estimasi tinggi badan dewasa pendek. Pubertas prekoks dialami oleh sebagian besar subjek.Pemberian glukokortikoid dengan dosis yang direkomendasikan. Ditemukan ketidakteraturan pengobatandan pemantauan yang buruk.

Perbandingan Respons Klinis dan Efek Samping Semprot Hidung Salin Isotonik (Air Laut) dengan Tetes Hidung Salin Isotonik pada Anak Balita dengan Common Cold

Latar belakang. Keunggulan semprot hidung salin isotonik air laut pada anak balita dengan common cold masih kontroversi, dan studi pada anak balita masih sedikit.Tujuan. Membandingkan respons klinis dan efek samping semprot hidung salin (air laut) dan tetes hidung salin pada pasien dengan common cold, melalui a) penurunan skor gejala hidung, b) penurunan skor suhu tubuh, c) lama sakit, dan d) efek samping (epistaksis).Metode. Suatu opened-label randomized clinical trial, dilaksanakan di Puskesmas Kecamatan Kalideres dengan subjek anak berusia 12-60 bulan. Subjek diberikan semprot hidung salin air laut dan sirup parasetamol (kelompok eksperimen) atau tetes hidung salin dan parasetamol (kelompok eksperimen) atau hanya parasetamol (kontrol) berdasarkan alokasi random. Semprot hidung salin (air laut) diberikan 3 kali sehari 1 semprot tiap lubang hidung selama 7 hari, tetes hidung salin diberikan 3 kali sehari 2 tetes tiap lubang hidung selama 7 hari, dan parasetamol sirup diberikan 10 mg/kgbb tiap 4 jam bila suhu tubuh ≥38ºC. Penilaian skor gejala hidung, skor suhu tubuh, dilakukan sebelum dimulai pengobatan sampai dengan hari ke delapan. Lama sakit dan efek samping obat dinilai dari awal pengobatan sampai sembuhHasil. Didapat 68 subjek yang memenuhi kriteria inklusi dirandomisasi menjadi kelompok eksperimen (semprot hidung salin air laut dan tetes hidung salin) atau kontrol. Pada hari kedelapan pengobatan, tidak terdapat perbedaan bermakna pada penurunan skor gejala hidung (p=0,976), skor suhu tubuh (p=0,884), dan lama sakit (p=0,805) antara ketiga kelompok penelitian. Tidak didapatkan efek samping berupa epistaksis.Kesimpulan. Pada anak balita dengan common cold yang diberikan semprot hidung salin (air laut) dibandingkan dengan tetes hidung salin dan kontrol tidak terdapat perbedaan bermakna pada respons klinis dan efek samping.

Infeksi Influenza A dan B pada Anak dengan Influenza Like Illness (ILI) atau Pneumonia di Jakarta

Latar belakang Secara global, influenza merupakan salah satu penyebab utama morbiditas dan mortalitas pada anak serta menimbulkan beban ekonomi yang cukup besar. Manifestasi infeksi ini secara klinis sulit dibedakan dengan penyebab lain pada pasien dengan Influenza Like Illness (ILI) atau pneumonia.Tujuan. Menilai proporsi infeksi influenza A dan B pada anak dengan ILI dan pneumonia, mengetahui karakteristik subjek dengan infeksi influenza serta faktor yang memengaruhinya.Metode. Penelitian potong lintang dilakukan di RS Cipto Mangunkusumo dan Puskesmas Kecamatan Pulo Gadung sejak Januari 2010 hingga Oktober 2010. Pada anak berusia 0-14 tahun dengan diagnosis ILI atau pneumonia sesuai kriteria WHO dilakukan rapid test untuk influenza dengan menggunakan bahan usapan nasofaring. Data karakteristik klinis, demografi, dan lingkungan dicatat dalam formulir penelitian.Hasil. Didapatkan proporsi infeksi influenza A dan B pada anak dengan ILI dan pneumonia 14/167 (8,3%). Sebagian besar menderita infeksi influenza B (12/14 subjek). Usia >5 tahun berhubungan dengan kejadian infeksi influenza yang lebih tinggi dibandingkan kelompok usia ≤5 tahun (p=0,012). Selain demam, gejala lain berupa batuk, sakit kepala, nyeri otot, lesu, dan nyeri tenggorok lebih banyak didapatkan pada subjek dengan infeksi influenza.Kesimpulan. Pada anak dengan ILI dan pneumonia, proporsi infeksi influenza 8,3%, terutama didapatkan infeksi Influenza B. Usia merupakan faktor yang memengaruhi infeksi influenza. Karakterustik klinis subjek dengan infeksi influenza sesuai dengan manifestasi klasik penyakit tersebut.

Adverse events following immunization (AEFI) reports of extended program immunization (EPI) in Indonesia during 1998-2002

Background The incidence of adverse events following immuni-zation (AEFI) increased in correlation with the number of vaccinedoses. Meanwhile AEFI reports should be managed properly tomaintain the compliance and immunization coverage.Objectives The aims of this study were to investigate the inci-dence and profile of AEFI, its onset, severity, classification, andoutcome.Methods This study was a passive surveillance of AEFI reportsreceived by the National Committee on AEFI, Ministry of Health ofIndonesia, during 1998 to 2002.Results Two hundreds and four AEFI cases were reported; 4 casesas zero reports, 182 cases as individual reports, and 18 clusterreports. The AEFI incidence was 0.44 per 1 million doses of vac-cines. Vaccine reaction rate was 1 per 2.3 million vaccine doses.The most common vaccines reported as the causes of AEFI wereDTP, Polio, and TT. Among 182 reported cases, local or mild AEFIreactions were observed in 45, moderate in 49, and severe in 88.Based on WHO field classification, this study reported that 84 casesbelonged to coincidence, 72 to vaccine reactions, 13 to program-matic errors, 7 to injection reactions, and 6 to unclassified reac-tions. Forty-seven patients died, 12 had some sequelae, and 123completely recovered. Meanwhile, among the death cases, 70%occurred coincidently, 17% due to vaccine reactions, and 6 wereunclassified.Conclusions The incidence of AEFI in the extended program im-munization (EPI) in Indonesia during the period of 1998-2002 were182 cases, thus vaccine reaction rate was 1 per 2.3 million vac-cine doses. The most common vaccine which caused AEFI wasDTP. Most AEFI with severe symptoms happened in 4-24 hoursafter immunization.