Immunogenicity and Safety of SARS-CoV-2 Protein Subunit Recombinant Vaccine (IndoVac®) as a Booster Dose against COVID-19 in Indonesian Adults

According to the WHO target product profile for COVID-19 vaccines, the vaccine in development should be indicated for active immunisation in all populations. Therefore, PT Bio Farma developed a candidate vaccine in a subunit protein recombinant platform to help overcome the issue. This trial was an observer-blind, randomised, prospective intervention study. This study targeted individuals who had received complete primary doses of the authorised/approved COVID-19 vaccine. The groups were divided into the primary inactivated vaccine (CoronaVac®) group, the primary viral vector vaccine (ChAdOx1) group, and the primary mRNA vaccine (BNT162b2) group that received the recombinant protein (IndoVac®). The groups were compared with the control and primary mRNA vaccine (BNT162b2). The participants enrolled in the study were from two primary care centres in Bandung City and three primary care centres in Denpasar City. A total of 696 participants were enrolled from 1 September to 31 October 2022. The demographic characteristics of the all-vaccine group showed a uniform distribution. The results showed that, compared with the control, the investigational product had inferior effectiveness 14 days after the booster dose was administered. However, 28 days after the booster dose, the investigational product exhibited non-inferior effectiveness compared with the primary groups that received CoronaVac® (GMR 0.76 (0.57-0.99)) and ChAdOx1 (GMR 0.72 (0.56-59.93)), but the BNT162b2 group (GMR 0.61 (0.39-0.94)) was inferior to the control. At 12 months follow-up after the booster dose, three serious adverse events (SAEs) were reported in three participants, with causality not correlated with the investigated products. Neither AEs of special interest nor severe COVID-19 cases were reported throughout the follow-up period; thus, the IndoVac® vaccine as a booster was immunogenic and safe. Until the 6-month follow-up after the booster dose, the IndoVac® vaccine was well tolerated and all reported AEs resolved. This vaccine is registered and can be included in the immunisation programme.

Correlation Between Vitamin D Status and HBsAg Antibody Levels in Indonesian Adolescents Immunised Against Hepatitis B

Introduction

Hepatitis B virus (HBV) infection is a global health problem. Anti-hepatitis B surface antigen (HBsAg) levels increase along with vitamin D levels in adults. However, few studies have examined this relationship in adolescents. Few studies have examined the relationship between vitamin D and HBsAg antibody levels, especially in Indonesia.

Methods

This cross-sectional study examined vitamin D and anti-HBsAg levels before and after hepatitis B immunisation. All subjects blood was taken to check for vitamin D level. This study was part of the Safety and Preliminary of Immunogenicity Following Recombinant Hepatitis B (Bio Farma) Vaccine in Adults and Children Phase I trial.

Results

This study found that 25-hydroxyvitamin D [25(OH)D] status was primarily deficient based on endocrine criteria. The children's hepatitis B antibody response was mostly <10 mIU/mL before and ≥10 mIU/mL after vaccination. There was a relationship between sex and 25(OH)D status, with median 25(OH)D levels higher in females (18.2 ng/mL) than in males (9.8 ng/mL). However, the relationship between vitamin 25(OH)D status and anti-HBsAg levels pre- and post-vaccination was not significant.

Discussion

However, some research found that vitamin D supplementation after immunisation did not impact vaccine response, several studies have reported that vitamin D can decrease HBV replication through various mechanisms, including reducing viral transcription and interfering with viral protein synthesis.

Conclusion

There was no relationship between 25(OH)D status and anti-HBsAg levels. Further research is needed to elucidate the underlying mechanisms and establish optimal treatment strategies.

Supplementation of Prenatal Vitamin D to Prevent Children's Stunting: A Literature Review

Background

Stunting is a common nutritional problem in children. Many risk factors contributing to stunting are identified in the literature. Vitamin D supplementation during pregnancy is useful for preventing impairment of fetal bone growth in the womb. However, lack of review in exploring supplementation of prenatal vitamin D is related to stunting in children.

Purpose

This study aims to identify the effectiveness of prenatal vitamin D supplementation in preventing stunting.

Methods

A literature review was conducted using PubMed, CINAHL, ScienceDirect, and Cochrane Library. Inclusion criteria were a randomized controlled trial study, published between 2011-2023, a full-text article for pregnant women and an independent variable supplement vitamin D to prevent children's stunting. The keywords used in English were "children OR child" AND "pregnant women" AND "preventive stunting" AND "vitamin D". Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool.

Results

From the results of the study selection of 511 articles, 11 articles met the inclusion and eligibility criteria for study analysis. Four studies indicated that the administration of vitamin D did not influence the length of the neonate's body or the Length for Age Z-Score (LAZ), used as an indicator of stunting. However, seven articles demonstrated that providing vitamin D supplements to pregnant women impacted various aspects of anthropometry, including the length of the neonate's body. Our findings show that the dosage used of vitamin D in pregnancy varied between 1400-60,000 per week. Overall, results of this study analysis show that the intervention of prenatal vitamin D supplementation has an impact on the prevention of stunting.

Conclusion

This literature review highlighted the benefits of maternal vitamin D during pregnancy and for the children's growth. Prenatal vitamin D supplementation is needed to prevent stunting.

Immunogenicity and safety of Quadrivalent Influenza HA vaccine compared with Trivalent Influenza HA vaccine and evaluation of Quadrivalent Influenza HA vaccine batch-to-batch consistency in Indonesian children and adults

One of the newest strategies developed by the Global Influenza Strategy has been to broaden the composition of the current influenza vaccine formulations from trivalent products to quadrivalent products. This study aimed to assess the immunogenicity and safety of Quadrivalent Influenza HA vaccine (QIV) compared with Trivalent Influenza HA vaccine (TIV) and to evaluate three consecutive batches of QIV equivalence in Indonesian children and adults. This was an experimental, randomized, double blind, four arm parallel group bridging study involving unprimed healthy children and adults aged 9-40 years. A total of 540 subjects were enrolled in this study and randomized into four arm groups. Each subject received one dose of TIV or QIV with three different batch codes. Serology tests were performed at baseline and 28 days after vaccination. Hemagglutination inhibition (HI) antibody titers were analyzed for Geometric Mean Titer (GMT), seroprotection, and seroconversion rates. Solicited, unsolicited, and serious adverse events were observed up to 28 days after vaccination. A total of 537 subjects completed the study per protocol and were analyzed for immunogenicity criteria. All randomized subjects were analyzed for safety criteria. The percentage of the subjects with anti-HI titer ≥1:40 28 days after QIV vaccination was 99.5% for A/H1N1; 99.5% for A/H3N2; 93.1% for B/Texas, and 99.0% for B/Phuket. The seroprotection, GMT, and seroconversion rates of QIV were not significantly different from those of TIV for the common vaccine strains (p > 0.01) and were significantly different from those of TIV for the added B/Phuket strains (p < 0.01). Most solicited injection-site and systemic reactions with either vaccine were mild to moderate and resolved within a few days. Antibody response to QIV were equivalence among vaccine batches and comparable between age groups for each of the 4 strains. QIV was immunogenic and well-tolerated and had immunogenicity and safety profiles compared with TIV for all common strains. The immunogenicity of the three batches of QIV was equivalent for the four strains. Trial registration. Clinical Trial registration: NCT03336593.

Factors Affecting the Developmental Status of Children Aged 6 Months to 2 Years in Urban and Rural Areas

The first two years of life, including the period from conception to 2 years of age, are very important for a child's growth and development. This study sought to describe the developmental status and the environmental factors that influence it in children aged 6 months to 2 years in urban and rural areas. The research sites were purposively selected: specific health centres in the city of Bandung and West Bandung district were chosen and the study was conducted from November to December 2022. A cross-sectional study was conducted with healthy children aged 6 months to 2 years and their parents, who agreed to participate in the study. Researchers performed developmental tests using the Developmental Pre-screening Questionnaire with classifications for normal developmental test results and developmental delays. During the study, 346 children met the inclusion criteria, resulting in a sample of 164 (47.4%) boys and 182 (52.6%) girls. There were no significant differences among children with developmental delays in urban and rural areas. The factors that influence the possibility of developmental delays in the two research areas were the child's age, exposure to screen time, stimulation, nutritional status, and the use of the mother-child handbook.

Comparison of Immunogenicity and Safety of Diphtheria–Tetanus–Pertussis–Hepatitis B–Haemophilus influenza B (Bio Farma) with Pentabio® Vaccine Primed with Recombinant Hepatitis B at Birth (Using Different Source of Hepatitis B) in Indonesian Infants

Satisfying the needs of the national immunization program requires maintaining diphtheria–tetanus–pertussis (DTP)–hepatitis B (HB)–Haemophilus influenza B (Hib) production. Therefore, new hepatitis B sources are needed. This study aimed to evaluate the immunogenicity of the DTP–HB–Hib vaccine (Bio Farma) that used a different source of hepatitis B. A prospective randomized, double-blind, bridging study was conducted. Subjects were divided into two groups with different batch numbers. Healthy infants 6–11 weeks of age at enrollment were immunized with three doses of the DTP–HB–Hib vaccine after a birth dose of hepatitis B vaccine. Blood samples were obtained prior to vaccination and 28 days after the third dose. Adverse events were recorded until 28 days after each dose. Of the 220 subjects, 205 (93.2%) completed the study protocol. The proportion of infants with anti-diphtheria and anti-tetanus titers ≥ 0.01 IU/mL was 100%, with anti-HBsAg titers ≥ 10 mIU/mL was 100%, and with Polyribosylribitol Phosphate-Tetanus Conjugate (PRP-TT) titers > 0.15 µg/mL was 96.1%. The pertussis response rate was 84.9%. No serious adverse events related to the study vaccine occurred. The three-dose DTP–HB–Hib vaccine (Bio Farma) is immunogenic, well tolerated, and suitable to replace licensed-equivalent vaccines.

Immunogenicity and safety in healthy adults of full dose versus half doses of COVID-19 vaccine (ChAdOx1-S or BNT162b2) or full-dose CoronaVac administered as a booster dose after priming with CoronaVac: a randomised, observer-masked, controlled trial in Indonesia

BACKGROUND

Inactivated COVID-19 vaccines effectively prevent death, but their effectiveness for preventing infection or severe illness is known to decrease within 3-6 months following the second priming dose. Here we aimed to evaluate the immunogenicity and safety of three potential booster vaccines administered as a full-dose homologous booster or full-dose or half-dose heterologous boosters among individuals primed with CoronaVac.

METHODS

We did an observer and participant masked, randomised controlled trial study of healthy Indonesian adults from five recruitment sites in Bandung and Jakarta, Indonesia, aged 18 years and older who had previously received two doses of CoronaVac within 3 to less than 6 months or 6 to 9 months before the booster dose. Participants were randomly assigned (1:1:1:1:1) by means of stratified randomisation with random block size to a homologous booster with full-dose CoronaVac or heterologous boosters with ChAdOx1-S or BNT162b2 in full dose or half dose. The primary outcome was to evaluate the seropositive, seroconversion rate, and the geometric mean titres of IgG anti-spike-receptor binding domain and neutralising antibodies, 28 days after booster dose vaccination in the per-protocol population. Safety was assessed as a secondary outcome in all vaccinated booster participants by the incidence rate and intensity of adverse events within 24 h, 7 days, and 28 days after the booster dose. This study is registered with ina-registry.org, INA-GO0HLGB, and is complete.

FINDINGS

Between Nov 26 and Dec 16, 2021, 1015 people were screened, and 960 healthy adults were enrolled; 190-193 were included in each group. 28 days after receiving the booster, combining the 3 to less than 6 months and 6 to 9 months groups, the proportions of seroconversion rates in each vaccine group were ChAdOx1-S 75 (82%) of 92 to 87 (88%) of 99 for full dose and half dose, BNT162b2 92 (92%) of 100 to 90 (98%) of 92 for full dose and half dose, and CoronaVac in 38 (41%) of 92 to 65 (66%) of 98. All booster groups achieved 100% seropositivity 28 days after the booster dose. Participants in the 6 to 9 months priming group achieved higher titres compared with participants in the 3 to less than 6 months priming group. The geometric mean titres in participants in the 6 to 9 months priming group in each vaccine group were ChAdOx1-S 11258·69 (9562·43-13 255·85) and 7853·04 (6698·92-9206·00) for full dose and half dose, BNT162b2 19999·84 (17 720·58-22 572·25) and 17 017·62 (14 694·40-19 708·16) for full dose and half dose and CoronaVac 1440·55 (1172·81-1769·42) achieved higher titres compared with participants in the 3 to less than 6 months priming group which in each vaccine group were ChAdOx1-S 7730·39 (6401·87-9334·60) and 6684·34 (5678·94-7867·73) for full dose and half dose, BNT162b2 16594·08 (13 993·08-19 678·55) and 12 121·67 (9925·21-14 804·19) for full dose and half dose, and CoronaVac 1210·23 (976·49-1499·92). The median percentage inhibition for the surrogate virus neutralisation test against the delta B.1.617.2 and wild-type (WT) variant before the booster and 28 days after the booster dose was very high in all groups (p<0·001), all with greater than 90% inhibition against both delta and WT strains. No serious adverse events were associated with the vaccines. Within the heterologous booster groups, the adverse event rates in the half-dose groups were lower compared with the full-dose groups.

INTERPRETATION

Geometric mean titre values between participants in the 6 to 9 months priming group and the 3 to less than 6 months priming group before the booster dose and between half-dose and full-dose groups 28 days before the booster were not significantly different for half-dose ChAdOx1-S, full-dose BNT162b2, and CoronaVac and were significantly different for full-dose ChAdOx1-S and half-dose BNT162b2. Among individuals primed with CoronaVac, boosting with BNT162b2 (full dose or half dose) or ChAdOx1-S (full dose or half dose) produces substantially better immune responses than in those boosted with CoronaVac. Full-dose and half-dose boosting with either BNT162b2 or ChAdOx1-S produced similar responses. Heterologous booster with half-dose might be considered in adults primed with two doses of CoronaVac vaccine.

FUNDING

Ministry of Health, Indonesia.

TRANSLATION

For the Indonesian translation of the abstract see Supplementary Materials section.

Correlation between anthropometric measurements of height and arm span in Indonesian children aged 7-12 years: a cross-sectional study

BACKGROUND

Height is an anthropometric measurement that serves as the most constant indicator of growth. In certain circumstances, arm span can be used as an alternative to height measurements. This study aims to analyze the correlation between anthropometric measurements of height and arm span in children aged 7-12 years.

METHODS

A cross-sectional study was carried out from September to December 2019 in six elementary schools in Bandung. Children aged 7-12 years were recruited with a multistage cluster random sampling method. Children with scoliosis, contractures, and stunting were excluded from the study. Height and arm span were measured by two pediatricians.

RESULTS

A total of 1,114 children, comprising 596 boys and 518 girls, fulfilled the inclusion criteria. The ratio of height to arm span was 0.98-1.01. The regression equation used to predict height through measurement of arm span in male subjects was Height = 21.8623 + 0.7634 x Arm span (cm) + 0.0791 x age (month); R2 = 94%; standard error of estimate (SEE): 2.66 and that in female subjects was Height = 21.2395 + 0.7779 x Arm span (cm) + 0.0701 x age (month); R2 = 95.4%; SEE: 2.39. The predicted height and the average actual height were not significantly different. There is a strong correlation between height and arm span in children aged 7-12 years.

CONCLUSIONS

Arm span can be used to predict the actual height of children aged 7-12 years and as an alternative measurement for growth.

Efficacy and Safety of the RBD-Dimer-Based Covid-19 Vaccine ZF2001 in Adults

BACKGROUND

The ZF2001 vaccine, which contains a dimeric form of the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 and aluminum hydroxide as an adjuvant, was shown to be safe, with an acceptable side-effect profile, and immunogenic in adults in phase 1 and 2 clinical trials.

METHODS

We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to investigate the efficacy and confirm the safety of ZF2001. The trial was performed at 31 clinical centers across Uzbekistan, Indonesia, Pakistan, and Ecuador; an additional center in China was included in the safety analysis only. Adult participants (≥18 years of age) were randomly assigned in a 1:1 ratio to receive a total of three 25-μg doses (30 days apart) of ZF2001 or placebo. The primary end point was the occurrence of symptomatic coronavirus disease 2019 (Covid-19), as confirmed on polymerase-chain-reaction assay, at least 7 days after receipt of the third dose. A key secondary efficacy end point was the occurrence of severe-to-critical Covid-19 (including Covid-19-related death) at least 7 days after receipt of the third dose.

RESULTS

Between December 12, 2020, and December 15, 2021, a total of 28,873 participants received at least one dose of ZF2001 or placebo and were included in the safety analysis; 25,193 participants who had completed the three-dose regimen, for whom there were approximately 6 months of follow-up data, were included in the updated primary efficacy analysis that was conducted at the second data cutoff date of December 15, 2021. In the updated analysis, primary end-point cases were reported in 158 of 12,625 participants in the ZF2001 group and in 580 of 12,568 participants in the placebo group, for a vaccine efficacy of 75.7% (95% confidence interval [CI], 71.0 to 79.8). Severe-to-critical Covid-19 occurred in 6 participants in the ZF2001 group and in 43 in the placebo group, for a vaccine efficacy of 87.6% (95% CI, 70.6 to 95.7); Covid-19-related death occurred in 2 and 12 participants, respectively, for a vaccine efficacy of 86.5% (95% CI, 38.9 to 98.5). The incidence of adverse events and serious adverse events was balanced in the two groups, and there were no vaccine-related deaths. Most adverse reactions (98.5%) were of grade 1 or 2.

CONCLUSIONS

In a large cohort of adults, the ZF2001 vaccine was shown to be safe and effective against symptomatic and severe-to-critical Covid-19 for at least 6 months after full vaccination. (Funded by the National Science and Technology Major Project and others; ClinicalTrials.gov number, NCT04646590.).

A phase III, observer-blind, randomized, placebo-controlled study of the efficacy, safety, and immunogenicity of SARS-CoV-2 inactivated vaccine in healthy adults aged 18-59 years: An interim analysis in Indonesia

Background

The WHO declared COVID-19 a pandemic on March 11th, 2020. This serious outbreak and the precipitously increasing numbers of deaths worldwide necessitated the urgent need to develop an effective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. The development of COVID-19 vaccines has moved quickly. In this study, we assessed the efficacy, safety, and immunogenicity of an inactivated (SARS-CoV-2) vaccine.

Methods

We conducted a randomized, double-blind, placebo-controlled trial to evaluate the efficacy, immunogenicity, and safety of an inactivated SARS-CoV-2 vaccine and its lot-to-lot consistency. A total of 1620 healthy adults aged 18–59 years were randomly assigned to receive 2 injections of the trial vaccine or placebo on a day 0 and 14 schedule. This article was based on an interim report completed within 3 months following the last dose of study vaccine. The interim analysis includes safety and immunogenicity data for 540 participants in the immunogenicity subset and an efficacy analysis of the 1620 subjects. For the safety evaluation, solicited and unsolicited adverse events were collected after the first and second vaccination within 14 and 28 days, respectively. Blood samples were collected for an antibody assay before and 14 days following the second dose.

Results

Most of the adverse reactions were in the solicited category and were mild in severity. Pain at the injection site was the most frequently reported symptom. Antibody IgG titer determined by enzyme-linked immunosorbent assay was 97.48% for the seroconversion rate. Using a neutralization assay, the seroconversion rate was 87.15%. The efficacy in preventing symptomatic confirmed cases of COVID-19 occurring at least 14 days after the second dose of vaccine using an incidence rate was 65.30%.

Conclusions

From the 3-month interim analysis, the vaccine exhibited a 65.30% efficacy at preventing COVID-19 illness with favorable safety and immunogenicity profiles.

Stunting Prevention with Education and Nutrition in Pregnant Women: A Review of Literature

Background : Stunting is a major nutritional problem in children under five years old which has an impact on slowing growth by reducing the number and development of body cells, including brain cells and other organs. Pregnant women are one of the groups who are vulnerable to nutritional problems, related to the process of growth and development of the fetus in the womb. The role of education and nutrition is important during pregnancy because it has implications for the health of mothers and children in later life. The aimed of this review was to identify research about effect stunting prevention and education and nutrition to pregnant women. Methods : A database review undertaken using Pubmed, CHINAHL and Google Scholar from 2011-2021 to collect focused study on education and nutrition research on pregnant women to prevent stunting. A total of 1788 articles were identified. These were scaned and 18 articles were retrieved with 13 articles shortlisted for to in depth review. Results : Education with using audiovisual media, moringa leaf ice cream and early nutrition has proved effective in increasing pregnant women knowledge regarding stunting prevention. Providing nutritional supplements/nutrients for moringa oliefera, folic acid and iron, specific nutrition, LNS, PM2A PROCOMIDA, nutrition before pregnancy, supplements antenatal iron and folic acid, prenatal micronutrients have an effect on reducing children stunting. Conclusion: Audio visual education can convery health knowledge because easily to facilitate the reception of health message for pregnant women. Continuous education and monitoring of the of pregnant women diet every month during pregnancy classes at the posyandu are needed to prevent stunting in children.  

Association of Mental Health Problems and Socio-Demographic Factors Among Adolescents in Indonesia

Mental health in adolescents represent a considerable public health issue in developing countries. These problems are considered a source of problem for adolescents’ quality of life. The study objective was to determine the association between mental health problems and sociodemographic variables among adolescents. A cross-sectional study was conducted from October to December 2016 using a school-based survey in 4 districts and 3 cities in West Java Province, Indonesia. Stratified multistage random sampling was used to select junior and senior high school students and self-administered questionnaires were used to collect study data which included: personal data, socioeconomic status scale, and self-reported version of Strengths and Difficulties Questionnaire (SDQ) which divided into 5 subscales. About 3452 adolescents of 32 schools were included in this study, 59% female, 56% junior high school, 56% district residence, most parents’ education were senior high school. The prevalence of mental health problems based on SDQ subscale as total difficulties, conduct problem, emotional symptoms, peer problems, hyperactivity-inattention, were abnormal 31.6, 38.9, 30, 29.3, 15.6, respectively. Mental health problems were more prevalent amongst adolescents in junior high school and residence in district area, with RR and 95% CI were 1.14 (1.04-1.26), and 1.18 (1.08-1.30). As conclusions mental health problems in adolescents were associated with education level and residence area

Hubungan Stunting dengan Gangguan Kognitif pada Usia Remaja Awal di Kecamatan Jatinangor

Latar belakang. Stunting merupakan salah satu permasalahan kesehatan nasional maupun dunia. Diperkirakan stunting berhubungan dengan penurunan dalam tingkat kognitif, kapasitas belajar, motorik, dan fungsi bahasa.Tujuan. Penelitian ini bertujuan menganalisis hubungan stunting dengan gangguan kognitif pada usia remaja awal di Kecamatan Jatinangor.Metode. Jenis penelitian ini merupakan studi penelitian analitik komparatif dengan metode potong lintang. Kriteria inklusi penelitian ini adalah murid sekolah dasar kelas 5-6 di Kecamatan Jatinangor. Kriteria eksklusi pada penelitian ini adalah pengambilan data yang tidak lengkap dan memiliki penyakit kronik. Pengambilan data berupa karakteristik subjek, antropometri dilakukan sesuai dengan prosedur WHO, dan fungsi kognitif menggunakan Mini Mental State Examination (MMSE) Folstein. Analisis data menggunakan Fisher’s Exact Test.Hasil. Penelitian ini terdiri dari 58 subjek yang terdiri dari 57% perempuan dan 43% laki-laki dengan rentang usia 10-12 tahun. Terdapat 26% subjek yang termasuk kategori stunting dan 26% yang termasuk kategori Mini Mental State Examination tidak normal. Berdasarkan hasil analisis bivariat menggunakan uji statistik Fisher’s Exact Test didapatkan hubungan antara stunting dengan gangguan kognitif dengan nilai p=0,013.Kesimpulan. Dari hasil penelitian ini ditemukan terdapat hubungan bermakna antara stunting dengan gangguan kognitif pada usia remaja awal di Kecamatan Jatinangor.

Neutrophil-lymphocyte count ratio correlation to procalcitonin and PELOD-2 score in pediatric sepsis

Background Sepsis is a leading cause of children’s mortality worldwide. Procalcitonin (PCT) is a widely used infection marker, but has limitations in terms of cost and availability. The neutrophil-lymphocyte count ratio (NLCR) is easy to perform, low-cost, and widely used as a diagnostic and prognostic marker of various inflammatory processes. Objective To investigate possible correlations of NLCR to PCT and Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score among pediatric sepsis patients. Method A retrospective study was conducted by reviewing the Pediatric Sepsis Registry at Dr. Hasan Sadikin General Hospital, Bandung, West Java, from January 2019–June 2020. We recorded patients’ characteristics, PELOD-2 score, NLCR, and PCT results. Correlation analysis was conducted using Spearman’s Rank test with significance value of P<0.05. Results Ninety patients were included in the study. Most patients were male (56.7%), under 2 years of age (57.8%), and had lower respiratory tract infection (67.8%) as the most common source of infection. The NLCR value had significant, positive correlations to PCT (r=0.642; P<0.001) and PELOD-2 score (r=0.233; P=0.027) in pediatric sepsis patients. Conclusion The NLCR is directly proportional to PCT in pediatric sepsis patients. This result suggents that NLCR may have a potential role as an alternative marker for sepsis in emergency setting.

Height Prediction Using the Knee Height Measurement Among Indonesian Children

BACKGROUND

Height is essential for assessing growth and nutrition in children. Assessing height with appropriate measurement is important, although in certain physically disabled and hospitalized children direct height measurement is almost not possible. In these situations, segmental measurements can be used as proxy height. Knee height (KH) has been determined as the most reliable surrogate.

OBJECTIVE

This study aimed to establish a height-predicted equation using KH for use in both community and clinical practices.

METHODS

This was a cross-sectional study design that collected data from 1114 healthy children (596 boys and 518 girls) aged 7 to 12 years to develop the equations for predicting height from KH. A multiple linear regression analysis was used to develop the equations.

RESULTS

Two equations were established to predict height using KH: (1) for boys H = 29.895 + (0.081 × age [months] + (2.267 × KH)) and (2) for girls H = 26.297 + (0.110 × age [months] + (2.278 × KH)). The very high correlation between KH and actual height indicates a very strong agreement.

CONCLUSIONS

Knee height can be used for prediction equations for height with a very good predictive power. The age variable using the month unit generates a more accurate equation.

Temporal association between serious bleeding and immunization: vitamin K deficiency as main causative factor

BACKGROUND

Bleeding as an adverse event following immunization (AEFI) that is rarely reported in children, although it can be a parental concern. Bleeding episodes ranging in severity from mild to severe and defined as any external and/or internal bleeding can be caused by acquired or hereditary disorders. This study analyzes whether bleeding episodes in children that were recorded as AEFIs are causally associated with immunization and elaborates their etiology.

METHODS

A cross-sectional study of 388 AEFI cases in children from West Java Provincial Committee in Indonesia confirmed by case findings from 2000 until 2017.

RESULTS

Of the total number of cases studied, 55 (14%) involved children aged 5 days to 12 years who presented with bleeding and were referred to a provincial hospital. Analysis revealed that 32 cases were most likely caused by acquired prothrombin complex deficiency (APCD) and 30 of these APCD cases were strongly suspected to be manifestations of vitamin K deficiency bleeding (VKDB). All VKDB subjects were aged 5 days to 3 months without a history of administration of prophylactic vitamin K. When a World Health Organization classification was used, most bleeding cases in this study became coincidental events with a temporal association with immunization. A causality assessment suggested that these cases were causally unrelated.

CONCLUSION

Most cases of bleeding reported as an AEFI were found to be VKDB, which is considered a coincidental event following immunization with a temporal association, and an unrelated category based on the results of a causality assessment. Vitamin K should be administered to all newborns as a prophylactic and AEFI surveillance should be improved based on the low numbers of AEFI reported in Indonesia.

Immunogenicity and safety profile of a primary dose of bivalent oral polio vaccine given simultaneously with DTwP-Hb-Hib and inactivated poliovirus vaccine at the 4th visit in Indonesian infants

In this study, we aimed to evaluate the immunological protectivity of infants following four doses of bivalent oral polio vaccine (bOPV; Bio Farma), which were given simultaneously with DTwP-Hb-Hib (Pentabio®), along with one dose of inactivated poliovirus vaccine (IPV) at the fourth visit. A total of 143 newborn infants who fulfilled the inclusion criteria were enrolled and completed the study. Subjects received the first dose of bOPV at birth. On days 60, 90 and 120, bOPV was given simultaneously with Pentabio®. On day 120, one dose of IPV was also administered. Serum samples for serology analysis were collected before the first dose of bOPV (at day 0), before the second dose of bOPV (at day 60) and 30 days after the last dose of bOPV. In addition, the intensity, duration and relationship of each adverse event to the trial vaccines were assessed. Seroprotection rates after the fourth dose of bOPV were 100%, 91.6% and 99.3% for poliovirus P1, P2 and P3, respectively. Seroconversion rates after the fourth dose of bOPV were 100.0%, 93.3% and 100% for poliovirus P1, P2 and P3, respectively. There were no severe adverse events, and systemic reactions were generally mild during the 1-28 day post-vaccination period. Collectively, our findings indicate that bOPV given simultaneously with Pentabio® and one dose of IPV at the 4th visit was immunogenic and well tolerated.

Hubungan Awitan Pengobatan Hipotiroid Kongenital dengan Gangguan Perkembangan Anak di Rumah Sakit Umum Pusat Dr. Hasan Sadikin

Latar belakang. Hipotiroid kongenital (HK) adalah kondisi kekurangan hormon tiroid, tiroksin, dan tri-iodotironina sejak lahir yang dapat menyebabkan gangguan organogenesis sistem saraf pusat serta metabolisme tubuh. Penderita HK yang tidak diterapi dapat berlanjut menjadi individu dengan gangguan perkembangan. Data di Indonesia dari Ikatan Dokter Anak Indonesia (IDAI) sejak tahun 2000-2013, angka kejadian HK pada bayi baru lahir sebanyak 1:2736. Tujuan. Mengetahui hubungan awitan pengobatan dengan gangguan perkembangan pada anak dengan HK.Metode. Penelitian observasional analitik dengan pendekatan potong lintang yang dilakukan periode bulan Agustus–November 2018. Subjek HK datang kontrol ke klinik rawat jalan endokrin dan tumbuh kembang RS. Hasan Sadikin, berusia <36 bulan dan mendapat terapi levotiroksin, dilakukan penilaian perkembangan dengan pemeriksaan Denver dan CAT/ CLAMS (cognitive adaptive test/ clinical linguistic auditory milestone scale). Analisis data menggunakan uji chi-kuadrat dan Mann Whitney (p<0,05). Hasil. Terdapat 92 kasus HK, 12 dieksklusi, subjek terdiri dari 38 laki-laki dan 42 perempuan dengan rerata usia diagnosis 3,0 bulan (0,5–22,0 bulan). Didapatkan adanya hubungan usia saat diagnosis dan awitan pengobatan dengan gangguan perkembangan (p<0,001). Usia saat diagnosis dan awitan pengobatan >3 bulan lebih banyak mengalami gangguan perkembangannya.Kesimpulan. Pasien HK yang terlambat didiagnosis dan diberikan terapi akan mengalami gangguan perkembangan yang lebih banyak. 

Risk factors associated with nasopharyngeal carriage and density of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in young children living in Indonesia

Background

Potentially pathogenic bacteria Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus are commonly carried in the nasopharynx of young children. Host and environmental factors have been linked with pathogen carriage, and in many studies rural children have higher carriage rates than their urban counterparts. There are few published data on what factors contribute to increased pathogen density. The objectives of this study were to identify risk factors for nasopharyngeal carriage and density of S. pneumoniae, H. influenzae, M. catarrhalis, and S. aureus in young children in Indonesia.

Methods

Risk factor analysis was done using data on bacterial carriage and participant characteristics from a cross-sectional study that enrolled 302 children aged 12–24 months living in urban or semi-rural areas of Indonesia. Associations between host factors and odds of pathogen carriage were explored using logistic regression. Characteristics identified to be independent predictors of carriage by univariable analysis, as well as those that differed between urban and semi-rural participants, were included in multivariable models. Risk factors for increased pathogen density were identified using linear regression analysis.

Results

No differences in carriage prevalence between urban and semi-rural children were observed. Multiple children under the age of 5 years in the household (< 5y) and upper respiratory tract infection (URTI) symptoms were associated with S. pneumoniae carriage, with adjusted odds ratios (aOR) of 2.17 (95% CI 1.13, 4.12) and 2.28 (95% CI 1.15, 4.50), respectively. There was some evidence that URTI symptoms (aOR 1.94 [95% CI 1.00, 3.75]) were associated with carriage of M. catarrhalis. Children with URTI symptoms (p = 0.002), and low parental income (p = 0.011) had higher S. pneumoniae density, whereas older age was associated with lower S. pneumoniae density (p = 0.009). URTI symptoms were also associated with higher M. catarrahlis density (p = 0.035). Low maternal education (p = 0.039) and multiple children < 5y (p = 0.021) were positively associated with H. influenzae density, and semi-rural residence was associated with higher S. aureus density (p < 0.001).

Conclusions

This study provides a detailed assessment of risk factors associated with carriage of clinically-relevant bacteria in Indonesian children, and new data on host factors associated with pathogen density.

Electronic supplementary material

The online version of this article (10.1186/s41479-018-0058-1) contains supplementary material, which is available to authorized users.

Serum IGF-1 and short stature in adolescents with beta-thalassemia major

Background The  prevalence  of  short  stature  in  thalassemia  patients ranges from 39.3 to 65%.  The  cause  of short stature is complex  and  still up for debate.  In  Indonesia, data on the  prevalence  and risk  factors  of  short  stature  in  adolescents  with  thalassemia  have been limited. Objective To assess for the prevalence and risk factors of short stature in adolescents with beta-thalassemia major. Methods This cross-sectional study was done from February to March 2017 at the Thalassemia Clinic at Dr. Hasan Sadikin General Hospital, Bandung. The baseline characteristics data of 80 adolescents with thalassemia aged 10-14 years were recorded. Short stature was assessed by height-for-age, (Z-score <-2SD) based on the 2007 WHO Reference Growth Chart. Mid-upper arm circumference was scored according to age and sex and serum IGF-1 was measured by ELISA method. Data analyses used were Chi-square, Fisher’s, and Mann-Whitney tests. Logistic regression model was used to further analyze for risk factors of short stature. Results Subjects were 40 males and 40 females, 81.2% of whom had short stature. The mean serum IGF-1 level was 32.2 (SD 26.38) ng/mL. The IGF-1 cut-off point by ROC curve was £38.51 ng/mL, with sensitivity of 64.4% and specificity of 86.7%. The risk factors of short stature were IGF-1 level £38.51 ng/mL (PR 40.66; 95%CI 4.37 to 377.58; P<0.001) and low family income (PR 19.76; 95%CI: 1.152 to 256.08; P=0.022). Conclusion IGF-1 level may be useful as a predictor of short stature in adolescent beta-thalassemia major patients.

DTwP-HB-Hib: antibody persistence after a primary series, immune response and safety after a booster dose in children 18-24 months old

Background

The new combination of DTwP-HB-Hib vaccines has been developed in Indonesia following World Health Organization (WHO) recommendation and integrated into national immunization program. The aims of the study were to measure 1) antibody persistence 12–18 months after a primary series, 2) immune response and safety after a booster dose of DTwP-HB-Hib.

Methods

This was a multi-center, open-labeled, prospective, interventional study. Subjects who had received complete primary dose of DTwP-HB-Hib vaccine from the previous phase III trial were recruited in this trial. Subjects were given one dose of DTwP-HB-Hib (Pentabio®) booster at age 18–24 months old. Diphtheria, tetanus, pertussis, hepatitis B, Hemophilus influenza type B antibodies were measured before and after booster to determine antibody persistence and immune response. Vaccine adverse events were assessed immediately and monitored until 28 days after the booster recorded with parent’s diary cards.

Results

There were 396 subjects who completed the study. Increased proportion of seroprotected subjects from pre-booster to post-booster were noted in all vaccine antigens: 74.5 to 99.7% for diphtheria; 100 to 100% for tetanus; 40.4 to 95.5% for pertussis; 90.2 to 99.5% for hepatitis B; and 97.7 to 100% for Hib. Common systemic adverse events (AEs) were irritability (23.7–25%) and fever (39.9–45.2%). Local AEs such as redness, swelling, and induration were significantly less common in the thigh group (7.7, 11.3, and 7.1%) than in the deltoid group (28.9, 30.7, and 25%) (P < 0.001). Most AEs were mild and resolved spontaneously within three-day follow-up period.

Conclusions

Booster of DTwP-HB-Hib vaccine at age 18–24 months is required to achieve and maintain optimal protective antibody. The vaccine is safe and immunogenic to be used for booster vaccination.

Trial registration

NCT02095314 (retrospectively registered, March 24, 2014).

Carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in Indonesian children: A cross-sectional study

Streptococcus pneumoniae is an important cause of infection and commonly colonizes the nasopharynx of young children, along with other potentially pathogenic bacteria. The objectives of this study were to estimate the carriage prevalence of S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in young children in Indonesia, and to examine interactions between these bacterial species. 302 healthy children aged 12–24 months were enrolled in community health centers in the Bandung, Central Lombok, and Padang regions. Nasopharyngeal swabs were collected and stored according to World Health Organization recommendations, and bacterial species detected by qPCR. Pneumococcal serotyping was conducted by microarray and latex agglutination/Quellung. Overall carriage prevalence was 49.5% for S. pneumoniae, 27.5% for H. influenzae, 42.7% for M. catarrhalis, and 7.3% for S. aureus. Prevalence of M. catarrhalis and S. pneumoniae, as well as pneumococcal serotype distribution, varied by region. Positive associations were observed for S. pneumoniae and M. catarrhalis (OR 3.07 [95%CI 1.91–4.94]), and H. influenzae and M. catarrhalis (OR 2.34 [95%CI 1.40–3.91]), and a negative association was found between M. catarrhalis and S. aureus (OR 0.06 [95%CI 0.01–0.43]). Densities of S. pneumoniae, H. influenzae, and M. catarrhalis were positively correlated when two of these species were present. Prior to pneumococcal vaccine introduction, pneumococcal carriage prevalence and serotype distribution varies among children living in different regions of Indonesia. Positive associations in both carriage and density identified among S. pneumoniae, H. influenzae, and M. catarrhalis suggest a synergistic relationship among these species with potential clinical implications.

Agreement between the Denver II and Parents’ Evaluation of Developmental Status tests, with and without the assistance of a table of categorical responses

Background Among standardized developmental screening tools, the Denver II is commonly used by Indonesian pediatricians, but the Parent’s Evaluation of Developmental Status (PEDS) test has gained in popularity. The Denver II test is filled by physicians, while the PEDS test is meant to be filled by parents. From a practical standpoint, however, parents often require assistance from doctors when filling out the PEDS forms. Hence, the advantage of the PEDS test over the Denver II test is not fully realized.Objective To compare the agreement between Denver II and PEDS tests, with and without parental use of a table of categorical responses taken from the PEDS manual.Methods We conducted a cross-sectional study in children aged 6 months to 5 years in Bandung from November 2015 to March 2016. Subjects were divided into two groups using block randomization. One group of subjects’ parents filled the PEDS questionnaires with the assistance of a table of categorical responses taken from the PEDS manual, while the other group of subjects’ parents filled PEDS forms without this table. All subjects underwent Denver II screening by pediatricans. The agreement between the PEDS and Denver II results were assessed by Kappa score.Results Of 254 children, 239 were analyzed. Kappa scores between the Denver II and PEDS tests were 0.05 (95%CI: -0.10 to 0.20) without the table of categorical responses, and -0.06 (-0.23 to 0.10) with the table of categorical responses.Conclusion Agreement between the Denver II and PEDS tests is poor. The table of categorical responses does not increase the agreement between Denver II and PEDS.

Pola Keterlambatan Perkembangan Balita di daerah Pedesaan dan Perkotaan Bandung, serta Faktor-faktor yang Mempengaruhinya

Periode lima tahun pertama kehidupan akan menentukan kualitas hidup anak dikemudian hari. Tujuan penelitian ini ialah untuk mengetahui gambaran perkembanganbalita di daerah pedesaan dan perkotaan serta faktor-faktor yang mempengaruhinya.Tempat penelitian dipilih secara purposive di 4 wilayah puskesmas (2 perkotaan dan 2pedesaan), Kabupaten Bandung. Penelitian dilakukan secara cross sectional dengan subjekpenelitian anak balita yang sehat dan kooperatif pada saat pemeriksaan, serta orang tuamenyetujui ikut dalam penelitian. Subjek dibagi atas 2 kelompok umur perkembangan(< 2 th, dan 2-5 th), dipilih secara stratified random sampling dengan alokasi sampelditentukan secara proporsional. Tes perkembangan dilakukan oleh 3 dokter denganmenggunakan metode Munchener yang telah dimodifikasi dengan klasifikasi hasil tesnormal dan ada keterlambatan perkembangan. Lima aspek perkembangan yang dinilaiyaitu motorik kasar, motorik halus, persepsi, vokalisasi/pengertian bahasa, dan sosial.Selama periode penelitian sebanyak 498 balita memenuhi kriteria inklusi, terdiri dari227 (46%) laki-laki dan 271 (54%) perempuan. Balita yang mengalami keterlambatanperkembangan di daerah pedesaan sebesar 30% dan di perkotaan 19%, perbedaan inisecara statistik bermakna (p=0,012). Di daerah pedesaan pola keterlambatanperkembangan secara urutan dari yang paling banyak adalah aspek vokalisasi/pengertianbicara (66%), persepsi (38%), motorik halus (35%), motorik kasar (35%) dan sosial(1%). Sedangkan di daerah perkotaan adalah vokalisasi/ pengertian bahasa (58%),motorik halus (38%), persepsi (36%), motorik kasar (26%) dan sosial (12%). Faktorfaktoryang berhubungan dengan status perkembangan adalah umur anak, pendidikanibu, penghasilan keluarga dan tempat tinggal. Perlu dilakukan upaya untukmenanggulangi keterlambatan perkembangan balita di daerah pedesaan maupun diperkotaan terutama pada kelompok umur di bawah 2 tahun.

Imunogenitas dan Keamanan Vaksin DPT Setelah Imunisasi Dasar

Imunisasi difteria, pertusis dan tetanus (DPT) telah lama masuk ke dalam programimunisasi nasional di Indonesia dan telah terbukti menurunkan angka kejadian maupunkematian yang disebabkan penyakit difteria, pertusis dan tetanus. Tujuan penelitian iniuntuk melakukan evaluasi status kekebalan dan faktor keamanan terhadap penyakitdifteria dan tetanus pada bayi yang mendapat imunisasi dasar DPT. Seratus enam puluhsubjek bayi sehat yang dipilih secara random, dilakukan imunisasi secara intramuskulardengan dosis 0,5 ml sebanyak 3 kali pada umur 2, 3 dan 4 bulan, menggunakan vaksinDPT buatan PT. Bio-Farma Bandung. Penentuan titer antibodi difteria dan tetanusdilakukan sebelum dilakukan imunisasi dan 1 bulan setelah imunisasi ke-1, 2 dan 3,menggunakan metode ELISA. Apabila hasilnya < 0,01 IU/ml disebut kelompok rentandan bila > 0,1 IU/ml disebut mempunyai kekebalan lengkap. Kejadian reaksi lokal(nyeri, kemerahan, bengkak, penebalan) dan sistemik (demam, iritabilitas) pasca imunisasidicatat dalam buku catatan harian ibu. Hasil penelitian menunjukkan sebelum dilakukanimunisasi 57% subjek sudah tidak mempunyai perlindungan terhadap difteri dan 6%sudah tidak mempunyai perlindungan terhadap tetanus. Terhadap difteria, rata-ratageometrik titer (GMT) sebelum dan setelah mendapat imunisasi ke-1, 2 dan 3,memberikan hasil berturut-turut 0,008; 0,005; 0,038; dan 0,217 IU/ml; sedang jumlahsubjek yang mempunyai titer > 0,01 IU/ml berturut-turut adalah 44, 28, 44 dan 80%.Terhadap tetanus, rata-rata geometrik titer (GMT) sebelum dan setelah mendapatimunisasi ke-1, 2 dan 3, memberikan hasil berturut-turut: 0,420; 0,273; 0,213; dan0,758 IU/ml; jumlah subjek yang mempunyai titer > 0,01 IU/ml berturtut-turut adalah94; 91; 100 dan 100%. Selama periode penelitian tidak ditemukan adanya reaksi vaksinberat. Reaksi lokal (nyeri, kemerahan, bengkak dan penebalan) dan reaksi sistemik(iritabilitas dan panas) sebagian besar dengan derajat ringan yang selanjutnya menghilangtanpa gejala sisa. Walaupun imunisasi DPT memberikan hasil kekebalan yang tinggidan aman diberikan, namun pada kelompok yang masih rentan perlu mendapat perhatian.

Kesetaraan Hasil Skrining Risiko Penyimpangan Perkembangan Menurut Cara Kuesioner Praskrining Perkembangan (KPSP) dan Denver II pada Anak Usia 12-14 Bulan dengan Berat Lahir Rendah

Latar belakang. Penilaian perkembangan pada anak penting dilakukan, terutama sampai usia 1 tahununtuk deteksi dini, agar bila ditemukan kecurigaan penyimpangan dapat dilakukan stimulasi dan intervensidini sebelum terjadi kelainan. Depkes RI mengeluarkan revisi buku deteksi dini tumbuh kembang untukidentifikasi dini perkembangan di tingkat kecamatan berupa kuesioner praskrining perkembangan (KPSP)yang dapat dilakukan oleh tenaga kesehatan ataupun nonkesehatan terlatih.Tujuan. Penelitian ini membandingkan kesetaraan hasil antara KPSP dan Denver II dalam mendeteksikecurigaan penyimpangan perkembangan.Metode. Penelitian dilakukan dengan metode evaluatif komparatif dan rancangan cross sectional, pada anakusia 12–14 bulan dengan berat lahir rendah di puskesmas Garuda Bandung pada bulan Februari sampaiMaret 2008. Dengan menggunakan metode KPSP skrining dilakukan oleh kader kesehatan terlatih kemudiandibandingkan dengan Denver II oleh dokter, dan dinilai kesetaraan dari dua hasil pemeriksaan tersebutmenggunakan perhitungan coefficient of agreement Kappa.Hasil. Delapan puluh lima subjek penelitian diperiksa status perkembangan oleh 10 orang kader kesehatan(dipilih random dan lolos uji inter dan intra-observer) kemudian oleh 2 dokter. Dari KPSP didapatkansebanyak 82,4% normal dan 17,6% curiga terganggu, menurut Denver II didapatkan sebanyak 77,6%normal dan 22,4% curiga terganggu. Nilai sensitifitas dan spesifisitas untuk KPSP dalam penelitian inimasing-masing adalah 95% dan 63%, dengan nilai Kappa 0,552 dan p<0,0001.Kesimpulan. Pemeriksaan KPSP setara moderate dengan Denver II dan dapat menjadi alat deteksi dini ditingkat Posyandu. Perlu dilakukan penelitian lebih lanjut pada usia dan tempat yang lebih bervariasi sertadengan jumlah kader yang lebih besar.

Pengaruh Pengetahuan Terhadap Sikap Ibu Mengenai Imunisasi Ulangan Difteria-Tetanus

Latar belakang. Peran serta dan penerimaan ibu mengenai imunisasi ulangan difteria-tetanus diperlukan untuk menunjang upaya pencegahan penyakit tersebut.Tujuan. Mengetahui pengaruh pengetahuan terhadap sikap ibu murid SD kelas I mengenai imunisasi ulangan difteria-tetanus.Metode. Subjek penelitian adalah ibu murid SD kelas I di Kotamadya Bandung, menggunakan penelitian kuantitatif dan kualitatif. Rancangan penelitian kuantitatif berupa survei cross-sectional dimulai bulan November sampai Desember 2007. Sampel diambil secara cluster random sampling. Analisis statistik dilakukan untuk melihat pengaruh pengetahuan ibu murid SD kelas 1 terhadap sikap imunisasi ulangan difteria-tetanus dengan menggunakan analisis jalur. Pengetahuan adalah informasi yang dimiliki oleh ibu mengenai penyebab, gejala, pengobatan, penularan, dan pencegahan tentang penyakit difteria-tetanus. Sikap adalah respons ibu terhadap penyakit difteria-tetanus mengenai penyebab, gejala, pengobatan, penularan, dan pencegahannya. Rancangan penelitian kualitatif berupa focus group discussion dengan analisis deskriptif, untuk menilai pengetahuan dan sikap ibu mengenai imunisasi ulangan difteria-tetanus yang tidak tergali dengan penelitian kuantitatif. Sampel diambil sebanyak 5-10 orang dari ibu yang telah ikut dalam penelitian kuantitatif.Hasil. Didapatkan 226 ibu dengan rata-rata usia 35 tahun. Hasil analisis jalur, didapatkan pengetahuan secara signifikan dipengaruhi oleh pendidikan ibu dan jumlah anak. Sikap signifikan dipengaruhi oleh pendidikan ibu dan pengetahuan (95%CI: -t<+1,96>t). Hasil analisis jalur didapatkan pengaruh total pendidikan ibu dan pengetahuan terhadap sikap adalah cukup. Pengaruh total pendidikan ibu dan jumlah anak terhadap pengetahuan adalah kurang. Analisis focus group discussion tergambarkan bahwa ibu yang mempunyai pengetahuan tinggi lebih bersikap mandiri terhadap pelaksanaan imunisasi ulangan difteria-tetanus.Kesimpulan. Pengetahuan ibu berpengaruh positif terhadap sikap ibu mengenai imunisasi ulangan difteria-tetanus

Hubungan antara Kortisol Saliva dan Masalah Mental Emosional pada Anak Usia 3–5 Tahun

Latar belakang. Masalah mental emosional pada anak usia prasekolah harus dideteksi dan diantisipasi sedini mungkin. Masalah mental emosional memengaruhi mekanisme aksis hipotalamus-pituitari-adrenal, menghasilkan produk akhir kortisol.Tujuan. Menentukan hubungan kadar kortisol saliva dan masalah mental emosional.Metode. Penelitian potong lintang ini dilakukan pada bulan Desember 2015 - Januari 2016 terhadap 82 anak usia 3–5 tahun yang dititipkan di tempat penitipan anak di Kota Bandung. Orangtua diminta untuk mengisi kuesioner strength and difficulties questionnaire (SDQ) untuk skrining masalah mental emosional subjek. Kortisol saliva subjek penelitian dianalisis menggunakan salivary cortisol kit dari Salimetrics®. Analisis data untuk menentukan hubungan antara kortisol saliva dan masalah mental emosional dilakukanmenggunakan analisis regresi logistik.Hasil. Terdapat hubungan bermakna antara kadar kortisol saliva dan masalah mental emosional (p=0,027; OR=3,431). Terdapat hubungan bermakna antara kadar kortisol abnormal dengan variabel conduct (p=0,001) dan emosi (p=0,017).Kesimpulan. Kadar kortisol saliva berhubungan dengan masalah mental emosional pada anak usia 3-5 tahun. Kadar kortisol berhubungan dengan variabel conduct dan emosi.

Pernikahan Usia Dini dan Permasalahannya

Kasus pernikahan usia dini banyak terjadi di berbagai penjuru dunia dengan berbagai latarbelakang. Telah menjadi perhatian komunitas internasional mengingat risiko yang timbul akibat pernikahan yang dipaksakan, hubungan seksual pada usia dini, kehamilan pada usia muda, dan infeksi penyakit menular seksual. Kemiskinan bukanlah satu-satunya faktor penting yang berperan dalam pernikahan usia dini. Hal lain yang perlu diperhatikan yaitu risiko komplikasi yang terjadi di saat kehamilan dan saat persalinan pada usia muda, sehingga berperan meningkatkan angka kematian ibu dan bayi. Selain itu, pernikahan di usia dini juga dapat menyebabkan gangguan perkembangan kepribadian dan menempatkan anak yang dilahirkan berisiko terhadap kejadian kekerasan dan keterlantaran. Masalah pernikahan usia dini ini merupakan kegagalan dalam perlindungan hak anak. Dengan demikian diharapkan semua pihak termasuk dokter anak, akan meningkatkan kepedulian dalam menghentikan praktek pernikahan usia dini

Booster Vaksinasi Hepatitis B Terhadap Anak yang Non Responder

Latar belakang. Berbagai penelitian terhadap respons imun setelah imunisasi hepatitis B dengan menggunakan vaksin monovalen dari plasma maupun yang berasal dari teknik DNA rekombinan menunjukkan antara 5%-15% tidak memberikan respons (non-responder) atau kurang memberikan respons (hypo-responder) Center of Disease Control merekomendasikan terhadap anak yang tidak mempunyai tingkat proteksi antibodi (anti-Hbs) setelah mendapat imunisasi dasar, perlu diberikan 3 kali suntikan rangkaian ke-2. Setelah rangkaian ke-2 imunisasi Hepatitis B tersebut maka 30%-50% diantaranya akan mempunyai kadar yang protektif.Tujuan. Penelitian bertujuan mengeksplorasi lebih mendalam mengenai manfaat pemberian vaksinasi rangkaian kedua pada anak hipo dan non responder sebagai salah satu data yang dapat dipergunakan strategi menghadapi masalah hepatitis B di Indonesia.Metode. Penelitian dilakukan terhadap 144 anak yang telah melaksanakan imunisasi dasar hepatitis B secara lengkap (3 kali) yang merupakan bagian uji klinis vaksin pentavalen (DPT/hepatitis B/Hib). Enam bulan setelah mengetahui kadar anti-Hbs hasil uji klinik pentavalen dilakukan pemberian imunisasi rangkaian ke-2 pada anak-anak hipo/non-responder.Hasil. Sebelas anak mempunyai kadar anti-Hbs <10 mIU/ml (non/hypo responder terhadap vaksinasi Hepatitis B). Terhadap kesebelas anak tersebut dilakukan pemeriksaan kadar anti-Hbs setelah 6 bulan pemberian imunisasi hepatitis B-3, didapatkan 3 anak (27,2%) mengalami peningkatan sehingga mempunyai kadar anti-Hbs >10 mIU/ml, 8 orang anak (72,2%) mempunyai kadar <10 mIU/ml. Pada 8 anak tersebut dilakukan imunisasi rangkaian ke-2 hepatitis B sebanyak 3 kali. Setelah mendapat rangkaian ke-2 imunisasi Hepatitis B, kedelapan subjek (100%) mencapai kadar protektif (>10 mIU/ml).Kesimpulan. Pemberian 3 dosis standar hepatitis B dapat digunakan untuk memberikan kekebalan pada anak sehat dengan hypo/non responder.

Wabah Difteri di Kecamatan Cikalong Wetan, Kabupaten Cianjur, Jawa Barat, Indonesia

Latar belakang.Sejak tahun 1986 tidak ditemukan lagi kasus difteri yang dirawat di Rumah Sakit Hasan Sadikin Bandung Jawa Barat. Namun, wabah difteri selalu terjadi di beberapa kabupaten di Jawa Barat seperti yang dilaporkan sejak tahun 1993 sampai tahun 2010. Kementerian Kesehatan juga melaporkan peningkatan kasus difteri di beberapa provinsi di Indonesia tahun 2010. Suatu penelitian saat wabah di Kecamatan Cikalong Wetan Kabupaten Cianjur tahun 2001 sebagai gambaran kejadian wabah di salah satu kabupaten di Jawa Barat.Tujuan. Menggambarkan kejadian wabah difteri, mengetahui tingkat kekebalan dengan mengukur kadar antibodi difteri dan untuk menemukan kemungkinan adanya kuman C. difteriaeberedar di masyarakat di daerah wabah.Metode. Data kejadian penyakit dan kematian diperoleh dari Puskesmas Cikalong Wetan RS Cianjur dan Dinas Kesehatan Kabupaten Cianjur. Data kadar antibodi diperoleh dengan mengukur kadar anti bodi terhadap difteri pada 698 subyek, yang dibagi menurut kelompok usia. Titer antibodi diukur dengan menggunakan teknik ELISA ganda.Hasil.Selama wabah terdapat 25 kasus yang dilaporkan dari Puskesmas Cikalong Wetan dengan angka kematian/crude fatality rate(CFR) 28%. Diduga kuat bahwa kasus pertama berasal dari kecamatan yang berdekatan dengan Kecamatan Cikalong Wetan. Beberapa bulan sebelumnya dijumpai kasus rawat inap 21 pasien, 55% di antaranya balita, dengan angka kematian 35% terutama disebabkan oleh miokarditis. Walaupun cakupan imunisasi difteri pertusis tetanus (DPT) tinggi pada anak kurang dari 1 tahun di Kecamatan Cikalong Wetan, hanya 19,3% anak usia 1 tahun memiliki tingkat kekebalan protektif yang memadai. Titer antibodi terus berkurang sesuai dengan meningkatnya usia anak, bahkan tidak ada subjek yang memiliki kadar protektif yang memadai pada kelompok usia 5 – 6 tahun. Enam dari 324 biakan apus tenggorokan pada masyarakat tumbuh strain toxigenic C. difteriae gravis.Kesimpulan.Wabah yang terjadi di Kecamatan Cikalong Wetan Kabupaten Cianjur disebabkan oleh karena rendahnya kadar antibodi terhadap toxigenic C.difteriaepada masyarakat.

Hubungan Status Gizi dan Perkembangan Anak Usia 1 - 2 Tahun

Latar belakang.Pada umumnya usia 1-2 tahun pertama kehidupan akan menentukan kualitas hidup anak di kemudian hari. Tujuan. Mengetahui gambaran perkembangan anak usia 1-2 tahun dan status gizi. Metode.Penelitian dilakukan di tiga Puskesmas Garuda, Ibrahim Aji, dan Puter yang terdiri dari 24 Posyandu di Kabupaten Bandung. Penelitian dilakukan dilakukan secara cross sectionaldengan subjek anak usia 1-2 tahun yang sehat dan kooperatif pada saat pemeriksaan, serta orang tua menyetujui ikut dalam penelitian. Tes perkembangan dilakukan oleh satu dokter anak dan dua dokter (residen) dengan menggunakan KPSP (Kuesioner Pra Skrening Perkembangan). Empat aspek perkembangan yang dinilai yaitu motorik kasar, motorik halus, bicara dan bahasa, sosial dan kemandirian. Penelitian dilakukan dari tanggal 15 November 2010 sampai 30 November 2010. Hasil.Jumlah subjek 321 anak usia 1–2 tahun dan yang memenuhi kriteria inklusi 308 anak, terdiri dari 164 laki-laki (53,2%) dan 144 perempuan (46,8%). Anak yang mengalami perkembangan normal 278 anak (90,22%) dan meragukan 30 anak (9,78%). Sedangkan status gizi dinilai berdasarkan BB/PB, hasil normal 277 anak (89,9%) dan kurus 31 anak (10,10%). Dari 31 anak dengan status gizi kurang, di antara 2 anak di antaranya mengalami perkembangan meragukan dan dari 28 anak dengan perkembangan meragukan mempunyai status gizi normal. Kesimpulan.Tidak terdapat hubungan antara gangguan perkembangan dengan status gizi (p=0,394) begitu juga dengan status gizi dengan kondisi ekonomi (p=2,500) dan perkembangan dengan status ekonomi (p=0,336). Dari perkembangan dengan nilai meragukan adalah motorik kasar (6,17%), motorik halus (0,65%), bicara dan bahasa (4,54%), serta sosialisasi dan kemandirian (2,92%). Faktor-faktor yang berhubungkan dengan status perkembangan adalah umur anak (p=0,009). Perlu upaya untuk mengevaluasi perkembangan yang meragukan dan perlu penelitian lanjut dengan pembanding.

Imunogenisitas dan Keamanan vaksin Tetanus Difteri (Td) pada Remaja sebagai salah satu upaya mencegah Reemerging Disease di Indonesia

Latar belakang. Di Indonesia berpotensi terjadi reemerging disease difteri akibat belum ada program imunisasi ulang yang berkesinambungan pada remaja.Tujuan. Menilai imunogenisitas dan keamanan vaksin tetanus difteri (Td) yang diberikan sebagai imunisasi ulang pada remaja.Metode. Uji klinis randomized double-blind controlled dilakukan terhadap 296 pelajar remaja sehat di kota Bandung, usia 10–18 tahun, pada September 2007–September 2008. Didapatkan 296 remaja sebagai subjek penelitian, dibagi dalam 2 kelompok secara acak sederhana. Kelompok I mendapat vaksin Td 0,5 mL intramuskular. Kelompok II mendapat vaksin TT sebagai kontrol. Pemeriksaan kadar antibodi anti difteri dan anti tetanus dilakukan sebelum dan 1 bulan setelah imunisasi menggunakan teknik enzyme-linked immunosorbent assays (ELISAs). Data keamanan dikumpulkan sampai 1 bulan pasca imunisasi menggunakan buku harianHasil. Konsentrasi antibodi seroproteksi (>0,1 IU/mL) terhadap difteri dan tetanus mencapai 93,2% dan 100,0%. The geometric mean titer (GMT) terhadap difteri meningkat dari 0,0618 IU/mL menjadi 0,7583 IU/mL (p<0,001), dan terhadap tetanus meningkat dari 0,4413 IU/mL ke 14,4054 IU/mL (p<0,001). Nyeri pada tempat suntikan terjadi pada 20,3% kelompok Td dan 18,2% pada TT (p=0,028). Demam >37,5°C hanya terjadi pada sedikit subjek dari kedua kelompok (rentang Td: 0,7-4,7%; rentang TT: 3,4–6,7%). Tidak terdapat reaksi kejadian ikutan pasca imunisasi serius dan dapat ditoleransi dengan baik.Kesimpulan. Imunisasi ulang Td meningkatkan kadar antibodi protektif terhadap difteri dan tetanus, serta aman diberikan pada remaja.

Kekebalan dan Keamanan setelah Mendapat Imunisasi Hepatitis B Rekombinan pada Anak Remaja

Latar belakang. Berdasarkan riwayat implementasi program imunisasi Hepatitis B di Jawa Barat, diperkirakan anak periode remaja akhir (15–18 tahun) belum terlindungi terhadap infeksi Hepatitis B.Tujuan. Menilai kekebalan dan keamanan pasca imunisasi 3 dosis vaksin Hepatitis B rekombinan pada anak remaja sehat yang belum pernah mendapat imunisasi Hepatitis B.Metode. Penelitian intervensi dengan label terbuka terhadap remaja usia 15–18 tahun yang belum pernah mendapatkan imunisasi Hepatitis B, diberikan 3 dosis (1,0 ml=20 µg of HBsAg) Hepatitis B rekombinan secara intramuskular pada daerah lengan atas dengan interval waktu 1 bulan. Respons antibodi diukur menggunakan Chemiluminescent Microparticle Immunoassay (CMIA) Architect ausab reagent kit on architect i 1000sr, dilakukan pra dan 28 hari pasca dosis ke-3 vaksinasi. Reaksi lokal dan kejadian sistemik dicatat pada buku catatan harian selama 28 hari pasca tiap imunisasi. Hasil. Selama periode penelitian didapatkan seratus lima puluh subyek dengan Hbs Ag negatif. Dari jumlah tersebut 112 (75,3%) dengan kadar anti-HBs <10 IU/ml, dan pasca mendapat 3 dosis imunisasi kekebalan terhadap hepatitis B tercatat pada 95,5% remaja; GMT 682,65 (495,11–941,24) mIU/mL. Tidak ditemukan reaksi serius pasca imunisasi dan semua vaksin dapat diterima dengan baik.Kesimpulan. Pemberian 3 dosis vaksin Hepatitis B rekombinan memberikan kekebalan yang tinggi dan aman diberikan pada remaja sehat.

Perbandingan Masalah Psikososial pada Remaja Obes dan Gizi Normal Menggunakan Pediatric Symptom Checklist (PSC)-17

Latar belakang. Obesitas pada anak merupakan faktor penting karena cenderung meningkat dan dapat berpotensi sebagai penyebab berbagai konsekuensi medis serta masalah psikososial. Remaja obes cenderung mengalami rasa rendah diri, penghargaan diri yang buruk, depresi, mengalami kesulitan di sekolah, dan kesulitan belajar dibandingkan dengan remaja dengan status gizi normal.Tujuan. Mengetahui perbandingan masalah psikososial antara remaja obes dan remaja status gizi normal dengan menggunakan kuesioner pediatric symptom checklist (PSC)-17, suatu kuesioner yang telah tervalidasi untuk mendeteksi masalah psikososial pada anak.Metode. Rancangan analitik dengan metode potong silang, dilakukan pada bulan Mei–l Juli 2011 di Sekolah Menengah Pertama Negeri 14 Bandung. Subjek penelitian adalah siswa usia 12–16 tahun yang dipilih secara berurutan (consecutive sampling), terdiri atas 31 remaja obes dan gizi normal. Indeks massa tubuh didapat dari pengukuran tinggi badan dan berat badan, kemudian dikelompokkan menjadi status gizi obes (>+3SD) dan gizi normal (-2 sampai +2 SD). Subjek mengisi kuesioner PSC-17 yang berisi beberapa pertanyaan mengenai variabel masalah psikososial, yaitu internalisasi, eksternalisasi, dan masalah perhatian. Uji statistik dengan chi-square test untuk perbandingan kedua kelompok.Hasil. Terdapat 15/31 remaja obes dan 5/31 remaja gizi normal mengalami masalah psikososial (p=0,007). Analisis aspek masalah psikososial kuesioner PSC memperlihatkan perbedaan bermakna mengenai masalah internalisasi antara kedua kelompok (p=0,007).Kesimpulan. Masalah psikososial kelompok remaja obes lebih tinggi dibandingkan dengan kelompok remaja gizi normal.

Hubungan Kadar Feritin Serum dengan Fungsi Kognitif Berdasarkan Pemeriksaan Status Mini-Mental (MMSE) pada Penyandang Thalassemia Anak

Latar belakang. Penyandang thalassemia yang mendapat transfusi rutin tanpa kelasi besi yang optimal dapat menyebabkankelebihan besi yang memicu stres oksidatif dan dapat mempercepat proses degenerasi di otak.Tujuan. Menentukan hubungan kadar feritin serum dengan fungsi kognitif.Metode. Penelitian analitik dengan rancangan potong lintang terhadap 95 penyandang thalassemia anak berusia di atas 10 tahunpada bulan April sampai Mei 2015. Pemilihan subjek dilakukan secara consecutive sampling. Fungsi kognitif dinilai berdasarkan tesmini mental state examination (MMSE). Kadar feritin serum dan faktor lain yang berhubungan dengan fungsi kognitif dianalisismenggunakan multipel regresi.Hasil. Subjek penelitian terdiri dari 95 anak, anak laki-laki 46 orang (48,4%) dan anak perempuan 49 orang 51,6%. Rerata(SB)kadar feritin serum 4355,9 (2149) μg/L. Berdasarkan pemeriksaan MMSE didapatkan rerata(sb) skor 29,6 (3,9). Terdapat hubunganantara feritin serum dan fungsi kognitif (p=0,040). Faktor lain yang berhubungan adalah pendidikan anak, pendidikan ibu danfrekuensi transfusi.Kesimpulan. Kadar feritin serum berhubungan dengan skor MMSE.

Hubungan Kebiasaan Sarapan dengan Prestasi Belajar dan Fungsi Kognitif pada Anak Sekolah Dasar

Latar belakang. Kebiasaan sarapan memiliki dampak positif dengan menyediakan kadar glukosa darah optimal untuk proses belajardi sekolah. Kadar glukosa darah optimal dapat mendukung prestasi belajar dan fungsi kognitif.Tujuan. Menganalisis hubungan sarapan dengan prestasi belajar dan fungsi kognitif pada anak sekolah dasar.Metode. Penelitian desain potong lintang dilakukan pada bulan Desember 2013 hingga Maret 2014 terhadap 164 subjek siswa kelas 5dan 6 sekolah dasar di Bandung. Prestasi belajar pada penelitian ini dinilai dengan melihat nilai matematika dan bahasa Indonesia. Fungsikognitif dinilai dengan melakukan tes Mini Mental State Examination (MMSE). Analisis statistik korelasi dilakukan dengan menggunakanuji Chi-square Pearson dan Exact Fisher. Untuk menganalisis faktor perancu yang lebih dari satu digunakan regresi logistik.Hasil. Terdapat 164 anak yang memenuhi kriteria penelitian, 28,7% memiliki kebiasaan sarapan dan 71,3% tidak sarapan. Darihasil analisis didapatkan hubungan yang bermakna antara sarapan dengan prestasi belajar matematika (p=0,015), sarapan denganprestasi belajar bahasa Indonesia (p=0,032), tetapi didapatkan hubungan yang tidak bermakna antara sarapan dengan fungsi kognitif(p=0,300).Kesimpulan. Terdapat hubungan kebiasaan sarapan dengan prestasi belajar pada anak sekolah dasar, namun tidak terdapat hubungandengan fungsi kognitif.

Hubungan Kadar Prokalsitonin dan Kultur Bakteri dengan Tingkat Keparahan Pneumonia pada Anak

Latar belakang. Di negara berkembang, pneumonia merupakan penyebab utama kesakitan dan kematian pada bayi dan balita. Penelitian sebelumnya menemukan prokalsitonin dapat menggambarkan keparahan pneumonia pada anak. Dilaporkan juga kultur bakteri positif lebih sering ditemukan pada pneumonia berat dengan komplikasi. Tujuan.Menentukan hubungan kadar prokalsitonin dan kultur bakteri dengan tingkat keparahan pneumonia.Metode. Penelitian potong lintang yang dilaksanakan dari bulan September 2014 hingga Januari 2015 di RSUP Dr. Hasan Sadikin Bandung. Dilibatkan 61 anak berusia 1 bulan hingga 5 tahun. Subjek terdiri atas 30 anak pneumonia berat dan 31 anak pneumonia. Pemeriksaan prokalsitonin dilakukan dengan Elecsys BRAHMS PCT. Kultur darah diperiksa dengan mesin BACTEC 9050, jika hasilnya positif bakteri kemudian dibiakkan dalam media agar McConkey atau agar darah. Data hasil penelitian diuji dengan Mann Whitney dan chi-square. Hasil.Nilai median PCT pneumonia berat 0,69 ng/mL dan pneumonia 0,075 ng/mL, dengan nilai p<0,001. Hasil kultur positif ditemukan 5 dari 30 pada pneumonia berat dan 10 dari 31 pada pneumonia, dengan nilai p=0,157.Kesimpulan. Keparahan pneumonia berhubungan dengan kadar prokalsitonin dan tidak berhubungan dengan hasil kultur bakteri. Sari Pediatri2015;17(4):261-6.

The occurrence of pulmonary hypertension in patients with thalassemia major

Background The life of patients with thalassemia major dependson blood transfusions, while repeated blood transfusions may causeadverse effects such as iron deposition in various organs, includ-ing heart and lungs, which eventually increases the pulmonaryarterial pressure.Objective This study was proposed to know the occurrence ofpulmonary hypertension in patients with thalassemia major, mea-sured by echocardiography in the Thalassemia Clinic, Departmentof Child Health, Medical School, Padjadjaran University/HasanSadikin Hospital, Bandung.Methods A descriptive cross-sectional study was carried outon 30 patients with thalassemia major, aged 10-14 year-old whoreceived repeated blood transfusions. The study was conductedfrom April to May 2002. Subjects were examined right after ablood transfusion completed and the pulmonary arterial pres-sure was assessed using Doppler–echocardiography and 2-Dechocardiography.Results Twenty two out of 30 subjects showed pulmonary hyper-tension, with pulmonary arterial pressure ranged between 32.3 to46.2 mmHg. According to the age group, pulmonary hypertensionwas found in 12 out of 17 subjects aged 10-12 years old and 10out of 13 subjects aged 13-14 years old.Conclusion The occurrence of pulmonary hypertension in patientswith thalassemia major at Hasan Sadikin Hospital was 22/30 andseemed to increase with the age of the patients

The immunogenicity, safety, and consistency of an Indonesia combined DTP-HB-Hib vaccine in expanded program on immunization schedule

Background

WHO recommended incorporation of Haemophilus influenzae type b (Hib) vaccination into immunization program. Indonesia would adopt Hib as a National Immunization Program in 2013. We aimed at analyzing immunogenicity, safety, and consistency of a new combined DTP-HB-Hib (diphtheria-tetanus-pertussis-Hepatitis B-Haemophilus influenza B) vaccine.

Methods

A prospective, randomized, double blind, multicenter, phase III study of Bio Farma DTP-HB-Hib vaccine conducted in Jakarta and Bandung, August 2012 - January 2013.

Subjects were divided into three groups with different batch number. Healthy infants 6–11 weeks of age at enrollment were immunized with 3 doses of DTP-HB-Hib vaccine with interval of 4 weeks, after birth dose of hepatitis B vaccine. Blood samples obtained prior to vaccination and 28 days after the third dose. Safety measures recorded until 28 days after each dose.

Results

Of 600 subjects, 575 (96 %) completed study protocol. After 3 doses, 100.0 and 96.0 % had anti-PRP concentration ≥0.15 and ≥1.0 μg/ml. Anti-diphtheria and anti-tetanus concentration ≥0.01 IU/ml detected in 99.7 and 100.0 %; while concentration ≥0.1 IU/ml achieved in 84.0 and 97.4 %. Protective anti-HBs found in 99.3 %. The pertussis vaccine response rate was 84.9 %.

None Serious Adverse events (SAEs) considered related to study vaccine or procedure.

Conclusions

The 3-dose of DTP-HB-Hib was immunogenic, well tolerated and suitable for replacement of licensed-equivalent vaccines based on immunologic and safety profiles.

Trial registration

NCT01986335 – October 30^th 2013.

Short term memory, physical fitness, and serum brain-derived neurotrophic factor in obese adolescents

Background Obesity in adolescents is a major health problem and has been associated with low academic achievement. Brainderived neurotrophic factor (BDNF), a neurotrophin, plays a role in appetite suppression and memory, and its secretion is enhanced by physical activity. This neurotrophin may be associated with academic achievement in obese. Objective To compare physical fitness and serum BDNF levels to short term memory levels in obese adolescents aged 10–14 years. Methods This comparative, cross-sectional, analytic study was carried out on 40 elementary and high school students in Bandung, West Java, who were recruited by stratified random sampling. Short term memory was assessed by a psychologist using the Wechsler Intelligence Scale for Children-III Digit Span test (WISC-III Digit Span). Physical fitness was assessed by a clinical exercise physiologist using the Asian Committee on the Standardization of Physical Fitness Test (ACSPFT). Serum BDNF levels were measured by ELISA test in a certified laboratory. ANOVA test was used to assess for a correlation between serum BDNF concentration and short term memory, as well as between physical fitness level and short term memory. Pearson’s correlation test was used to analyze for a correlation between serum BDNF and physical fitness levels. Results The majority of subjects were in the physical fitness categories of moderate or poor. Subjects had a mean BDNF level of 44,227.8 (SD 10,359) pg/mL. There was no statistically significant difference in physical fitness with either serum BDNF or with short term memory levels (P=0.139 and P=0.383, respectively). Also, no correlation was determined between serum BDNF and physical fitness levels (r=0.222; P=0.169). Conclusion In obese adolescents, short term memory levels are not significantly different between physical fitness levels nor between serum BDNF levels.

Risk factors for obesity in 6 to 12-year-old children

Background The causes of obesity in children are multifactorial, including genetics, physiology, metabolism, psychology, socioeconomic status, lifestyle, and culture. Objective To assess for relationships between obesity in 6 to 12-year-old children and maternal nutritional status, maternal education, eating breakfast, eating fast food, physical activity, TV watching, and playing video games. Methods This case-control study included students of Sejahtera Public School aged 6 to 12 years. Questionnaires were distributed to their parents for data on maternal education, eating breakfast, eating fast food, physical activity, TV watching and playing video games. Maternal nutritional status was assessed by one of the researchers. Univariate analysis with Chi–square test was used to assess every risk factor. Those with a P value of <0.25 were subjected to multivariate analysis, performed using multiple logistic regression analysis. Results From June to July 2013, 60 obese children and 60 wellnourished children, as a control group, were enrolled in the study. Obese mothers tended to have obese children [odds ratio/OR 252.48; 95%CI 33.4 to 1908.4]. Children who ate fast food 6–8 times/week, had low physical activity, and watched TV more than 8 hours/week had significantly higher risk for obesity [OR 12.94, 95%CI 1.7 to 100.7; and OR 266.94, 95% CI 7.8 to 9137.7; OR 21.44, 95%CI 2.68 to 171.61; respectively]. Maternal education, eating breakfast, and playing video games were not significant risk factors for childhood obesity. Conclusion Maternal obesity, eating fast food 6-8 times per week, low physical activity and watching TV more than 8 hours/ week are risk factors for childhood obesity.

Safety and immunogenicity of the DTP/HB /Hib combination vaccine: phase I study

Background The World Health Organization (WHO) hasrecommended the introduction ofhepatitis B (HB) and Haemophilusinfluenza type b (Hib) vaccines into routine childhood vaccinationprograms. A new diptheria/tetanus/pertussis (DTP) /hepatitis B/Hibpentavalent combination vaccine has been developed.Objective To evaluate the safety and immunogenicity of a newcombination DTP/HB/Hib liquid vaccin e in infants.Met hods An open-label, uncontrolled, prospective interventionphase I study was con ducted on 30 healthy infants aged 6- 11weeks. Each subject received 3 doses of DTP/HB/Hib vaccine,formulated by Bio Fanna, 0.5 mL intramuscularly at the leftanterolateral thigh region using a 25-gauge n eedle of 25 mmlength . Subjects were followed for 1 month after administration ofeach vaccine dose to evaluate its safety, while serum anti-diphteria,tetanus, HB, Hib, and per tussis antibodies were measured priorto the l '' dose and 1 month after the Jtd dose.Results Among 30 vaccinated subjects, 18 infants had fever within24 hours after the first vaccination. Most cases of fever were mildin intensity and resolved within 24 hours. No other systemic orlocal reactions, or serious adverse events were observed in oursubjects during the study. The immunogenicity results after Jtdvaccine dose showed that the geometric mean titer of the antipolyribosylribitolphosphate (PRP) antibody levels increasedsignificantly from 0.0041μ,g/mL to 4.3 7 μ,g/mL after vaccination,and most infants h ad a fourfo ld or greater rise in antibody levelsover their pre-injection levels . All subjects who received DTP/HB/Hib liquid vaccine had seropro tective antibodies againsttetanus, diphtheria,a and hepatitis B, while 29/30 infants hadseroprotective antibodies against pertussis.Conclusion This new diphtheria/tetanus/pertusis/hepatitis B/Hibcombination vaccine has excellent safety profile and antibodyresponses in infants. These results encourage further clinicalevaluation in phase II.