Search

As one of the essential programs that have been developed for decades, childhood immunizations are mandatory to protect children from vaccine-preventable diseases. Despite its availability and accessibility, immunization coverage has not reached the intended goals. Vaccine hesitancy and COVID-19 pandemic may threaten immunization coverage in children. This study aimed to evaluate the tailored educational videos to reduce vaccine hesitancy and analyze the changes in childhood routine immunization status.This was an interventional quasi-experimental study in three subdistricts of North Jakarta, Indonesia. Participants were allocated into educational videos exposures (intervention group, n = 116) or to the digital version of the maternal and child health handbook (control group, n = 104). We administered a pre- and post-intervention vaccine hesitancy survey using the Parent Attitudes about Childhood Vaccines (PACV) questionnaire with cut-off scores of 50.A total of 220 parents were recruited in this study from June 18, 2021, to December 10, 2021. The pre-intervention PACV survey showed that 19 (8.6%) parents were vaccine-hesitant from both groups: 12 (10.3%) and 7 (6.7%) of parents among intervention and control groups. After the interventions, there were 8 (6.9%) and 8 (7.7%) vaccine-hesitant parents in the intervention and control groups, respectively. We found a significant difference in the post-intervention PACV median score between the intervention and control groups (17 vs 23; p = 0.035). Around 25% of parents have not completed their children's immunization status: 22.4% and 28.8% in the intervention and control groups, respectively. There was a significant difference between the proportion of PACV hesitancy on the immunization status within intervention and control groups (p = 0.001).There was a reduction in vaccine hesitancy after interventions. Educational videos intervention distributed through WhatsApp group was associated with lower vaccine hesitancy and can be used as health education tools among Indonesian parents in the community.

AIM: This study aimed to assess the consecutive 3-month length increment thresholds, by the first 6 months, to predict stunted at the age of 6 months. METHODS: We analyzed data from the Bogor Longitudinal Study on Child Growth and Development in West Java, Indonesia. A total of 635 free of stunting at birth children were analyzed in this study. Early linear growth faltering, as the dependent variable, was the stunted at 6 months of age. The four thresholds of the consecutive 3-month length increment were considered in predicting stunted at the age of 6 months. The thresholds were a consecutive 3-month length increment below 25th percentile, 15th percentile, and 5th percentile of the WHO Child Growth Velocity Standard. The 4th threshold was generated from the Bogor Longitudinal Study sample and determined using receiver operating characteristic analysis. The sensitivity, specificity, PPV, and NPV of the thresholds were calculated. RESULTS: Among the thresholds, the 25th percentile of the WHO Child Growth Velocity Standard generates the highest sensitivity. The ability of the 25th percentile threshold to correctly identify children who had stunting at 6 months of age is 56.7%. However, the children whose experience a consecutive 3-month length increment below 15th percentile had highest risk to become stunted at the age of 6 months, adjusted by sex, birthweight, and birth length. CONCLUSION: A consecutive 3-month length increment could be beneficial as a tool in identifying infants at high risk of early linear growth failure in stunted prevalent population.

BACKGROUND Monitoring children’s intellectual development is important to align their educational needs. This study compared nonverbal intelligence subtest of the cognitive test battery for Individuals with or without intellectual disability (CIID) to measure visual logical reasoning, verbal intelligence subtest (verbal fluency [VF]–animal test) to assess vocabulary and semantic memory, and the modified Indonesian version of Hopkins verbal learning test (IHVLT) to assess learning ability and episodic memory, against the Wechsler intelligence scale for children (WISC) as an alternative cognitive screening tool in school-aged children. METHODS A cross-sectional study was conducted in 145 grade 1–6 elementary school students in Jakarta between March and May 2017. Performance on the CIID subtest, VF, and modified IHVLT was assessed by a pediatrician, and the WISC test was performed by a psychologist. The associations between variables were evaluated using nonparametric Spearman’s rank correlations, regressions, and box plots. RESULTS The correlation between total intelligence quotient (IQ) WISC and CIID was 0.42 (p

Background : Language development of children starts early in infantcy and surges in 2 years of life, updated knowledge about association of language delay with its aggravating risk factor, in this case prolong sreening time, is very important to determine the prognosis of language development in children. Objective: To investigate the association between increased risk of language delay in toddlers with prolonged screen time. Methods: All included studies were collected from Pubmed, Scopus, EBSCO, Clinical Key and Science Direct on February 11 th 2020. These articles were then critically appraised using standard Oxford criteria of Evidence Based Medicine prognostic checklist. Result: Two eligible retrospective cohort studies from Lin et al (2014) and Byeon and Hong (2015) are included in this EBCR. Both were calculating the risk of language delay in toddlers between 15-35 months and 24-30 months exposed to screen viewing. Toddlers with more than 2 hours of watching television have higher risk of language delay (Odds Ratio: 3.3 (95%CI 1.5-7.3) and 2.74 (95%CI 1.13-6.65) respectively). Conclusion : The risk of language delay in toddlers is confirmed to be proportionately increased with the increases of screen duration. Maximum language development may be achieved by giving more two-way communication opportunities other than screen viewing. Keywords: Language delay, Toddlers, Screen time. ABSTRAK Latar belakang : Perkembangan bahasa anak-anak dimulai sejak kanak-kanak dan melonjak dalam dua tahun awal kehidupan, pengetahuan terbaru tentang hubungan antara keterlambatan bahasa dengan faktor risiko yang memburuk, dalam hal ini memperpanjang waktu menonton televisi sangat penting untuk menentukan prognosis perkembangan bahasa pada anak-anak. Tujuan : Untuk menyelidiki hubungan antara peningkatan risiko keterlambatan bahasa pada balita dengan waktu menonton televisi yang lama. Metode : Semua studi literatur yang dimasukkan dan dikumpulkan dari Pubmed, Scopus, EBSCO, Clinical Key dan Science direct pada 11 Februari 2020. Jurnal-jurnal ini kemudian di nilai secara appraisal menggunakan kriteria standar Oxford dalam kaidah laporan kasus berbasis bukti. Hasil : Dua studi kohort retrospektif yang memenuhi syarat kaidah laporan kasus berbasis bukti / EBCR yaitu Lin et al (2014) dan Byeon dan Hong (2015) dimasukkan dalam EBCR ini. Keduanya melakukan penelitian dan menghitung risiko keterlambatan bahasa pada balita usia antara 15-35 bulan dan 24-30 bulan yang terpapar menonton televisi dalam waktu lama . Balita yang menonton televise lebih dari dua jam sehari memiliki risiko keterlambatan bahasa yang lebih tinggi masing-masing(Odds Ratio: 3.3 (95%CI 1.5-7.3) dan 2.74 (95%CI 1.13-6.65). Kesimpulan : Risiko keterlambatan bahasa pada balita dipastikan akan meningkat secara proporsional dengan meningkatnya durasi menonton televise. Perkembangan bahasa pada anak lebih maksimal dapat dicapai dengan memberikan lebih banyak waktu untuk berkomunikasi dua arah antara keluarga selain dari menonton televisi .

Background Growth and developmental delays are common among children under the age of five years (under-five children), especially in slum areas. Early detection and intervention may give better prognoses. Objective To detect growth and developmental delays and related risk factors among under-five children living in an inner-city slum area of the Indonesian capital. Methods This cross-sectional study was conducted from October to November 2018 in Tanah Tinggi, Johar Baru District, an inner-city slum area in Central Jakarta. Subjects were healthy children aged 3–60 months. Socioeconomic profile was obtained through questionnaires, anthropometric data through measurements, and developmental status through the Kuesioner Pra Skrining Perkembangan (KPSP) instrument. Development was considered to be delayed for KPSP scores

Preterm neonates are at risk of delayed growth and development. Hence, early tactile-kinesthetic stimulation (TKS) is required to improve their growth and development.To evaluate the effect of TKS on growth, neurobehavior and development among preterm neonates.An interventional study was conducted from August 2015 to July 2017 in the neonatal unit of Dr. Cipto Mangunkusumo Hospital. Preterm neonates were recruited via random sampling and divided into two groups (the intervention group and control group). TKS was performed for 15 min, three times a day, for 10 days. The anthropometric measurements, neurobehavior (Dubowitz score) and development (Capute Scale score) of neonates in both groups were assessed.There were 126 preterm neonates (n = 63 in each group). During the 10-day TKS period, the intervention group had a significant increment in weight and length compared to the control group (p 0.05) at 11-14 days, at term and 3 months. Moreover, increased tone, reflexes, and improvement in behavior based on the Dubowitz score were observed during monitoring. However, the result did not differ significantly (p 0.05). There was no significant difference in terms of cognitive and language development in both groups (Developmental Quotient of Clinical Linguistic Adaptive Milestone Scale, Developmental Quotient of Clinical Adaptive Test and Full Scale Developmental Quotient scores, p 0.05).TKS was significantly effective in promoting growth, particularly weight and length, among preterm neonates. However, it did not significantly influence neurobehavior and development at 3 months of chronological age.

BACKGROUND Congenital hypothyroidism is one of the most prevalent, albeit preventable causes of intellectual disability. This study determined the intellectual outcome and health-related quality of life (QoL) in children and adolescents clinically diagnosed with congenital hypothyroidism and the associations among age of starting thyroid hormone treatment, current free thyroxine (FT4) level, intelligence quotient (IQ), and QoL.METHODS Intelligence (Wechsler scales) and QoL (PedsQLTM 4.0 parent proxy-report) tests were administered to 25 patients with congenital hypothyroidism in the pediatric clinic of Cipto Mangunkusumo Hospital, Jakarta. Nineteen patients underwent thyroid ultrasonography or scintigraphy to determine the etiology of congenital hypothyroidism.RESULTS A total of 25 patients with the median age of 9 (5.5–12.5) years were recruited. Eighteen patients had a total IQ of

Various clinical manifestations, complex pathogenesis and different virus serotypes in diverse area make us difficult to predict course of disease, even the child admitted in early. Prognostic factors are very important to predict cases progressing to become DSS. Dengue shock syndrome (DSS) occurs in 15.53% of Dengue hemorrhagic fever (DHF) patients with 7.81% mortality rate. Aim: To explore the prognostic factors of shock in hospitalized DHF children regarding the new 2011 WHO dengue virus infection classification guideline. This was a retrospective study using medical records of children age below 18 years old with WHO fulfilled grade 1 and 2 DHF diagnosis from January 2013–December 2016 in Child Health Department of Dr. Cipto Mangunkusumo Hospital, Jakarta. Independent variables were sex, age, nutritional status, secondary dengue infection, leucopenia, abdominal tenderness, gastrointestinal bleeding, hepatomegaly and plasma leakage. Shock was dependent variable. Multivariate analysis was done by using logistic regresion analysis. There were 98 DHF subjects, 5 subjects became DSS during hospitalization. DSS subject characteristics were age of >5 years old, female, malnutrition, abdominal tenderness, hemoconcentration ≥20%, secondary dengue infection, leucocyte ≥5.000 mm3 and thrombocyte 3. Multivaryate analysis showed malnutrition and hepatomegaly were prognosis factors of DSS. Malnutrition and hepatomegaly were prognotic factors of dengue shock syndrome. Clinicians should be more aware with these factors when managed hospitalized DHF patients.

Introduction High rate of influenza infection in children made influenza vaccination strongly recommended for all person aged >6 months in Indonesia. Bio Farma Trivalent Influenza HA (Flubio®) vaccine has been used in adolescents and adults, resulted in increased seroconversion, seroprotection rates and geometric mean titer (GMT). However, no data is available regarding its efficacy and safety in children. This study aimed to assess the immunogenicity and safety of Flubio® vaccine in infants and children. Materials and methods This was a phase II, open-labeled, clinical trial conducted on healthy children aged 6 month-11 years, vaccinated with 1 or 2 doses of Influenza HA vaccine, with a 28-day interval. Flubio® vaccine composed of A/California/7/2009 (H1N1) pandemic 09, A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012 strain. This study was held at East Jakarta, Indonesia from May until July 2014. A Total of 405 subjects were included and divided into three groups: A(6–35 months), B(3–8 years), and C(9–11 years). Antibody titer was measured at visit V1 (Day 0), V2 (28 days/+7days after the first dose) and V3 (28 days/+7days after second dose). The seroprotection and seroconversion rates were assessed. Safety was assessed up to 28 days following each dose. Results A total of 404 subjects completed the study. After vaccination, all subjects achieved seroprotection and increased seroconversion rates, with post-vaccination antibody titer of ≥1:40 HI for all strains. The GMT also increased significantly. Within 30 min after vaccination, 14.6% and 2% had local and systemic reactions; meanwhile, between 30 min to 72 h after vaccination, 35.1% and 13.6% subjects had local and systemic reactions, respectively. Most reactions were mild. No serious adverse event (SAE) was reported related to vaccine. Conclusion Flubio® (Influenza HA Trivalent) vaccine is immunogenic and safe for children aged 6 months-11 years. Trial Registration: The trial is registered at the US National Institutes of Health ( ClinicalTrials.gov ) #NCT02093260.

Vaccines are one of the most successful health interventions in history. Yet, vaccine-preventable diseases still claim the lives of 2.5 million individuals globally every year. Approximately 60% of the 19.4 million infants that did not have access to routine immunization services in 2018 live in 10 countries, one of which is Indonesia. In order to reach global targets, it is critical for countries such as Indonesia to prioritize, tailor, and operationalize vaccination strategies to address immunization gaps. Pediatricians and national pediatric societies (NPS) are trusted stakeholders in their countries and are uniquely qualified to promote vaccination programs. The American Academy of Pediatrics (AAP) partnered with the Indonesian Pediatric Society (IPS), with support from the US Centers for Disease Control and Prevention (CDC), to initiate a multiyear project to build the capacity of IPS, individual members, and other child health clinicians to strategically advocate for improved immunization services across both public and private sectors.

Purpose Impaired intestinal mucosal integrity may affect the gastrointestinal function, especially in relation to nutrition, absorption, and barrier function. The purpose of this study was to measure the prevalence of impaired intestinal mucosal integrity in presumed healthy children aged 1-3 years and assess the effects of zinc, glutamine, fiber, and prebiotic supplementation in them. Methods A cross-sectional study was conducted in 200 children aged 1-3 years in Pasar Minggu, South Jakarta, Indonesia. A randomized double-blind parallel group method clinical trial was then performed to assess the effects of zinc, glutamine, fiber, and prebiotic supplementation. Results Elevated calprotectin was found in 91/200 subjects (45.5%) at the onset of the study. After 10 months, 144 subjects completed the study: 72 subjects received the trial formula, whereas the other 72 received the standard formula. A transitory decrease in fecal calprotectin (FC) was observed after 6 months in the subgroup with normal FC levels, who were fed the test formula (p=0.012). Conclusion The prevalence of impaired intestinal mucosal integrity in this group of Indonesian children aged 1-3 years was high. Supplementation with zinc, glutamine, fiber, and prebiotics during 6 months reduced FC only in those who had low levels at baseline but not in those with impaired integrity.

Background: Turner syndrome is characterized by the absence of part of or the entire X chromosome in a woman, resulting in short stature, gonadal dysgenesis, and congenital anomaly. Based on karyotype, Turner syndrome is categorized as classical (45XO) and mosaic. The aim of this study is to evaluate the correlation of the karyotype with the puberty stage, volume of the uterus, and ovary in Turner syndrome’s adolescent with estrogen therapy. Methods: Analytic correlative cross-sectional study was done in Pediatric Endocrinology Outpatient Clinic at Cipto Mangunkusumo National Hospital since July to December 2018. Pubertal staging based on Tanner stage, uterine, and ovary volume were measured by transrectal sonography. Results: Of 21 study subjects, 8 were having classical karyotype and 13 were having mosaic karyotype in 12–21-year-old subjects. There was a significant correlation between karyotype and Tanner M stage (mammae stage) (p = 0.035). Breasts development in Turner syndrome with mosaic karyotype showed better development compared to classic karyotype. No significant correlation was found between karyotype and uterine and ovary volume in sonography transrectally. Conclusion: Karyotype correlates to mammae stage of Tanner but not in uterine and ovary volume in adolescents with Turner syndrome who underwent estrogen therapy.

Demam tifoid masih merupakan masalah kesehatan masyarakat. Upaya pencegahan meliputi perbaikan sanitasi lingkungan, higiene perorangan, persiapan makanan yang baik dan pemberian vaksin. Baik vaksin tifoid peroral maupun parenteral dapat mencegah gejala klinis demam tifoid. Kejadian ikutan pasca imunisasi (KIPI) vaksin antigen Vi polisakarida kapsuler pada anak Indonesia belum banyak dilaporkan. Penelitian ini bertujuan untuk mengetahui KIPI vaksin antigen Vi polisakarida kapsuler pada anak Indonesia. Metode. Penelitian deskriptif potong-lintang dilakukan pada anak Indonesia sehat umur 2-5 tahun yang mengunjungi Klinik Tumbuh Kembang Utan Kayu pada Juli 2000 atau Klinik Dokter Keluarga Kiara pada Agustus 2000. Digunakan vaksin antigen Vi polisakarida kapsuler (typhim-Vi) dalam kemasan 10 ml. Penyuntikan 0,5 ml vaksin dilakukan oleh dokter Peserta Pendidikan Spesialis Anak pada paha bagian anterolateral dengan menggunakan semprit steril sekali pakai. KIPI dimonitor dengan menggunakan formulir KIPI Departemen Kesehatan. Hasil. Dari 198 anak yang divaksinasi, KIPI yang berhasil dipantau 174 (87,9%) anak. Gejala klinis KIPI yang ditemukan adalah nyeri pada tempat suntikan (44,8%), demam > 38,5∞ C (14,4%), indurasi (9,2%), dan muntah (0,6%). Kesimpulan. KIPI vaksin antigen Vi polisakarida kapsuler penelitian ini cukup komparabel dengan penelitian lain dalam hal demam. Bengkak dan indurasi lebih tinggi dibanding penelitian lain. Hal yang mungkin berperan adalah vial multidosis yang rentan terhadap timbulnya kontaminasi.

Latar belakang. Gangguan tidur adalah kondisi yang ditandai dengan gangguan jumlah, kualitas, atau waktu tidur. Dampak gangguan tidur adalah gangguan belajar, memori, mood, perilaku, dan atensi.Tujuan. Mengetahui prevalensi, gambaran gangguan tidur, pengaruh intervensi sleep hygiene pada keluhan mengantuk, mood, kesulitan bangun, durasi tidur, nilai SDSC dan PDSS.Metode. Penelitian quasi eksperimental di SDN di Jakarta Pusat pada bulan Mei-Juni 2015. Skrining dan evaluasi pasca intervensi sleep hygiene selama 8 minggu menggunakan sleep disturbance scale for children (SDSC) dan pediatric daytime sleepiness scale (PDSS).Hasil. Prevalensi gangguan tidur 25,1%, terdiri atas disorder of initiating and maintaining sleep (DIMS) 61,5%, sleep wake transition disorder (SWTD) 61,5%, disorder of excessive somnolence (DOES) 55,4%, dan disorder of arousal (DA) 51,5%. Setelah intervensi dilaporkan perbaikan mengantuk, mood, kesulitan bangun pagi, nilai SDSC pre dan pasca intervensi (p

Latar belakang. Terapi yang adekuat pada hiperplasia adrenal kongenital (HAK) diharapkan dapat menghasilkan perkembangan pubertas dan pertumbuhan linear yang optimal. Saat ini, di Indonesia, belum ada 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 menjalani terapi. Metode. Studi serial kasus terhadap 14 kasus HAK yang memasuki masa pubertas di Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo Jakarta selama bulan November 2012 hingga April 2013. Pencatatan data berisi anamnesis, pemeriksaan fisis, pemeriksaan laboratorium, dan radiologi bone age. 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 terdiagnosis sejak kurang dari satu tahun. Tujuh dari 14 subjek mengalami obesitas. Undertreatment terjadi pada 11/14 subjek memiliki bone age accelerated dengan perhitungan tinggi badan dewasa yang pendek. Tiga belas subjek sudah pubertas dan 10/14 subjek mengalami pubertas prekoks. Rekomendasi dosis glukokortikoid yang diberikan (median 18,12 mg/m2/hari) dengan median durasi terapi 8,1 tahun. Kontrol metabolik dengan menggunakan 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 accelerated dengan estimasi tinggi badan dewasa pendek. Pubertas prekoks dialami oleh sebagian besar subjek. Pemberian glukokortikoid dengan dosis yang direkomendasikan. Ditemukan ketidakteraturan pengobatan dan pemantauan yang buruk.

Terapi sensori integrasi, sebagai bentuk terapi okupasi, mulai populer diberikan untuk tata laksana anak dengan berbagai gangguan perkembangan, belajar, maupun perilaku. Namun dasar teori, bentuk gangguan pemrosesan sensori, dan efektivitas terapi umumnya belum diketahui secara luas di kalangan dokter spesialis anak. Bukti sahih tentang manfaat terapi sensori integrasi untuk tata laksana anak dengan gangguan spesifik memungkinkan aplikasi dan pemberian edukasi pada keluarga pasien secara lebih optimal.

Background Data in Indonesia show that adolescents still have the highest rate for rape and other sexual assaults among age group. There are gender differences in adolescent rape and sexual assault, with female victims exceeding males with a ratio of 3:1. Sexual assault and rape can affect numerous children and often lead to short-term and long-term consequences. Objectives To determine the characteristics and short-term impacts of adolescent rape. Methods A cross-sectional study was conducted on 31 adolescents who had been raped 1-9 months previously. Subjects and parents were assessed using Child Behavior Checklist, Draw a Person, House Tree Person, and Raven’s Progressive Matrices to determine psychological problems. History and physical examination findings at the time of rape were reviewed. Results Thirty out of 31 female adolescents were 13-18 years old. Almost half of them came from low income families and large families, two-thirds of all subjects were living with their parents. Nineteen of 31 perpetrators were friends or acquaintances, only 4 were relatives. Tears of hymen were found in 21 subjects and only 8 of them had non-genital injuries. Nine of 31 subjects had a high average range in non-verbal processing. Most subjects had a great tendency to feel insecure, anxiety, depression, and had interpersonal relationship problems. Regression and aggressiveness were found in almost half of the subjects. All subjects felt that their mothers were protective and half of them had dominant fathers. Conclusion Almost half of the adolescent victims come from loweconomic status and large families, most of the assailants were friends or acquaintances. Adolescent rape victims have ongoing behaviour problems. The most common problems are anxiety, depression, and relationship problems [Pediatr Indones 2005;45:246-250].

Background Hearing disorder may cause speech delay so that every child with speech delay should undergo hearing test. The gold standard for audiometric test is otoacustic emission (OAE) and brainstem evoked response audiometry (BERA). They have high sensitivity and specificity, but the availability is limited and expensive. Hence, both tests are not available at the primary health care centers. In 1997, the Department of Health, Republic of Indo- nesia, established a simple subjective test instrument, i.e. the hear- ing capability test (HCT). Objective To asses the accuracy of HCT compared to the gold standard hearing tests (OAE and/or BERA). Methods This study was a cross sectional study on 89 children aged less than 5 years who had speech delay and came to the Growth and Development Outpatient Clinic or the General Outpa- tient Clinic, Pediatric Neurology Clinic of the Department of Child Health, Cipto Mangunkusumo (CM) Hospital; and Center for Ear Care and Communicative Disorders (CECCD), Department of ENT, CM Hospital, during March to August 2005. Results HCT sensitivity and specificity were 92.9% and 27.7%, respectively. Positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likehood ratio (NLR) were 84%, 50%, 1.9, and 0.7, respectively. Conclusion The sensitivity and specificity of HCT as a screening test of hearing disorder in children with speech delay were 93% and 28%, respectively. Based on this result, HCT should only be used as screening test and not as a diagnostic test

IntroductionThere is a high global incidence of typhoid fever, with an annual mortality rate of 200,000 deaths. Typhoid fever also affects younger children, particularly in resource-limited settings in endemic countries. Typhoid vaccination is an important prevention tool against typhoid fever. However, the available polysaccharide typhoid vaccines are not recommended for children under 2 years of age. A new typhoid conjugate Vi-diphtheria toxoid (Vi-DT) vaccine has been developed for infant immunization. We aimed to define the safety and immunogenicity of the Vi-DT vaccine among adults and children in Indonesia.MethodsAn observational, blinded, comparative, randomized, phase I safety study in two age de-escalating cohorts was conducted in East Jakarta, Indonesia, from April 2017 to February 2018. We enrolled 100 healthy subjects in 2 age groups: adults and children (18-40 and 2-5 years old). These groups were randomized into study groups (Vi-DT vaccine), and comparator groups (Vi-polysaccharide (Vi-PS) vaccine and another additional vaccine) which was administered in 4 weeks apart. Subjects were followed up to six months.ResultOne hundred healthy adults and children subjects completed the study. The Vi-DT and Vi-PS vaccines showed no difference in terms of intensity of any immediate local and systemic events within 30 minutes post-vaccination. Overall, pain was the most common local reaction, and muscle pain was the most common systemic reaction in the first 72 hours. No serious adverse events were deemed related to vaccine administration. The first and second doses of the Vi-DT vaccine induced seroconversion and higher geometric mean titers (GMT) in all subjects compared to that of baseline. However, in terms of GMT, the second dose of Vi-DT did not induce a booster response.ConclusionThe Vi-DT vaccine is safe and immunogenic in adults and children older than two years. A single dose of the vaccine is able to produce seroconversion and high GMT in all individuals.

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

Background Long-term anticonvulsant therapy, especially with enzyme inducers, has been associated with low 25-hydroxyvitamin D [25(OH)D] levels and high prevalence of vitamin D deficiency. However, there have been inconsistent results in studies on the effect of long-term, non-enzyme inducer anticonvulsant use on vitamin D levels.Objective To compare 25(OH)D levels in epileptic children on long-term anticonvulsant therapy and non-epileptic children. We also assessed for factors potentially associated with vitamin D deficiency/insufficiency in epileptic children.Methods This cross-sectional study was conducted at two pediatric neurology outpatient clinics in Jakarta, from March to June 2013. Subjects in the case group were epileptic children, aged 6-11 years who had used valproic acid, carbamazepine, phenobarbital, phenytoin, or oxcarbazepine, as a single or combination therapy, for at least 1 year. Control subjects were non-epileptic, had not consumed anticonvulsants, and were matched for age and gender to the case group. All subjects’ 25(OH)D levels were measured by enzyme immunoassay.Results There were 31 epileptic children and 31 non-epileptic control children. Their mean age was 9.1 (SD 1.8) years. Most subjects in the case group were treated with valproic acid (25/31), administered as a monotherapy (21/31). The mean duration of anticonvulsant consumption was 41.9 (SD 20) months. The mean 25(OH)D level of the epileptic group was 41.1 (SD 16) ng/mL, lower than the control group with a mean difference of 9.7 (95%CI 1.6 to 17.9) ng/mL. No vitamin D deficiency was found in this study. The prevalence of vitamin D insufficiency in the epileptic group was higher than in the control group (12/31 vs. 4/31; P=0.020). No identified risk factors were associated with low 25(OH)D levels in epileptic children.Conclusion Vitamin D levels in epileptic children with long-term anticonvulsant therapy are lower than that of non-epileptic children, but none had vitamin D deficiency.

Background: In Indonesia, approximately 35.5% of children under five years old were stunted. Stunting is related to shorter adult stature, poor cognition and educational performance, low adult wages, lost productivity, and higher risk of nutrition-related chronic disease. The aim of this study was to identify parental socio-demographic risk factors of declined linear growth in children younger than 2 years old.Methods: This was a cohort-prospective study between August 2012 and May 2014 at three primary community health care centers (Puskesmas) in Jakarta, Indonesia, namely Puskesmas Jatinegara, Mampang, and Tebet. Subjects were healthy children under 2 years old, in which their weight and height were measured serially (at 6–11 weeks old and 18–24 months old). The length-for-age based on those data was used to determine stature status. The serial measurement was done to detect growth pattern. Parental socio-demographic data were obtained from questionnairesResults: From the total of 160 subjects, 14 (8.7%) showed declined growth pattern from normal to stunted and 10 (6.2%) to severely stunted. As many as 134 (83.8%) subjects showed consistent normal growth pattern. Only 2 (1.2%) showed improvement in the linear growth. Maternal education duration less than 9 years (RR=2.60, 95% CI=1.23–5.46; p=0.02) showed statistically significant association with declined linear growth in children.Conclusion: Mother with education duration less than 9 years was the determining socio-demographic risk factor that contributed to the declined linear growth in children less than 2 years of age.

Background Indonesia reports the second highest dengue disease burden in the world; these data are from passive surveillance reports and are likely to be significant underestimates. Age-stratified seroprevalence data are relatively unbiased indicators of past exposure and allow understanding of transmission dynamics. Methodology/Principal Findings To better understand dengue infection history and associated risk factors in Indonesia, a representative population-based cross-sectional dengue seroprevalence study was conducted in 1–18-year-old urban children. From October to November 2014, 3,210 children were enrolled from 30 geographically dispersed clusters. Serum samples were tested for anti-dengue IgG antibodies by indirect ELISA. A questionnaire investigated associations between dengue serologic status and household socio-demographic and behavioural factors. Overall, 3,194 samples were tested, giving an adjusted national seroprevalence in this urban population of 69.4% [95% CI: 64.4–74.3] (33.8% [95% CI: 26.4–41.2] in the 1–4-year-olds, 65.4% [95% CI: 69.1–71.7] in the 5–9-year-olds, 83.1% [95% CI: 77.1–89.0] in the 10–14-year-olds, and 89.0% [95% CI: 83.9–94.1] in the 15–18-year–olds). The median age of seroconversion estimated through a linear model was 4.8 years. Using a catalytic model and considering a constant force of infection we estimated 13.1% of children experience a primary infection per year. Through a hierarchical logistic multivariate model, the subject’s age group (1–4 vs 5–9 OR = 4.25; 1–4 vs. 10–14 OR = 12.60; and 1–4 vs 15–18 OR = 21.87; p, Author summary Indonesia reported to the WHO the world’s second highest average number of dengue cases and the highest in Asia from 2004 to 2010. These passive surveillance reports vary widely within the country and are likely to be a severe under-estimation of the full disease burden as frequently only dengue haemorrhagic fever is captured. Understanding the intensity of dengue virus transmission and associated risk factors nationwide is necessary to guide and prioritize appropriate prevention and control measures against dengue disease, especially considering the availability of the first dengue vaccine and recent recommendations for its use in areas of high endemicity, as measured by seroprevalence and other indicators. Age-stratified seroprevalence data provide robust estimates of past exposure and can inform on transmission intensity. Therefore, we conducted a seroprevalence study of anti-dengue IgG antibodies in a representative sample of urban-dwelling Indonesian children. We found an overall dengue seroprevalence of 69.4% with half of the children having been infected at least once by the age of 5 years. Age of the subject and the number of dengue cases diagnosed in the household were associated with serostatus. These results confirm the high dengue disease burden in Indonesia and the urgency of implementation of effective prevention and control measures.

OBJECTIVE: To investigate the efficacy of probiotics added to oral rehydration solution and zinc in the treatment of acute infectious diarrhea in Indonesian children. METHODS: A prospective randomized double blind placebo-controlled trial was performed to test the efficacy of a probiotic food supplement in 112 children in the Kenari subdistrict, central Jakarta, aged 6-36 mo with acute infectious diarrhea and moderate dehydration. The supplemented group was given standard therapy (oral rehydration solution and zinc) and the probiotic strains Lactobacillus (L.) rhamnosus R0011 1.9?×?109 colony forming units (cfu) and L. acidophilus R0052 0.1?×?109 cfu/d for 7 d, while the control group was given standard therapy and placebo. RESULTS: Median duration of diarrhea was 68.5 h (range 13-165) in the supplemented and 61.5 h (range 21-166) in the control group (P?=?0.596). Median daily frequency of defecation until diarrhea stopped was 5.0 in the supplemented vs. 5.5 in the control group (P?=?0.795). CONCLUSIONS: This probiotic food supplement tested did not reduce the duration of acute infectious diarrhea as compared to oral rehydration and zinc.

Poliomielitis adalah penyakit menular yangditandai dengan kelumpuhan akibat kerusakanmotor neuron di kornu anterior sumsum tulangbelakang; disebabkan oleh tiga serotipe virus polioyaitu serotipe 1 (brunhilde), serotipe 2 (lansig) danserotipe 3 (leon).1 Poliomielitis ditularkan secarafekal-oral atau oral-oral.Sebelum vaksin polio ditemukan, semua anakyang terinfeksi virus polio dan sekitar 1 dari 200anak yang terinfeksi akan menderita kelumpuhan.Setelah ditemukan vaksin polio inaktivasi (IPV,salk) pada tahun 1955, vaksin polio oral monovalen(mOPV, sabin) tahun 1961 dan vaksin polio oraltrivalen (tOPV) pada tahun 1963, program imunisasipolio berlangsung di seluruh dunia. Vaksin IPVdiganti dengan tOPV karena pemberiannyamudah, lebih unggul dalam merangsang kekebalanmukosa usus, dan lebih murah. Vaksin tOPV masukdalam Program Pengembangan Imunisasi/PPI diIndonesia sejak tahun 1978.

HBV-infected patients are potential sources of intra-familial transmission. We studied HBV transmission and molecular characteristics within families of HBV-related chronic liver disease (CLD) patients. Family members [index cases (ICs), spouses, and 1–18-year-old children] of HBV-related CLD patients were tested for HBsAg, anti-HBc, and anti-HBs. HBsAg-positive subjects were tested for HBeAg/anti-HBe. Anti-HBc-positive children together with their family members were further investigated for HBV DNA. Sequences of positive isolates were analyzed over surface, precore (PC) and basal core promoter (BCP) regions. Among 94 children of 46 ICs, the prevalence of HBsAg, anti-HBc, and anti-HBs was 10 (10.6 %), 19 (20.2 %), and 46 (48.9 %), respectively. Thirty-eight (40.4 %) children were seronegative, indicating susceptibility to HBV infection. HBV DNA was identified in all ICs, 4 spouses, and 16 children. Having both parents with HBsAg positive and at least two HBV carriers in the households were significant risk factors of intra-familial transmission. HBV genotype/subtype distributions were comparable between children and ICs/spouses, with predominance of genotype B. The majority of HBV DNA sequences found in children were identical to their corresponding ICs—particularly mothers—including mutation patterns in the surface, PC, and BCP regions. Recognized mutations associated with HBsAg detection and/or vaccination failure, T140I, T143S/M, G145R, and Y161F, were identified in 20 subjects; while mutations linked to HBeAg-defective variants, PC G1896A and BCP A1762T/G1764A, were found in 7 and 11 subjects, respectively. Children of HBV-related CLD patients were at increased risk of HBV infection through multi-modal transmission routes despite negative parental HBsAg and HBeAg status.

Congenital cytomegalovirus (CMV) infection can lead to severe neurological sequelae and (progressive) sensorineural deafness. Neonatal imaging data is mainly based on cranial ultrasound (US) and computed tomography (CT). The additional value of magnetic resonance imaging (MRI) was assessed in congenital CMV infection. The eleven infants studied had a gestational age between 34 and 41 weeks and a birth weight between 1000 and 2780 grams. All but 2 of the infants presented with microcephaly and jaundice at birth. The diagnosis was confirmed postnatally in all infants by isolation of the virus or a polymerase chain reaction (PCR) from the urine. Cranial US was performed in all, MRI in 6 during the neonatal period and later in infancy in 2. Auditory brainstem evoked responses (ABR) were performed in all survivors. US showed periventricular calcifications and/or lenticulostriate vasculopathy associated with mild to moderate ventricular dilatation in 10 of the 11 children. Periventricular (pseudo) cysts were seen in 6 children, being occipital in 4, temporal in 3 and fronto-parietal in 1. The cerebellum appeared to be small in 4 children. MRI provided additional information in 6 of the 8 children. Polymicrogyria in the perisylvian region was seen in 4 children, hippocampal dysplasia in 3 and cerebellar hypoplasia in 4 children. Abnormal signal intensity in the white matter was seen in 4 infants. ABRs were abnormal in 7 of the 9 children. Four children died in the neonatal period, 4 developed severe neurological sequelae, associated with epilepsy and sensorineural deafness in 3. Three children were still too young to be tested, but 2 of these showed sensorineural deafness. MRI provided important additional information, especially with regard to associated polymicrogyria, hippocampal dysplasia, and cerebellar hypoplasia. Calcifications were better seen using US. A combination of US and neonatal MRI should be recommended instead of a CT which is still recommended in the literature.

[no abstract available]

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. 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. 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. 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. NCT01986335 – October 30th 2013.