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Individuals with COVID-19 and no symptoms, known as asymptomatic carriers, are found mostly in the community. Testing is very important to help reduce the spread of COVID-19. This study aimed to detect virus and antibodies of SARSCoV-2 in healthy Indonesian volunteers. In September 2020, 45 healthy volunteers participated were taken nasopharyngeal/ oropharyngeal swabs to detect the virus SARS-CoV-2 using RT-PCR, and blood samples to detect antibodies qualitatively by three rapid tests (Vazyme, Clugene, and RIGHA kits) and quantitatively by ELISA tests. Among healthy volunteers, COVID-19 asymptomatic carriers who have RT-PCR positive were 16% (7/45) with average of Ct 36.14. The seroprevalence of total SARS-CoV-2 antibodies (IgM and/or IgG) in RT-PCR positivity (asymptomatic carriers) detected by vazyme, clugene and RIGHA kits was 86%, 76% and 52%, respectively and was higher than the negative group (34, 21 and 24%). SARS-CoV-2 IgG antibody titers in the group that were positive for IgM and/or IgG (detected in at least one rapid test) by ELISA was averaged 109.76 ± 114.14 BAU/ml and significantly higher in negative group with titer of 11.45 ± 9.87 BAU/ ml. High titer of SARS-CoV-2 IgG anti-RBD antibodies was resulted in consistent positive in three rapid tests (vazyme, clugene, and RIGHA) compared to lower titer. Our findings suggest that healthy individuals with virus and/or antibodies of SARS-CoV-2 may have been infected recently or in the past. Antibody-positive results detected in healthy volunteers by three rapid tests were more common in asymptomatic carriers, and had higher titer antibody

Latar Belakang: Hand hygiene (HH) merupakan salah satu cara yang digunakan untuk mencegah penyebaran infeksi terkait pelayanan kesehatan. Audit hand hygiene digunakan untuk menilai kepatuhan hand hygiene. Kepatuhan hand hygiene di Rumah Sakit Haji Surabaya pada tahun 2020 mengalami peningkatan yang signifikan sebesar 93,65% dibandingkan tahun sebelumnya. Hal ini tidak sesuai dengan angka kepatuhan pelaporan audit yang mengalami penurunan sebesar 77,5% dari tahun sebelumnya. Tujuan: Penelitian ini bertujuan untuk mengevaluasi pelaporan audit kepatuhan kebersihan tangan sebagai upaya pencegahan HAIs di RS Haji Surabaya. Metode: Penelitian ini merupakan penelitian deskriptif dalam bentuk studi evaluasi berdasarkan pendekatan sistem (input, proses, output) menggunakan data sekunder laporan audit kepatuhan hand hygiene Rumah Sakit Haji Surabaya tahun 2020. Pengumpulan data diperoleh dari wawancara mendalam dengan Komite Pencegahan dan Pengendalian Infeksi (PPI) dan IPCLN (Infection Prevention and Control Link Nurse) di RS Haji Surabaya. Data dianalisis dengan membandingkan dan mendeskripsikan target dan capaian laporan audit kepatuhan hand hygiene. Hasil: Hasil penelitian ini menunjukkan bahwa berdasarkan komponen input, fasilitas sudah tersedia dengan baik, sedangkan SPO terkait penggunaan aplikasi healthy plus dan jumlah IPCLN belum terpenuhi. Berdasarkan komponen proses, pengumpulan data sudah sesuai dengan pedoman WHO tahun 2009, sedangkan pengolahan data, analisis data, pelaporan data belum belum sesuai. Berdasarkan kompenen output, angka kepatuhan hand hygiene berdasarkan waktu, tempat, dan orang telah dilaporkan sesuai dengan pedoman WHO tahun 2009 dan telah mencapai target yang ditentukan, sedangkan ketepatan pelaporan mengalami penurunan dan masih jauh dari target yang diharapkan. Kesimpulan: Ketepatan pelaporan audit kepatuhan kebersihan tangan di rumah sakit haji Surabaya masih belum baik, sehingga disarankan untuk membuat SPO terkait dengan penggunaan aplikasi healthy plus, mengatur jam kerja IPCLN, dan memperbaiki sistem pada aplikasi healthy plus khususnya pada item penilaian hand hygiene yang tidak terinstal di dalam komputer setiap ruangan di rumah sakit. Kata kunci: audit, infeksi terkait pelayanan kesehatan, kebersihan tangan, pelaporan

Introduction: COVID-19 continues to be a global problem. Surabaya is among the cities hit by COVID-19. Lack of information and awareness of COVID-19 and its vaccination in teenagers might have impacted their preventative behavior and belief in COVID-19 vaccination. This study examined differences in high school students' understanding of COVID-19 and its vaccination before and after the intervention. Methods: The quasi-experimental design was utilized in this study, which took place between September and December of 2021. PowerPoint materials (webinar), videos, and pocketbooks about COVID-19 and its vaccination were the educational community initiatives. Students in grades 10-12 at SMA 4 Muhammadiyah Surabaya, MA Mamba'ul Hisan Gresik, and SMA Negeri 1 Sidoarjo participated in the study, and 160 students completed the pre-test and post-test. The study variables were knowledge, student characteristics (gender, age, class, and school origin), and parental characteristics (age, education, and occupation). The paired t-test was used to evaluate the univariable and bivariable data. Results: With an average pre-test value of 7.09 and a post-test value of 7.94, there was a difference of high school students' understanding of COVID-19 before and after the intervention (p < 0.001). Furthermore, there was also a difference of knowledge about COVID-19 vaccination (p < 0.001), with an average pre-test value of 5.87 and a post-test value of 7.03. Conclusion: There are considerable differences in students' knowledge of COVID-19 disease and its vaccination before and after the intervention. In order to prevent COVID-19, community service activities involving the distribution of information (webinars), videos, and pocketbooks could help them gain more knowledge.

We followed 45 participants in Surabaya, Indonesia, for 10 months and compared their PCR and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) results. As much as 13 out of 45 participants were IgG seropositive at least once while the remaining 32 stayed IgG seronegative throughout the study. Among 13 seropositive participants, 9 were consecutively seropositive at least twice and were eligible for IgG longevity evaluation. The duration of IgG detection varied from 47 to ≥233 days. We observed intermittent re-positive PCR results suggestive of viral shedding in participants with a longer duration of IgG detection.

Norovirus (NoV) is one of the most important viral causes of acute gastroenteritis (AGE) in children worldwide. Only a few studies have reported AGE with NoV-positive in some cities in Indonesia. This study aimed to investigate the incidence and clinical characteristic of NoV infection, and also genotype distribution of NoV in children with AGE in Jambi, as the capital and the largest city of Jambi province, Indonesia. Stool samples were collected from children (≤15 years of age) with AGE at three participating hospitals in Jambi from February to April 2019. The detection of NoV and its genotyping were carried out by reverse-transcriptase polymerase chain reaction and direct sequencing. Of the 91 stool samples collected, 14 (15.4%) were positive for NoV. Fever, vomiting, and severe diarrhea were commonly observed in AGE with NoV, while level of dehydration was statistically significant difference between children with NoV-positive and those with NoV-negative. The most prevalent genotype was GI.4 (42.9%), followed by GII.6 (28.6%) and some other genotypes. Interestingly, this study found the predominance of GI.4, differed from previous reports in Indonesia. Continuously investigation of the circulating genotype is needed to control the NoV-infected AGE.

Penurunan kasus COVID-19 memunculkan isu kesiapan Indonesia menghadapi COVID-19 yang awalnya berstatus pandemi menjadi endemi. Oleh karena proses transisi menuju endemi itu artinya bukan berarti kasus COVID-19 tidak ada sama sekali tapi tetap kasus itu akan ada. Kondisi ini membuat masyarakat harus bersiap untuk terus berdampingan dengan COVID-19. Tujuan kegiatan untuk akselerasi pemahaman guru terhadap kondisi pergesaran pandemi menuju endemi sebagai upaya preventif pasca pandemi COVID-19. Kegiatan inti berupa edukasi kepada guru Sekolah Dasar (SD) dan Sekolah Menengah Pertama (SMP) dengan media buku saku dan materi dalam bentuk digital. Buku saku sebagai bahan saat guru melakukan edukasi pada anak didik dilengkapi dengan materi dalam bentuk digital. Hasil penilaian pengetahuan sebelum dilakukan edukasi (pre-test) mempunyai rata-rata 71,44. Rata-rata nilai pengetahuan meningkat saat post-test, yaitu 78,67. Evaluasi kehadiran yaitu 45 guru yang hadir dari 50 guru yang diundang (90%). Kegiatan ini telah memberikan kontribusi peningkatan pengetahuan guru SD dan SMP terkait pemahaman kondisi pergeseran pandemi menuju endemi, sehingga diharapkan guru SD dan SMP bisa melakukan edukasi kepada anak didik sebagai upaya preventif pasca pandemi COVID-19.

Healthcare Acquired Infections (HAIs) or nosocomial infections are infections that occur in patients during hospitalization. HAIs are classified into 4 namely Catheter-Associated Urinary Tract Infection, Surgical Site Infection, Ventilator-Associated Pneumonia, and Blood Stream Infection. The purpose of this study is to evaluate the implementation of the HAIs surveillance sistem. The research method used is a descriptive evaluation study with an observational research design. The data sources used are the Reports and dissemination of HAIs Surveillance at RSU Haji Surabaya in 2019-2020. The results showed that HAIs cases at RSU Haji Surabaya in 2020 were 0.03%. The problems in the implementation of HAIs surveillance are the accuracy and completeness of data reports, implementation support facilities, and employee participation in training has not been running optimally, application bundle items are under repair, and job rotation for employees. Conclusion : the implementation of HAIs surveillance activities is in accordance the Regulation of the Peraturan Menteri Kesehatan Republik Indonesia Number 27 of 2017 Tentang Pedoman Pencegahan Dan Pengendalian Infeksi di Fasilitas Pelayanan Kesehatan, but the implementation still running unoptimally, researchers recommend the implementation of reward and punishment activities for surveillance officers as a solution to improve the sistem surveillance.

Mutations in the hepatitis B virus (HBV) X region and truncation of the preS2 region are well‑known to affect the progression of liver disease. Recently, it has been observed that an increasing number of S region quasispecies variants are associated with disease progression. However, few studies have analysed quasispecies of the whole genome using high‑throughput sequencing methods. Using high‑throughput sequencing, whole‑genome variations in 12 Indonesian patients infected with HBV (eight with advanced liver disease and four with chronic hepatitis) were examined. Variations with cut‑off values of ≥1% of the total viral population were investigated. It was revealed that within the four open reading frames, quasispecies variations of the S and X regions were higher in advanced liver diseases compared with in chronic hepatitis (S region: 89.53 vs. 50.69%, P=0.047; X region: 76.95 vs. 35.88%, P=0.044). Notably, the mutation frequencies in the basal core promoter, B cell epitope, RT Box G, RNAseH and small S region were greater in advanced liver disease. The proportion of quasispecies variants increased for the majority of the mutations, with the exception for W196* in the small S gene, during disease progression. The present study demonstrated that quasispecies in the S and X regions of the HBV genome changed during disease progression and were associated with advanced liver disease development in Indonesian patients with HBV.

Outbreaks of hepatitis A have occurred in some cities in Indonesia. In Surabaya, the capital city of East Java province, Indonesia, hepatitis A outbreaks have been reported since2013, with a marked increase in the number of cases in 2015. The aim of the present study was to analyze the genetic and serology of acute symptomatic cases (early infection) during a hepatitis A outbreak and asymptomatic cases after the outbreak in two junior high schools in Surabaya in 2015 to 2016. Students with acute symptomatic hepatitis A during the outbreak and other students who were asymptomatic 3 to 4 months after the outbreak were enrolled. Asymptomatic students had no symptoms from the outbreak until they were enrolled. Sera were collected to identify anti-hepatitis A virus (HAV) IgM (by enzyme-linked immunosorbent assay) and HAV genetic variations/genotypes (using polymerase chain reaction [PCR]-sequencing and phylogenetic analysis). A total of 33 (97.1%) out of 34 sera of students with acute symptoms were positive for anti-HAV IgM and 18% of them were positive by PCR, identified as HAV subgenotype IA. No prominent amino acid variations were observed from reported HAV sequences from Indonesia. Among 38 sera of asymptomatic students, most (55.3%) were positive for anti-HAV IgM, while none were positive by PCR. In conclusion, HAV-IA was the only subgenotype identified in acute symptomatic cases during the outbreak. The percentage of HAV-specific IgM-positive cases was very high among acute symptomatic students, but that was also high among asymptomatic students, which might contribute as the important source of infection during the outbreak.

Rotavirus A (RVA) is a major cause of acute gastroenteritis in humans and animals worldwide. As a result of the segmented nature of the rotavirus genome, genetic reassortment commonly occurs. This study aims to clarify the genetic characteristics of RVAs circulating in Indonesia. From June 2015 through August 2016, stool samples were collected from 134 children aged

Noroviruses are recognized as a leading cause of outbreaks and sporadic cases of acute gastroenteritis (AGE) among individuals of all ages worldwide, especially in children

Human leukocyte antigen (HLA) DPA1/DPB1 variants have been reported to influence Hepatitis B virus (HBV) infection. HLA-DPA1/DPB1 plays a pivotal role in antigen presentation to CD4(+) helper T cells and influences the outcome of HBV infection. To investigate the influence of HLA-DP variants on the outcome of HBV infection in an Indonesian population where it has the third-highest prevalence of HBV infection worldwide, we performed a case-control study of 686 participants, including patients with HBV-related advanced or nonadvanced liver disease, patients with spontaneously resolved HBV, and healthy controls. Single-nucleotide polymorphisms in HLA-DPA1 (rs3077) and HLA-DPB1 (rs3135021, rs9277535, and rs228388) were genotyped using real-time TaqMan® genotyping assays. Because rs2281388 deviated from Hardy-Weinberg equilibrium, it was excluded from subsequent analyses. The results of logistic regression analyses showed that the HLA-DPB1 rs9277535 variants were associated with a reduced risk of persistent HBV infection (odds ratio [OR] 0.70, 95% confidence interval [95% CI] 0.52-0.96, P=0.026, additive genetic model; OR 0.60, 95% CI 0.38-0.96, P=0.033, dominant genetic model). The HLA-DPA1 rs3077 variant was associated with a protective effect increasing the spontaneously resolved HBV infection (OR 0.64, 95% CI 0.41-0.98, P=0.039, dominant genetic model). By contrast, the HLA-DPB1 rs3135021 variant was not associated with the outcome of HBV infection, including susceptibility, spontaneously resolved, or disease progression. Combinations of haplotype markers were also associated with HBV susceptibility (CA for rs3077-rs9277535, OR 0.57, 95% CI 0.36-0.92, P=0.021; GA for rs3135021-rs9277535, OR 0.56, 95% CI 0.36-0.86, P=0.0087). In conclusion, these findings confirm that HLA-DPA1/DPB1 variants were associated with the outcomes of HBV infection in an Indonesian population.

Xylo-oligosaccharide derived from corncob hemicellulose has been reported to possess antioxidant activity. In order to assess the effective scavenging of xylo-oligosaccharide, we conducted in vitro studies based on self-made xylo-oligosaccharide with DPPH (2,2diphenyl-1-picrilhydrazil) method. Xylo-oligosaccharide was prepared with enzymatic hydrolysis. The enzyme used for hemicellulose hydrolysis was endo-β-xylanase enzyme from PC-01 isolated bactrerium. PC-01 isolated bacterium used in this study was Pacet hot spring which was isolated from East Java. Endo-β-xylanase enzyme is an extracelluler enzyme. There was about 0.199 U/mL after purification and dialysis process. Hydrolisis product of hemicellulose A and B from corncob were analyzed with TLC (Thin Layer Chromatography) and HPLC (High Performance Liquid Chromatography). This analysis showed that hydrolysis product of hemicellulose B had a lot of xylo-oligosaccharide hydrolysis product of hemicellulose than Xylo-oligosaccharide hydrolysis product of hemicelluloses A. Xylo-olygosaccharide was analyzed as on antioxidant activity. Xylo-oligosaccharide hydrolysis product ofhemicellulose B (IC = 48.96) has higher antioxidant activity than Xylo-oligosaccharide hydrolysis product of hemicellulose A (IC 50 50 = 92.302). The toxicity of xylo-oligosaccharide can be calculated by the value of LC 50 (Lethality concentration). LC of xylooligosaccharide derived from corncob hemicellulose was 400 ppm so that xylo-oligosaccharide has anti tumor activity because xylooligosaccharide has LC 50 < 1000 ppm.

Liver cirrhosis (LC) and hepatocellular carcinoma (HCC) are life-threatening conditions frequently associated with chronic hepatitis B virus (HBV) infection in Asian countries, including Indonesia. HBV genotypes and several specific mutations are associated with disease progression. To clarify the geographical variation in viral characteristics, HBV genotypes and gene mutations were investigated in patients with advanced liver disease (ALD) in Samarinda, East Kalimantan, Indonesia. Sera were collected from 41 patients with ALD at Abdul Wahab Sjahranie Hospital and HBV carriers from Red Cross Center blood bank in Samarinda, and screened for hepatitis B surface antigen and hepatitis B e-antigen. Liver function data were obtained from the medical records from each patient. HBV genotype and gene mutations were determined by polymerase chain reaction sequencing. Analysis of HBV isolates indicated that genotype B was the most frequent genotype, at 85.4 and 97.8%, followed by C, at 14.6 and 2.2%, in patients with ALD and in HBV carriers, respectively. The C1505A mutation in X region, T1753V and A1762T/G1764A mutations in the basal core promoter region and C1858T in precore (PC) region were frequent and only detected in patients with ALD (28.9, 40, 73.5 and 17.6%, respectively), whereas the G1896A mutation in the PC region was frequently detected in HBV carriers. The presence of HBV genotype B and certain HBV gene mutations were characteristic of patients with ALD in East Kalimantan.

Quasispecies of hepatitis B virus (HBV) with variations in the major hydrophilic region (MHR) of the HBV surface antigen (HBsAg) can evolve during infection, allowing HBV to evade neutralizing antibodies. These escape variants may contribute to chronic infections. In this study, we looked for MHR variants in HBV quasispecies using ultradeep sequencing and evaluated the relationship between these variants and clinical manifestations in infected patients. We enrolled 30 Indonesian patients with hepatitis B infection (11 with chronic hepatitis and 19 with advanced liver disease). The most common subgenotype/subtype of HBV was B3/adw (97%). The HBsAg titer was lower in patients with advanced liver disease than that in patients with chronic hepatitis. The MHR variants were grouped based on the percentage of the viral population affected: major, ≥20% of the total population; intermediate, 5% to

Mutations in the reverse transcriptase (RT) region of the hepatitis B virus (HBV) genome are an important factor in low therapeutic effectiveness. Nonetheless, the prevalence of these mutations in HBV strains isolated previously in Indonesia has not been systematically examined. Therefore, in this study, we investigated the profile of mutations in the RT region and the associations of these mutations with amino acid changes in the surface protein in the virus of treatment-naive Indonesian HBV carriers. Overall, 96 sequences of the full-length Indonesian HBV genomes (genotype B, n = 54; genotype C, n = 42) were retrieved from the National Center for Biotechnology Information. Naturally occurring primary and/or compensatory drug resistance mutations were found in 6/54 (11.1%) genotype B strains and in 1/42 (2.4%) genotype C strains. The potential mutations underlying resistance to a nucleos(t)ide analog and/or pretreatment mutations were more frequent in both genotypes but more frequent in genotype C strains than in genotype B strains. The A-B interdomain region in the RT gene was more frequently mutated in genotype C than in genotype B (3.51 ± 2.53 vs. 1.08 ± 1.52, P ＜ 0.001). Knowledge about the mutational profiles of the RT gene and changes in the surface protein may help clinicians to select the most appropriate antiviral drug and vaccination or HBV immunoglobulin regimen for management of HBV infection in Indonesia.

A nucleos(t)ide analog (NA) is the common antiviral drug available for directly treating hepatitis B virus (HBV) infection. However, its application has led to the emergence of NA-resistant mutations mostly in a conserved region of the reverse transcriptase domain of HBV polymerase. Harboring NA-resistant mutations decreases drug effectiveness and increases the frequency of end-stage liver disease. The invention of next-generation sequencing that can generate thousands of sequences from viral complex mixtures provides opportunities to detect minor changes and early viral evolution under drug stress. The present study used ultra-deep sequencing to evaluate discrepant quasispecies in the reverse transcriptase domain of HBV including NA-resistant hotspots between seven treatment-naïve Indonesian patients infected with HBV and five at the early phase of treatment. The most common sub-genotype was HBV B3 (83.34%). The substitution rate of variants determined among amino acids with a ratio of ≥ 1% changes was higher among the population in conserved regions (23.19% vs. 4.59%, P = 0.001) and in the inter-reverse transcriptase domain (23.95% vs. 2.94%, P = 0.002) in treatment naïve, than in treated patients. Nine hotspots of antiviral resistance were identified in both groups, and the mean frequency of changes in all patients was < 1%. The known rtM204I mutation was the most frequent in both groups. The lower rate of variants in HBV quasispecies in patients undergoing treatment could be associated with virus elimination and the extinction of sensitive species by NA therapy. The present findings imply that HBV quasispecies dynamically change during treatment.

This study demonstrated that Indonesian patients with chronic hepatitis C (mostly ethnic Java people) mostly were infected with hepatitis C virus (HCV) genotype 1; however, they carried mainly the major genotypes of interleukin 28B (IL-28B) single nucleotide polymorphisms (SNPs) (rs12979860 CC, rs11881222 TT, rs8103142 AA, and rs8099917 TT), and they mostly achieved sustained virological responses to pegylated interferon/ribavirin treatment.

Objective: The long-term administration of a nucleos(t)ide analogue (NA) for the treatment of chronic hepatitis B may encourage the emergence of viral mutations associated with drug resistance. Minor populations of viruses may exist before treatment, but are difficult to detect because of technological limitations. Identifying minor viral quasispecies should be useful in the clinical management of hepatitis B virus (HBV) infection. Methods: Six treatment-naïve Indonesian patients with chronic HBV infection participated in this study. The polymerase region of the HBV genome, including regions with known drug-resistant mutations, was subjected to capillary sequencing and MiSeq sequencing (Illumina). Mutations were analyzed with Genomics Workbench software version 6.0.1 (CLC bio). Results: The mean mapping reads for the six samples was 745,654, and the mean number of amplified fragments ranged from 17,926 to 25,336 DNA reads. Several known drug-resistant mutations in the reverse transcriptase region were identified in all patients, although the frequencies were low (0.12-1.06%). The proportions of the total number of reads containing mutations I169L/M, S202R, M204I/L or N236S were >1.0%. Conclusion: Several known NA-resistant mutations were detected in treatment-naïve patients in Indonesia using deep sequencing. Careful management of such patients is essential to prevent drug-resistant mutations from spreading to other patients.