Agus Sjahrurachman

The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance

BackgroundIn preparation of vaccines trials to estimate protection against shigellosis and cholera we conducted a two-year community-based surveillance study in an impoverished area of North Jakarta which provided updated information on the disease burden in the area.MethodsWe conducted a two-year community-based surveillance study from August 2001 to July 2003 in an impoverished area of North Jakarta to assess the burden of diarrhoea, shigellosis, and cholera. At participating health care providers, a case report form was completed and stool sample collected from cases presenting with diarrhoea.ResultsInfants had the highest incidences of diarrhoea (759/1 000/year) and cholera (4/1 000/year). Diarrhea incidence was significantly higher in boys under 5 years (387/1 000/year) than girls under 5 years (309/1 000/year; p < 0.001). Children aged 1 to 2 years had the highest incidence of shigellosis (32/1 000/year). Shigella flexneri was the most common Shigella species isolated and 73% to 95% of these isolates were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline but remain susceptible to nalidixic acid, ciprofloxacin, and ceftriaxone. We found an overall incidence of cholera of 0.5/1 000/year. Cholera was most common in children, with the highest incidence at 4/1 000/year in those less than 1 year of age. Of the 154 V. cholerae O1 isolates, 89 (58%) were of the El Tor Ogawa serotype and 65 (42%) were El Tor Inaba. Thirty-four percent of patients with cholera were intravenously rehydrated and 22% required hospitalization. V. parahaemolyticus infections were detected sporadically but increased from July 2002 onwards.ConclusionDiarrhoea causes a heavy public health burden in Jakarta particularly in young children. The impact of shigellosis is exacerbated by the threat of antimicrobial resistance, whereas that of cholera is aggravated by its severe manifestations.

The Evaluations of Bleach as Decontaminant Solution to Promote The Positivity Rate of Mycobacterium Tuberculosis Culture for Sputum Specimen

Background: Tuberculosis (TB) is still worldwide health problems. Sputum is contaminated by normal flora, that make its should be decontaminated prior to culture. Bleach known as a potent disinfectant, easy to access because it is commercially available, could be the alternative solution as decontaminant in TB culture. Aims Assessing the capability of bleach to promote the positivity rate in TB culture compared by others decontaminant solution. Method We use 35 sputum samples with volume 3-5 ml. The research was conducted at TB laboratory of Faculty of Medicine University of Indonesia, by using 35 samples sputum with positive AFB, 3-5 ml. Each sample was divided into 4 groups that were decontaminated by different methods. The methods are 4%NaOH, 2%NALC-NaOH, 5% oxalic acid and 1% bleach. 1% bleach was prepared from commercially bleach. The positive culture was validated using MPT 64. The culture positivity rate was compared based on its AFB score. Result Bleach had the same 100% positivity rate as the 4% NaOH and NALC for (+2) and (+3) AFB. However, its became smaller rate for the (+1) AFB group, which was 88% for bleach and 96% for NALC and 100% for NaOH. Oxalic acid had the smallest positivity rate in all AFB score compared to the others. Conclusion The positivity rate of the bleach as same as 4% NaOH and NALC for AFB score higher than (+2)

Antigenic differences between wildtype measles viruses and vaccine viruses in Indonesia

Measles virus has a single, negative strand RNA genome which codes 6 structural proteins: N, F, P, M, H and L. Currently there are several variances in the nucleotide sequences of N, F, M and H genes across wild type measles viruses, hence measles viruses can be categorized into clades and genotypes. The antigenicity of the previous genotype of measles is different from the current genotype. Objective To determine the antigenic differences between wild type measles virus and measles vaccine virus. Methods Analysis of the antigenic differences between wild type virus (G2, G3 and D9) and vaccine virus (CAM-70 and Schwarz) was performed by immunizing mice with the respective viruses. The serum was then tested with micro-cross-neutralization technique using the G2, G3, D9 and CAM-70 virus. Tests with cross ELISA examination technique were also performed using the same set of virus. Results Analysis of the cross neutralization test and cross ELISA showed that the highest antigenicity reaction was found between wild type virus with antibody against wild type virus, while the lowest reaction was between wild type virus with antibody against CAM-70. Conclusions We conclude that the antigenicity of antigenic protein from wild type virus is higher than antigenicity of vaccine virus protein. In addition, it was found that the antigenicity of proteins from Schwarz vaccine virus was higher than proteins CAM-70 vaccine virus. (Paediatr Indones 2008;48:125-35).

Differences of antigenic profiles on immunoblotting of wild type measles virus and vaccine virus in Indonesia

Background Measles virus has a negative, single strand RNA genome which codes for six important structural proteins. The genes of the wild type measles virus have many variances hence the nucleotide sequences of each wild type virus and vaccine virus are different. This differences lead to the antigenic differences between wild type and vaccine virus. Objective The purpose of this research is to investigate the differences in the antigenic profiles on immunoblotting between wild type and vaccine virus. Results The analysis results are 1) the antigen ofCAM-70 vaccine virus was less able in cross reacting with the antibodies from G2, G3, 09, CAM-70 and Schwarz; 2) The antibody aga inst CAM- 70 was only able to cross react with antigens of N protein and a few of antigens ofF proteins; 3) The wild type virus were very immunogenic, hence the antibody titers were very high; 4) The CAM-70 and MMR vaccine virus were less immunogenic, hence their antibody were very low; 5) The antibody responses that always occurred from all immunized mice serum were antibody for N and F proteins. However, the antibody against CAM-70 vaccine virus was still able to react with wild type virus (G2, G3 and 09). Conclusion All antigen-antibody reaction on immunoblotting resulted in different profiles especially between wild type virus and CAM-70 vaccine virus. Although CAM-70 vaccine virus showed clear differences compared to G2, G3 and 09 genotypes, antibodies against CAM-70 were still able to cross react with antigens from other genotypes (G2, G3 and D9).