Arwin Ap Akib

Reduced seroconversion to measles in infants given vitamin A with measles vaccination

Administration of 100,000 IU vitamin A at the time of measles immunisation is currently recommended for infants in developing countries. However, the safety and value of giving vitamin A, a potent immune enhancer, with live measles virus vaccines are unknown. We conducted a randomised, double-blind, placebo-controlled clinical trial in Indonesia to evaluate the effect of simultaneous vitamin A supplementation on the immune response to measles immunisation at six months of age. 336 infants received either vitamin A (100,000 IU) or placebo when immunised with standard-titre Schwarz measles vaccine. 82% of infants seroconverted to measles. In a multiple logistic regression model adjusting for maternal antibody titres, vitamin A supplementation was associated with a lower likelihood of seroconversion to measles (odds ratio 0.40, 95% CI 0.19-0.88), and girls were less likely to seroconvert than boys (0.34, 0.15-0.76). Immunisation with standard-titre Schwarz vaccine at six months of age in this study population is characterised by high seroconversion rates. However, simultaneous high-dose vitamin A may interfere with seroconversion to live measles vaccine in infants with maternal antibody.

The influence of vitamin A status on iron-deficiency anaemia in anaemic adolescent schoolgirls in Myanmar.

OBJECTIVE The present study was conducted to investigate reasons for the high prevalence of anaemia among adolescent schoolgirls and to elucidate the role of vitamin A in contributing to Fe-deficiency anaemia (IDA). DESIGN Among 1269 schoolgirls who were previously screened for anaemia (Hb < 120 g/l), 391 anaemic girls were further assessed for Fe, vitamin A and subclinical inflammation status. Fe and vitamin A indicators were corrected for inflammation and were compared in the Fe-deficient and non-deficient groups as well as between those with and without inflammation. Logistic regression was done to determine whether vitamin A status and subclinical inflammation were risk factors for Fe deficiency. The differences in Fe status among tertiles of vitamin A concentrations were assessed using ANOVA. SETTING Myanmar. SUBJECTS Adolescent schoolgirls (n 391). RESULTS One-third of the anaemia (30·4%) was IDA. Prevalence of low vitamin A status (serum retinol <1·05 μmol/l) was 31·5%. Fe and vitamin A status were significantly different between the IDA and non-IDA groups and also based on their inflammation status. Logistic regression showed that low vitamin A status was a significant predictor for being Fe deficient (OR = 1·81; 95% CI 1·03, 3·19 and OR = 2·31; 1·31, 4·07 in the middle (1·056-1·298 μmol/l) and low (≤1·056 μmol/l) vitamin A tertiles, respectively). ANOVA showed that better Fe status was associated with a higher concentration of serum retinol but only in IDA. CONCLUSIONS Fe deficiency was not the main cause of anaemia in the present population. The role of vitamin A as well as other micronutrients should be taken into account in addressing the problem of anaemia.

Folate and vitamin B12 status and dietary intake of anaemic adolescent schoolgirls in the delta region of Myanmar.

The aim of the present study was to assess the prevalence of deficiency of folate and vitamin B12 and, simultaneously, the nutrient intake adequacy of folate, vitamin B12, iron, vitamin A, vitamin C, vitamin B6 and calcium in 391 adolescent anaemic (Hb<120 g/l) schoolgirls living in the delta region of Myanmar (Burma). Dietary intakes were assessed using a 3 d estimated food record. The distribution of observed intakes calculated from the food records were adjusted for usual intakes, and the prevalence of inadequacy was estimated using the estimated average requirement cut-point method. Median (first, third quartile) serum folate and vitamin B12 concentrations were 6·5 (4·6, 8·5) nmol/l and 612·8 (443·2, 795·2) pmol/l, respectively. The prevalence of folate deficiency defined as <6·8 nmol/l was 54 %; however, vitamin B12 deficiency defined as <148 pmol/l was negligible (<1 %). The prevalence of inadequate intake of folate was high (100 %) as was the prevalence of inadequate intakes of vitamin A, vitamin C, vitamin B6 and calcium, ranging from 60 to 100 %. Red meat or poultry was rarely consumed, but fish was consumed on a daily basis. Green leafy vegetables were also consumed frequently but consumption of dairy products was uncommon. Folate deficiency was high, and the prevalence of inadequate intake of folate among other key micronutrients was relatively common in this sample of anaemic adolescent schoolgirls. Appropriate strategies such as food fortification and dietary diversification are needed to improve the micronutrient status of these young women to ensure optimal health and future reproductive success.

Jadwal Imunisasi Anak Usia 0 – 18 tahun Rekomendasi Ikatan Dokter Anak Indonesia 2017

Ikatan Dokter Anak Indonesia melalui Satuan Tugas Imunisasi mengeluarkan rekomendasi Imunisasi IDAI tahun 2017 untuk menggantikan jadwal imunisasi sebelumnya. Jadwal imunisasi 2017 ini bertujuan menyeragamkan jadwal imunisasi rekomendasi IDAI dengan jadwal imunisasi Kementerian Kesehatan RI khususnya untuk imunisasi rutin. Jadwal imunisasi 2017 juga dibuat berdasarkan ketersediaan kombinasi vaksin DTP dengan hepatitis B seperti DTPw-HB-Hib, DTPa-HB-Hib-IPV, dan dalam situasi keterbatasan atau kelangkaan vaksin tertentu seperti vaksin DTPa atau DTPw tanpa kombinasi dengan vaksin lainnya. Hal baru yang terdapat pada jadwal 2017 antara lain: vaksin hepatitis B monovalen tidak perlu diberikan pada usia 1 bulan apabila anak akan mendapat vaksin DTP-Hib kombinasi dengan hepatitis B; bayi paling sedikit harus mendapat satu dosis vaksin IPV (inactivated polio vaccine) bersamaan (simultan) dengan OPV-3 saat pemberian DTP-3; vaksin DTPw direkomendasikan untuk diberikan pada usia 2,3 dan 4 bulan. Hal baru yang lain adalah untuk vaksin influenza dapat diberikan vaksin inaktif trivalen atau quadrivalen, vaksin MMR dapat diberikan pada usia 12 bulan apabila anak belum mendapat vaksin campak pada usia 9 bulan. Vaksin HPV apabila diberikan pada remaja usia 10-13 tahun, pemberian cukup 2 dosis dengan interval 6-12 bulan; respons antibodi setara dengan 3 dosis. Vaksin Japanese Encephalitis direkomendasikan untuk diberikan mulai usia 12 bulan pada daerah endemis atau pada turis yang akan bepergian ke daerah endemis. Vaksin dengue direkomendasikan untuk diberikan pada anak usia 9-16 tahun dengan jadwal 0, 6, dan 12 bulan. Dengan pemberian imunisasi sesuai rekomendasi, diharapkan anak-anak Indonesia terlindungi dari penyakit infeksi yang dapat dicegah dengan imunisasi.

A Case of HIV (Human Immunodeficiency Virus) Infected Child Born to HIV Positive Mother

A case of HIV infected Indonesian baby girl bom from an HIV positive mother is reported. This is the first HIV infected child reported in Indonesia. The diagnosis was based on the positive DNA HIV and HIV culture in the babys blood taken at 3 days old. At this time the baby is still asymptomatic. Despite this we gave her prophylactic treatment against Pneumocystis Carinii infection to prevent the possibility of Pneumocystis Carinii Pneumonia which is usually fatal under 1 year old. The positive HIV at 3 days old may indicative of intrauterine nans mission. Because she is still asymptomatic, the intrauterine infection may be occured during late gestation. In spite of this we hope that the HIV- infection in this baby is not a progressive one.

Penyakit Respiratorik pada Anak dengan HIV

Latar belakang. Kejadian AIDS pada anak meningkat seiring dengan peningkatan kasus dewasa. Gejala dan manifestasi klinis sering tidak khas, sehingga menyebabkan underdiagnosis. Anak HIV sering datang dengan keluhan yang berasal dari infeksi oportunistik, bahkan infeksi oportunistik banyak ditemukan sebagai penyebab kematian. Salah satu infeksi oportunistik yang sering terjadi adalah infeksi respiratorik. Tujuan penelitian. Penelitian ini bertujuan untuk melihat pola penyakit respiratorik pada anak HIV yang dirawat di Bagian Ilmu Kesehatan RS Dr. Cipto Mangunkusumo (RSCM), Jakarta. Metoda. Data berasal dari rekam medis anak HIV tahun 2002-2005. Penelitian dilakukan dengan desain potong lintang. Kriteria inklusi adalah anak usia 0-13 tahun, dengan HIV positif dan menderita penyakit respiratorik. Data yang dicatat meliputi umur, jenis kelamin, faktor risiko, status gizi, parut BCG, diameter uji tuberkulin, riwayat kontak dengan pasien tuberkolosis, kategori HIV, diagnosis penyakit respiratorik, outcome. Data klinis khusus meliputi batuk kronik berulang, demam lama, sesak nafas, laboratorium rutin, foto torak, dan kadar CD4, PCR. Hasil. Sejak Januari 2002-Desember 2005, telah dirawat 85 anak yang terinfeksi HIV, dengan 13 orang (15,2%) di antaranya meninggal. Tiga belas orang (13/35) didiagnosis HIV berdasarkan serologi dan PCR, 24/35 hanya dengan serologi, dan 1/35 orang dengan PCR. Sebanyak 38 (44,7%) orang menderita infeksi respiratorik dengan pola penyakit: TB 47,3%, pneumonia 44,7%, pneumocytis corinii pneumonia (PCP) 13,1%. Pada penelitian ini, didapatkan bahwa 3/38 (7,8%) anak HIV dengan penyakit paru meninggal karena pneumonia berat, dengan 2/3 di antaranya pada kelompok umur 1-5 tahun. Penyebab kematian lainnya adalah PCP 2/38 pasien (5,2%), dan tersangka sepsis pada 2 pasien (5,2%). Kesimpulan. Pada anak HIV, TB merupakan penyakit respiratorik terbanyak, diikuti pneumonia, sedangkan penyebab kematian terbanyak adalah pneumonia. Penyakit respiratorik pada anak HIV dapat menjadi pembuka jalan untuk diagnosis anak HIV.

Artritis Idiopatik Juvenil Kesepakatan Baru Klasifikasi dan Kriteria Diagnosis Penyakit Artritis pada Anak

Klasifikasi dan kriteria diagnosis penyakit reumatik anak sudah sering menimbulkan kontroversi para peneliti dan ahli reumatologi. Dengan berkembangnya spesialisasi reumatologi pediatri dalam ruang lingkup yang luas, maka berbagai ketidaksepahaman tersebut sudah selayaknya diselesaikan dalam suatu kesepakatan. Prakarsa ILAR membuat nomenklatur baru AIJ di Santiago (1994) serta revisi Durban (1997) patut mendapat penghargaan semua pihak karena diharapkan akan dapat menjadi pemersatu untuk mempermudah komunikasi antar dokter dan peneliti. Kriteria AIJ diharapkan dapat mengidentifikasi kelompok homogen penderita artritis pada anak, untuk mempermudah penatalaksanaan dan penentuan prognosis penderita, serta merancang dan melakukan penelitian di bidang re umatologi pediatri seperti misalnya penelitian imunogenetik dan ilmu kedokteran dasar lainnya, epidemiologi, prognosis, dan uji terapetik. Walaupun pemakaian kriteria Durban di lapangan belum teruji dengan baik, laporan yang sudah ada menunjukkan bahwa tidak tertutup kemungkinan untuk melakukan revisi ulang kriteria AIJ. Dengan demikian maka terpulang kepada kita, apakah akan memakainya sekarang ataukah menunggu sampai keluar revisi berikutnya yang sudah tentu lebih tahan uji.

Asma pada Anak

Asma pada anak mempunyai berbagai aspek khusus yang umumnya berkaitan dengan proses tumbuh dan kembang seorang anak, baik pada masa bayi, balita, maupun anak besar. Peran atopi pada asma anak sangat besar dan merupakan faktor terpenting yang harus dipertimbangkan dengan baik untuk diagnosis dan upaya penatalaksanaan. Mekanisme sensitisasi terhadap alergen serta perkembangan perjalanan alamiah penyakit alergi dapat memberi peluang untuk mengubah dan mencegah terjadinya asma melalui kontrol lingkungan dan pengobatan pada seorang anak. Pendidikan pada pasien dan keluarga merupakan unsur penting penatalaksanaan asma pada anak yang bertujuan untuk meminimalkan morbiditas fisis dan psikis serta mencegah disabilitas. Upaya pengobatan asma anak tidak dapat dipisahkan dari pemberian kortikosteroid yang merupakan anti-inflamasi terpilih untuk semua jenis dan tingkatan asma. Pemberian kortikosteroid topikal melalui inhalasi memberikan hasil sangat baik untuk mengontrol asma tanpa pengaruh buruk, walaupun pada anak kecil tidak begitu mudah untuk dilakukan sehingga masih memerlukan alat bantu inhalasi.

Incidence of HIV-infected infants born to HIV- infected mothers with prophylactic therapy: Preliminary report of hospital birth cohort study

Background Human immunodeficiency virus (HIV) is expanding rapidly and was reported double in several places in Indonesia To our knowledge, reports regarding HIV-infected infants are still scarce. Objectives To investigate the incidence of HIV-infected infants born to HIV- mothers who had received prophylaxis therapy at birth. Methods A prospective hospital-based cohort study was held from January 2003 until December 2004 in Cipto Mangunkusumo Hos- pital, Jakarta. The inclusion criteria were mothers with positive HIV and their infants had been given anti retroviral (ARV) therapy. The babies were followed up monthly and the status of infection was determined by PCR at the age of 4 weeks and 6 months. Outcome was measured based on PCR assays or clinical signs of HIV in- fection. Results The mothers’ age ranged from 19 to 27 years. All of them were carrying their first child and only 41% mothers took ARV pro- phylaxis. Almost all mothers underwent caesarean section and the infants had formula feeding. HIV infection was diagnosed in 7 in- fants and 2 of them had RNA assays more than 5,000 copies/ml. Six infants were negatives whereas 3 infants were diagnosed as indeterminate HIV infection and needed further examination. One needed no further investigation as the mother was seronegative. Conclusions Preventing HIV transmission from mother to infant can be done by giving ARV during prenatal, intrapartum, and post- natal period to the newborn. In our hospital, transmission was con- firmed in 6 of 17 infants. Unison protocol must be used and popu- lation of HIV-pregnant mother must be registered in order to know how high the transmission rate among Indonesian HIV people