Cissy B. Kartasasmita

Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis

Summary Background The global burden of disease attributable to respiratory syncytial virus (RSV) remains unknown. We aimed to estimate the global incidence of and mortality from episodes of acute lower respiratory infection (ALRI) due to RSV in children younger than 5 years in 2005. Methods We estimated the incidence of RSV-associated ALRI in children younger than 5 years, stratified by age, using data from a systematic review of studies published between January, 1995, and June, 2009, and ten unpublished population-based studies. We estimated possible boundaries for RSV-associated ALRI mortality by combining case fatality ratios with incidence estimates from hospital-based reports from published and unpublished studies and identifying studies with population-based data for RSV seasonality and monthly ALRI mortality. Findings In 2005, an estimated 33·8 (95% CI 19·3–46·2) million new episodes of RSV-associated ALRI occurred worldwide in children younger than 5 years (22% of ALRI episodes), with at least 3·4 (2·8–4·3) million episodes representing severe RSV-associated ALRI necessitating hospital admission. We estimated that 66 000–199 000 children younger than 5 years died from RSV-associated ALRI in 2005, with 99% of these deaths occurring in developing countries. Incidence and mortality can vary substantially from year to year in any one setting. Interpretation Globally, RSV is the most common cause of childhood ALRI and a major cause of admission to hospital as a result of severe ALRI. Mortality data suggest that RSV is an important cause of death in childhood from ALRI, after pneumococcal pneumonia and Haemophilus influenzae type b. The development of novel prevention and treatment strategies should be accelerated as a priority. Funding WHO; Bill & Melinda Gates Foundation.

Respiratory syncytial virus infection: denominator-based studies in Indonesia, Mozambique, Nigeria and South Africa

OBJECTIVE To assess the burden of respiratory syncytial virus (RSV)-associated lower respiratory infections (LRI) in children in four developing countries. METHODS A WHO protocol for prospective population-based surveillance of acute respiratory infections in children aged less than 5 years was used at sites in Indonesia, Mozambique, Nigeria and South Africa. RSV antigen was identified by enzyme-linked immunosorbent assay performed on nasopharyngeal specimens from children meeting clinical case definitions. FINDINGS Among children aged < 5 years, the incidence of RSV-associated LRI per 1000 child-years was 34 in Indonesia and 94 in Nigeria. The incidence of RSV-associated severe LRI per 1000 child-years was 5 in Mozambique, 10 in Indonesia, and 9 in South Africa. At all study sites, the majority of RSV cases occurred in infants. CONCLUSION These studies demonstrate that RSV contributes to a substantial but quite variable burden of LRI in children aged < 5 years in four developing countries. The possible explanations for this variation include social factors, such as family size and patterns of seeking health care; the proportion of children infected by human immunodeficiency syndrome (HIV); and differences in clinical definitions used for obtaining samples. The age distribution of cases indicates the need for an RSV vaccine that can protect children early in life.

The Epidemiology of Respiratory Syncytial Virus Lower Respiratory Tract Infections in Children Less than 5 Years of Age in Indonesia

Background: Although the epidemiology of respiratory syncytial virus (RSV) lower respiratory tract infections (LRI) is well known in industrialized countries, the burden in developing Asian countries is not well studied. Methods: To define the burden of RSV disease in children <5 years of age in rural and urban Indonesia, infants and children were enrolled from peri-urban and rural subdistricts, in the following 2 cohorts: (a) a cross-sectional cohort of approximately 100 children from each of 2 subdistricts in the following 5 age groups: 3 to 5, 6 to 8, 9 to 11, 12 to 23, and 24 to 48 months; (b) a birth cohort of all newborns in both subdistricts during the 28 months of the study. All subjects were visited weekly at home. Children with World Health Organization-defined LRI or wheezing had a nasal wash for detection of RSV using an enzyme immunoassay and polymerase chain reaction. Results: Of the 2014 children studied, 1074 were in the cross-sectional and 940 in the newborn cohorts. Of the 802 episodes of LRI, 163 were caused by RSV. The RSV LRI incidence per 1000 child-years (C-Y) was higher in rural areas (57.25 vs. 38.54), P < 0.05. No RSV LRI occurred in the first 2 months of life and the peak incidence was in the 6- to 8-month-old infants (103/1000 C-Y). The rates were lowest in those <6 months, 16.5 per 1000 C-Y, compared with 83.1 per 1000 C-Y in those 6 to 11 months of age (P < 0.001), 66.99 in those 12 to 23 months of age, and 28.1 in 2- to 5-year-olds. Conclusions: In Indonesia, the incidence of RSV LRI in the first 6 months of life is relatively low with most disease occurring in older children.

Otitis media in indonesian urban and rural school children.

Background: Although the epidemiology of otitis media is well-known in industrialized countries, the extent of otitis media in developing Asian countries, especially in south East Asia is not well studied. Methods: To define the burden of otitis media and its sequelae in children 6–15 years of age, we enrolled elementary and junior high school children in 6 areas in rural and urban Indonesia. Randomly selected schools and classrooms were selected. All children were administered a questionnaire and had ear examinations, pneumatic otoscopy and screening audiometry. Children with any abnormality on examination or with a relevant history underwent diagnostic audiometry and tympanometry, if indicated. Results: Of the 7005 children studied, 116 had chronic suppurative otitis media (CSOM), 30 had acute otitis media and 26 had otitis media with effusion. 2.7% of rural children had CSOM compared with 0.7% of urban children (P < 0.0001). The rates per 1000 of CSOM in rural Bali and Bandung were significantly higher (75 and 25, respectively) than in the rest of Indonesia (P < 0.05). In rural Bali, the rate per 1000 children of inactive CSOM was 63 in 6- to 9-year-old children, compared with 37 in children aged 13–15 years. Concomitantly, the rates of tympanosclerosis were 7 and 26/1000, respectively, in these age groups. Conclusions: In Indonesia, the prevalence of CSOM is relatively high with most disease occurring in rural areas. The high rates in rural Bali with early progression to tympanosclerosis suggest a significant burden of potentially vaccine preventable illness.

A qualitative study on knowledge, perceptions, and attitudes of mothers and health care providers toward pneumococcal conjugate vaccine in Bandung, West Java, Indonesia.

UNLABELLED Due to the high burden of pneumonia in Indonesia, the inclusion of pneumococcal conjugate vaccine (PCV) into Indonesias National Immunization Program (NIP) is recommended by World Health Organization. Prior to the introduction of new vaccines, it is imperative to assess the perceptions of the public and medical community about the disease and the vaccine. The purpose of this qualitative study was to explore the knowledge, perceptions, and attitudes of mothers and health care providers (HCPs) toward PCV in Bandung, West Java, Indonesia. METHODOLOGY Fifty-five respondents (26 mothers and 29 HCPs) were interviewed at public and private health care facilities in Bandung using semi-structured interviews in May-June 2011. Data were analyzed manually according to pre-defined themes. RESULTS Although most mothers had low knowledge about PCV, did not perceive themselves as susceptible to the disease, perceived that cost was the main barrier to PCV access, and obtained little information on PCV, they considered pneumonia as a severe disease and a priority health problem, perceived benefits of the vaccine, and were likely to adopt it. Similarly, knowledge about PCV among most HCPs was limited. Despite perceiving cost as the main barrier, most HCPs perceived benefits of the vaccine, susceptibility and severity of the disease, regarded pneumonia as a priority health problem, and were likely to suggest the new vaccination. DISCUSSION/CONCLUSIONS Despite the poor knowledge of mothers and HCPs about PCV, they are aware of the high burden of pneumonia and the need for a vaccine in the NIP. Perceived severity and benefits among mothers, and, additionally, perceived susceptibility among HCPs were manifested in the willingness to accept PCV. The findings would contribute to better understanding the factors, which could support decision-making about vaccine introduction, and be utilized for developing suitable messages for mothers and HCPs.

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.

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.

Demographic and ecological risk factors for human influenza A virus infections in rural Indonesia

Indonesia has the worlds highest reported mortality for human infections with highly pathogenic avian influenza (HPAI) A(H5N1) virus. Indonesia is an agriculturally driven country where human‐animal mixing is common and provides a unique environment for zoonotic influenza A virus transmission.

533 Viral Respiratory Infections and the Development of Atopy and Asthma.

Background There is an association between severe RSV bronchiolitis in early childhood, recurrent wheezing, asthma, and allergy in later childhood. And also becomes increasingly evident that other viruses such as RV, also showed association with the development of asthma. The objective of this study is to know the relationship between viral respiratory infections in the first 5 years of age and the development of atopy and asthma. Methods This study is a prospective follow-up study in 2 communities, 9 years after a respiratory infection study was performed. Assessment included questionnaires, physical examination, skin prick tests (SPT), pulmonary function test (PFT), and reversibility testing. Results Three hundred thirty-two children, age 7 to 14 years, including 182 (54.8%) boys, were enrolled in the study. In 86 children, histories of viral respiratory infections (RSV, RV, and hMPV) were detected. The rate of positive SPT was high (81.6%), and 15 (4.5%) children showed dermatographism. The percentage of positive SPT among children with and without viral respiratory infections was almost similar (83.4% vs 85.4%). The positive SPT > 1 in children with history of viral respiratory infections was 65.9%; 5.9% with 1 positive, 27.1% with 2 to 3 positive, 20% with 4 to 5 positive and 18.8% with > 5 positive; while the positive SPT > 1 in the non viral respiratory infections was 75,3%; 9.3%, 23.9%, 30.4%, and 21.1%, respectively. The difference between those 2 groups of children was not significant (P = 0.076). History of asthma in the children with history of respiratory infections was higher compared with the non infections group (19.7% vs 8.1%). However, the spirometry results show no difference (P > 0.05) of FEV1 < 80%, FVC < 80%, FEV1/FVC < 80% and bronchodilator response > 12%, between those 2 groups. Conclusions The positive rate of SPT in the children is high, but no difference is found between history of viral respiratory infections in early life in relation to the later development of atopy and asthma. The spirometry test results show no difference between the 2 groups.