Dwi Prasetyo

Burden of Severe Rotavirus Diarrhea in Indonesia

Globally, rotavirus is the leading cause of diarrhea-related hospitalizations and deaths among young children, but the burden of rotavirus disease in Indonesia is poorly documented. From January through December 2006, we conducted prospective surveillance (inpatient and outpatient) among children aged <5 years at 6 hospitals in 6 provinces of Indonesia, using standardized methodology. Of 2240 enrolled children hospitalized for diarrhea, 1345 (60%) were rotavirus positive. Of 176 children enrolled in outpatient clinics in 3 hospitals, 73 (41%) were rotavirus positive. Among children hospitalized for diarrhea, dehydration was more common among those who tested positive for rotavirus than among those who did not (91% vs 82%; P < .05), as was vomiting (86% vs 67%; P < .05). Children aged 6-23 months experienced 72% of all rotavirus episodes. Rotavirus prevalence increased slightly in the cool, dry season. The most commonly detected genotypes were G9 (30%) and P[6] (56%). G1P[6] and G9P[6] accounted for 34% and 21% of strains, respectively. A high proportion of genotype P[6] was detected, in combination with the common G types G1 and G9. Available rotavirus vaccines would likely be efficacious against the most common circulating strains, but continued monitoring of uncommon genotypes is needed.

Association between Severe Dehydration in Rotavirus Diarrhea and Exclusive Breastfeeding among Infants at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.

Background. Rotavirus is the leading cause of severe acute diarrhea in children. Infants who are exclusively breastfed develop fewer infections and have less severe illnesses. This study aimed to determine association between severe dehydration in rotavirus diarrhea and exclusive breastfeeding. Methods. This is a cross-sectional study in infants ≤ 6 months old with acute diarrhea in Dr. Hasan Sadikin Hospital, Bandung, Indonesia. Results. From 134 infants ≤ 6 months old with acute diarrhea enrolled from April 2009 to December 2012, there were 88 (65.6%) boys and 46 (34.4%) girls in this study. Rotavirus was detected in 60 (44.8 %), 32 (53.3%) of whom were exclusively breastfed. From rotavirus positive subjects, severe dehydration occurred in 4 (12.6%) exclusively breastfed infants and 6 (21.5%) not exclusively breastfed infants. No significant association was found between severe dehydration and exclusive breastfeeding (p = 0.491) in rotavirus diarrhea. Conclusions. In rotavirus diarrhea, there was no significant association between exclusive breastfeeding and severe dehydration.

Diarrhea among hospitalized children under five: A call for inclusion of rotavirus vaccine to the national immunization program in Indonesia

CONTEXT Rotavirus diarrhea is a common disease worldwide which mostly affects children under five years old. Rotavirus infection causes severe diarrhea and leads to substantial health care costs. In Indonesia the rotavirus vaccine has been available since 2011, however it has not been included into the National Immunization Program. This study aims to describe the proportion of rotavirus in children under 5 in Indonesia, the clinical characteristics of rotavirus infections, and the rotavirus strains circulating in the country during 2010-2015. METHODS Children under five years of age with acute watery diarrhea were prospectively identified and enrolled through the active diarrhea surveillance system in 5 sites in four provinces in Indonesia during 2010-2015. The rotavirus specimens were tested using Enzyme Immunoassay. Bivariate logistic regression tests were performed to compare rotavirus positive and negative results with respect to the collected demographic and clinical variables. RESULTS From January 2010 to December 2015, the average annual rotavirus prevalence among children hospitalized with acute watery diarrhea in four provinces in Indonesia was 47.5%. Rotavirus diarrhea occurred mostly in children under 2 years of age. Of all age groups, children aged 6-11 and 12-23 months had the highest prevalence of rotavirus diarrhea in all years (54.2% and 50.6%, respectively). This study found that the most prevalent of G and P genotypes were G1P8 in 2010 (63.2%), 2011 (64.1%) and 2012 (74.6%) and G3P8 in 2013 (49.7%), 2014 (82.5%) and 2015 (84.4%) CONCLUSIONS: This study demonstrates that rotavirus is a major cause of diarrhea in hospitalized children in Indonesia. These findings highlight the need for inclusion of the rotavirus vaccine to the National Immunization Program in Indonesia.

Pancreatic exocrine insufficiency in malnourished children and those with persistent diarrhoeae.

BACKGROUND AND OBJECTIVES Persistent diarrhoea, a serious health problem, is closely related to malnutrition. Children with severe malnutrition have a 9-fold risk of death, and children with severe stunting have a 4-fold risk of death. Prolonged mucosal injury from diarrhoea causes reduced secretin and cholecystokinin secretion, which decreases stimulation to the pancreas, and is indicated by faecal elastase-1 levels. This further aggravates persistent diarrhoea and malnutrition because of the low levels of digestive enzyme production. This study evaluated the exocrine function of the pancreas in children with persistent diarrhoea and malnutrition. METHODS AND STUDY DESIGN This study used a cross-sectional design to compare exocrine pancreatic function among children with persistent diarrhoea, children with malnutrition, and apparently healthy children as reference Children aged 6-60 months were selected from the inpatient and outpatient units of various general hospitals in Jakarta. Faecal elastase- 1 levels were used to determine exocrine pancreatic function. RESULTS The median values of faecal elastase- 1 in children with persistent diarrhoea, children with malnutrition, and reference children were 743 (1-1503) mcg/g, 861 (17-2909) mcg/g, and 1210 (26-3000) mcg/g, respectively. A significant difference was observed in the faecal elastase-1 levels between reference children and those with persistent diarrhoea (p<0.001). However, no differences in the faecal elastase-1 levels were noted between malnourished and reference children (p>0.05). Children with both persistent diarrhoea and malnutrition showed mean FE-1 392.3±206.9 and median 419 (125- 593). CONCLUSIONS Exocrine pancreatic insufficiency is found in children with persistent diarrhoea. Children with combined persistent diarrhoea and malnutrition have the lowest FE-1, to which persistent diarrhea has the most significant contribution.

Correlation between climate variations and rotavirus diarrhea in under-five children in Bandung.

ABSTRACT Objective To find correlations between climate variations (temperature, rainfall, humidity, and wind speed) and the prevalence of rotavirus diarrhea, particularly evinced by hospital admission. Methods Stool specimens were obtained from under five-year-old children suffering from acute diarrhea at the Dr. Hasan Sadikin General Hospital over the period from April 2009 to December 2012. Stool specimens were obtained from the sick children within 24 h of their hospital admission. Weather information was obtained monthly. Results From 945 stool specimens, rotavirus was positively identified in 427 (45.2%) of them. Correlation of rotavirus diarrhea prevalence to temperature, rainfall, humidity, and wind speed were amounted to r = −0.427, r = 0.101, r = 0.536 and r = −0.069, respectively. No significant correlation could be determined to link the prevalence of rotavirus to either the dry and the wet season (P = 0.939). A slight seasonal climate variation was shown in the dry season, where the rotavirus was found to be positive in 250 out of 552 specimens (45.3%). However, in the wet season, only 177 out of the 393 specimens (45.0%) were proved to be positive. Conclusions Our study showed that rotavirus is found year-round, and has a negative correlation to temperature, a moderate correlation only to humidity, but no significant correlation at all to either rainfall or wind speed.

Prevalence of HBsAg positive among non- immunized junior high school students in Bandung

Background Sero-epidemiologic survey of hepatitis B is used to determine the prevalence of hepatitis B infection in community, particularly among population which has not been covered by hepatitis B immunization program. Objective To determine the prevalence of HBsAg positive among junior high school’s students in Bandung. Methods A cross-sectional study was conducted on junior high school (SMP) students. Subjects were selected randomly using stratified cluster sampling of 4 junior high schools in Bandung. The inclusion criteria were students of first and second grade, lived in Bandung area, without history of hepatitis B immunization. Subjects were interviewed and were screened for HBsAg using Reverse Passive Hemagglutination technique. Results There were 341 subjects consisted of 201 girls and 140 boys. None of the subjects had any sexual intercourse or intravenous drugs, while 261 subjects (76.5%) had shared personal care. History of blood transfusion was found in 13 subjects (3.8%), tattooing in 2 (3.8%), body piercing in 28 (8.2%), and contact with chronic liver disease patients in 16 (4.7%). Based on HBsAg serologic test, 3 subjects (2 boys and 1 girl) were found to be positive, thus HBsAg positive prevalence was 0.9% (95%CI -0.001;0.019). Two of them had shared personal care with their relatives or friends. None of them had tattoo, body pierce, blood transfusion, or contact with chronic liver disease patients. Their physical condition were within normal limit. One of them refused to do further laboratory tests because no permission from his parents. Liver function of those students were normal, anti-HBc IgM were negative, and total anti- HBc were positive in two of them. Conclusion The prevalence of HBsAg positive in junior high school students in Bandung is low and there is no obvious risk factor for the transmission of the disease.