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Genotypic analysis of hepatitis C virus in blood donors in Indonesia.

A study was conducted to describe the genetic diversity of hepatitis C virus (HCV) in a population of positive blood donors from throughout Indonesia. Repeat analysis by reverse transcription-polymerase chain reaction (RT-PCR) of 102 anti-HCV positive samples showed that 67 gave HCV-specific positive signals by the PCR for the 5'-untranslated genomic region of HCV. Further genotypic analysis on 64 HCV RNA-positive samples indicated that 57 belonged to the following individual genotypes: 1a, 1b, 2a, 2b, and 3b. The predominant HCV genotypes in this donor population were 1b (57.8%), 2a (17.2%), and 3b (10.9%). The core sequences of the 4 indeterminate samples when aligned with published sequences of various HCV genotypes showed a range of homology from 16.16% to 78.67%. Comparative analysis of genotypic representation from other anti-HCV-positive study populations, including polytransfused pediatric and adult renal dialysis groups, is now being carried out to determine the potential genotypic association with mechanistic HCV spread.

5' Untranslated Regions↗

Chloroquine/doxycycline combination versus chloroquine alone, and doxycycline alone for the treatment of Plasmodium falciparum and Plasmodium vivax malaria in northeastern Irian Jaya, Indonesia.

Combination therapy is one method of overcoming the global challenge of drug-resistant Plasmodium falciparum malaria. We conducted a hospital-based 28-day in vivo test comparing chloroquine/doxycycline to chloroquine or doxycycline alone for treating P. falciparum and Plasmodium vivax malaria in Irian Jaya, Indonesia. Eighty-nine patients with uncomplicated falciparum malaria were randomized to standard dose chloroquine (n = 30), doxycycline (100 mg every 12 hours [7 days], n = 20), or chloroquine with doxycycline (n = 39); corresponding numbers for vivax malaria (n = 63) were 23, 16, 24. Endpoints were parasite sensitivity (S) or resistance (RI/RII/RIII). Of the 105 evaluable patients, chloroquine/doxycycline cured (S) 20/22 (90.9% [95% CI 78.9-100%]) patients with P. falciparum malaria; 2/22 (9.1% [0-21%]) were RIII resistant. Doxycycline cured 11/17 (64.7% [42.0-87.4%]) patients, and chloroquine 4/20 (20% [2.5-37.5%]). Against P. vivax, chloroquine/doxycycline cured (S) 12/17 (70.6% [48.9-92.2%]) patients, doxycycline 4/12 (33.3% [6.6-59.9%]), and chloroquine 5/17 (29.4% [7.7-51.1%]). Chloroquine/doxycycline was effective against P. falciparum but only modestly effective against P. vivax. These findings support the use of chloroquine/doxycycline as an inexpensive alternative to mefloquine for treating chloroquine-resistant P. falciparum but not chloroquine-resistant P. vivax in this setting.

Adult↗

Therapy of uncomplicated falciparum malaria: a randomized trial comparing artesunate plus sulfadoxine-pyrimethamine versus sulfadoxine-pyrimethamine alone in Irian Jaya, Indonesia.

Combining artesunate with existing antimalarial drugs may improve cure rates, delay emergence of resistance, and reduce transmission. We performed a randomized comparative trial to quantify the effect of adding artesunate to sulfadoxine-pyrimethamine in the treatment of uncomplicated falciparum malaria in Indonesia. Using a modified 1997 World Health Organization protocol for assessment of therapeutic efficacy of antimalarial drugs, 105 patients (stratified by age/ethnic group) were randomized: 53 received artesunate orally, 4 mg/kg of body weight, a single daily dose for three days, plus sulfadoxine-pyrimethamine orally (1.25 mg of pyrimethamine/kg of body weight), a single dose on day 0, and 52 patients received sulfadoxine-pyrimethamine alone. Six from the combination group were withdrawn from analysis, as were six of the sulfadoxine-pyrimethamine group. Treatment failure rates on day 14 were 0% in the artesunate plus sulfadoxine-pyrimethamine group and 8.7% in the sulfadoxine-pyrimethamine group (P = 0.12). Treatment failure rates on day 28 were 4.4% and 15.2%, respectively (P = 0.16). Relative risk of treatment failure at 28 days was 0.3 (95% confidence interval [CI] = 0.1-1.3). Mean fever clearance time (1.3 versus 1.7 days) and mean parasite clearance time (1.4 versus 2.0 days) were both faster in the artesunate plus sulfadoxine-pyrimethamine group than in the sulfadoxine-pyrimethamine group (P = 0.08 and P < 0.0001, respectively). Only 20 (39.2%) of 51 patients treated with artesunate plus sulfadoxine-pyrimethamine were still parasitemic on day 1 compared with 45 (86.5%) of 52 patients treated with sulfadoxine-pyrimethamine alone (P = 0.000001, relative risk [RR] = 0.4, 95% CI = 0.3-0.6). Gametocyte carriage was lower following artesunate plus sulfadoxine-pyrimethamine than following sulfadoxine-pyrimethamine (RR = 0.5, 95% CI = 0.2-1.0 on day 7 and RR = 0.5, 95% CI = 0.2-1.1 on day 14). Mild diarrhea, rash, and itching resolved without treatment. Combined artesunate plus sulfadoxine-pyrimethamine resulted in more rapid fever and parasiteclearance, was well tolerated, reduced risk of treatment failure, and lowered gametocyte carriage.

Administration, Oral↗

Hepatitis C among child transfusion and adult renal dialysis patients in Indonesia.

Hepatitis C virus (HCV) prevalence among high-risk pediatric and adult patients was evaluated. The study included 269 adults and 150 children in a case-control research design. Risk factors of HCV exposure in Indonesia were assessed among adult renal dialysis patients and pediatric patients who received multiple blood transfusions. A high prevalence of anti-HCV was found among the adult renal dialysis patients, measured by second-generation electroimmunoassay tests. Family members of dialysis patients, who served as a comparison group for dialysis patients, were found to have a 9.0% seroprevalence. The prevalence of anti-HCV among pediatric patients with hematological disorders was found to be 39.0%. The comparison group seroprevalence (pediatric patients and family members) was 4.3% among sera available for confirmatory testing. Patients with history of hospitalization (odds ratio [OR] = 7.94, 95% confidence interval [CI]: 4.06-15.51, P = 0.0001), blood transfusion (OR = 6.85, 95% CI: 3.95-11.88, P = 0.0001), circumcision (OR = 2.39, 95% CI: 1.43-3.99, P = 0.0001), or marital partner/family member history of jaundice (OR = 3.62, 95% CI: 1.97-6.62, P = 0.0001) were found to have an increased odds of HCV exposure compared with individuals without similar histories.

Adolescent↗

High prevalence of Brugia timori infection in the highland of Alor Island, Indonesia.

To identify areas endemic for Brugia timori infection, a field survey was carried out in 2001 on Alor, East Nusa Tenggara Timor, Indonesia. Elephantiasis was reported on this island by villagers as a major health problem. Bancroftian filariasis was detected in four villages in the coastal area, whereas B. timori was identified in four rice-farming villages. No mixed infections with both species were found. In the highland village Mainang (elevation = 880 m), 586 individuals were examined for B. timori infection and 157 (27%) microfilaria carriers were detected. The prevalence of microfilaremic individuals standardized by sex and age was 25%. The geometric mean microfilarial density of microfilaremic individuals was 138 microfilariae/ml. Among teenagers and adults, males tended to have a higher microfilarial prevalence than females. Microfilaria prevalence increased with age and a maximum was observed in the fifth decade of life. In infected individuals, the microfilarial density increased rapidly and high levels were observed in those individuals 11-20 years old. The highest microfilaria density was found in a 27-year-old woman (6,028 microfilariae/ml). Brugia timori on Alor was nocturnally periodic, but in patients with high parasite loads, a small number of microfilariae was also detected in the day blood. The disease rate was high and many persons reported a history of acute filarial attacks. Seventy-seven (13%) individuals showed lymphedema of the leg that occasionally presented severe elephantiasis. No hydrocele or genital lymphedema were observed. This study showed that B. timori infection is not restricted to the lowland and indicated that it might have a wider distribution in the lesser Sunda archipelago than previously assumed.

Adolescent↗

Short report: therapeutic efficacy of chloroquine combined with primaquine against Plasmodium falciparum in northeastern Papua, Indonesia.

Chloroquine combined with primaquine was evaluated for therapy of uncomplicated malaria caused by Plasmodium falciparum in nonimmune Javanese migrants to northeastern Papua, Indonesia. Subjects were randomized to treatment with standard chloroquine therapy (25 mg/kg in 3 doses over the course of 48 hours) with 30 mg primaquine administered daily for 28 days (n = 25) or a placebo of primaquine (n = 28). The 14-day cumulative incidence of therapeutic failure was 56% with primaquine and 79% with placebo (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.1-1.3; P = 0.08). Primaquine administered daily created a marginally significant improvement in therapeutic efficacy at day 14, but not at day 7 (20% versus 36%; OR, 0.2; 95% CI, 0.1-1.8; P = 0.2) or day 28 (82% versus 93%; OR, 0.31; 95% Cl, 0.04-2.1; P = 0.23). This report corroborates studies suggesting that therapeutic doses of primaquine exert no discernible effect on parasitemia by P. falciparum.

Antimalarials↗

Transmission of epidemic dengue hemorrhagic fever in easternmost Indonesia.

In April 2001, a second suspected outbreak of dengue hemorrhagic fever in the easternmost region of Indonesia was investigated in Merauke, a town located in the southeastern corner of Papua, by the Indonesian Ministry of Health and the U.S. Naval Medical Research Unit No. 2. Principal case criteria of hemorrhagic disease provided for a study enrollment of 15 clinically acute and 37 convalescing subjects. Additionally, 32 comparable age/sex controls were selected from neighboring households. Laboratory diagnosis involved three testing methodologies: virus isolation by cell culture, a reverse transcriptase-polymerase chain reaction (RT-PCR) assay, and serologic assays. Antibody (IgM) to dengue virus was detected in 27% of the acute clinical cases, 30% of the convalescing cases, and only 3% of the matched controls. Dengue 3 was the only viral serotype detected from acute serum samples by the RT-PCR. The mean +/- SD age of the acute and convalescing cases was 7.8 +/- 5.4 years. Overall hospital records accounted for 172 suspected outbreak cases, all urban residents of Merauke with no recent travel history outside the area. The estimated outbreak-associated case fatality rate among all suspected dengue cases was 1.2%. A seven-year retrospective review of hospital records in Merauke showed negligible disease reporting involving hemorrhagic disease prior to the outbreak.

Adolescent↗

[A case of Hansen's disease seen in an Indonesian resident, and tracing of the patient after coming back to Indonesia].

A 26-year-old Indonesian male living in Japan consulted our hospital with complaint of fever, general malaise and infiltrative erythematous plaques associated with lymph node swelling. Physical examination revealed a sensation disorder in the distal portion of the extremities and hypertrophy of peripheral nerves. Histopathology of the skin lesion showed the multifocal granulomatous inflammation containing many acid-fast bacilli associated with infiltration of foam cells and neutrophils. Under the diagnosis of leprosy (LL type) accompanied by erythema nodosum leprosum, the combined chemotherapy (clofazimine, rifampicin, and diphenyl sulfone) was started. For the leprosy reaction, short-term administration of the systemic steroid was added. The general condition was carried out soon, and the sensation disorder has also been gradually improved. The patient came back to Indonesia after 6 months treatment because of the time limit of visa. We traced the patient's condition through personal networks, and knew that the patient could not have continual treatment for the disease, and that he is suffering from disability of hands and feet. In this case, several medical facilities were consulted before the final diagnosis of leprosy. The Japanese medical doctors should also remember this disease when they examine persons with infiltrative skin eruptions and sensation disorders.

Adult↗

Leprosy control in 7 districts of south Sulawesi, Indonesia, 1986-91.

This paper describes the leprosy control programme in 7 districts of the South Sulawesi Province in Indonesia. This province is reported to have the highest prevalence of leprosy in the country. The programme started in 1986 with re-registration of all patients on the cumulative registers. Strict criteria for admission of patients to MDT were initially applied. In 1990 it appeared that these criteria had been too strict, thus necessitating a second re-registration of patients still on DDS monotherapy. More flexible criteria for admission to MDT led to an increase in MDT coverage from 45% to 78% within 6 months. By April 1991, 5 years after the start of the programme, the registered prevalence had decreased from 4.4 per 1000 in 1986 to 1.6 per 1000; the coverage with MDT had increased from 6% in 1986 to 78%, and the case detection rate remained stable around 4 per 10,000 after an initial increase at the start of the programme.

Humans↗

Ultrastructure of Sarcocystis spp. (Protozoa: Apicomplexa) in rodents from North Sulawesi and West Java, Indonesia.

Tissue cysts of the protozoan genus Sarcocystis were detected in the skeletal muscles of 16 (40%) of 40 wild rodents captured in North Sulawesi and West Java, Indonesia. Two types of cysts were found to differ in their morphological characteristics. Macroscopic and microscopic cysts bounded by thick radially-striated cyst walls were detected at both locations in a total of 13 rodents belonging to seven different species (Bunomys chrysocomus, B. fratrorum, Maxomys bartelsii, M. musschenbroekii, Paruromys dominator, Rattus xanthurus and R. exulans). The primary cyst walls contained numerous broad spatula-like protrusions and the cysts were identified as S. singaporensis Zaman and Colley, 1976. In contrast, microscopic cysts bounded by thin smooth cyst walls were detected in seven rodents belonging to three different species captured at Toraut in North Sulawesi (B. chrysocomus, B. fratrorum and P. dominator). Ultrastructural examination revealed numerous slender hair-like protrusions of their primary cyst walls. It is proposed that these cysts be named S. sulawesiensis sp. n. on the basis of their unique morphological characteristics, their intermediate host range and their limited geographic distribution. Mixed infections by both species were found in three rodent species (B. chrysocomus, B. fratrorum and P. dominator).

Animals↗

Epidemiological study of malaria in north Sulawesi, Indonesia by fluorescence and Giemsa staining.

An epidemiological study of malaria infection was conducted in the Likupang District, Minahasa Regency, North Sulawesi Province, Indonesia, during August 2-15, 1991. In this study, 510 people of six villages, representing ages between 1 month to 84 years cooperated voluntarily. Blood smears stained with Giemsa and acridine orange (AO), revealed 33 and 83 malaria parasite positives respectively. This significant difference was due particularly to the fact that AO staining examined under either a daylight- or halogen-illuminated microscope equipped with interference filters was sensitive to detect low-density parasitemia in many subjects previously diagnosed negative by Giemsa staining in the field. The low malaria prevalence obtained by Giemsa staining may have been attributable to the lack of standard-quality diagnostic tools in the field or inadequate observation of the slides. In both staining methods, Plasmodium falciparum was found to be the predominant species, while the remainings were P. vivax or a mixture of both. Subjects infected with P. vivax revealed higher density of parasitemia and gametocytemia than those with P. falciparum.

Acridine Orange↗

Seroepidemiological survey of wild rats for Seoul virus in Indonesia.

The prevalence of antibodies against Seoul virus was investigated in 655 wild rats (Rattus norvegicus, R. rattus, R. rattus diardii, R. exulans, R. tiomanicus) captured in seven port areas of Indonesia. Twenty-four of 238 R. norvegicus, one of 142 R. rattus and one of 102 R. exulans from two port areas had the antibodies against Seoul virus.

Animals↗

Home delivery of heat-stable vaccines in Indonesia: outreach immunization with a prefilled, single-use injection device.

Extending immunization coverage to underserved populations will require innovative immunization strategies. This study evaluated one such strategy: the use of a prefilled, single-use injection device for outreach immunization by village midwives. The device, UniJect, is designed to prevent refilling or reuse. Stored at ambient temperatures for up to 1 month in midwives' homes, vaccine-filled UniJect devices were immediately available for outreach. Between July 1995 and April 1996, 110 midwives on the Indonesia islands of Lombok and Bali visited the homes of newborn infants to deliver hepatitis B vaccine to the infants and tetanus toxoid to their mothers. Observations and interviews showed that the midwives used the device properly and safely to administer approximately 10,000 sterile injections in home settings. There were no problems with excessive heat exposure during the storage or delivery of vaccine. Injection recipients and midwives expressed a strong preference for the UniJect device over a standard syringe. Use of the prefilled device outside the cold chain simplified the logistics and facilitated the speed and efficiency of home visits, while the single-dose format minimized vaccine wastage.

Adult↗

The effects of access to health care on infant mortality in Indonesia.

This paper examines the impact of access to health facilities and personnel on infant and child mortality in Indonesia. Demographic and Health Survey data are combined with village-level censuses of infrastructure collected by the Central Bureau of Statistics. Because the village-level data are available from two points in time, it is possible to analyse the effects on mortality risks within the village of changes in access to health care. Factors about villages that might affect both access to health care and mortality risks are held constant. Adding a maternity clinic to a village decreases the odds of infant mortality by almost 15 per cent, in comparison to the risk before the clinic was added. An additional doctor reduces the odds by about 1.7 per cent.

Demography↗

An input and process evaluation of Internet-based distance learning education for hospital managers in Indonesia.

An evaluation study was carried out to describe the input and process of internet-based distance learning graduate education program for hospital managers in indonesia. The main research question addressed in the study was whether the program supported quality learning among students who were working full time and could not leave their jobs for the whole study period. The results of the study indicated that the program benefited those who lived in remote areas and women who could not leave their family for long period of time. The study suggests that interactions between students and their peers or tutors motivated better learning processes. Variability of performances were observed among students who were not equally supported by technological helps and with different learning motivations. It needs another year to evaluate whether the internet-based program is no less effective and efficient or even better than the in-class programs.

Adult↗

A clinico-pathologic study of cases with Schistosoma japonicum infection in Indonesia.

Combined clinico-pathological and laboratory examinations were carried out on 52 S. japonicum infected patients from an endemic area in Central Sulawesi, Indonesia. All of these patients exhibited signs and symptoms of chronic hepato-splenic schistosomiasis. None of the patients showed evidence of liver cirrhosis on histopathological examination. However, varying degrees of portal fibrosis were exhibited. The correlation between the degree of fibrosis and the clinical and laboratory findings were presented and discussed. Based on the results, liver biopsy proved to be a vaulable method of diagnosis in this particular type of infection. This study provides new information on S. japonicum infection in the area and may support a more solid basis for treatment.

Adolescent↗

The bandicoot rat, a new host record for Angiostrongylus cantonensis in Indonesia.

A survey for Angiostrongylus cantonensis in possible definitive and intermediate hosts was conducted in Ancol, Jakarta. Adult worms were found in 43% of bandicoot rats, Bandicota indica setifera, in 14% of Rattus rattus diardii and 36% of the Achatina fulica were infected with larval forms of the parasite. The finding of the parasite in the bandicoot rat constitutes a new host record for Indonesia.

Animals↗

Prevalence and distribution of schistosomiasis in Indonesia: a review.

The prevalence and distribution of schistosomiasis in Indonesia is given, with the emphasis on the current data. An extensive investigation was started in 1971. Control measures became desirable because of development schemes in and around the endemic areas, thus increasing the possibility of the spread of the infection. This investigation consisted of: a study of prevalence, distribution, and intensity of the infection in man and animals; clinical studies, treatment and follow-up; and epidemiological studies. A comparison was made between the results of different workers. In addition to the only known endemic area at Lake Lindu, another endemic area was discovered recently at Napu Valley, situated 50 km southeast of Lake Lindu at an altitude of 1200 meters. Surveys in other areas gave negative results. Nine species of wild and domestic animals were found positive. The intermediate host was discovered in 1971 and described as Oncomelania hupensis lindoensis. This snail is widely distributed in the endemic areas.

Animals↗