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Dr. Mulya Rahma Karyanti, SpA(K), MScKetua Divisi Infeksi dan Pediatri Tropik,
Departemen Ilmu Kesehatan Anak, RSCM-FKUI
Pendidikan• Dokter Umum - Fakultas Kedokteran UI, 1988 - 1994 • Spesialis Anak - Fakultas Kedokteran UI, 2004• Master of Science in clinical epidemiology - Utrecht Medical Centre, 2011• Konsultan Infeksi dan Pediatri Tropis - Fakultas Kedokteran UI, 2011Pengalaman Organisasi• Anggota IDAI Jaya, 2004 - Sekarang• Pengurus UKK Infeksi dan Pediatri Tropik, 2017 - 2020• Ketua Satgas Farmasi Pediatri PP IDAI, 2017 – Sekarang• KOMLI Demam Berdarah Dengue• KOMLI Malaria• Komite verifikasi nasional eliminasi campak dan pengendalian rubela (CRS)• Komite ahli pengendalian difteri
Dengue Vaccine Update & Recommendation
Dr. Mulya Rahma Karyanti, SpA(K), MSc
Divisi Infeksi dan Pediatri Tropik Departemen Ilmu Kesehatan Anak, RSCM-FKUI
Dengue Seroprevalence Study in Indonesia
RESEARCH ARTICLEDengue virus serotype distribution based on serological evidence in pediatric urban population in Indonesia
Tedjo Sasmono, Anne-Frieda Taurel, Ari Prayitno, Hermin Sitompul,B.Yohan, Rahma F. Hayati, Alain Bouckenooghe, Sri Rezeki Hadinegoro, Joshua Nealon
PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0006616 June 28, 2018
RESEARCH ARTICLEDengue seroprevalence and force of primary infection in a representative
population of urban dwelling Indonesian children
Ari Prayitno, Anne-Frieda Taurel, Joshua Nealon, Hindra Irawan Satari, Mulya Rahma Karyanti,
Rini Sekartini, Soedjatmiko, Hartono Gunardi, Bernie Medise, Tedjo Sasmono, James Mark
Simmerman, Alain Bouckenooghe, Sri Rezeki Hadinegoro
PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0005621 June 15, 2017
DNG26 study
Multi-stage cross-sectional
community-based
seroprevalence study
3,210 subjects
1 to 18 year of age
Duration
Sept 2014-January 2015
30 sites
(district as cluster
in 15 provinces)
Primary objective
Determine the prevalence of
specific antibodies IgG against
dengue in healthy 1 to 18 year-old
children in urban Indonesia
Secondary objectives
• Determine the dengue virus
serotype (DENV-1, 2, 3, and/or 4)
specific to the antibodies in
positive IgG samples
• Identify the potential factors
associated with the serologic
status
Ari Prayitno et al. PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0005621 June 15, 2017
Study design and sites• DNG26: first nationally representative dengue
seroprevalence study in urban dwelling Indonesian children (1-18 years old)
• Multi-stage cross sectional seroprevalence study, cluster sampling (PPS)
• Improve understanding of dengue burden in <19 year of age and socio-economic determinants associated
Study SitesNo Province Regency Cluster No Province Regency Cluster
1 Aceh Subulusalam 1 9 Jawa Tengah Klaten 18
2 Sumatera Utara Medan 2 Jepara 19
3 Sumatera Barat Padang 3 Tegal 20
4 Jambi Bungo 4 Tegal 21
5 Lampung Lampung Selatan 5 10 Jawa Timur Ponorogo 22
6 Banten Tangerang 6 Banyuwangi 23
Tangerang 7 Mojokerto 24
7 DKI Jakarta Jakarta Selatan 8 Sumenep 25
Jakarta Timur 9 Surabaya 26
Jakarta Barat 10 11 Bali Denpasar 27
8 Jawa Barat Bogor 11 12 Kalimantan Timur Samarinda 28
Bandung 12 13 Sulawesi Selatan Toraja Utara 29
Cirebon 13 14 Sulawesi Tenggara Kendari 30
Bekasi 14
Bandung 15
Bekasi 16
Tasikmalaya 17
Site
14 provinces, 30 regencies, 30
clusters
DNG26 study procedure
Primary health workers inform population about the study
Subject visits PHC for blood draw (5ml)
DEN-1 DEN-2 DEN-3 DEN-4
Enrollment during house visits:• ICF and assent• Collection of socio-demographic data• Schedule visit to Primary Health Care (PHC)
IgG ELISA for dengue
Dengue negative Dengue positive
PRNT for serotype
At
each
stu
dy
site
Eijk
man
Inst
itu
te,
Jaka
rta
ResultDengue IgG seroprevalence according to age group (all sites)
| 13
• Overall dengue seroprevalence in 1-18 year old : 69.4% [95%CI,
67.7-71.0]
• Seroprevalence increasing with age group
n = 3,195
Dengue IgG seroprevalence according to age as continuous variables (all sites)
| 14
• At 1 year old, > 25% and at 5 years old > 50% infected by dengue
• Over 9 years old, ≥80% of children were infected at least once
• Dengue seroprevalence at 18 years old children was 95%
n = 3,194
Sasmono T, et al. PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0006616 June 28, 2018
Proportion of individuals by age groupwith naïve, monotypic, or multitypic PRNT profiles
Proportion of monotypic dengue antibody profiles against each dengue serotype, by province containing at least one study site (in grey)
Sasmono T, et al. PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0006616 June 28, 2018
Dengue serotype specific GMT by age-group
Sasmono T, et al. PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0006616 June 28, 2018
Dengue IgG seroprevalence according to gender and age group
• Seroprevalence increase with older age
• Seroprevalence in female and male are similar, small trend of female
higher seroprevalence especially in younger age group
¹ chi-square (missing values are excluded from the testing);
Age group M n
Overall Overall adjusted
% IgG
positive 95% CI
% IgG
positive 95% CI
Male 1,527 1,030 67.5 [65.0 ; 69.8] 67.5 [62.4 ; 72.5]
1 to 4 years 333 102 30.6 [25.7 ; 35.9] 30.6 [23.2 ; 38.0]
5 to 9 years 428 273 63.8 [59.0 ; 68.3] 63.8 [57.2 ; 70.4]
10 to 14 years 412 343 83.3 [79.3 ; 86.7] 83.3 [77.0 ; 89.5]
15 to 18 years 354 312 88.1 [84.3 ; 91.3] 88.1 [82.1 ; 94.2]
Female 1,667 1,186 71.1 [68.9 ; 73.3] 71.1 [65.9 ; 76.3]
1 to 4 years 339 125 36.9 [31.7 ; 42.3] 36.9 [28.7 ; 45.1]
5 to 9 years 433 290 67.0 [62.3 ; 71.4] 67.0 [59.9 ; 74.1]
10 to 14 years 474 393 82.9 [79.2 ; 86.2] 82.9 [76.2 ; 89.7]
15 to 18 years 421 378 89.8 [86.5 ; 92.5] 89.8 [84.4 ; 95.2]
n = 3,194
Dengue IgG seroprevalence according to reported dengue infection history
• Among subjects “no” or “don’t know” about medical history of
dengue infection, 67% and 69% respectively had a positive
dengue IgG result, indicative of a previous dengue infection
¹ chi-square (missing values are excluded from the testing);
n = 2,971
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