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"ABSTRACTLow adult vaccination coverage in Indonesia may contribute to a recent outbreak of diphtheria in Indonesia. Although well known as a pediatric vaccine, diphtheria vaccination should be administered as booster to adolescence and adults for longer prevention. Adult vaccine differs from pediatric vaccine but have similar protection. Additionally, there is special recommendation to vaccinate pregnant women and elderly people aged 65 years or more."

"Penyakit difteri disebabkan oleh bakteri Corynebacterium diptheriae yang menyerang sistemorgan pernapasan. Pengobatan pada penyakit berkisar 2-3 minggu. Penyakit difterimerupakan salah satu penyakit yang dapat dicegah dengan vaksinasi. Penyakit tersebutdimodelkan dalam tugas akhir ini dengan menggunakan sistem persamaan diferensial biasaberdimensi tujuh. Kajian analitik dan numerik dalam menentukan titik keseimbangan,kestabilan titik keseimbangan, basic reproduction number R0 , serta kriteria terjadinyaendemik yang bergantung pada beberapa parameter dibahas dalam tugas akhir ini. Kajiananalitik untuk menentukan titik keseimbangan bebas penyakit, titik keseimbanganendemik, kestabilan titik keseimbangan bebas penyakit, dan R0. Kajian numerik untukmenentukan kestabilan titik keseimbangan endemik. Kajian numerik juga menentukankestabilan titik bebas penyakit stabil asimtotik pada saat R0 < 1, kestabilan endemik stabilasimtotik pada saat R0 > 1, dan dinamika populasi dengan perubahan nilai parameter.Dengan kajian analitik dan numerik dapat menunjukkan situasi yang mungkin ditemukandi lapangan.

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Diphtheria is an infection caused by Corynebacterium diphteriae that affect humanrespiratory system. Treatment for this infection takes 2 3 weeks. Diphtheria is also oneof the infection that can be prevented by giving vaccinations. This infection is modeledin this thesis using system of seven dimensions ordinary differential equation. Analyticaland numerical study to determine the equilibrium point, basic reproduction number R0 , and sufficient condition for some parameters to satisfy the endemic condition. Theanalytical study are determining the disease free equilibrium point, endemic equilibriumpoint, stability of disease free equilibrium point, and R0. The numerical study canalso determine the stability of endemic equilibrium point. This numerical study canalso determine the stability of disease free equilibrium point when R0 1, stability ofendemic equilibrium point when R0 1, and population dynamics based on the changeof parameters. This analytical and numerical study can show the situation in real life."

"Difteri merupakan penyakit menular yang dapat menyebabkan kematian. Di Indonesia, Difteri merupakan masalah endemis dimana tingkat kematian Difteri selama lima tahun terakhir mengalami peningkatan yaitu sebesar 1,8% pada tahun 2018 menjadi 8,5% pada tahun 2022. Penelitian sebelumnya menunjukkan bahwa riwayat vaksinasi dan pemberian Anti Difteri Serum (ADS) merupakan faktor independen yang mempengaruhi kematian akibat Difteri, namun efek gabungan kedua faktor tersebut belum banyak diketahui. Oleh karena itu, dilakukan penelitian dengan tujuan untuk mengetahui hubungan riwayat vaksinasi Difteri dan riwayat pemberian ADS dengan kejadian kematian Difteri di Indonesia. Penelitian ini menggunakan desain studi kasus kontrol dengan menggunakan data sekunder dari laporan surveilans Difteri Kementerian Kesehatan tahun 2018-2022. Hasil penelitian menunjukkan risiko gabungan pada mereka yang tidak divaksinasi dan tidak diberikan ADS sebesar 4,57 kali (95% CI 2,30-9,09) lebih tinggi dibandingkan kasus Difteri dengan riwayat divaksinasi dan diberikan ADS. Risiko indepeden menunjukkan kelompok yang tidak divaksinasi memiliki risiko kematian 3,03 kali (95% CI 1,93-4,75) lebih tinggi dibandingkan dengan kelompok yang divaksinasi. Sedangkan kelompok yang tidak diberikan ADS memiliki risiko kematian 0,31 kali (95% CI 0,11- 0,82) lebih rendah dibandingkan dengan kelompok yang diberikan ADS, namun hasil ini mungkin masih dipengaruhi oleh faktor-faktor perancu yang belum dikontrol dalam penelitian ini, sehingga tidak dapat disimpulkan bahwa tidak memberikan ADS justru menurunkan risiko kematian akibat Difteri. Sebanyak 45% kejadian kematian Difteri dikaitkan dengan interaksi antara tidak divaksinasi dan tidak diberikan ADS. Oleh karena itu, penting untuk melakukan upaya bersama untuk meningkatkan cakupan vaksinasi dan pemberian ADS secara tepat untuk menurunkan kejadian kematian akibat Difteri.

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Diphtheria is an infectious disease that can cause death. In Indonesia, Diphtheria is an endemic problem with an increasing death rate over the last five years by 1.8% in 2018 to 8.5% in 2022. Previous studies have shown that vaccination and administration of diphtheria antitoxin (DAT) affect mortality, but their combined effect is not widely known. Therefore, a study was conducted to determine the relationship between these two factors and Diphtheria mortality in Indonesia. The research used a case-control design with secondary data from the Ministry of Health's 2018-2022 Diphtheria surveillance report. The findings revealed that individuals who were neither vaccinated nor given DAT had a 4.57 times higher risk of death (95% CI 2.30-9.09) than vaccinated and received DAT group. Unvaccinated individuals had a 3.03 times higher risk of death (95% CI 0.11-0.82) than vaccinated individuals. The risk of death was 0.31 times lower (95% CI 0.11-0.82) in those who did not receive DAT. However, it is important to note that these results may still influenced by uncontrolled factors, thus no conclusion can be drawn regarding the reduction of death risk through withholding DAT. Up to 45% of diphtheria-related mortality were linked to the combination of this two factors. To reduce diphtheria deaths, it is essential to enhance immunization coverage and administer DAT properly."

"ABSTRACTVaccination is the administration of agent-specific, harmless antigenic components to someone that meant to induce protective immunity against the infectious agents. The term vaccination and immunization often use interchangeably. In general, vaccination is a highly effective method of preventing infectious diseases. Routine immunization programmes prove to protect many children in the world and saves millions of live each year. However, different understanding applied to adult, even though adults can be protected from 14 deadly diseases started with lesser losses work or school days due to Rubella, Diphteria, Hepatitis A and HPV infection. Decrease hospitalizations and deaths due to Hepatitis B, Shingles, and Pertussis. Minimize spreading diseases of Mumps, Tetanus, Influenza, Pneumococcal diseases. Avoid permanent disability due to Chicken pox, Measles, and Meningococcal disease. Children under the age of 5 years of age, more than 90% were received vaccines and this was contrast with adult immunization rates. Two possible explanations are adults do not aware their own risk and the nation do not have sustained commitment to vaccination for adults as for children. One of the most deteriorating diseases that could be prevented is varicella zoster virus. In initial, Shingles more common and severe in older persons. In addition to that, the long-term effects of the infection known as post-herpetic neuralgia (PHN), could lasting long and difficult to treat. The recommendation on how delivering herpes zoster vaccine will be discussed further. "

"ABSTRACTBackground: in recent years, diphtheria has reemerged in several countries including Venezuela, Yemen, Bangladesh, and Haiti. Similarly, Indonesia also showed an increased number of diphtheria cases in 2010-2017 despite the Diphteria, Tetanus, Pertussis (DTP) immunization program applied in Indonesia for children. This study aimed to evaluate the epidemiology of diphtheria cases which occurred in Indonesia during 2010-2017. Methods: this was a retrospective study of diphtheria cases in Indonesia. The following source of data about diphtheria disease burden and vaccine coverage was obtained from Ministry of Health Republic of Indonesia, Indonesian Pediatric Society and World Health Organization South East Asia Regional Office. Results: the number of diphtheria cases in Indonesia were distributed across 30 provinces with a total of 811 cases in 2011; 1,192 cases in 2012; 296 cases in 2014; and 939 cases in 2017. Based on age group, the highest number of case fatality rate were in age group of 5-9 years old. Diphtheria immunization coverage in Indonesia among children was fluctuated, reported as 67.7 % in 2007, 61.9 % in 2010, 75.6% in 2013 and 61.3% in 2018. In addition to that, the organization of internal medicine has recommend booster of DPT immunization every 10 years for those children that had received complete DPT vaccination during childhood, however this was not applied. As the countermeasure towards this trend, the Ministry of Health implemented three rounds of Outbreak Response Immunization (ORI) targeted for the age group of 0-1-6 months old and 1-18 years old in 2017 and tailor approached for adults that had exposed to cases. Banten, DKI Jakarta and West Java were the first three provinces to implement this program considering their condensed population and high risk of disease transmission. Conclusion: in Indonesia, there was dramatic increase of diphtheria case in 2010-2017, where immunization in children should be reinforced by increasing coverage more than 95% and adult boosted vaccination approaches should be initiated to prevent the spread of these fatal diphtheria diseases in Indonesia."

"Golongan usia anak merupakan golongan usia yang paling ringan terdampak infeksi COVID-19. Salah satu kemungkinan penyebab keadaan tersebut adalah perlindungan dari efek nonspesifik vaksinasi rutin yang diterima anak sebelumnya. Vaksinasi rutin yang diterima anak dapat memodulasi sistem imun anak terhadap infeksi lain di luar target imunisasi yang dituju melalui mekanisme imunitas heterolog. Bukti-bukti penelitian terdahulu menimbulkan hipotesis antigen vaksin DTP berpotensi menimbulkan imunitas heterolog dengan SARS-CoV-2. Hal ini berdasarkan kemiripan epitop antara antigen SARS-CoV-2 dengan antigen pada vaksin DTP. Belum diketahui bagaimana pengaruh vaksinasi DT booster terhadap respons imun (antibodi S-RBD SARS-CoV-2 dan IFN-ɤ-sel T spesifik SARS-CoV-2) pascavaksinasi COVID-19 inaktif pada anak usia 6–7 tahun. Penelitian ini bertujuan mengetahui pengaruh pemberian vaksinasi DT booster pada anak yang mendapat vaksinasi COVID-19 inaktif terhadap respons imun humoral dan selular anak.Studi potong lintang dilakukan dengan didahului tahapan pengambilan data pada orang tua subjek penelitian di wilayah Senen, Jakarta Pusat. Pengambilan data menggunakan kuesioner yang disebarkan secara luring kepada orang tua melalui guru sekolah anaknya. Dari kuesioner didapatkan data status vaksinasi anak, yang dibedakan dalam 4 kelompok yaitu COVID+/DT+, COVID+/DT–, COVID–/DT+ dan COVID–/DT–, dan diukur antibodi S-RBD, IFN-ɤ-sel T spesifik SARS-CoV-2 dan IgG antidifteri.Hasil penelitian menunjukkan 113 dari 154 subjek penelitian (73,4%) telah memiliki status relative immune terhadap difteri, dengan hasil IgG antidifteri > 0,1 IU/mL. Terdapat imunitas heterolog vaksinasi DT booster terhadap COVID-19 dengan adanya perbedaan bermakna kadar antibodi S-RBD SARS-CoV-2 antara anak yang sudah mendapat vaksin DT booster dibanding yang belum (1182 U/mL vs. 612,5 U/mL, p = 0,026), dan perbedaan bermakna IFN-ɤ-sel T spesifik SARS-CoV-2 pada anak COVID+/DT+ dibanding COVID+/DT– (560,87 mIU/mL vs. 318,03 mIU/mL, p = 0,03). Tidak didapatkan korelasi antara IgG antidifteri dan S-RBD SARS-CoV-2. Selain hasil penelitian data laboratorium, didapatkan pula data keinginan orang tua untuk vaksinasi COVID-19 bagi anaknya adalah sebesar 69,7%.Disimpulkan vaksin DT booster dapat berperan menguatkan respons imun spesifik SARS-CoV-2 pada anak yang menerima vaksin COVID-19 inaktif.

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Corona Virus Disease 2019 (COVID-19) in children tends to be mild. A possible cause is existing protection from the routine vaccination previously received by children. Routine vaccinations can modulate the child's immune system against other pathogen, presumably through a mechanism of heterologous immunity. Previous research had suggested that the Diphtheria-Tetanus-Pertussis (DTP) vaccine antigen has potential to incite heterologous immunity towards SARS-CoV-2, due to similarities between SARS-CoV-2 epitopes and various epitopes found within the DTP vaccine. It was not known whether the Diphtheria-Tetanus (DT) vaccination could modulate the SARS-CoV-2-specific immune response among children aged 6–7 years who received inactivated COVID-19 vaccine.

This study thus aimed to assess the impact of DT booster immunization in SARS-CoV-2-specific humoral and cellular immune responses among children who received two doses of CoronaVac.

A cross-sectional study was performed on children aged 6–7 years old in the Senen area, Central Jakarta. This study was started with data collection from parents of eligible subjects using questionnaire that was distributed to parents via their children’ school teachers. Based on the collected demographic data and the child's vaccination status, eligible subjects were further screened. The participating subjects were subsequently classified into 4 groups, i.e., COVID+/DT+, COVID+/DT-, COVID-/DT+ and COVID-/DT-. Blood collections were performed to determine anti-diphtheria toxoid antibodies, anti-S-RBD antibodies and SARS-CoV-2-specific T cell-produced IFN-ɤ.

The results showed that 113 of 154 subjects (73.4%) had relative immune-status against diphtheria as the result of the anti–diphtheria toxoid antibodies was > 0.1 IU/mL. There was a heterologous immunity of DT booster and COVID-19 vaccine, as there was significant difference in anti-S-RBD antibody titers between the group with DT booster compared to non-DT booster (1182 U/mL vs. 612.5 U/mL, p = 0.026), and a significant difference in IFN-ɤ concentration between the group of COVID+/DT+ and COVID+/DT- (560.87 mIU/mL vs. 318.03 mIU/mL, p = 0.03). No correlation was found between anti-diphtheria and anti-S-RBD antibodies. In addition, our data indicated that parental intention to vaccinate their children against COVID-19 in the Senen area was 69.7%.

In conclusion, our results suggested that DT booster vaccine might able to enhance SARS-CoV-2-specific immune responses among children who received inactivated COVID-19 vaccine."

"ABSTRAKPenyakit campak merupakan penyakit menular dan sangat berbahaya. Oleh karenaitu, perlu dilakukan suatu upaya untuk mencegah terjadinya penyebaran penyakit ini.Salah satu cara yang efektif untuk mengatasi penyebaran penyakit ini adalahvaksinasi campak. Strategi vaksinasi dibedakan menjadi dua, yaitu strategi constantvaccination dan strategi pulse vaccination. Tesis ini membahas pengaruh strategipulse vaccination terhadap pencegahan penyebaran penyakit campak denganmenggunakan model epidemik SIR (Susceptible, Infectious, Recovered).Berdasarkan pembentukan model tersebut, diperoleh suatu nilai ambang batasepidemik yang digunakan sebagai batasan untuk analisis selanjutnya. Analisa sistemdinamik pada model dengan menentukan solusi periodik bebas infeksi, yangmenggunakan pemetaan stroboskopik dan titik tetap. Selain itu, ditentukan kestabilandari solusi periodik bebas infeksi dengan menggunakan metode linierisasi dan teoriFloquet. Hasil penelitian menunjukkan bahwa kestabilan solusi periodik bebasinfeksi bergantung pada pengambilan nilai dari periode pulse vaccination (T) yangkestabilannya bersifat lokal. Berdasarkan kriteria kestabilan tersebut diperoleh bahwastrategi pulse vaccination akan berhasil mencegah terjadinya penyebaran penyakitcampak jika nilai dari T < Tmax . Untuk mendukung pembahasan teori di dalampenelitian ini, dilakukan simulasi dengan menggunakan software Matlab.

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AbstractMeasles is a highly infectious and dangerous disease. Therefore, there should be anattempt to prevent the spread of this disease. One effective way to tackle the spreadof this disease is measles vaccination. Vaccination strategies can be divide into two,that are constant vaccination and pulse vaccination. In this thesis, it is discussed theinfluence of pulse vaccination strategy against measles prevention of the spread ofdisease by using the SIR (Susceptible, Infectious, Recovered) epidemic model. Basedon the model building, it is obtained an epidemic threshold values that are used asconstraints for further analysis. Analysis of dynamical systems on the model bydetermining the infection-free periodic solution by using a stroboscopic map andfixed point. Furthermore, we determine the stability of infection-free periodicsolution by using the linearization method and Floquet theory. The results of thisstudy showed that the stability of infection-free periodic solution depends on theuptake values of pulse vaccination period (T) which is local stability. Based on thestability criteria is obtained that the pulse vaccination strategy will successfullyprevent the spread of measles disease if the value of T < Tmax. To support thediscussion of the theory in this study, we perform simulations using the softwareMatlab."

"Buku yang berjudul "Clinical guidelines in adult health" ini ditulis oleh Constance R. Uphold and Mary Virginia Graham. Buku ini merupakan buku panduan mengenai kesehatan orang dewasa."