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"Measles immunization has been introduced since 1960, thereby markedly reducing the number of cases in developed countries. However, measles epidemics still occur even in developed countries. In the United States, in 1988-1992 an increase in the number of measles cases reaching 50,000 cases was reported. Some of these cases occurred in previously immunized patients. This was thought to be caused by genetic mutation of the measles virus, aside from weaknesses of the vaccine and low immunization coverage.Since measles immunization was employed in Indonesia, the number of measles patients has decreased. However, epidemics are still frequently reported. About 15-30% of reported cases occurred in those previously immunized, raising the question of whether a genetic difference exists between the wild-type measles virus circulating in Indonesia and the vaccine virus being used. Such a difference may lead to the differences in the antigenicity of the wild-type and vaccine viruses, rendering the resulting antibody incapable of neutralizing the wild-type viruses. Based on the above, this study is aimed to demonstrate the extent of genetic and antigenic differences between the wild-type and vaccine measles viruses.We conducted an experimental laboratory study to sequence the N, H, and F genes of the wild-type measles viruses (G2, G3, and D9) and the CAM-70 vaccine virus. To show antigenic differences, the wild-type viruses (G2, G3, and D9) and the CAM-70 and Schwarz viruses were injected to BALB/c mice. Serum antibodies of the mice were analyzed using ELISA, cross-neutralization test, and immunoblotting using antigens from the respective viruses.Results of this study showed that the wild-type and the vaccine viruses differ in the sequence of the N gene by 73-79 nucleotides, resulting in amino acid substitution of 17-24 residues; the H gene by 60-99 nucleotides, resulting in amino acid substitution of 13-29 residues; the F gene by 71-88 nucleotides, resulting in amino acid substitution of 4-3 I residues. Differences between the wild-type and the CAM-70 and Schwarz vaccine viruses were also found in the epitope site of the CTL and antibodies, which are important to virus antigenicity.We conclude that a significant difference in antigenicity exists between the wild-type measles viruses circulating in Indonesia with the CAM-70 measles virus. We also found the immunogenicity of the CAM-70 and Schwarz vaccine viruses to be lower than that of the wild-type viruses."

"Measles immunization has been introduced since 1960, thereby markedly reducing the number of cases in developed countries. However, measles epidemics still occur even in developed countries. In the United States, in 1988-1992 an increase in the number of measles cases reaching 50,000 cases was reported. Some of these cases occurred in previously immunized patients. This was thought to be caused by genetic mutation of the measles virus, aside from weaknesses of the vaccine and low immunization coverage. Since measles immunization was employed in Indonesia, the number of measles patients has decreased. However, epidemics are still frequently reported. About 15-30% of reported cases occurred in those previously immunized, raising the question of whether a genetic difference exists between the wild-type measles virus circulating in Indonesia and the vaccine virus being used. Such a difference may lead to the differences in the antigenicity of the wild-type and vaccine viruses, rendering the resulting antibody incapable of neutralizing the wild-type viruses. Based on the above, this study is aimed to demonstrate the extent of genetic and antigenic differences between the wild-type and vaccine measles viruses. We conducted an experimental laboratory study to sequence the N, H, and F genes of the wild-type measles viruses (G2, G3, and D9) and the CAM-70 vaccine virus. To show antigenic differences, the wild-type viruses (G2, G3, and D9) and the CAM-70 and Schwarz viruses were injected to BALB/c mice. Serum antibodies of the mice were analyzed using ELISA, cross-neutralization test, and immunoblotting using antigens from the respective viruses. Results of this study showed that the wild-type and the vaccine viruses differ in the sequence of the N gene by 73-79 nucleotides, resulting in amino acid substitution of 17-24 residues; the H gene by 60-99 nucleotides, resulting in amino acid substitution of 13-29 residues; the F gene by 71-88 nucleotides, resulting in amino acid substitution of 4-3 I residues. Differences between the wild-type and the CAM-70 and Schwarz vaccine viruses were also found in the epitope site of the CTL and antibodies, which are important to virus antigenicity. We conclude that a significant difference in antigenicity exists between the wild-type measles viruses circulating in Indonesia with the CAM-70 measles virus. We also found the immunogenicity of the CAM-70 and Schwarz vaccine viruses to be lower than that of the wild-type viruses."

"Pencegahan dan pemberantasan penyakit, merupakan prioritas pembangunan kesehatan masyarakat di Indonesia. Hal ini tidak hanya terbatas pada upaya pengobatan, melainkan juga pencegahan terhadap kematian dan kecacatan. Menurut WHO, polio merupakan salah satu penyakit penyebab kecacatan. Pada tahun 1992, diperkirakan adanya 140.000 kasus baru kelumpuhan akibat poliomyelitis diseluruh dunia, dimana jumlah anak-anak yang menderita lumpuh sebesar 10 sampai 20 juta orang. Sedangkan jumlah kasus AFP (Accute Placcid Paralysis yaitu kasus lumpuh layuh yang belum tentu polio) yang ditemukan sampai dengan tanggal 15 Desember 2005 adalah 1.351 anak di bawah usia 15 tahun.Polio adalah suatu penyakit infeksi yang disebabkan oleh virus polio, dan dapat mengakibatkan terjadinya kelumpuhan yang permanen. Walaupun penyakit ini dapat menyerang semua kelompok umur, namun kelompok umur yang paling rentan adalah umur < 3 tahun (50-70% dari semua kasus polio). Pelaksanaan surveilans AFP tahun 2005?2006 menemukan 305 kasus polio yang tersebar di 47 Kabupaten/Kota pada 10 Provinsi. Surveilans AFP dilakukan melalui tata laksanan kasus AFP dan penegakan diagnosis oleh laboratorium. Sampai sejauh ini belum diketahui bagaimana validitas penapisan AFP untuk diagnosis polio.Penelitian ini bertujuan untuk mengetahui validitas penapisan AFP untuk diagnosis polio di Indonesia. Desain penelitian yang digunakan adalah cross sectional dengan pendekatan kuantitatif. Data yang digunakan adalah data sekunder Surveilans AFP Depkes tahun 2005. Populasi penelitian ini adalah semua anak usia kurang dari 15 tahun yang mengalami kelumpuhan secara tiba-tiba dan terjaring oleh petugas surveilans daerah yang mendapatkan pemeriksaan spesimen di laboratorium untuk menegakkan diagnosis polio yaitu sebanyak 1.601 pasien. Sedangkan, sampel penelitian adalah anak usia kurang dari 15 tahun yang mengalami kelumpuhan secara tiba-tiba dan terjaring oleh tenaga surveilans daerah (n = 1.601).Gejala penapisan AFP berupa layuh, akut, dan kelumpuhan mempunyai sensitivitas 98,5%, gejala demam mempunyai sensitivitas 91,7%, sedangkan gejala gangguan rasa raba mempunyai sensitivitas 21,9%. Nilai Prediksi Positif (NPP) yang paling tinggi terdapat pada gejala demam (29,4%), kemudian diikuti dengan gejala gangguan rasa raba. Nilai ini menunjukkan sebanyak 29,4% pasien penapisan AFP dengan gejala demam yang ternyata menunjukkan polio positif.Nilai Prediksi Negatif (NPP) tertinggi terdapat pada gejala gangguan rasa raba (75%) dan yang paling rendah adalah gejala kelumpuhan dan demam (60%). NPP menunjukkan bahwa 75% pasien penapisan AFP diagnosis polio negatif tidak memiliki gejala gangguan rasa raba. Dari gejala yang ada, yang mempunyai likelihood rasio positif (LR+) tertinggi adalah gejala demam (1,205) artinya gejala demam 1,205 kali lebih banyak ditemukan pada pasien penapisan AFP diagnosis polio positif. Persentase diagnosis polio pada penapisan AFP ini sebesar 0,256.Tujuan surveilans AFP adalah untuk menjaring sebanyak-banyaknya penderita AFP, sehingga yang perlu diperhatikan adalah nilai sensitivitas gejala penapisan AFP untuk diagnosis polio.Dari penelitian ini disimpulkan bahwa empat gejala (flaccid, akut, kelumpuhan, dan demam) cukup sensitif untuk diagnosis polio positif pada penapisan AFP. Sedangkan gejala gangguan rasa raba kurang sensitif untuk diagnosis polio positif pada penapisan AFP. Peningkatan sensitivitas pada gejala gangguan rasa raba dapat dilakukan dengan meningkatkan kualitas data gejala gangguan rasa raba. Peningkatan keahlian tenaga kesehatan dalam diagnosis gejala klinis penderita AFP dapat melalui pendidikan dan pelatihan mengenai anamnesis penyakit."

"Indonesia mengalami Kejadian Luar Biasa (KLB) polio pada tahun 2005. Di tiga kabupaten Lebak, Serang dan Sukabumi merupakan 58,9% kasus KLB nasional. Tujuan penelitian ialah diketahuinya besar risiko spesimen yang tidak memenuhi ketepatan waktu ambiI terhadap risiko basil pemeriksaan negatif virus polio di laboratorium nasional polio di Bandung dan Jakarta.Pada studi potong lintang (cress-.seclionalO terhadap semua sampel spesimen yang pertama yang diambiI dari kasus acute fkrcid paralysis (AFP) selama tahun 2005 dari tiga kabupaten. Data berasal dari laboratorium nasional polio tentang identitas kasus AFP, tanggal lumpuh, tanggal' ambil spesimen, tanggal kirim, tanggal diterima, kondisi diterima, tanggal proses, tanggal dan basil uji. Di samping itu dilakukan konf rmasi lapangan untuk data tempat pengambilan spesimen, fasilitas, dan tenaga surveilans. Analisis faktor-faktor risiko terhadap risiko relatif (RR) basil pemeriksaan negatif virus polio menggunakan regresi Cox.Prevalensi basil negatif dari sampel adalah 31,46%, Hasil negatif pada masa awal KLB Februari-April (60%) dan akhir KLB Juli-Desember 2005 (66,2%), dan yang terendah pada bulan Mei-Juni (15,5%). Faktor-faktor yang berkaitan secara signifikan terhadap risiko basil pemeriksaan negatif virus polio pada spesimen meliputi faktor tidak tepat waktu ambit spesimen, kabupaten asal spesimen, dan periode bulan pengambilan. Keterlambatan pengambilan spesimen mempertinggi risiko basil pemeriksaan negatif virus polio sebesar 70% dibandingkan dengan spesimen yang diambil tepat waktu [risiko relatif suaian (RN = 1,70; 95% interval kepercayaan (CI): 1,01 - 2,88).Selama masa awal dan akhir KLB, perhatian khusus harms diberikan terhadap ketepatan waktu pengambilan spesimen dan kabupaten asal spesimen untuk memperkecil risiko basil pemeriksaan negatif virus polio.

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In 2005 Indonesia had a polio outbreak of positive wild polioviruses (WPV). The three districts namely Lebak, Serang and Sukabumi contributed 59.% of total national cases. The aim of this study was to identify the risk of late collection of stool specimen for negative detection of poliovirus.

A cross sectional study conducted on all acute flaccid paralysis (AFP) surveillance's stool speciment from the three districts tested for polio virus in Bandung and Jakarta national polio laboratory in 2005. Data derived from laboratory registry books for case identity, date of paralysis onset; spesiment collection: sent; recieved; testing process; and result of test. In addition, field visits were conducted to the three districts for confirmation on data collecting methods, and human resources. Analysis was using Cox regression method for relative risk (RR).

The prevalence of negative results was 31,46%. Negative results during early stage of outbreak in February -April was 60% and late stage July- December was 66.2%, while in May -June was Ioweer (15.5%). Factors that significantly associated with the risk of poliovirus negative results were late of speciment collection, district origin of speciment and period of month speciment collection. Late than on time collection for first stool speciment had 70% increased risk to be negative results (adjusted relative risk =-1.70; 95% confidence intervals = 1.01 - 2.88).

During early and late stage of polio outbreak, special attention should be taken for timing of speciment collection and district origin of speciment to minimize risk of negative detection of poliovirus."