BackgroundIndonesia reports the second highest dengue disease burden in the world; these data are from passive surveillance reports and are likely to be significant underestimates. Age-stratified seroprevalence data are relatively unbiased indicators of past exposure and allow understanding of transmission dynamics.Methodology/Principal FindingsTo better understand dengue infection history and associated risk factors in Indonesia, a representative population-based cross-sectional dengue seroprevalence study was conducted in 1–18-year-old urban children. From October to November 2014, 3,210 children were enrolled from 30 geographically dispersed clusters. Serum samples were tested for anti-dengue IgG antibodies by indirect ELISA. A questionnaire investigated associations between dengue serologic status and household socio-demographic and behavioural factors. Overall, 3,194 samples were tested, giving an adjusted national seroprevalence in this urban population of 69.4% [95% CI: 64.4–74.3] (33.8% [95% CI: 26.4–41.2] in the 1–4-year-olds, 65.4% [95% CI: 69.1–71.7] in the 5–9-year-olds, 83.1% [95% CI: 77.1–89.0] in the 10–14-year-olds, and 89.0% [95% CI: 83.9–94.1] in the 15–18-year–olds). The median age of seroconversion estimated through a linear model was 4.8 years. Using a catalytic model and considering a constant force of infection we estimated 13.1% of children experience a primary infection per year. Through a hierarchical logistic multivariate model, the subject’s age group (1–4 vs 5–9 OR = 4.25; 1–4 vs. 10–14 OR = 12.60; and 1–4 vs 15–18 OR = 21.87; p<0.0001) and the number of cases diagnosed in the household since the subject was born (p = 0.0004) remained associated with dengue serological status.Conclusions/SignificanceThis is the first dengue seroprevalence study in Indonesia that is targeting a representative sample of the urban paediatric population. This study revealed that more than 80% of children aged 10 years or over have experienced dengue infection at least once. Prospective incidence studies would likely reveal dengue burdens far in excess of reported incidence rates.

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Introduction There is a high global incidence of typhoid fever, with an annual mortality rate of 200,000 deaths. Typhoid fever also affects younger children, particularly in resource-limited settings in endemic countries. Typhoid vaccination is an important prevention tool against typhoid fever. However, the available polysaccharide typhoid vaccines are not recommended for children under 2 years of age. A new typhoid conjugate Vi-diphtheria toxoid (Vi-DT) vaccine has been developed for infant immunization. We aimed to define the safety and immunogenicity of the Vi-DT vaccine among adults and children in Indonesia. Methods An observational, blinded, comparative, randomized, phase I safety study in two age de-escalating cohorts was conducted in East Jakarta, Indonesia, from April 2017 to February 2018. We enrolled 100 healthy subjects in 2 age groups: adults and children (18–40 and 2–5 years old). These groups were randomized into study groups (Vi-DT vaccine), and comparator groups (Vi-polysaccharide (Vi-PS) vaccine and another additional vaccine) which was administered in 4 weeks apart. Subjects were followed up to six months. Result One hundred healthy adults and children subjects completed the study. The Vi-DT and Vi-PS vaccines showed no difference in terms of intensity of any immediate local and systemic events within 30 minutes post-vaccination. Overall, pain was the most common local reaction, and muscle pain was the most common systemic reaction in the first 72 hours. No serious adverse events were deemed related to vaccine administration. The first and second doses of the Vi-DT vaccine induced seroconversion and higher geometric mean titers (GMT) in all subjects compared to that of baseline. However, in terms of GMT, the second dose of Vi-DT did not induce a booster response. Conclusion The Vi-DT vaccine is safe and immunogenic in adults and children older than two years. A single dose of the vaccine is able to produce seroconversion and high GMT in all individuals.

Background: In Indonesia, approximately 35.5% of children under five years old were stunted. Stunting is related to shorter adult stature, poor cognition and educational performance, low adult wages, lost productivity, and higher risk of nutrition-related chronic disease. The aim of this study was to identify parental socio-demographic risk factors of declined linear growth in children younger than 2 years old.Methods: This was a cohort-prospective study between August 2012 and May 2014 at three primary community health care centers (Puskesmas) in Jakarta, Indonesia, namely Puskesmas Jatinegara, Mampang, and Tebet. Subjects were healthy children under 2 years old, in which their weight and height were measured serially (at 6–11 weeks old and 18–24 months old). The length-for-age based on those data was used to determine stature status. The serial measurement was done to detect growth pattern. Parental socio-demographic data were obtained from questionnairesResults: From the total of 160 subjects, 14 (8.7%) showed declined growth pattern from normal to stunted and 10 (6.2%) to severely stunted. As many as 134 (83.8%) subjects showed consistent normal growth pattern. Only 2 (1.2%) showed improvement in the linear growth. Maternal education duration less than 9 years (RR=2.60, 95% CI=1.23–5.46; p=0.02) showed statistically significant association with declined linear growth in children.Conclusion: Mother with education duration less than 9 years was the determining socio-demographic risk factor that contributed to the declined linear growth in children less than 2 years of age.

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Background Growth and developmental delays are common among children under the age of five years (under-five children), especially in slum areas. Early detection and intervention may give better prognoses. Objective To detect growth and developmental delays and related risk factors among under-five children living in an inner-city slum area of the Indonesian capital. Methods This cross-sectional study was conducted from October to November 2018 in Tanah Tinggi, Johar Baru District, an inner-city slum area in Central Jakarta. Subjects were healthy children aged 3–60 months. Socioeconomic profile was obtained through questionnaires, anthropometric data through measurements, and developmental status through the Kuesioner Pra Skrining Perkembangan (KPSP) instrument. Development was considered to be delayed for KPSP scores <9. Data were analyzed using Chi-square test. Results Of 211 subjects, prevalence of underweight, stunting, and wasting were 35.1%, 28.0%, and 20.9%, respectively, meanwhile low maternal education, and low family income were 57.9% and 75%. The prevalence of developmental delay was 10%, while suspected developmental delay was 26.1%. The prevalence increased from age 21 months and peaked at 36 months. Associated risk factors were low maternal education, low family income, underweight weight-for-age, stunted height-for-age, and microcephalic head circumference-for-age. Conclusion Low education and low income were significant risk factors for growth and developmental delay.

Latar belakang. Pandemi Covid-19 sangat memengaruhi pelayanan imunisasi di seluruh dunia. Tenaga kesehatan dialihkan untuk pelayanan Covid-19 dan orangtua merasa takut membawa anaknya untuk imunisasi ke fasilitas kesehatan sehingga menurunkan cakupan imunisasi. Penurunan cakupan imunisasi akan meningkatkan kejadian penyakit yang dapat dicegah dengan imunisasi (PD3I). Jakarta sebagai ibukota negara adalah kota dengan populasi terbesar dan juga kasus Covid-19 terbanyak di Indonesia.Tujuan. Mengetahui faktor-faktor yang memengaruhi penurunan cakupan imunisasi di Jakarta dari sudut pandang orangtua dan tenaga kesehatan.Metode. Penelitian potong lintang menggunakan kuesioner disebarkan kepada tenaga kesehatan (dokter spesialis anak, dokter umum, perawat, bidan, kader) dan orangtua di Jakarta pada bulan Agustus hingga September 2020. Hasil di evaluasi menggunakan SPSS.Hasil. Sebanyak 125 tenaga kesehatan dan 145 orangtua mengikuti penelitian ini. Tenaga kesehatan menghadapi masalah seperti adanya peraturan pemerintah untuk menghentikan sementara pelayanan imunisasi, kurangnya alat pelindung diri (APD), tenaga kesehatan terinfeksi Covid-19 dan tenaga imunisasi dialihkan untuk pelayanan Covid-19. Masalah pada orangtua antara lain keraguan untuk membawa anaknya imunisasi karena takut tertular Covid-19 dari tenaga kesehatan ataupun pasien lain, Posyandu ditutup, adanya peraturan PSBB dan masalah transportasi.Kesimpulan. Penurunan cakupan imunisasi pada masa pandemi Covid-19 disebabkan oleh multi faktor yang harus diminimalisasi untuk mengurangi kejadian PD3I.

Background Typhoid fever caused by Salmonella enteric serovar Typhi (S. Typhi) is a common cause of morbidity in the world. In 2017, 14.3 million cases of Typhoid and paratyphoid fever occurred globally. School age children between 3 to 19 years old are the most affected. Poor sanitation and multi drug resistance have increased the need for vaccines to reduce the global burden of disease. Based on previous trials, typhoid conjugate vaccines have longer- lasting protection, higher efficacy, require fewer doses and are suitable from infancy that allows them to be incorporated into the routine immunization program. Our previous phase I trial proved that a novel Vi-DT typhoid conjugate vaccine is safe and immunogenic in subjects 2–5 and 18–40 years. Our phase II trial consisted of subjects 6 months to 40 years. Our previously published paper on subjects 6 to < 24 months proved that this vaccine is safe and immunogenic for this age group. Therefore, with this paper we aimed to evaluate the safety and immunogenicity in children 2–11 years. Methods A randomized, observer-blind, superiority design of Vi-DT Typhoid conjugate vaccine compared to Vi-polysaccharide vaccine (Vi-PS) phase II study was conducted from October 2018 to December 2018 where 200 subjects aged 2–11 years were recruited. A blood sample prior to vaccination was taken, followed by administration of a single dose of either test vaccine (Vi-DT) or control vaccine (Vi-PS) and then a second blood sample was collected 28 days post vaccination. Adverse reactions were assessed and antibody increment was evaluated at 28 days post vaccination through collected serum sample. Results Pain was the most common local reaction. Fever and muscle pain were the most common systemic reactions. Both Vi-DT and Vi-PS groups had roughly the same number of adverse reactions. At 28 days post vaccination, 100% of subjects in the Vi-DT group and 93% of subjects in the Vi-PS group produced antibody increment ≥4 times. The Vi-DT group produced a higher GMT as compared to Vi-PS. Conclusion Vi-DT vaccine is safe and immunogenic in children 2–11 years old. Trial registration Trial registration number: NCT03460405.