Between June and October 2005, 45 laboratory-confirmed type 1 vaccine-derived poliovirus (VDPV) cases were identified on Madura Island in Indonesia. Genetic sequencing data on VDPV isolates were consistent with replication and circulation for up to ϳ2 years. Concurrent circulation with type 1 wild poliovirus (WPV) enabled comparisons of VDPV and WPV cases and found that clinical and epidemiological features of both were similar. Attack rates for VDPV were as high as those for WPV. Of 41 VDPV case patients with known vaccination status, 25 (61%) had received zero oral polio vaccine (OPV) doses. Low population immunity due to low routine OPV coverage in rural areas and the absence of WPV circulation for more than a decade were major predisposing factors for the emergence of VDPV. Suboptimal surveillance and a limited initial immunization response may have contributed to widespread circulation. Sensitive surveillance and prompt high-quality immunization responses are recommended to prevent the spread of VDPVs.Trivalent oral polio vaccine (tOPV), a live vaccine consisting of Sabin attenuated poliovirus strains 1, 2 and 3, is the primary tool for the global eradication of poliovirus. OPV prevents paralytic disease through stimulation of humoral immunity and induces intestinal mucosal immunity that reduces person-to-person transmission, thereby protecting both vaccine recipients and the community. Other advantages of OPV include low cost, easy administration, and suitability for use in mass campaigns in developing countries [1]. However, replicating polioviruses have a high frequency of genetic mutation and recombination with other vaccine serotypes and other enteroviruses [2][3][4][5], which rarely may result in vaccine variants reacquiring the ability of the parent wild strains to cause paralytic polio [6 -8]. In settings with low population immunity, Sabin vaccine strains may be transmitted for an extended period among susceptible carriers, increasing the possibility of emergence and spread of virulent strains [6,9].Vaccine-derived polioviruses (VDPVs) are defined as having at least 1% nucleotide difference from their parent Sabin strains in the VP1 capsid protein region of the poliovirus genome [8]. On the basis of the average rate of poliovirus capsid evolution, a 1% divergence in the VP1 area implies that a virus has replicated for ϳ1 year since administration of the initiating OPV dose. VDPVs are classified into 3 categories: circulating VDPVs (cVDPVs), which are associated with sustained personto-person transmission; immunodeficiency-associated VDPVs (iVDPVs), which have been isolated from immunodeficient persons with prolonged viral infection after exposure to OPV; and ambiguous VDPVs (aVDPVs), which either have been isolated from a single patient without immunodeficiency or are environmental isolates with an unidentified source [8] pines [3,12], China [9,13], Madagascar [14], and the United States [15], among others [8, 16, 17]. In addition to low vaccine coverage, other risk factors for cVDPV emergence and ...

Significant variation exists in vaccine coverage and seroprevalence of immunity to diphtheria in East Java. Immunity in high incidence districts is likely because of natural immunity acquired through exposure to toxigenic C. diphtheriae. Booster vaccines are essential for achieving protective levels of immunity.

BackgroundDiphtheria has been reported as an outbreak in some regions in Indonesia, most especially in East Java Province. Resistance to penicillin, erythromycin, and other antibiotics, single or multiple, has been reported in several studies. This study aims to evaluate the first-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae isolates.MethodsThis descriptive observational study was performed from August to November 2018. C. diphtheriae isolates were collected from diphtheria patients and carriers in East Java from 2012 to 2017 and kept at the Balai Besar Laboratorium Kesehatan Daerah Surabaya or the Public Health Laboratory of Surabaya. Sample selection was done by random cluster sampling. The sensitivity test by E-test®of the five antibiotics (penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin) was done to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute M45A (2015) Corynebacterium spp. for penicillin and erythromycin was used as standard.ResultsFrom 114 targeted isolates, 108 were viable and toxigenic. The E-test was performed on the viable isolates. The majority of the hosts were male (58.3%), with median (range) age of 6.5 (1–14) years. Half of the samples were from the 1 to 5-year-old age group. The isolates were acquired much more from patients (78.7%) than carriers (21.3%) and from pharyngeal swab (74.1%). Most of these isolates were from Madura Island (47.2%) and the northern and eastern parts of the province (horseshoe area). Mitis isolates were the major variant (76.9%). The susceptibility pattern of C. diphtheriae to erythromycin was better than that to penicillin. The E-test result for penicillin was 68.52% susceptible, 31.48% intermediate, and 0% resistant (MIC range, < 0.016 to 2 μg/L) and for erythromycin (MIC range, < 0.016 to > 256 μg/L) was 85.2% susceptible, 12% intermediate, and 2.8% resistant The MIC range for oxacillin was 1 to 96 μg/L, while for both azithromycin and clarithromycin were <  0.016 to > 256 μg/L.ConclusionThe susceptibility rate of C. diphtheriae to erythromycin is higher than that to penicillin. The regular update of antibiotic selection to the national guidelines is recommended. The MIC reference standard to azithromycin and clarithromycin is also needed.

Background: An increase in diphtheria cases has occurred in East Java Province since 2011. The resistance level to diphtheria is considered as the most important cause. Purpose: The study aims analyzed the immunity level immunity to diphtheria in adolescents aged 16-18 years old in Bangkalan and Kediri Districts. Methods: This study was a cross-sectional study, conducted on students in eleven grade of senior high schools (SMAN) from both districts. The inclusion criteria included being 16-18 years old and students in eleven grades of senior high schools in Bangkalan and Kediri. This study was approved by their parents/guardians. The exclusion criteria included immunocompromised students and those who have a history of diphtheria infection. The data were obtained from 204 samples, 89 samples in Bangkalan, and 115 samples in Kediri. The antidiphtheria antibodies examination was carried out by the Vero cell method. The antibodies levels were grouped according to WHO standard, consist of vulnerable, basic, full, and long-term. Further analysis was done with 2 tiers of immunity, consist of immune and vulnerable. Results: The immunization coverage for basic and booster diphtheria vaccine is better in Kediri than in Bangkalan. In contrast, levels of antibodies samples in Bangkalan District is better. The participants who were immune in Bangkalan were higher than those in Kediri (91% vs. 44.3%). Conclusion: The immunity adolescents of Bangkalan is higher than in adolescent Kediri District. The adolescents in Kediri have a greater risk to get infected by the disease

Pendahuluan: Penyakit difteri telah ditetapkan menjadi kejadian luar biasa di berbagai wilayah di Indonesia, sebagian besar kasus berasal dari Jawa Timur. Tujuan: Mengetahui profil isolat Corynebacterium diphtheriae toksigenik di Jawa Timur. Metode. Penelitian deskriptif, dilakukan 20 Agustus sampai 30 November 2018. Isolat yang diteliti dipilih secara cluster random sampling kemudian dilakukan uji viabilitas dan toksigenisitas di BBLK Surabaya. Isolat yang viabel dan toksigenik dilakukan analisis karakteristik. Hasil: Penelitian ini melibatkan 114 isolat, 6 tidak viabel, 108 viabel dan toksigenik. Jenis kelamin pejamu ialah 58,3% laki-laki, 41,7% perempuan. Usia median 6,5 tahun (termuda 1 tahun, tertua 14 tahun). Mayoritas pada kelompok usia 1-5 tahun (50%) disusul 6-10 tahun (30,6%) dan 11-15 tahun (19,4%). Wilayah asal isolat didominasi dari Madura (47,2%) dan Jawa Timur tapal kuda (32,4%), sedangkan Jawa Timur bukan tapal kuda hanya 20,4%. Lokasi pengambilan sampel 74,1% dari usap tenggorok dan 25,4% dari usap hidung. Varian mitis mendominasi sejumlah 76,9%, sedangkan varian gravis hanya 23,1%. Kesimpulan: Isolat Corynebacterium diphtheriae toksigenik terbanyak didapatkan pada pejamu kelompok usia 1-5 tahun, mayoritas berdomisili di Madura dan Jawa Timur tapal kuda. Isolat terutama didapat dari usap tenggorok pasien. Varian mitis mendominasi dalam penelitian ini.