Hubungan Status Imunisasi dengan Kejadian Difteri Berat pada Pasien Anak yang Dirawat di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung Periode Januari 2015 – Juli 2019

Abstract

Latar belakang. Jawa Barat menjadi provinsi kedua dengan insiden difteri terbanyak di Indonesia pada tahun 2016 dan 2018. Infeksi difteri berat ditandai oleh bull neck dan komplikasi seperti miokarditis, neuritis, dan obstruksi saluran napas atas (OSNA). Status imunisasi merupakan faktor yang memengaruhi infeksi difteri. Tujuan. Penelitian ini bertujuan untuk mengetahui hubungan antara status imunisasi dengan kejadian difteri berat.Metode. Penelitian ini menggunakan rancangan potong lintang. Populasi penelitian adalah data rekam medis pasien difteri anak rawat inap RSUP Dr. Hasan Sadikin Bandung periode Januari 2015 – Juli 2019 dengan metode total sampling. Kriteria inklusi adalah rekam medis yang terdapat data mengenai jenis kelamin, usia, status imunisasi, manifestasi klinis, durasi, serta keluaran. Hubungan status imunisasi dengan kejadian difteri berat dianalisis menggunakan uji eksak Fisher.Hasil. 42 pasien terdiri dari 29 (69 %) laki-laki dan 13 (31 %) perempuan, usia terbanyak 5-9 tahun. Terdapat 20 (47,6%) pasien dengan bull neck, 13 (31,0%) pasien OSNA, 1 (2,4%) pasien neuritis. Satu orang meninggal, yaitu pasien difteri berat dengan OSNA dan sepsis. Hasil analisis uji eksak Fisher diperoleh hubungan antara status imunisasi dengan kejadian difteri berat dengan nilai p=0,036. Kesimpulan. Terdapat hubungan antara status imunisasi dengan kejadian difteri berat.

Clinical Manifestation of Childhood Diphtheria

“…Most of the patients were 6-11 years old (n=62 people; 44,0%) and followed by 0-5 years old (n=60 people; 42,6%). This finding was in line to (Harsanti et al, 2020) that stated 5-9 years old children was the most vulnerable group to diphtheria. (Harwalkar & Kadegaon, 2019) also reported the highest distribution fell onto 6-10 years old children.…”

“…This finding was in line to result of (Arifin & Prasasti, 2017)'s research that pointed boys were more prone to get infected due to their outdoor activity that lead to bigger exposure to the disease. It was also supported by two other studies, (Arya et al, 2022) and (Harsanti et al, 2020). They also observed boys were in higher risk to the infection than girls.…”

“…These studies also observed more children with completed vaccination experienced the disease (Arifin & Prasasti, 2017). A number of factor might causes lower effectivity of the vaccine such as patient's condition, logistic factor and epidemiologic factor (Harsanti et al, 2020). This finding reminded us the importance to check vaccine qualities which should be done by surveillance officer (Alfiansyah, 2015).…”

“…Toxoid diphtheria vaccine gives protection up to 90% to clinical diphtheria and 50-80% to the disease complication such as myocarditis, neurological deficit and mortality (Quick et al, 2000). According to (Harsanti et al, 2020), it might be correlated to low antibody titer due to inadequate booster vaccine. Interaction to schoolmates and teacher also increase possibility to Corynebacterium diphtheriae exposure.…”

“…The toxin causes irreversible inhibition of protein synthesis and epithelial cell dysfunction in the respiratory system, kidney, heart, and nervous system (Tosepu et al, 2018). Diphtheria can be easily transmitted via droplet or direct close contact with a confirmed patient (Harsanti et al, 2020). Classically, diphtheria was found in children less than 12 years.…”