Dr. Mulya Rahma Karyanti, SpA(K), MScKetua Divisi Infeksi dan Pediatri Tropik,

Departemen Ilmu Kesehatan Anak, RSCM-FKUI

Pendidikan• Dokter Umum - Fakultas Kedokteran UI, 1988 - 1994 • Spesialis Anak - Fakultas Kedokteran UI, 2004• Master of Science in clinical epidemiology - Utrecht Medical Centre, 2011• Konsultan Infeksi dan Pediatri Tropis - Fakultas Kedokteran UI, 2011Pengalaman Organisasi• Anggota IDAI Jaya, 2004 - Sekarang• Pengurus UKK Infeksi dan Pediatri Tropik, 2017 - 2020• Ketua Satgas Farmasi Pediatri PP IDAI, 2017 – Sekarang• KOMLI Demam Berdarah Dengue• KOMLI Malaria• Komite verifikasi nasional eliminasi campak dan pengendalian rubela (CRS)• Komite ahli pengendalian difteri

Dengue Vaccine Update & Recommendation

Dr. Mulya Rahma Karyanti, SpA(K), MSc

Divisi Infeksi dan Pediatri Tropik Departemen Ilmu Kesehatan Anak, RSCM-FKUI

Dengue Seroprevalence Study in Indonesia

RESEARCH ARTICLEDengue virus serotype distribution based on serological evidence in pediatric urban population in Indonesia

Tedjo Sasmono, Anne-Frieda Taurel, Ari Prayitno, Hermin Sitompul,B.Yohan, Rahma F. Hayati, Alain Bouckenooghe, Sri Rezeki Hadinegoro, Joshua Nealon

PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0006616 June 28, 2018

RESEARCH ARTICLEDengue seroprevalence and force of primary infection in a representative

population of urban dwelling Indonesian children

Ari Prayitno, Anne-Frieda Taurel, Joshua Nealon, Hindra Irawan Satari, Mulya Rahma Karyanti,

Rini Sekartini, Soedjatmiko, Hartono Gunardi, Bernie Medise, Tedjo Sasmono, James Mark

Simmerman, Alain Bouckenooghe, Sri Rezeki Hadinegoro

PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0005621 June 15, 2017

DNG26 study

Multi-stage cross-sectional

community-based

seroprevalence study

3,210 subjects

1 to 18 year of age

Duration

Sept 2014-January 2015

30 sites

(district as cluster

in 15 provinces)

Primary objective

Determine the prevalence of

specific antibodies IgG against

dengue in healthy 1 to 18 year-old

children in urban Indonesia

Secondary objectives

• Determine the dengue virus

serotype (DENV-1, 2, 3, and/or 4)

specific to the antibodies in

positive IgG samples

• Identify the potential factors

associated with the serologic

status

Ari Prayitno et al. PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0005621 June 15, 2017

Study design and sites• DNG26: first nationally representative dengue

seroprevalence study in urban dwelling Indonesian children (1-18 years old)

• Multi-stage cross sectional seroprevalence study, cluster sampling (PPS)

• Improve understanding of dengue burden in <19 year of age and socio-economic determinants associated

Study SitesNo Province Regency Cluster No Province Regency Cluster

1 Aceh Subulusalam 1 9 Jawa Tengah Klaten 18

2 Sumatera Utara Medan 2 Jepara 19

3 Sumatera Barat Padang 3 Tegal 20

4 Jambi Bungo 4 Tegal 21

5 Lampung Lampung Selatan 5 10 Jawa Timur Ponorogo 22

6 Banten Tangerang 6 Banyuwangi 23

Tangerang 7 Mojokerto 24

7 DKI Jakarta Jakarta Selatan 8 Sumenep 25

Jakarta Timur 9 Surabaya 26

Jakarta Barat 10 11 Bali Denpasar 27

8 Jawa Barat Bogor 11 12 Kalimantan Timur Samarinda 28

Bandung 12 13 Sulawesi Selatan Toraja Utara 29

Cirebon 13 14 Sulawesi Tenggara Kendari 30

Bekasi 14

Bandung 15

Bekasi 16

Tasikmalaya 17

Site

14 provinces, 30 regencies, 30

clusters

DNG26 study procedure

Primary health workers inform population about the study

Subject visits PHC for blood draw (5ml)

DEN-1 DEN-2 DEN-3 DEN-4

Enrollment during house visits:• ICF and assent• Collection of socio-demographic data• Schedule visit to Primary Health Care (PHC)

IgG ELISA for dengue

Dengue negative Dengue positive

PRNT for serotype

At

each

stu

dy

site

Eijk

man

Inst

itu

te,

Jaka

rta

ResultDengue IgG seroprevalence according to age group (all sites)

| 13

• Overall dengue seroprevalence in 1-18 year old : 69.4% [95%CI,

67.7-71.0]

• Seroprevalence increasing with age group

n = 3,195

Dengue IgG seroprevalence according to age as continuous variables (all sites)

| 14

• At 1 year old, > 25% and at 5 years old > 50% infected by dengue

• Over 9 years old, ≥80% of children were infected at least once

• Dengue seroprevalence at 18 years old children was 95%

n = 3,194

Sasmono T, et al. PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0006616 June 28, 2018

Proportion of individuals by age groupwith naïve, monotypic, or multitypic PRNT profiles

Proportion of monotypic dengue antibody profiles against each dengue serotype, by province containing at least one study site (in grey)

Sasmono T, et al. PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0006616 June 28, 2018

Dengue serotype specific GMT by age-group

Sasmono T, et al. PLOS Negl Trop Dis | https://doi.org/10.1371/journal.pntd.0006616 June 28, 2018

Dengue IgG seroprevalence according to gender and age group

• Seroprevalence increase with older age

• Seroprevalence in female and male are similar, small trend of female

higher seroprevalence especially in younger age group

¹ chi-square (missing values are excluded from the testing);

Age group M n

Overall Overall adjusted

% IgG

positive 95% CI

% IgG

positive 95% CI

Male 1,527 1,030 67.5 [65.0 ; 69.8] 67.5 [62.4 ; 72.5]

1 to 4 years 333 102 30.6 [25.7 ; 35.9] 30.6 [23.2 ; 38.0]

5 to 9 years 428 273 63.8 [59.0 ; 68.3] 63.8 [57.2 ; 70.4]

10 to 14 years 412 343 83.3 [79.3 ; 86.7] 83.3 [77.0 ; 89.5]

15 to 18 years 354 312 88.1 [84.3 ; 91.3] 88.1 [82.1 ; 94.2]

Female 1,667 1,186 71.1 [68.9 ; 73.3] 71.1 [65.9 ; 76.3]

1 to 4 years 339 125 36.9 [31.7 ; 42.3] 36.9 [28.7 ; 45.1]

5 to 9 years 433 290 67.0 [62.3 ; 71.4] 67.0 [59.9 ; 74.1]

10 to 14 years 474 393 82.9 [79.2 ; 86.2] 82.9 [76.2 ; 89.7]

15 to 18 years 421 378 89.8 [86.5 ; 92.5] 89.8 [84.4 ; 95.2]

n = 3,194

Dengue IgG seroprevalence according to reported dengue infection history

• Among subjects “no” or “don’t know” about medical history of

dengue infection, 67% and 69% respectively had a positive

dengue IgG result, indicative of a previous dengue infection

¹ chi-square (missing values are excluded from the testing);

n = 2,971