RECOMMENDATION OF DIPHTHERIA ANTITOXIN TO DIFFERENT SUSPECTS DURING THE DIPHTHERIA OUTBREAKS,LUMAJANG DISTRICT IN 2018

The number of diphtheria suspects in Lumajang district was the second highest in East Java province during the diphtheria outbreaks in 2018. The number of diphtheria cases was more than 500% in 2018 compared to 2017. To give diphtheria antitoxin (DAT), the provincial diphtheria expert team consider various suspects’ characteristics for DAT recommendation as DAT supplies are limited. This case report aimed to explore and describe the relationship between diphtheria suspects’ characteristics, including age, gender, symptoms, immunization status, duration of disease, and contact status with other suspects according to the DAT recommendations from the expert team. This case report was descriptive and used a cross-sectional approach. It was conductedduring the diphtheria outbreaks and involved total samples of all suspects. Based on age, the majority of the suspects (92%)were under 19 years old. Suspects at this age were the target of an outbreak response immunization (ORI) program. Those who were not targetted to receive ORI (aged over 19 years) began to appear in November and mostly in December. The trend of non-ORI targetted age increased after the third round of ORI implementation. According to the report form parents, most suspects (46.7%) had complete immunization status, and only 6.7% of their immunization records were reported on growth chart cards. All suspects with positive diphtheria never had and know routine immunization records. The laboratory tests show only 5% were suspected with positive diphtheria with a cultural type of mitis toxigenic. As many as 32% of the total suspects were recommended for DAT treatment. The use of controlled DAT could save 1,640,000 iU. Keywords: Diphtheria, outbreak response immunization, diphtheria antitoxin.

Efektifitas Kompres Hangat dan Kompres Dingin terhadap Tingkat Nyeri Balita Pasca Outbreak Response Immunization (ORI)

Introduction: The Medical treatment which carried out by using needles, such as immunization, is a source of pain for children. the importance of evidence-based immunization strategies is used to reduce pain. Pain management with compresses that can be done before immunization in the injection area is considered capable of reducing pain in children. Warm compresses can cause physiological effects, the effects of giving warm compresses can reduce the pain. Cold compresses proved to be an effective way to reduce pain during immunization because it increases endorphins and suppresses prostaglandins so that it can increase pain thresholds. The purpose of this study is to explain the effectiveness of using warm compresses and cold compresses to the pain level in toddlers after ORI diphtheria immunization.Methods: Analytical This study was pre-experimental with posttest only design. Data collection was carried out with FLACC scale sheets. The number of respondents as many as 66 toddlers was taken by inclusion and exclusion criteria with purposive sampling technique. Data were analyzed using Mann-Whitney analysis.Results: the average pain in compress warm group of 4.48 in the cold compress 2.91. However statistical test Mann-Whitney point a difference meaningful influence in both group on the pain of p = 0.001. Cold compress more effective to reduce the pain with the mean the difference between of 25.41 than warm compress of 41.59Conclusion: Increasing Cold compresses are more effective in reducing the level of pain in toddlers after ORI diphtheria immunization. Cold compresses with the temperature of 15° c that were conducted before the act of injection can be used as the management of pain non pharmacology to lower the level of pain in toddler after ORI diphtheria immunization.

Evaluation of outbreak response immunization in the control of pertussis using agent-based modeling

BackgroundPertussis control remains a challenge due to recently observed effects of waning immunity to acellular vaccine and suboptimal vaccine coverage. Multiple outbreaks have been reported in different ages worldwide. For certain outbreaks, public health authorities can launch an outbreak response immunization (ORI) campaign to control pertussis spread. We investigated effects of an outbreak response immunization targeting young adolescents in averting pertussis cases.MethodsWe developed an agent-based model for pertussis transmission representing disease mechanism, waning immunity, vaccination schedule and pathogen transmission in a spatially-explicit 500,000-person contact network representing a typical Canadian Public Health district. Parameters were derived from literature and calibration. We used published cumulative incidence and dose-specific vaccine coverage to calibrate the model’s epidemiological curves. We endogenized outbreak response by defining thresholds to trigger simulated immunization campaigns in the 10–14 age group offering 80% coverage. We ran paired simulations with and without outbreak response immunization and included those resulting in a single ORI within a 10-year span. We calculated the number of cases averted attributable to outbreak immunization campaign in all ages, in the 10–14 age group and in infants. The count of cases averted were tested using Mann–WhitneyUtest to determine statistical significance. Numbers needed to vaccinate during immunization campaign to prevent a single case in respective age groups were derived from the model. We varied adult vaccine coverage, waning immunity parameters, immunization campaign eligibility and tested stronger vaccination boosting effect in sensitivity analyses.Results189 qualified paired-runs were analyzed. On average, ORI was triggered every 26 years. On a per-run basis, there were an average of 124, 243 and 429 pertussis cases averted across all age groups within 1, 3 and 10 years of a campaign, respectively. During the same time periods, 53, 96, and 163 cases were averted in the 10–14 age group, and 6, 11, 20 in infants under 1 (p< 0.001, all groups). Numbers needed to vaccinate ranged from 49 to 221, from 130 to 519 and from 1,031 to 4,903 for all ages, the 10–14 age group and for infants, respectively. Most sensitivity analyses resulted in minimal impact on a number of cases averted.DiscussionOur model generated 30 years of longitudinal data to evaluate effects of outbreak response immunization in a controlled study. Immunization campaign implemented as an outbreak response measure among adolescents may confer benefits across all ages accruing over a 10-year period. Our inference is dependent on having an outbreak of significant magnitude affecting predominantly the selected age and achieving a comprehensive vaccine coverage during the campaign. Economic evaluations and comparisons with other control measures can add to conclusions generated by our work.