Successful COVID-19 Contact Tracing of Crew from Two Cargo Ships at the Morowali Seaport, Indonesia.

OBJECTIVES: This study aims to report a successful systematic quarantine of coronavirus disease (COVID-19) to detect Omicron, a new variant of concern, among 2 cargo ships in the Morowali seaport, Indonesia. METHODS: An international standard entry point protocol had been followed in this study for all crew. Rapid diagnostic tests and whole-genome sequencing (WGS) tests have been conducted to identify Omicron, the variant of concern. Individual characteristics, laboratory result, and vaccine status were collected in this study. RESULTS: On December 9 and 18, 2021, there was an increase of 21 and 22 new cases, respectively, from 2 ships in the seaport. Both ships came from abroad, 43 new cases with a positivity rate increase from 0 to 13.4% and 13.7% within 2 weeks. A polymerase chain reaction (PCR) examination was carried out on all crews and obtained results 21 of the 22 positive COVID-19 crew (95.5%). The monitoring results showed that there was no fever in the entire crew, no symptoms of cough, runny nose, shortness of breath, and other symptoms pointing to COVID-19. CONCLUSION: Systematic quarantine has successfully contained the large clusters of COVID-19 in the crews of 2 ships and prevented further outbreaks in the local community.

Side Effects after mRNA COVID-19 Vaccine as a Booster in Health Workers.

Background: In Indonesia, around 400 health workers died due to Covid-19 between June-July 2021, therefore the health workers need to be given further immunity. Health workers were among the first to get a booster shoot. However, they may experience side effects after vaccination. We aimed to describe side effects of Moderna vaccine as a booster in health workers. Methods: A cross sectional study was conducted on health workers who received mRNA Covid-19 vaccine booster (Moderna) at Sulianti Saroso Infectious Disease Hospital, Indonesia and had filled the questionnaire assessing side effects form. We associated the form of the questionnaire assessing side effects from the originating source of hospital immunization unit in September 2021. Results: A total of 101 health workers who received mRNA Covid-19 vaccine booster in Jul-Aug 2021 were included. Most of health worker experienced more than 3 side effects. The side effects were sore arm (100%); chills (72%); fatigue (57%); headache (53%) and fever (51%), other symptoms (28%). The side effects mostly happened a day of receiving a booster shot (61.4%). There was no association between age, gender, comorbid to amount of side effects (P>0.05). Conclusion: Since the public must fulfil the immunization program during pandemic, it is the responsibility of the healthcare provider to inform about the potential side effects and benefits of a new Covid-19 vaccine.

Antimicrobial Sensitivity Pattern from Hospitalized Pneumonia Patients in National Referral Infectious Disease Hospital in Indonesia.

Background: Pneumonia is still a major global problem with high morbidity and mortality. The increasing number of pneumonia cases caused by bacteria, especially multidrug-resistant pathogens, increasing age of the population, patients with chronic disease (comorbid), and inappropriate antimicrobial therapy at initial administration make the treatment become less effective. These issues finally contribute to higher morbidity and mortality in cases of hospitalized pneumonia patients. Therefore, it is crucial to know the microbial pattern and select the therapy according to local antimicrobial sensitivity patterns. Method: A cross-sectional study was conducted for hospitalized pneumonia patients between January 2015 and December 2016 in Indonesia National Referral Infectious Disease Hospital. Data were collected from medical records to show patient characteristics, antimicrobial treatment data, culture examination, and bacterial sensitivity. Results: A total of 99 pneumonia patients required hospitalization and underwent sputum culture examination. The patients were mostly above 65 years old (32.3%) and male (57.6%). The most common comorbidities were pulmonary tuberculosis (21%), and the others were heart failure, chronic obstructive pulmonary disease (COPD), and HIV/AIDS. Based on the sputum culture, fungi were identified in most specimens (56%), while the bacteria identified were Klebsiella pneumoniae (14%), Acinetobacter sp. (12%), and Pseudomonas sp. (8%). Third-generation cephalosporin, such as ceftriaxone (50%), was commonly used as an antibiotic for pneumonia treatment. Conclusion: Most common bacteria isolated from sputum culture were Klebsiella pneumoniae which were more sensitive to the beta-lactam and aminoglycoside groups. The higher risk factors were age above 65 years old, being male, and having tuberculosis.

Health System Disruption at the Primary Health Center Level Affected by Earthquake, Tsunami, and Liquefaction in 3 Districts of Central Sulawesi, Indonesia.

OBJECTIVES: An earthquake followed by tsunami and liquefaction on September 28, 2018, in Central Sulawesi caused health system disruptions. This study aimed to know health system disruption at the primary health center (PHC) level due to the disaster in 3 districts (Palu, Sigi, Donggala) of Central Sulawesi. METHODS: This was a qualitative study conducted in March 2019 involving 36 PHCs. Data were collected through interview of PHC officers using a structured questionnaire. Variables included disruption of management, budget, human resources, drug supply, Early Warning Alert and Response System (EWARS) of epidemic prone disease (EPD), human resource migration, health facility damage, and health facility access. Descriptive analysis was conducted to define disruption for a 1-y projection. RESULTS: Health system disruptions in Palu affected management, budget, human resources, EWARS, health facility damage, and health access; occurred within 1-2 mo; and were projected to become better after 6 mo. Problems in Sigi were management, human resources, drug supply, EPD, and EWARS for 1 mo after disaster and were projected to be better after 2 mo. The problems in Donggala were health services access, management, human resources for 1 mo after the disaster and were projected to be normal after 2 mo. CONCLUSIONS: Health system disruptions occurred in Central Sulawesi Province at the PHC level within 1-2 mo and were projected to become better after 3 mo in most PHCs.

Early Initiation of ARV Therapy Among TB-HIV Patients in Indonesia Prolongs Survival Rates!

BACKGROUND: The HIV epidemic remains a public health problem with rising tuberculosis (TB) numbers around the world. Antiretroviral (ARV) therapy (ART) is essential to increase the survival of patients with TB-HIV coinfection. The aim of this study is to investigate the effect of ARV treatment initiation within TB treatment duration for the survival of patients with TB-HIV coinfection. METHODS: This is a retrospective cohort study of patients with TB-HIV coinfection and who were ARV naive from Prof. Dr. Sulianti Saroso Infectious Disease Hospital between January 2011 and May 2014 (N = 275). The Kaplan-Meier method, bivariate with the log rank test, and multivariate with the Cox regression were applied in this study. RESULTS: Cumulative survival probability of the patients with TB-HIV coinfection receiving ARV in a year was 81.5%. The death rate in patients with TB-HIV coinfection who received late ART initiation during TB treatment is higher by 2.4 times [adjusted hazard ratio (aHR) = 2.4, 95% confidence interval: 1.3-4.5, p = 0.006] compared with the patients who were in early ART initiation and were thereafter adjusted by the location of Mycobacterium tuberculosis infection. CONCLUSION: The effect of ART initiation is essential in the intensive phase (2-8 weeks) of anti-TB medication to increase the survival among TB-HIV coinfection group.