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3.pencegahan Pneumonia PDF
3.pencegahan Pneumonia PDF
12 November 2018
Pencegahan Pneumonia
Bahayanya pneumonia
oksigen kurang
kematian
15 negara dengan kematian akibat
pneumonia terbanyak di dunia
Sumber:
One is too many: ending child deaths from pneumonia and diarrhea. UNICEF. 2016.
Pneumonia Penyebab Kematian Utama pada
Usia 0 - 11 bulan dan 0-59 bulan
No Causes of Death (ICD 10), 0 - 11 months % No Causes of Death (ICD 10), 0-59 months %
Disorders relating to length of gestation Disorders relating to length of
1 18.9 1 14.0
and fetal growth (P05 – P08) gestation and fetal growth (P05 – P08)
Intrauterine hypoxia and birth asphyxia Diarrhoea and gastroenteritis of
2 14.8 2 11.1
(P20, P21) presumed infectious origin (A09)
3 Pneumonia (J12 – J18) 9.7
Intrauterine hypoxia and birth asphyxia
Diarrhoea and gastroenteritis of presumed 3 11.0
4 9.2 (P20, P21)
infectious origin (A09)
4 Pneumonia (J12 – J18) 9.5
Congenital malformations of the heart
5 5.8 Congenital malformations of the heart
(Q20 - Q24) 5 5.9
(Q20 - Q24)
6 Respiratory distress of newborn (P22) 4.3
6 Meningitis (G03) 3.5
Fetus and newborn affected by maternal 7 Respiratory distress of newborn (P22) 3.2
7 factors and by complications of pregnancy 2.4 Accidental drowning and submersion (W65
8 2.0
labour and delivery (P00 – P04) – W74)
0 250.000 500.000
Karier
Nasofaring di
Asia berkisar
9.0 % – 43.2 %
Lee NY, Song J-H, Kim S, et al, Carriage of Antibiotic-Resistant Pneumococci among Asian Children: A Multinational Surveillance by the ANSORP
CID 2001;32:1463-69
Distribusi Serotipe Pada Pasien dengan
Pneumonia yang Disebabkan Pneumokokus
Gentile et al. Bender et al. Resti et al. Bewick et al. Cilloniz et al.
Serotypes (62) (63) (64) (66) (60)
Prospective Prospective
Retrospective Observational
Desain Study Meta-analysis Observational Observational
Study Study
Study Study
Latin America
Wilayah Study US Italy UK Spain
and Caribbean
Adult (Age Not
Usia Populasi Study <5 Yr <18 Yr 0–16 Yr ≥16 Yr
Specified)
Jenis Pneumonia CAP Pneumonia Bacteremic CAP CAP Invasive CAP
15 B/C 45 8
• Karier S. pneumoniae 46%
11A 19 3
10A 13 2
35B 10 2
18 9 2
Others* 60 11
Untypable 115 21
* Serotype (number): 34 (7); 22F (7); 35F (7); 15A (6); 3 (5); 20 (4); 31 (4); 38 (4); 4 (3); 17F (3); 7F (3); 1 (2); 12F (2); 33F (1); 7C (1); 9V (1).
Hadinegoro SR, Prayitno A, Khoeri MM, et al. Nasopharyngeal carriage of Streptococcus pneumoniae in healthy children under
five years old in Central Lombok Regency, Indonesia. Southeast Asian J Trop Med Public Health 2016;47(3):485-493
Gunungkidul and Sumba Barat Daya
(Eijkman Institute, US CDC Jakarta, US CDC Atlanta, FKUI)
Studi cross sectional dengan sample minimum:
432 anak <1 tahun dan 986 anak 1-<5 tahun
Karier Nasofaring S.pneumoniae overall: 55%
• Gunungkidul: 31.2%
• N=188. Distribusi serotype: 6A/6B, 19F, 3, 14, 23F,
6C/6D, 15B/15C, 34
• Sumba Barat Daya: 84.5%
• N=364. Distribusi serotype: 6A/6B, 19F, 23F, 19A, 14,
11A/11D, 21
PCV13 coverage >50%
Safari D, Daningrat WOD, Khoeri M, et al. Risk Factors of Pneumococcal Carriage in Children Under 5 Years of Age in Indonesia. Poster No.198 ISPPD 11 th.
April 2018, Melbourne
Karier Nasofaring pada Bayi, Bandung (1/2)
Universitas Padjajaran, Murdoch Children’s Research Institute, The University of Melbourne,
London School of Hygiene and Tropical Medicine, PATH
• 200 bayi sehat belum pernah divaksin PCV usia 8 • Total 1575 swab dikumpulkan. Ditemukan 314 episode
dan 12 minggu pada Visit 1: 98 bayi dari perkotaan karier. Prevalensi karier nasofaring meningkat sesuai
(Puter) dan 102 dari pedesaan (Jaya Mekar) umur dalam tahun pertama kehidupan
Murad C, Dunne, E, Sudigdoadi S, et al. Nasopharyngeal carriage, serotype distribution and antimicrobial resistance genes of Streptococcus
pneumoniae among healthy infant in Indonesia during first years of life. Poster presented in ISPPD 11 th, Melbourne 15-19 April 2018
Karier Nasofaring pada Bayi, Bandung (2/2)
Universitas Padjajaran, Murdoch Children’s Research Institute, The University of Melbourne,
London School of Hygiene and Tropical Medicine, PATH
3 19A 6A
Murad C, Dunne, E, Sudigdoadi S, et al. Nasopharyngeal carriage, serotype distribution and antimicrobial resistance genes of Streptococcus
pneumoniae among healthy infant in Indonesia during first years of life. Poster presented in ISPPD 11 th, Melbourne 15-19 April 2018
Deteksi Gen Resistensi Antibiotik
Universitas Padjajaran, Murdoch Children’s Research Institute, The University of Melbourne,
London School of Hygiene and Tropical Medicine, PATH
Murad C, Dunne, E, Sudigdoadi S, et al. Nasopharyngeal carriage, serotype distribution and antimicrobial resistance genes of Streptococcus
pneumoniae among healthy infant in Indonesia during first years of life. Poster presented in ISPPD 11 th, Melbourne 15-19 April 2018
Karier Nasofaring di Padang, Bandung, Lombok
Universitas Padjajaran, Universitas Andalas, Universitas Mataram, Murdoch Children’s
Research Institute, The University of Melbourne, London School of Hygiene and Tropical
Medicine, PATH
Studi cross sectional dengan sample 302 anak sehat usia 12-24 bulan
Dunne EM, Murad C, Sudigdoadi S, et al. OneCarriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus
aureus in Indonesian children: A cross-sectional study. Plos One 2018;13(4): e0195098.
Karier Nasofaring di Padang, Bandung, Lombok
Universitas Padjajaran, Universitas Andalas, Universitas Mataram, Murdoch Children’s
Research Institute, The University of Melbourne, London School of Hygiene and Tropical
Medicine, PATH
20 serotype tersering yang diidentifikasi dalam swab nasofaring pada anak
Indonesia usia 12-24 bulan, berdasarkan area
Cakupan Serotype
PCV13:
Bandung 26/73 (36%)
Lombok 28/53 (53%)
Padang 22/38 (58%)
Dunne EM, Murad C, Sudigdoadi S, et al. OneCarriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus
aureus in Indonesian children: A cross-sectional study. Plos One 2018;13(4): e0195098.
20
~72% ~64%
20,
11.8 reduction 16, reduction
10.9
(per 10,000 admissions)
(95% CI 8.4–15.9)
Hospitalization rates
(95% CI 7.2–14.5)
16,
12,
12,
8, 3.9
3.3
8, (95% CI 1.6–6.2)
(95% CI 1.6–5.9)
4,
4,
0, 0,
Pre-PCV Post-PCV Pre-PCV Post-PCV
The pre-PCV period was 2009–2011; the post-PCV period was 2012–2013.
IPD refers to PE, P-CAP, meningitis, bacteremia, peritonitis, arthritis, cellulitis and other.
CAP=community-acquired pneumonia; CI=confidence interval; PE=pneumococcal empyema; P-CAP= pneumococcal community-acquired pneumonia; P-PD=pneumococcal pulmonary disease
(P-CAP+PE). 34
López EL, et al. J Pediatric Infect Dis Soc. 2017; doi: 10.1093/jpids/piw089.
Efek Pneumococcal Conjugate Vaccine
Usia Dosis
7–11 3 kali, 4–8 minggu jarak antar dosis, dosis ketiga setelah usia 1
Bulan tahun, atau minimal 2 bulan setelah dosis kedua
Chest Indrawing
(tarikan dinding dada ke dalam)
Obati !!!!!!
• Setiap kader kesehatan dan petugas kesehatan mampu
melakukan Manajemen Terpadu Balita Sakit (MTBS).
• Diagnosis dini dan tepat oleh dokter.