Titer Imunoglobulin G ( Ig G) Difteri Pada Anak Sekolah Studi Kasus Di Kota Semarang ( The difteri Immunoglobulin G titer in school children)

Abstract

In Central Java at 2002, 11 districts have reported 53 cases, 31 cases of them were reported by Kota Semarang. Universal Child Immunization (UC1) DPT3 has been reached at the city areas. The five research areas are Puskesmas Poncol, Miroto, Halmahera, Tlogosari Wetan and Tlogosari Kulon. The coverage of DPT3 at those areas were > 85%. DT BIAS were reached by those area > 86% - 100%. At 2002, there have been controlled, however, there were cases still reported by Kota Semarang Health Department has not evaluated yet to serology of DPT roufine immunization and BIAS. This research aims to lcnow the diphtheria G immunoglobulin titer in school children and factors that cause deferential in occurring titer because of the vaccine potency, age, amount of immunization were got to baby, time interval getting immunization, the way giving immunization, nutrition, density population, the history of skin sicicness, and tonsillitis. The cross secfional research, population is pupils under 15 years old at the village whereas outbreak was occurred at Kota Semarang in 2002. Subject of the research are pupils in play group or kindergartens and elementary school. Those are TK Tritunggal, Dian Wacana, Supriyadi, SD Dian Wacana, YSICI, Marsudirini, Tlogosari Kulon, Wetan The method of sampling is proportional random sampling with 200 children; blood sample is vena 3 ml. Treatment to the vena blood sample is using single diphtheria IgG titer with Enzyme Immune Assay at Center of Research and Development, Health Department. There were 221 samples in this research. There were 7.2% did not have titer yet, those are 93.75% in kindergarten and 6.25% in elementary school. Pupils who not have titer yet are need basic immunization; 66.2% is needed booster immunization; 26.7% is needed continued booster in five years. The significantly difference between diphtheria Ig G titer and place of school (F=12.523 and p<0.05). The test result toward potency of DPT vaccine at five Puskesmas has required both BPOM arid WHO that is 77.04 FU/DTM — 218.08 IU/DTM. The average of Ig G titer are higher at 6 — 7 years old, than the condition decrease until 5-6 years old, and increase again at 6-7 years old (0.700 IU/m1). BIAS increase fiter for 1-2 years coming. 1g G deferent at each group is statistically significant (F=4.462; p<0.05). IgG with many got immunization (F=0.956; p>0.05). The average of DT immunization titer reached higher titer (0.825 1U/m1), DPT3 + DT (0.697 IU/m1), DPT3 (0.487 IU/m1) significant (F=15.763; p<0.05). The interval giving, 1 month at 61 children, 2 month at 42 children, and for more than 2 month at 27 children are not significantly difference (F=0.956; p>0.05). The way of giving DPT at abscess group statistically significant (F=9.093; p<0.05). Nutritious status were not statistically significant (F=1.239; p>0.05). Average IgG titer at high density population was not significant (F=1.217; p>0.05). Skin illness is not significant through fonmed 1g G (F=1.082; p>0.05). In term of tonsillitis was not statistically significant (F=0.050; p>0.05). Suggestion to other researchers, this research should be developed to broad age group to get risk of age group description. Prospective approach is better to know effect base on treatment with examination of germ identification. At the Diphtheria outbrealc village, DT booster injection should be given to the children before 5-6 years old for defending protective titer. Td vaccination in kids above 8 years old is considered to be used to control an outbreak. An active surveillance through patient at Puskesmas who has throat symptoms should be implemented. DT program as fourth injection after DPT3 for the under five years old should be developed. Health department provides Td vaccine and trial it at diphtheria outbreak areas at Central Java. Jawa Tengah tahun 2002 terjadi KLB difteri di 1 I Kabupaten kasus 53 kasus 31 kasus di antaranya dilaporkan Kota Semarang Universal Child Immunization (UCI) DPT3 dicapai di tingkat Kota. Lima Puskesmas wilayah penelitian, Puskesmas Poncol, Miroto, Halmahera, Tlogosari Wetan, Kulon DPT3 >85%. BIAS DT dicapai ke lima Puskesmas > 86% Tahun 2002 dilakukan penanggulangan, kasus difteri masih dilaporkan dari Kota Semarang. Belum pemah dilakukan evaluasi serologi dari imunisasi DPT dan BIAS. Penelitian ini bertujuan untuk mengetahui titer IgG difteri yang sudah terbentuk pada anak sekolah. serta faktor terjadinya perbedaan pembentukan titer karena potensi vaksin, umur, jumlah imunisasi interval waktu imunisasi, cara pemberian imunisasi, gizi,. kepadatan huni, riwayat sakit kulit, tonsilitis. Rancangan cross sectional study, populasi umur <15 tahun di desa KLB difteri tahun 2002 di Kota Semarang. Subyek penelitian anak sekolah play group, TK Tritunggal, Than wacana, Supriyadi, SD Dian Wacana, YSKI, Marsudirini, Tlogosari Kulon. Sampel secara acak dan proporsional (proporsional random sampling). Besar sampel 200 anak, sampel darah vena 3 ml. Pemeriksaan titer IgG difteri tunggal dengan teknik Enzym Imuno Assay di Pusat Penelitian dan Pengembangan Dep. Kes. Hasil 221 anak masuk dalam penelitian, 7,2% titer IgG 0,0 1U/m1 yaitu 93,75% pada anak TK dan 6,25% pada anak SD diperlukan imunisasi dasar, 66,2% diperlukan imunisasi booster, 26,7% diperlukan booster dalam 5 tahun. Terdapat perbedaan yang bermakna titer IgG difteri menurut lokasi sekolah (F:12,532 dan p < 0,05). Basil uji potensi vaksin DPT di 5 Puskesmas memenuhi syarat BPOM, WHO yaitu 77,04 IU/DTM - 218,08 IU/DTM. Rerata titer IgG 0,9 IU/ml tertinggi pada usia 2-3 tahun keadaan menurun sampai usia 5-6 tahun (0,4 IU/ml), Perbedaan Ig G menurut umur bermakna (F = 4,462; p < 0,05). Perbedaan Ig G menurut banyaknya imunisasi bermakna (F = 3,153; p < 0,05). Rerata imunisasi DT dicapai titer tertinggi dibanding DPT dan bermalcna (F = 15,763; p < 0,05). Interval pemberian imunisasi, 1, 2 dan >2 bulan, tidak ada perbedaan yang bermakna (F = 0,956; p > 0,05). Cara pemberian imunisasi bermakna secara statistik (F = 9,093; p < 0,05). Status gizi tidak bemiakna secara statistik (F = 1,239; p > 0,05). Riwayat sakit Ispa titer paling rendah dan bermakna secara statistik (F = 2,642; p < 0,05). Titer Ig G menurut padat huni tidak bermakna (F = 1,217; p > 0,05). Terbentuknya IgG menurut sakit kulit tidak bermakna (F = 1,082; p > 0,05). Radang tonsil tidak bermakna secara statistik (F = 0,050; p > 0,05). Disarankan untuk peneliti lain, dikembangkan pada kelompok umur yang lebih luas Sebaiknya booster DT diprogramkan pada anak sebelum usia 5-6 tahun di Desa KLB difteri, untuk mempertahankan titer protektif. Vaksinasi Td dipertimbangan digunakan untuk pengendalian KLB. Dikembanglcan Program DPT/DT ke-4 rutin setelah 12-18 bulan dari DPT 3 kali. Dep Kes RI agar menyediakan vaksin Td dan melakukan trial penggunaan Td di wilayah KLB difteri di Jawa Tengah