TANGGAP KEBAL VAKSIN HEPATITIS B PADA BAYI BERAT LAHIR RENDAH DAN BAYI BERAT LAHIR NORMAL SETELAH VAKSINASI DASAR HEPATITIS B
Muhardison, Prof. dr. Hari Kusnanto, DrPH
2014 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang: Hepatitis B penyakit yang banyak ditemukan di dunia penyebab utama kesakitan dan kematian. Lebih 2 milyar penduduk sudah terinfeksi virus hepatitis B, 378 juta penderita kronis, kematian 1-2 juta, dan lebih 4 juta kasus klinis akut terjadi setiap tahun. Prevalensi HB di Indonesia 3-20%. Transmisi vertikal maupun horizontal pada bayi dan anak terjadi 25-45%. 25-50% anak terinfeksi sebelum usia 5 tahun. Pendekatan paling efektif mengurangi infeksi HB pencegahan primer melalui vaksinasi massal bayi baru lahir dan anak secara berkesinambungan. Tujuan: Melihat tanggap kebal vaksin HB BBLR dan BBLN setelah vaksinasi dasar HB serta faktor lain yang berhubungan terhadap respon imun, jenis kelamin, umur kehamilan dan kenaikan berat badan 6 bulan pertama kehidupan. Methode: Penelitian ini kohort retrospektif. Populasi bayi lahir bulan Mei-Juli tahun 2012. Sampel terpilih 106 bayi berumur 13-15 bulan, mendapatkan vaksinasi dasar HB rekombinan 4 dosis jadwal 0, 2, 3, dan 4 bulan sesuai kriteria inklusi dan ekslusi. Serum anak diperiksa titer antibodi anti-HBs dengan metode Elisa. Hasil dikategorikan respon negatif titer anti-HBs <10 IU/L dan respon positif ≥10 IU/L. Uji hipotesis yang digunakan fisher’s exact dan logistic regression. Hasil: Sebanyak 98 subjek (92,5%) menyelesaikan penelitian. Tanggap kebal BBLR (89,7%) sama dengan BBLN (95,9) RR 2,5 CI (0,50-12,2) p=0,2178. Jenis kelamin tidak berhubungan terhadap tanggap kebal RR 0,6 CI (0,15-2,69) p=0,6996. Umur kehamilan <37 berhubungan dengan tanggap kebal RR 8 CI (1,05-63,9) p=0,0399. BB 6 bulan pertama tidak berhubungan terhadap tanggap kebal RR 3,6 CI (0,73-17,7) p=0,1178. Hasil logistic regression berat lahir tidak berhubungan terhadap tanggap kebal OR 1 CI (0,16-7,18) p=0,929. Umur kehamilan berhubungan dengan tanggap kebal OR 9 CI (1,05-79,3) p=0,044 dan BB 6 bulan pertama tidak berhubungan terhadap tanggap kebal RR 3,7 CI (0,65-21,1) p=0,138. Kesimpulan: Tanggap kebal vaksin HB BBLR sama dibanding BBLN, umur kehamilan berhubungan terhadap tanggap kebal, dan BB 6 bulan pertama tidak berhubungan terhadap tanggap kebal. Disarankan kepada ibu yang mempunyai bayi berat lahir rendah tidak perlu kuatir karena tanggap kebal yang terbentuk melindungi anak dari risiko infeksi HB, diperlukan penelitian lebih lanjut yang berfokus pada bayi lahir kurang bulan atau prematur terhadap tanggap kebal setelah vaksinasi dasar HB.
Background: Hepatitis B is a common disease in the world as a major cause of morbidity and mortality. Over 2 billion people are infection to the HB, 378 million carriers of HB, mortality rate 1-2 million and over 4 million acute clinical cases occur each year. Prevalence of HB in Indonesia 3-20%. Vertical and horizontal transmission in infants and children occurs 25-45%. 25-50% of children infected before 5 years. The most effective approach to reducing the burden of HB infection is primary preventive mass vaccination of new borns and children continuously. Objective: To determine immune response of HB vaccine LBW and NBW after basis HB vaccination, and factors related to the immune response to gender, pregnant age and weight gain the first 6 months of life. Methods: This retrospective cohort study. Population babies born in May-July 2012. Selected samples 106 infants aged 13-15 months after vaccination of HB recombinant basic of 4 doses of 0, 2, 3, and 4 months according to inclusion and exclusion criteria. Serum of children examined for knows anti-HBs antibody titers with Elisa method. Results are categorized respon negatif titers anti-HBs <10 IU/L and respon positif titers anti-HBs ≥10 IU/L. Hypothesis testing is used fisher’s exact and logistic regression. Results: A total of 98 subjects (92,5%) completed the study. Immune response LBW (89,7%) together with NBW (95,9%) RR 2.5 CI (0,50 to 12,2) p=0,2178. Gender was not related to immune response RR 0,6 CI (0,15 to 2,69) p=0,6996. Gestational age associated with immune response RR 8 CI (1,05 to 63,9) p=0,0399. The first 6 months weight was not related to immune response RR 3,6 CI (0,73 to 17,7) p=0.1178. Results of logistic regression LBW was not related the immune response OR 1 CI (0,16 to 7,17) p=0,929. Gestational age related to immune response OR 9 CI (1,05 to 79,3) p=0,044 and the first 6 months of weight was not related immune response OR 3,7 CI (0,65 to 21,1) p=0.138. Conclusion: Immune response of hepatitis B vaccine LBW egual than NBW. Gestational age related to immune response and weight first 6 months was not related to immune response. It is recommended to mothers have low birth weight babies do not need to worry because the immune response that is formed can protect children from the risk of infection with HB. Further research is needed that focuses on infants born preterm gestational age <37 weeks or premature immune response after basis vaccination HB.
Kata Kunci : Imunisasi, vaksin HB, tanggap kebal, BBLR.
