REACTOGENICITY OF HETEROLOGOUS MRNA-BASED COVID-19 VACCINE BOOSTER IN YOUNG ADULTS IN INDONESIA- A SHORT COMMUNICATION.

Background: Heterologous priming with the inactivated SARS-CoV-2 vaccine (CoronaVac) and boosting with mRNA-based COVID-19 vaccine (Moderna or Pfizer) is currently recommended in Indonesia. The reactogenicity data of these heterologous vaccine regimens are not entirely available, particularly in young adults. The present study, therefore, aimed to evaluate the solicited local and systemic reactions in the first seven days post-vaccination either with Moderna or Pfizer vaccine among previous recipients of two doses of CoronaVac. Materials and Methods: An electronic-based cross-sectional study was conducted among medical students at the Pelita Harapan University, Banten, Indonesia, who received mRNA-based COVID-19 vaccine following two doses of CoronaVac. Samples were collected using a cluster sampling technique. Comparison between groups was performed by Fisher's exact test. Results: A total of 72 participants, 23 (32%) of which received the Moderna vaccine and 49 (68%) received the Pfizer vaccine, were included in this study. The median age of participants was 21 (IQR 19-22) years old. The most common local and systemic events for mRNA-based COVID-19 vaccines were injection site pain, fever, headache, fatigue, myalgia, and arthralgia. Solicited local and systemic reactions were reported more frequently in Moderna recipients than Pfizer recipients. Most local and systemic reactions were graded as mild to moderate and did not lead to hospitalization. Conclusions: The reactogenicity of the heterologous prime-boost with CoronaVac and mRNA-based COVID-19 vaccine booster among young adults is reassuring, and no unexpected concerns were identified.

Safety and Immunogenicity of a Single Dose of BNT162b2 COVID-19 mRNA Vaccine in a Warfarin-Treated Protein S Deficient Patient: A Case Report and Literature Review.

Patients with protein S (PS) deficiency possibly have a higher risk of developing severe COVID-19 disease. Therefore, vaccination against SARS-CoV-2 infections is recommended for PS-deficient patients. However, there are limited data regarding the safety and immunogenicity of the currently available COVID-19 mRNA vaccine in PS-deficient patients. We report a case of monitoring the antibody response of a 40-year-old female diagnosed with PS deficiency and on warfarin treatment following a single dose of BNT162b2 mRNA vaccine. Antibody against the receptor-binding domain (RBD) of the SARS-CoV-2 spike (S) protein (anti-S) was measured on days 7, 14, and 21 after vaccination. Seroconversion was detected on day 21 but was possibly lower than the anti-S level previously reported in healthy individuals after receiving the first dose of the BNT162b2 mRNA vaccine. There were no local and systemic events reported up to 7 days in this patient after vaccination. This case highlights that the administration of the BNT162b2 vaccine had a favourable safety profile, and the second dose of the vaccine is required to provide the optimal protection against SARS-CoV-2 infection in PS-deficient patients.

Skin Damage and Quality of Life among Healthcare Workers Providing Care during the COVID-19 Pandemic: A Multicenter Survey in Banten Province, Indonesia.

Background: Since the occurrence of the coronavirus disease-2019 pandemic, healthcare workers (HCWs) have been strictly adhering to infection control practices within healthcare facilities. However, regular use of personal protective equipment (PPE) and hand hygiene have led to increased prevalence of skin damage, subsequently impacting the quality of life (QoL). Objective: To analyse the connection between skin damage and the QoL among HCWs in a multicenter setting in Indonesia. Methods: A cross-sectional survey was conducted among HCWs working in hospitals in Banten Province, Indonesia. The data was obtained using a reliable self-reported questionnaire (Cronbach α 0.765) and a validated Indonesian version of the Dermatology Life Quality Index. Results: A total of 113 respondents (56.5%) who experienced at least one self-perceived PPE-related skin damage and had worn PPE of any level within the last 7 days were analysed. The mean age ± SD of respondents was 26.09 ± 6.22 years old, while the mean DLQI score ± SD was 5.46 ± 4.88, with a median of 4.0 (range, 0-24). The regression model showed that the level of PPE used (P < 0.05) to be a significant risk factor. Conclusions: Skin damage due to PPE affects HCWs physically and emotionally. It is crucial to recognise its impact on life and reinforce awareness, prevention, and treatment of skin damage. Dermatologist referral and intervention should be considered for optimum management.

ANTIMICROBIAL RESISTANCE AND MORTALITY.

Background: Antibiotic resistance has been a long-debated topic since decades ago. The development of stronger, newer antibiotics, implementation of antibiotic stewardship and revised guidelines remain the main focus of our society to prevent resistancy. But is it really resistancy that cause higher mortality to patients with multidrug resistance (MDR) infections? Methods: We conducted a cohort retrospective study from 2016 to 2019 in our Intensive care unit (ICU). Antimicrobial susceptibility test (AST) results were analyzed for their association with patient mortality outcomes. Results: Over the four-year period, 381 positive bacterial cultures were analyzed and 51% of them grew MDR pathogens upon their first culture. The overall mortality rate was 19% (38/195), and there was no significant association between MDR and mortality; p 0.387. A strong association was however found between patients with medical cases with an OR 1.76; CI 1.76-2.55; p 0.003 and those with APACHE scores ≥20 upon admittance to the ICU, OR 1.32; CI 1.68-8.29; p 0.001. Conclusion: Resistancy is not the true cause of mortality. Infection by resistant microbes does not necessarily mean the worst outcome since virulency is the actual cause of pathogenicity, and thus mortality.

Recurrence of Asymptomatic COVID-19 after Recovery among Healthcare Workers.

We describe five healthcare workers (HCWs) with a recurrence of asymptomatic SARS-CoV-2 infection at Siloam Teaching Hospital, Indonesia. All cases involved nurses, with an average age of 27 years. The RT-PCR assay confirmed the first and second infection episodes. All cases showed negative RT-PCR results in the period between two infection episodes. The median interval time between two infection episodes was 123 days, ranging from 92 to 158 days. The clinical outcomes for all cases were favourable, with no mortality observed among study cases. Further studies will be required to understand the true nature of this phenomenon.

Antibody response after a third dose mRNA-1273 vaccine among vaccinated healthcare workers with two doses of inactivated SARS-CoV-2 vaccine.

BACKGROUND: Health care workers (HCWs), a high-risk group for contracting COVID-19 disease, are being prioritized to receive COVID-19 vaccination. A third dose messenger RNA (mRNA) vaccine, mRNA-1273 (Moderna), after 2 doses of inactivated vaccine (CoronaVac), has been used to increase the level of protection against SARS-CoV-2 among Indonesian HCWs. However, data regarding antibody response after mRNA-1273 booster dose are limited. OBJECTIVE: To evaluate the receptor-binding domain (RBD) of the SARS-CoV-2 spike (S) protein (anti-S) titers induced by the third mRNA-1273 vaccine among fully vaccinated HCWs with CoronaVac. RESULTS: A total of 90 HCWs with no history of SARS-CoV-2 infection and who had received the third dose of vaccination were included in this study. The mRNA-1273 vaccine booster was administered 6 months after completing primary vaccination with CoronaVac. After the third dose, the anti-S antibodies level significantly increased, from a median of 41.7 U/mL (interquartile range [IQR], 22.4-92.5) to 28 394 U/mL (IQR, 20 837-41 646) (p <0.0001). After the third dose, seropositivity with the anti-S antibodies level >210 U/mL was observed in all HCWs. Age was negatively associated with the anti-S antibodies level after the mRNA-1273 booster. CONCLUSION: The heterologous prime booster with CoronaVac and mRNA-1273 vaccine booster elicit a pronounced antibody response against SARS-CoV-2 infection.

Co-Occurrence of SARS-CoV-2 Infection and Inactivated SARS-CoV-2 Vaccination among Healthcare Workers.

The presented cases describe the concurrent SARS-CoV-2 infection and inactivated SARS-CoV-2 vaccination among eight healthcare workers (HCWs). These cases highlighted the importance of broad hospital screening during the COVID-19 vaccination campaign. Further study regarding the durability of antibody response induced by infection and first-dose vaccination is required to determine the appropriate time for giving a second dose of inactivated SARS-CoV-2 vaccine among these cases.

How Does Mucorales Benefit from the Dysregulated Iron Homeostasis During SARS-CoV-2 Infection?

Mucorales is the cause of mucormycosis, an emerging opportunistic infection in the era of coronavirus disease 2019 (COVID-19) pandemic. Condition of hyperglycemia, diabetes mellitus, and acidosis; dysregulated iron homeostasis in the form of hyperferritinemic syndrome, and high concentration of iron in circulation; and endothelial injury related to abundance glucose regulated protein 78 (GRP78), which are present in severe COVID-19, could favor Mucorales infection. In this short communication, we summarized how the dysregulated iron homeostasis in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection benefits Mucorales.

Antibody response to the inactivated SARS-CoV-2 vaccine among healthcare workers, Indonesia.

BACKGROUND: As healthcare workers (HCWs) are at high risk for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), they have priority for receipt of the coronavirus disease 2019 (COVID-19) vaccine. The inactivated SARS-CoV-2 vaccine has been used in Indonesia to induce an antibody response against SARS-CoV-2 infection in HCWs. However, information regarding the kinetics of antibodies induced by this vaccine remains scarce. OBJECTIVE: To investigate the magnitude and durability of antibodies against the spike (S) protein (anti-S) in fully-vaccinated HCWs using an electrochemiluminescence immunoassay. RESULTS: Seroconversion of anti-S antibodies was observed among 159 (99.4%) of 160 HCWs without prior SARS-CoV-2 infection 14 days after full-dose vaccination. The level of anti-S antibodies decreased significantly by day 42 post-vaccination compared with day 14 post-vaccination, but persisted for up to 98 days post-vaccination. In contrast, vaccinated HCWs with prior SARS-CoV-2 infection had significantly higher, stable levels of anti-S antibodies compared with vaccinated HCWs without prior SARS-CoV-2 infection. CONCLUSION: The remarkable decline and lower level of anti-S antibodies among HCWs without prior SARS-CoV-2 infection may indicate the need for an additional booster dose of SARS-CoV-2 vaccine for protection against COVID-19. This study of antibody responses induced by the inactivated SARS-CoV-2 vaccine among HCWs may contribute to future policy decisions regarding vaccination.

A High Distribution of Resistant Pathogens among Critically Ill Neonates from Secondary Referral Hospital of Indonesia.

BACKGROUND: The spread of resistant pathogens among critically ill neonates has increased in recent years. Therefore, information about the antimicrobial profile and its susceptibility over time helps to select the most appropriate therapy. The study assesses the distribution of resistant pathogens and its susceptibility among neonates' patients. METHODS: Eight hundred and eight suspected neonatal infected from January 2011 to December 2019 were recruited anonymously in our retrospective, observational analysis. The study was conducted in the secondary-care level NICU which located on the western border of Jakarta, Indonesia. The MDROs definition was define by Centre for Disease Prevention and Control (CDC) criteria and standardized international terminology. Microbial identification and susceptibility testing were carried out following standard protocols. RESULTS: Culture positivity was found in 132 (16.3%) with dominating MDR-Gram negative bacteria 47 (61.8%). The most common pathogens were extended-spectrum ß-lactamase and multidrug-resistant Acinetobacter 18 (38.3%), respectively. There were coagulase negative staphylococci 29 (38.2%) among MDROs. Most of the Gram negative bacteria were highly susceptible to the combination of cefoperazone/sulbactam (79.6%), amikacin (88.7%), and tigecycline (77.1%). Staphylococcus aureus had a good susceptibility to almost all classes' antibiotics. Candida isolates showed 100.0% susceptibility to all antifungal classes. CONCLUSIONS: Our study highlighted the microbial profile along with its susceptibility among neonatal patients that able to provide necessary information for antimicrobial guidelines and policies for effective infectious case management.

Post-vaccination cases of COVID-19 among healthcare workers at Siloam Teaching Hospital, Indonesia.

BACKGROUND: Healthcare workers (HCWs) are at increased risk of exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), compared with the general population. Therefore, they are given priority for the COVID-19 vaccine in the national COVID-19 vaccination campaign in Indonesia. However, while the daily number of new COVID-19 cases remains high, and data regarding the efficacy of the vaccine in healthcare settings remain unavailable, vaccinated HCWs remain at risk of COVID-19 infection and further transmission. OBJECTIVE: To identify cases of COVID-19 among vaccinated HCWs at Siloam Teaching Hospital, Indonesia via active and passive surveillance conducted by the hospital's COVID-19 infection prevention and control unit. RESULTS: Of 1040 HCWs who had received two doses of the COVID-19 vaccine, 13 (1.25%) tested positive for SARS-CoV-2 RNA on reverse transcriptase polymerase chain reaction between 2 and 11 days (median 5 days) after the second vaccination. CONCLUSION: Laboratory-confirmed COVID-19 among vaccinated HCWs soon after the second vaccination indicates that HCWs remain at risk of COVID-19. Therefore, the presence of symptoms soon after full vaccination cannot be considered as vaccine-related symptoms, and regular COVID-19 testing should be conducted among HCWs.

Knowledge, attitudes and practices regarding rabies among community members: a cross-sectional study in Songan Village, Bali, Indonesia.

BACKGROUND: Rabies is a preventable yet endemic zoonotic disease caused by a neurotrophic virus, a member of Rhabdoviridae family. Rabies remains a public health threat in Indonesia, specifically Bali Province. The present study aimed to understand the knowledge, attitudes and practices (KAP) regarding rabies among community members in Songan Village, Bali, Indonesia. MATERIALS AND METHODS: We conducted a cross-sectional survey using a structured questionnaire among 175 community members residing in the administrative area of public health centre of Kintamani V in Songan Village of Bangli District, from December 2019 to February 2020. Statistical analyses were performed with SPSS software, version 21. RESULTS: Of the 175 community members, 53 (30.3%) owned a dog. Majority of the respondents were Hindu (98.8%), female (56.0%), aged ≥ 29 years old (54.9%), with an educational background of higher secondary (28.6%), residing in Songan A and B residential village (86.9%), working as farmers (50.9%), with the level of income less than district minimum wage (71.4%). The KAP scores mean ± standard deviation were 6.93 ± 1.83 and 8.04 ± 1.07 (out of 10), respectively. Multivariable logistic regression models were constructed and the KAP of the community members was found to be significantly influenced by occupation (p-value < 0.05). CONCLUSIONS: Albeit community members demonstrated some level of KAP regarding rabies, overall, this study revealed critical gaps in their fundamental knowledge of rabies, the prevention in dogs, and the local rules and regulations concerning rabies. In accordance with One Health Approach, further enforcement on the collaborative efforts for comprehensive education programmes, scheduled mass vaccination for dogs, and promotion for healthier attitudes and practices are recommended.

Extensive drug resistant (XDR) Acinetobacter baumannii parappendicular-related infection in a hydrocephalus patient with ventriculoperitoneal shunt: a case report.

Ventricular infection due to XDR-Acinetobacter baumanii (A. baumanii) is the most severe complication after neurosurgery which associated with high morbidity and mortality. Managing A. baumanii ventriculitis/shunt infection and multiple brain abscesses is challenging since its nature that tends to be pandrug resistant to all antibiotics used. Thus, we present the first such case with problems in administration based on the available data.