Safety, immunogenicity, and transmissibility of single-dose live oral cholera vaccine strain CVD 103-HgR in 24- to 59-month-old Indonesian children.

Recombinant A-B+ Vibrio cholerae O1 strain CVD 103-HgR is a safe, highly immunogenic, single-dose live oral vaccine in adults in industrialized countries. Safety, excretion, immunogenicity, vaccine transmissibility, and environmental introduction of CVD 103-HgR were investigated among 24- to 59-month-old children in Jakarta. In 81 households, 1 child was randomly allocated a single dose of vaccine (5 x 10(9) cfu) and another, placebo. Additionally, 139 unpaired children were randomly allocated vaccine or placebo. During 9 days of follow-up, diarrhea or vomiting did not occur more often among vaccines than controls. Vaccine was minimally excreted and was isolated from no controls and from 1 (0.6%) of 177 unvaccinated family contacts. A 4-fold or higher rise in serum vibriocidal antibody was observed in 75% of vaccines (10-fold rise in geometric mean titer over baseline). Of 135 paired placebo recipients or household contacts, 5 had vibriocidal seroconversions. Moore swabs placed in sewers and latrines near 97 households failed to detect vaccine. These observations pave the way for a large-scale field trial of efficacy.

Problems and solution of malabsorption syndrome in Indonesia.

PIP: In most developing countries like Indonesia, problems of malabsorption syndrome are commonly related with: 1) gastroenteritis; 2) protein calorie malnutrition (PCM); 3) low birthweight and post bowel surgery; and 4) infection or parasite of the small bowel in the malnourished child. Two factors which cause sugar intolerance in Indonesian children are the high incidence of gastroenteritis and PCM, and being unused to drink milk after weaning. The presence of overgrowth of bacteria in the malnourished child can cause sugar intolerance indirectly through gastroenteritis. The high incidence of PCM, LBW and gastroenteritis in Indonesian children also result in a high incidence of fat malabsorption. Management of malabsorption syndrome in diarrheal children with or without malnutrition include: 1) correction of fluid and electrolyte imbalance; 2) treatment of predisposing condition; and 3) temporary withdrawal of any lactose in the diet or giving lactose low formula, beside MCT (medium chain triglycerides) or UFA (unsaturated fatty acids). The 1st choice in treating fat malabsorption is the use of MCT in the milk formula; the 2nd choice is UFA.^ieng

Recent advances in the Indonesian paediatric gastroenterology.

PIP: This paper focuses on recent advances by the Indonesian Pediatric Gastroenterology in the field of diarrheal diseases: 1) the 'ROSE' system as the principle of treatment of diarrhea. It has been proven to be effective in reducing mortality rate of acute gastroenteritis, particularly cholera. R stands for rehydration, preferably with Ringer's lactate solution. O for Oralyte or oral glucose electrolyte, S for simultaneous rehydration (intravenously and orally), and E for educating parents in oral rehydration. 2) MCT and low lactose-containing formula in low birthweight infants give good to excellent results in improving fat malabsorption, elimination of diarrhea, and increase of body weight. 3) the use of the pediatric Enterotest duodenal capsule to study the upper intestinal microflora. The capsule consists of a number 1 size gelatin capsule (20 mm x 6 mm) containing a silicone rubber bag with an attached fine yarn line 90 cm long. The free end of the line is taped to the cheek and the patient swallows the capsule. After a certain period of time, the line is pulled out and intestinal secretions are scraped from the line and immediately examined under the microscope. Enterotest is particularly useful where radiologic examination is not available. 4) this report is the 1st to document virus particles in fecal specimens from Indonesian children, and suggests that viruses may be important etiological agents in diarrheal diseases in Indonesia, where malnutrition and diarrhea are important health problems.^ieng