A population-based survey of Haemophilus influenzae type b nasopharyngeal carriage prevalence in Lombok Island, Indonesia.

BACKGROUND: The Haemophilus influenzae type b (Hib) nasopharyngeal carriage prevalence and invasive disease incidence rates are unknown in Indonesia; consequently Hib vaccine is not included in the routine vaccine schedule. METHODS: To determine carriage prevalence we conducted a population-based, island-wide prospective study of a systematic sample of 484 children 0 to 2 years of age in Lombok, Indonesia. We conducted a risk factor questionnaire and determined serotypes and antibiotic sensitivity patterns. RESULTS: We identified 155 H. influenzae isolates, of which 22 were type b and 12 were encapsulated but not type b. The age- and population-weighted Hib carriage prevalence, adjusted for the sampling design, was 4.6% (95% confidence interval, 3.7 to 5.5%). Children younger than 6 months of age had a carriage prevalence less than one-half that of older children, and carriage varied within the four administrative regions of the island; otherwise no risk factors for Hib carriage were identified. All Hib specimens were sensitive to ampicillin and 20 (91%) were sensitive to chloramphenicol. CONCLUSIONS: The Hib carriage prevalence in Lombok is similar to that found in developed countries before vaccine introduction. This suggests that further studies should proceed to determine whether Lombok has invasive disease rates as high as those that justified vaccine introduction in developed countries.

Incidence and clinical features of hospitalization because of respiratory syncytial virus lower respiratory illness among children less than two years of age in a rural Asian setting.

BACKGROUND: Lower respiratory illness is the leading cause of child death in the developing world. Despite this few reports on respiratory syncytial virus (RSV) lower respiratory illness disease burden exist from rural areas of the developing world, and none exist for Indonesia. METHODS: We evaluated children living in any of 83 villages on Lombok Island, Indonesia who were <2 years of age when hospitalized for severe lower respiratory illness during 2000 and 2001. All hospitals on Lombok were included in the evaluation. We obtained the number of births and deaths that occurred within the study villages and time frame, allowing for incidence determination. RESULTS: Of 2677 children hospitalized for severe lower respiratory illness whose RSV status was determined, 23% had a positive test; this percentage varied from 50% at the end of the rainy season to 0% shortly before the start of the rainy season. Among children <2 years of age, the confirmed and estimated incidences of severe RSV lower respiratory illness hospitalization were 10 and 14 per 1000 child-years, respectively; values for children <1 year of age were 17 and 25 per 1000 child-years. The confirmed case-fatality percentage among RSV-positive cases was 1.9%; however, 84% of children who died were dead before RSV status could be determined, suggesting the actual case fatality percentage was higher. CONCLUSIONS: Lombok has a large burden of severe childhood RSV lower respiratory illness, and death occurs frequently. Novel RSV vaccines thus could have a substantial positive impact on lower respiratory illness morbidity and mortality.

Streptococcus pneumoniae nasopharyngeal carriage prevalence, serotype distribution, and resistance patterns among children on Lombok Island, Indonesia.

Few data exist on childhood pneumococcal carriage prevalence, serotype distribution, and resistance patterns for Indonesia, the world's fourth most populous country. During August 1997, nasopharyngeal samples were collected from a population-based, island-wide sample of 484 healthy children (age, 0-25 months) from Lombok Island, Indonesia. Two hundred twenty-one pneumococcal isolates were identified, for a carriage prevalence of 48%; 66% of isolates were of serogroup or serotype 6, 23, 15, 33, or 12. All isolates were susceptible to penicillin and cefotaxime. Twelve percent of the isolates were nonsusceptible to sulfamethoxazole or chloramphenicol and 4% were nonsusceptible to both of these drugs. Nonsusceptible organisms were most frequently serogroup or serotype 6, 12, and 33. Lombok has a moderate pneumococcal carriage prevalence and a relatively low proportion of resistant isolates. At least 3 of the 5 most common serogroups and serotypes and 2 of the 3 most common nonsusceptible serogroups and serotypes are not included in the current 7-valent pneumococcal conjugate vaccine.