DIARE PROF YATIE

1. Yati Soenarto Deptartment of Pediatrics Gadjah Mada University/Sardjito Hospital Yogyakarta, Indonesia

3. POPULATION DENSITY IN THE WORLD Central Bureau, 2003

4. MOH, 2003 LEADING CAUSES OF DEATH IN CHILDREN U 5

8. THE INCREASE OF ORT USE FOR DIARRHEA 1991 - 2000 SOURCE : Indonesian Demographic Health Survey (IDHS)

10. MCHS : Mother & Child Health Survey IDHS : Indonesian Demography & Health Survey HOME MANAGEMENT OF DIARHEA Increased fluids and continued feeding: MCHS (2003) 31,9 Urban 27,3 Rural 36,0 Continued feeding: IDHS 52,0 49,6 - Increased fluids: IDHS (2003) 56,5 57,0 96.7 * Urban 90,5 61,7 - Rural 53,5 56,5 - 1994 1997 2000

11. Drugs given by HC personal in cases with bloody & watery stool (1991-1992) 16.5 73.0 2.6 7.0 19 84 3 8 13.6 86.4 0 0 3 19 0 0 Antibiotics & antidiarrhea Antibiotics Anti Diarrhea No drugs % n % N Watery Dysentery Drugs given to 168 diarrhea attacks/ from 141 U5childen (out of 497 children living at 2 villages)

12. Studies on the etiology of Diarrhea 29 Not yet analyzed NE (not examined) 6 1 NE NE NE ’ 04 – ’05 % (n=638) 80 66 NE 2.1* 1.8* 1.3** 0 3 56 38 11.5 6 4 0.3 7.6 Enteropathogens Rotavirus ETEC (LT&ST) Salmonella Shigella Cryptosporidium E. Histolytic Mix enteropahogens ’ 90 – ’92 % (n=131) ’ 78 – ’79 % (n:338) Causative agents

14. Courtesy of U. Parashar 1 dot = 1000 deaths GLOBAL DISTRIBUTION OF RV MORTALITY IN CHILDREN U 5

16. Longitudinal (1/> yr) hospital studies;RV diarrhea: ‘ 80 – ‘84: 21% – 42% (8 long.studies); ‘ 78 – ‘79: 38%; Strain: G1 – G4; ’ 00 – ‘05: 53%; Strain: G1,3,4; G9 Cost: ? Deaths: Diarrhea :2 nd cause RV: ? Economic crisis Mortality Morbidity RV Indonesia

17. 1970’s 1980’s 1990’s 2000’s 30 YEARS JOURNEY (UniMelb/RCH - GMU/ Sardjito) 79 78 77 76 75 74 73 72 71 70 89 88 87 86 85 84 83 82 81 80 99 98 97 96 95 94 93 92 91 90 09 08 07 06 05 04 03 02 01 00

21. LONGITUDINAL RV STUDIES IN INDONESIA 1978 - 2008 20.9 All ager 287 ELISA 13 1980-1981 Jakarta Sutoto 34.8 38.1 All ages All ages 466 113 ELISA ELISA 12 12 1980-1981 1981-1982 Jakarta Simanjuntak 1.4 0 37.8 < 1 < 1 1 mo 12 yrs 42 30 334 EM, IEM & Electrophoresis of Genome RNA 13 19 78- 19 79 Yogyakarta Yati Soenarto (collaborator UniMelb) % with rotavirus Age (mos) Number Detection assay Duration (mos) Years/City Author

22. Not yet analyzed 0-60 785 ELISA On going 2005 – 2008 Multicenter surveillance Yati Soenarto collaboratorUniMelb) 31.3 34.5 36.1 42.0 0-24 0-24 0-24 113 144 319 LX LX LX 12 60 12 12 1984 1996 1997 Surabaya Soepa r to P Wasito EB 53.4 0-36 1321 ELISA 32 2001 -2004 Jogjakarta & Central Java Yati Soenarto collaborators CDC Atlanta, UniMelb) % with rotavirus Age (mos) Number Detection assay Duration (mos) Years/City Author

23. A RV STUDY IN RURAL AND URBAN HEALTH A RV STUDY IN COMMUNITY *: urban health center** : rural health center 40.9* 24.3* * 0-36 89* 86** RPHA 5 1990 Bandung Yuwono D % with Rotavirus Age (month) Number Detection Assay Duration/ months Years/ City Authors Patient Characteristics Study Characteristics 16.2 All ages 136 ELISA 13 ’ 80 – ‘81 Jakarta Sutoto Rotavirus seroprevalence Age (months) Number Detection assay Duration/ months Years/City Author Patient Characteristic s Study Characteristics

24. Hospital-based system and strain surveillance for rotavirus diarrhoea and estimate of disease burden in Indonesia. A Multi Country Study on Rotavirus Surveillance . Aug 2001 - April 2004

25. RV DISEASE BURDEN IN YOGYAKARTA AND CENTRAL JAVA (2001 – 2004)b 8929 cases of < 5 children 1397 diarrheal cases (100%) 705 rotavirus diarrhea (53.4%) 36 severe dehydration (5.1%) 2 deaths (RV positive) (0.03%) 440 dehydration (62.4%)

26. Dehydration N valid = 1397 P=0.005 N valid = 1321 P=0.024

29. G-type comparison: 1978-1979 and 2001-2003

32. EXTENTION FOR HOSPITAL-BASED SURVEILLANCE AND STRAIN CHARACTERIZATION OF ROTAVIRUS DIARRHOEA IN INDONESIA January 2006 – January 2008 Multi Center Surveillance Indonesian Rotavirus Surveillance Network (IRSN) Palembang, Jakarta, Bandung, Yogyakarta, Denpasar, Mataram

33. Palembang Jakarta Bandung Yogyakarta Denpasar Mataram Aceh Irian

35. COLLABORATORS