BAB V. KESIMPULAN DAN SARAN
5.2 Saran
a) Sebagai masukan bagi pemerintah Indonesia untuk meningkatkan kembali cakupan imunisasi wajib pada tahun pertama kelahiran, memastikan dokumentasi yang memadai sehingga mempermudah akses informasi di kemudian hari, dan melakukan pemeriksaan paska imunisasi guna melihat respon pembentukan antibodi yang adekuat terhadap vaksin.
b) Pihak fakultas ataupun rumah sakit sebaiknya melakukan skrining para petugas kesehatan sebelum melakukan kontak dengan pasien berisiko, sebagai bentuk perlindungan penularan HBV terhadap petugas maupun pasien
c) Penelitian selanjutnya dapat dilakukan untuk memperjelas risiko kerja pada instansi, memeriksakan status imunitas melalui sel memori, dan melakukan penelitian mengenai non-responder terhadap vaksin HBV.
DAFTAR PUSTAKA
Aghasadeghi, M.R. et al., 2014. No evidence for occult HBV infection in hepatitis B vaccine non-responders. , 6(5), pp.350–353.
Alavian, S.M. & Mahboobi, N., 2011. Anti-HBs antibody status and some of its associated factors in dental health care workers in Tehran University of Medical Sciences: Anti-HBs Ab and associated factors in dental society. Hepat Mon, 11(2), pp.99–102. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22087125.
Aspinall, E.J. et al., 2011. Hepatitis B prevention, diagnosis, treatment and care: A review. Occupational Medicine, 61(8), pp.531–540.
Batra, V. et al., 2015. Hepatitis B immunization in healthcare workers. Annals of Gastroenterology, 28(2), pp.276–280.
Baumert, T.F. et al., 2007. Pathogenesis of hepatitis B virus infection. World Journal of Gastroenterology, 13(1), p.82. Available at: http://www.wjgnet.com/1007-9327/full/v13/i1/82.htm\nhttp://www.wjgnet.com/1007-9327/13/82.pdf.
Bhat, M. et al., 2012. Hepatitis B and the infected health care worker: Public safety at what cost? Canadian Journal of Gastroenterology, 26(5), pp.257–260.
Cardell, K.U., 2009. Studies on Hepatitis B Vaccination and Factors Associated with the Vaccine Response Kristina Cardell Division of Infectious Diseases
Department of Clinical and Experimental Medicine Faculty of Health Sciences Linköping University Sweden Linköping 2009,
Centers for Disease Control and Prevention, 2011. Hepatitis B and health-care workers. Centers for Disease Control and Prevention. Available at:
https://www.google.co.id/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad
=rja&uact=8&ved=0ahUKEwjy4tnv1dbOAhUHrY8KHVA4DP4QFgg9MAQ&
url=http%3A%2F%2Fwww.immunize.org%2Fcatg.d%2Fp2109.pdf&usg=AFQj CNE8_ltumEzzKnn72eBgvOQwNVA5zw&sig2=pgUGCyAlhPI9sCGLIWsd-w.
Centers for Disease Control and Prevention, 2012. Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. Morbidity & Mortality Weekly Report Recommendations & Reports, 61(3), pp.1–12. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr6103.pdf.
Chisari, Francis V; Isogawa, M; Wieland, S., 2010. Pathogenesis of Hepatitis B virus infection. Pathol Biol, 58(4), pp.258–266.
Coutinho, R.A., 2011. Hepatitis B vaccination. J.Virol.Methods., 10, pp.327–331.
Coleman, W.B., Tsongalis, G.J. & Liaw, Y. eds., 2016. Hepatitis B Virus in Human Diseases, Humana Press.
Dahlann MS, 2014. Statistik Untuk Kedokteran dan Kesehatan : Deskriptif, Bivariat dan Multivariat. Seri I dan Edisi VI, Jakarta
de Carvalho Dominguez Souza, B.F. et al., 2014. Theories about evolutionary origins of human hepatitis B virus in primates and humans. The Brazilian Journal of Infectious Diseases, 18(5), pp.535–543. Available at:
http://dx.doi.org/10.1016/j.bjid.2013.12.006.
de Oliveira, L.C.M. & Pontes, J.P.J., 2010. Frequency of hepatitis B immunity and occupational exposures to body fluids among Brazilian medical students at a public university. Revista do Instituto de Medicina Tropical de Sao Paulo, 52(5), pp.247–251.
Desombere, I. et al., 2005. Non-responsiveness to hepatitis B surface antigen vaccines is not caused by defective antigen presentation or a lack of B7 co-stimulation. Clinical and Experimental Immunology, 140(1), pp.126–137.
Dienstag, J., 2010. Hepatitis B virus infection. New England Journal of Medicine, 359(9959).
Dienstag, J., 2012. Acute Viral Hepatitis. In T. Harrison et al., eds. Harrison’s Principles of Internal Medicine. McGraw Hill.
Dinas Kesehatan Provinsi Sumatera Utara, 2012. Profil Kesehatan Sumateran Utara 2012, Available at: http://diskes.sumutprov.go.id.
Dini, G. et al., 2017. Persistence of protective anti-HBs antibody levels and anamnestic response to HBV booster vaccination : A cross-sectional study among healthcare students 20 years following the universal immunization campaign in Italy. Human Vaccines & Immunotherapeutics, 13(2), pp.440–444.
Doo, E., Ghany, MG., 2010. Hepatitis B Virology for Clinicians. In C. Naoky et al., eds. Clinics in Liver Disease.
Evdokimov, K. et al., 2016. SC. Clinical Microbiology and Infection. Available at:
http://dx.doi.org/10.1016/j.cmi.2016.10.007.
Floch, M.H. & Dunitz, M., 2003. Hepatitis B and C: Management and Treatment.,
Gerlich, W.H., 2013. Medical virology of hepatitis B: how it began and where we are now. Virology journal, 10(1), p.239. Available at:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3729363&tool=pmc entrez&rendertype=abstract.
Grimm, D., Thimme, R. & Blum, H.E., 2011. HBV life cycle and novel drug targets.
Hepatology International, 5(2), pp.644–653.
Hepatitis B Foundation, Understanding Hepatitis B Blood Tests. Available at:
www.hepb.org.
Ibrahim, N. & Idris, A., 2014. Hepatitis B Awareness among Medical Students and Their Vaccination Status at Syrian Private University. Hepatitis Research and Treatment, pp.1–7. Available at:
http://www.hindawi.com/journals/heprt/2014/131920/.
Kementrian Kesehatan RI, 2012. Profil Kesehatan Indonesia 2012 B. Hardana et al., eds., Jakarta: Kementrian Kesehatan Republik Indonesia.
Kim, Y.J. et al., 2017. A Single Center Analysis of the Positivity of Hepatitis B Antibody after Neonatal Vaccination Program in Korea. , 1990(8), pp.810–816.
Lao, T.T. & Lao, T.T., 2017. Long-term persistence of immunity after hepatitis B vaccination : Is this substantiated by the literature ? by the literature ? Human Vaccines & Immunotherapeutics, 0(0), pp.1–3. Available at:
http://dx.doi.org/10.1080/21645515.2016.1267084.
Leuridan, E. & Van Damme, P., 2011. Hepatitis B and the Need for a Booster Dose.
Clinical Infectious Diseases, 53(1), pp.68–75.
Lok, A., 2011. Hepatitis B. In J. Dooley, A. Lok, & A. Burroughs, eds. Sherlock’s diseases of the liver and biliary system. Blackwell, pp. 386 – 392.
MacMahon, B., 2010. Natural History of Chronic Hepatitis B. In C. Naoky et al., eds.
Clinics in Liver Disease.
Menteri Kesehatan Republik Indonesia, 2013. PERMENKES No 42 Tahun 2013 tentang penyelenggaraan imunisasi, Indonesia.
Mesfin, Y.M. & Kibret, K.T., 2013. Assessment of knowledge and practice towards hepatitis B among medical and health science students in Haramaya University, Ethiopia. PLoS ONE, 8(11), pp.1–6.
Nashibi, R. et al., 2015. Post-vaccination immunity against hepatitis B virus and predictors for non-responders among medical staff. Jundishapur Journal of Microbiology, 8(3).
Ng, K.P. et al., 2013. Hepatitis B seroprevalence among university of Malaya students in the post-universal infant vaccination era. Medical Journal of Malaysia, 68(2), pp.144–147.
Norouzirad, R. et al., 2014. Serum levels of anti-hepatitis B surface antibody among vaccinated population aged 1 to 18 years in ahvaz city southwest of iran.
Hepatitis monthly, 14(1), p.e13625. Available at:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3909642&tool=pmc entrez&rendertype=abstract.
Noubiap, J.J.N. et al., 2013. Occupational exposure to blood, hepatitis B vaccine knowledge and uptake among medical students in Cameroon. BMC medical education, 13, p.148. Available at:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3874660&tool=pmc entrez&rendertype=abstract.
Organization, W.H., 2006. Infection control standard precautions in health care.
World Health Organization, pp.1–2. Available at:
http://www.who.int/patientsafety/information_centre/ghhad_download/en/index.
html.
Organization, W.H., 2006. Hepatitis B Global Infection Rates, Available at:
www.pkids.org.
Osti, C., 2005. Hepatitis B virus: evaluation of infection risk and serological response to vaccine in hospital cleaners of the botucatu school of medicine.
Parker, J. & Parker, P. eds., 2004. Hepatitis B: A medical Dictionary, Bibliography, and Annotated Research Guide to Internet References,
Perhimpunan Peneliti Hati Indonesia, 2006. Panduan tata aksana infeksi hepatitis B kronik P. Setiawan et al., eds., PT Bristol-Myers Squibb Indonesia.
Perhimpunan Peneliti Hati Indonesia, 2012. Konsensus Nasional Penatalaksanaan Hepatitis B N. Akbar, ed., PPHI.
Pracoyo, N.E. & Wibowo, 2016. Faktor-Faktor yang Berhubungan dengan Tingkat Kekebalan Hepatitis B ( anti-HBs ) pada Anak Umur 1-14 Tahun dari Data Hasil Riskesdas 2007. Media Litbangkes, 26(1), pp.59–64.
Prevention, C. for D.C. and, Interpretation of Hepatitis B Serologic Test Results.
Centers for Disease Control and Prevention. Available at:
www.cdc.gov/hepatitis.
Pusat Data dan Informasi Kementrian Kesehatan RI, 2014. Situasi dan Analisis Hepatitis.
Pyrsopoulos, N.T., 2015. Hepatitis B. Medscape. Available at:
http://emedicine.medscape.com/article/177632-overview#a2.
Ramsay, I. et al., 2016. Transmission of Hepatitis B Core Antibody and
Galactomannan Enzyme Immunoassay Positivity via Immunoglobulin Products : A Comprehensive Analysis. Clinical Infectious Diseases, pp.1–7.
Romanò, L. et al., 2017. Persistence of immunity 18 – 19 years after vaccination against hepatitis B in two cohorts of vaccinees primed as infants or as adolescents in Italy. Taylor and Francis Group, 5515(March).
RI, B.P. dan P.K.K.K., 2013. Riset Kesehatan Dasar, RI, D.K., 2015. Profil Kesehatan Indonesia 2014,
Schillie, S. et al., 2013. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management.
MMWR. Recommendations and reports : Morbidity and mortality weekly report.
Recommendations and reports / Centers for Disease Control, 62(RR-10), pp.1–
19.
Sheek-Hussein, M. et al., 2012. Seroprevalence of measles, mumps, rubella, varicella-zoster and hepatitis A-C in Emirati medical students. BMC public health, 12(1), p.1047. Available at:
http://www.scopus.com/inward/record.url?eid=2-s2.0-84870387357&partnerID=tZOtx3y1.
Towell, V. & Cowie, B., 2012. Hepatitis B serology. Australian Family Physician, 41(4), pp.212–214.
Tsay, P.-K. et al., 2009. Impact of gender, viral transmission and aging in the prevalence of hepatitis B surface antigen. Chang Gung medical journal, 32(2), pp.155–164.
Wang, C. et al., 2005. Long-Term Follow-Up of Hepatitis B Surface Antibody Levels in Subjects Receiving Universal Hepatitis B Vaccination in Infancy in an Area of Hyperendemicity : Correlation between Radioimmunoassay and Enzyme
Immunoassay Long-Term Follow-Up of Hepatitis B Su. Clinical and Diagnostic Laboratory Immunology, 12(12), pp.1442–1447.
Wang, Y. et al., 2017. Adolescent booster with hepatitis B virus vaccines decreases HBV infection in high-risk adults. Vaccine. Available at:
http://dx.doi.org/10.1016/j.vaccine.2016.12.062.
Wang, Z. et al., 2015. Long-term persistence in protection and response to a hepatitis B vaccine booster among adolescents immunized in infancy in the western region of. , pp.1–24.
WHO, 2015. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Guidelines for the prevention, care and treatment of persons with chronic hepatitis b infection, (March), p.166.
World Health Organization, 2015. Guideline development for the prevention, care and treatment of persons with chronic hepatitis B,
Yano, Y. et al., 2015. Hepatitis B virus infection in Indonesia. World journal of gastroenterology : WJG, 21(38), pp.10714–10720.
Zhu, C. et al., 2011. Presence of immune memory and immunity to hepatitis B virus in adults after neonatal hepatitis B vaccination. Vaccine, 29(44), pp.7835–7841.
Available at: http://dx.doi.org/10.1016/j.vaccine.2011.07.098.
LAMPIRAN 1
Lembar Penjelasan Kepada Calon Subjek Penelitian Kepada Yth Sdr/i ...
Sebelumnya saya ingin memperkenalkan diri (dengan menunjukkan surat tugas dari Program Studi Magister Kedokteran FK USU). Nama saya dokter Annisa, mahasiswa Magister Kedokteran Tropis.
Bersama ini, saya ingin menyampaikan kepada Sdr/i bahwa saya akan mengadakan penelitian mengenai “Analisis status proteksi terhadap infeksi hepatitis B dinilai dari titer anti-HBs, riwayat vaksinasi dan riwayat infeksi berdasarkan anti-HBc pada mahasiswa pendidikan profesi dokter.”
Sdr/i, pertama saya akan menjelaskan mengenai masalah kesehatan yang masih banyak di terjadi di dunia dan Indonesia, yaitu Hepatitis B. Hepatitis B adalah suatu infeksi virus yang dapat ditularkan melalui kontak langsung terhadap cairan tubuh dari penderita Hepatitis B. Virus ini menyerang hati dan dapat memberikan gejala mulai dari yang ringan sampai yang berat hingga menimbulkan kanker hati.
Penyakit ini sangat menular terutama bagi Sdr/i selaku mahasiswa pendidikan profesi dokter yang senantiasa kontak dengan pasien dengan penyakit menular. Atas rekomendasi WHO/CDC terhadap para petugas kesehatan, maka sebaiknya seluruh petugas memiliki kekebalan tubuh terhadap hepatitis B. Kekebalan ini bisa didapatkan dari vaksinasi dan riwayat infeksi terdahulu yang telah sembuh.
Untuk mengetahui pasti adanya kekebalan terhadap penyakit ini dibutuhkan pemeriksaan darah yaitu anti – HBS, dan untuk mengetahui riwayat infeksi dapat diperiksa anti – HBC.
Jika Sdr/i bersedia diperiksakan darahnya, maka saya mengharapkan kesukarelaan Sdr/i agar menandatangani lembar Persetujuan Setelah Penjelasan (PSP), Apabila dijumpai keluhan atau efek samping berkelanjutan pada Sdr/i sehubungan dengan pemeriksaan yang telah dilakukan misalnya dijumpai tanda infeksi di tempat pengambilan darah, yaitu bengkak, kemerahan, teraba lebih hangat dari kulit sekitar, serta nyeri, Sdr/i dapat menghubungi saya, dr.Annisa di nomor 081218615119.
Demikianlah yang dapat saya sampaikan. Atas perhatian dan kerja sama Bapak/Ibu saya ucapkan terima kasih.
Medan, 2017
Peneliti,
___________________
LAMPIRAN 2
SURAT PERSETUJUAN MENGIKUTI PENELITIAN
Saya yang bertanda tangan di bawah ini :
Nama : ... Umur ... Tahun.…..… L / P Alamat : ...
Asal Universitas : ...
Dengan ini menyatakan :
Setelah mendapat keterangan secukupnya tentang prosedur pemeriksaan dan mendapat penjelasan mengenai tujuan dan tata cara penelitian yang berjudul :
ANALISIS STATUS PROTEKSI TERHADAP INFEKSI HEPATITIS B DINILAI DARI TITER ANTI-HBS, RIWAYAT VAKSINASI DAN RIWAYAT INFEKSI BERDASARKAN
ANTI-HBC PADA MAHASISWA PENDIDIKAN PROFESI DOKTER
Saya menyatakan bersedia dan tidak keberatan untuk dilibatkan dan berpartisipasi dalam penelitian ini. Biaya penelitian tidak dibebankan kepada saya.
Demikian surat persetujuan ini saya buat dengan penuh kesadaran dan penuh tanggung jawab tanpa paksaan dari pihak manapun.
Medan, 2017 Yang membuat pernyataan
Nama Jelas dan Tanda tangan
LAMPIRAN 3
KUESIONER PENELITIAN
PROGRAM STUDI MAGISTER KEDOKTERAN TROPIS
FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA
Nomor urut register pasien |__|__|-|__|__|__|-|__|__|__|
Inisial pasien |__|__|__|(Initials of first, middle and last name)
DATA DEMOGRAFI
Kriteria inklusi /ekslusi (harus yes semua apabila tidak maka tidak
direkrut) YA TIDAK
Mahasiswa sehat yang secara umum terdaftar di program Pendidikan Profesi
Dokter Fakultas Kedokteran Muhammadiyah Universitas Sumatera Utara Apakah pasien memenuhi kriteria? Y tidak (tidak direkrut)
Jika direkrut: No rekrut pasien : |__|-|__|__|__|-|__|__|
LAMPIRAN 4
LAMPIRAN 5