WITH AND WITHOUT VACCINATED
Wahyu Indah Dewi Aurora1, Nuriyah2, Andika Sulistiawan3, Armaidi Darmawan4, Ima Maria5, Erny Kusdiyah6
1,2,5,6 Medical Faculty and Health Science Universitas Jambi
3 Center of Excellent Scientific of Environmental Health And Diseases (SEHAD) Universitas Jambi
4 Nursing Department Medical Faculty and Health Science Universitas Jambi Email: [email protected]
ABSTRACT
Introduction: Since the emergence of Emerging Diseases, namely the discovery of a new virus in 2019 which was named Covid-19, the World Health Organization (WHO) has established a Pandemic status throughout the world. To anticipate the large number of fatalities, it is necessary to have a vaccine to reduce morbidity and mortality. The purpose of this study was to find out the differences in clinical manifestations that appeared in patients with positive Covid-19 before and after receiving vaccination.
Method: The design of this study was Cross Sectional conducted at the Puskesmas/Clinic in Jambi City from April to October 2022. The number of samples used was 721 samples using the simple random sampling technique, the medical records of patients positive for Covid 19 were taken randomly at the Puskesmas/Clinic/ Hospitals that meet the inclusion criteria will be included as samples.
Results: From the results of the study, the most samples were aged 21-30 years (35.2%). Based on gender, there were 330 respondents (45%). From the results of the study, it was found that the percentage of respondents who had fever (62.41%), coughing (50.5%), body weakness (32.4%), itching in the throat (21.63%), runny nose/runny nose (44.8%), dizziness/headache (25.65%). Pain in muscles and joints (25.4%), nausea (13.6%), vomiting (5%), diarrhea (5.3%), fever (26.5%), chest pain (5.8%) ), loss of sense of smell (20.24%), loss of sense of taste (13.86%), itching of the skin (2.35%), and other symptoms such as disorders of the eyes, ears, etc. as much as 8.8% .
Conclusion: The clinical manifestations of patients who are positive for Covid 19 are milder in respondents who have been vaccinated compared to those who have not been vaccinated.
Keywords: Clinal Manifestation Covid-19, Vaccine
INTRODUCTION
At the end of 2019, in December, to be precise, the world was shocked by the news of the emergence of a pneumonia outbreak with no known exact cause.1 This outbreak was first discovered in the city of
Wuhan, Hubei Province, China. Officially, WHO names this disease Covid-19 (Corona Virus Disease 2019) and the name of the virus is SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2)2.
234 The problem of non-communicable
diseases in the world is an important focus for future health sustainability. Non- communicable diseases are a double burden or a world burden because of the long illness process and expensive treatment. If this is not addressed, it can be estimated that the health costs that will be incurred for the management of non- communicable diseases range from 213- 396 billion dollars or around 7-13% of the world health budget1.
Since the emergence of Emerging Diseases, namely the discovery of a new virus in 2019 which was named Covid-19, the World Health Organization (WHO) has established a Pandemic status throughout the world. The number of deaths due to Covid-19 has killed more than four million people worldwide. To anticipate this, it is necessary to have a vaccine to reduce morbidity and mortality. The Covid-19 vaccine is expected to be a solution to the status of a World Pandemic becoming Endemic
WHO for the first time declared a global pandemic status on March 11 2020 because this virus has spread to various countries in the world3. The Americas are followed by Europe, while Asia is third, with the number of deaths reaching 6 million cases.4 Indonesia first confirmed the Covid- 19 case on March 2, 2020 with the discovery of two confirmed cases.5 Cases in Indonesia have continued to increase until now as many as 6 million confirmed cases with a total of 153,411 cases of
death. In Jambi Province, 37,664 confirmed cases and 851 deaths were recorded, while Jambi City is currently the highest statistically with 13,449 confirmed cases recorded with 279 deaths, followed by Muaro Jambi. Jambi with 5,544 cases and Batanghari with 3,718 cases.
In the world of medicine and nursing, of course this is a new thing to know about the clinical manifestations that appear in patients before being vaccinated with patients after receiving the vaccine.
Nursing issues are also interesting to study in terms of the effectiveness of the vaccine.
The prevalence of osteoporosis is still high in Jambi Province, especially in Jambi Jambi City, so the researchers concluded the formulation of the problem
"What are the differences in clinical manifestations that arise and nursing problems in patients with positive Covid-19 before and after receiving vaccinations?"
The general aim of this study is to analyze the differences in clinical manifestations that arise and nursing problems in patients with positive Covid-19 before and after receiving vaccinations.
This research is still rarely done in Jambi Province and rarely done in Jambi City. With the results of this study, it can be used as a reference for government policies in handling Covid 19 in Jambi City, Jambi.
METHOD
Cross Sectional Research Approach. This research will be conducted
235 at the Puskesmas/Clinic in Jambi City from
April to October 2022. The target population in this study is the people in Jambi City. The number of samples required is a minimum of 721 samples. The sampling technique used was simple random sampling, the medical records of Covid-19 positive patients were taken
randomly at the Health
Center/Clinic/Hospital and met the inclusion criteria to be included as a sample. The sample inclusion criteria were positive patients with Covid-19 declared positive swab antigen or PCR test, medical
records that could be read clearly. The exclusion criterion was that medical records could not be read clearly.
RESULTS
Characteristics of Respondents
The research was conducted at the First Health Facility. The first was in Jambi City from August-October 2022. The samples obtained were 721 samples. From the results of the study, the characteristics of the respondents were obtained on Table 1.
Table. 1 Characteristics of Respondents by Age
No Age amount Percentage
1. <10 years 35 4,85%
2. 11-20 years 65 9%
1. 21-30 years 254 35,2%
2. 31-40 years 167 23,16%
3. 41-50 years 103 14,28%
4. 51-60 years 68 9,4%
5. 61-70 Years 23 3,19%
6. >70 years 6 0,8%
Total 721 100%
This study does not limit the age of the respondents. All ages are grouped into 9 age groups. From the results of the study, it was found that the majority of the sample was aged 21-30 years (35.2%), then aged 31-40 (23.16% and aged 41-50 years
(14.28%). Meanwhile, respondents aged
>70 years were only 6 people or 0.8%).
Gender is categorized into male and female. Based on gender, 330 respondents (45%) were male and 391 respondents (55%) were 100%.
Table 2 Characteristics of Respondents by Gender
No Gender amount Percentage
1. Male 330 45%
2. Female 391 55%
Total 721 100%
236 Clinical Manifestations
The clinical manifestations of the respondents were measured using
medical record data and examination results on patients. The results can be seen in the following table 3.
Table 3 Characteristics of Respondents Based on Clinical Manifestations
No Age Amount Percentage
1. Fever Yes No
450 271
37,5%
62,4%
2. Cough
Yes No
357 364
50,48%
49,51%
3. Tired Yes No
234 487
32,45%
67,5%
4. Itchy Throat Yes
No
156 565
21,6%
78,36%
5. Runny Nose Yes
No
323 398
44,8%
55,2%
6. Headache Yes No
185 536
25,65%
74,34%
7. Myalgia Yes No
183 537
25,38%
74,47%
8. Nausea Yes No
98 623
13,59%
86,4%
9. Vomitus Yes No
36 685
5%
95%
10. Diarrhea Yes No
38 683
5,2%
94,8%
11. Dizzy Yes No
191 530
26,5%
73,5%
12. Chest pain Yes
No
42 679
5,8%
94,2%
13. Anosmia Yes No
146 575
20,24%
79,75%
14. Dysgeusia Yes No
100 621
13,86%
86,13%
15. Itchy Rash Yes No
17 703
2,35%
97,5%
16. Others Yes No
64 657
8,8%
91,12%
Total 721 100%
237 From the results of the study it was
found that the percentage of respondents who experienced fever (62.41%), cough (50.5%), tired (32.4%), itching in the throat (21.63%), runny nose (44, 8%), headache (25.65%), myalgia (25.4%), nausea (13.6%), vomiting (5%), diarrhea (5.3%), fever (26.5%), chest pain (5.8%) ), anosmia (20.24%), dysgeusia (13.86%), itching rash
(2.35%), and other symptoms such as disorders of the eyes, ears, etc. as much as 8.8% .
Vaccine History
Vaccine history of respondents was measured using medical record data and examination results on patients. The results can be seen in the following table 4.
Table 4 Characteristics of Respondents Based on Vaccine History No Covid Vaccine
History
Ammount Percentage
1. Not Yet Vaccinated 400 55,5%
2. First Vaccinated 207 28,7%
3. Second Vaccinated 114 15,8%
Total 721 100%
From the results of the study it was found that 400 people (55.5%) had not been vaccinated, only 207 people (28.7%)
had received the first vaccine and had received the second vaccine, namely 114 people (15.8%).
DISCUSSION
Corona Virus Disease 2019 or what people usually call Covid-19 disease is a new infectious disease caused by the Sars- CoV-2 virus. This virus is similar to the virus that causes SARS (Severe Acute Respiratory Syndrome) or acute respiratory syndrome and common influenza. The Covid-19 virus is included in the large family of corona viruses, which can cause respiratory tract illnesses ranging from mild symptoms such as coughing, flu, body chills, head aches to severe symptoms such as shortness of breath.
Corona viruses are the largest group of viruses in the order Nidovirales. All
viruses in the order Nidovirales are nonsegmented positive-sense RNA viruses. Corona virus belongs to the Coronaviridae family, the Coronavirinae sub-family, the Betacoronavirus genus, the Sarbecovirus subgenus. It was further explained that the Sarbecovirus subgenus includes Bat-SL-CoV, SARS-CoV and 2019-nCoV. Bat-SL-CoV was initially found in Zhejiang, Yunnan, Guizhou, Guangxi, Shaanxi and Hubei, China. Corona viruses are spherical in shape with a diameter of about 125 nm as described in studies using cryo-electron microscopy. Corona virus particles contain four main structural proteins, namely protein S (spike protein)
238 which is shaped like a nail,14 protein M
(membrane protein), protein E (envelope protein), and protein N (nucleocapside protein).5
The virus can pass through mucous membranes, especially the nasal and laryngeal mucosa, then enter the lungs through the respiratory tract. Furthermore, the virus will attack target organs that express Angiotensin Converting Enzyme 2 (ACE2), such as the lungs, heart, renal system and gastrointestinal tract. The S protein in SARS-CoV-2 facilitates the entry of the corona virus into target cells. Viral entry is dependent on the ability of the virus to bind to ACE2, an extracellular membrane receptor expressed on epithelial cells, and dependent on protein S priming to a cellular protease, namely TMPRSS2. The S protein in SARS-CoV-2 and SARS-CoV has an almost identical three-dimensional structure in the receptor- binding domain. The S protein in SARS- CoV has a strong binding affinity with ACE2 in humans. In further analysis, it was found that SARS-CoV-2 has a better recognition of ACE2 in humans compared to SARS- CoV. 4
The incubation period for COVID- 19 is between 3-14 days. It is characterized by leukocyte and lymphocyte levels that are still normal or slightly decreased, and the patient has not felt any symptoms.
Subsequently, the virus began to spread via the bloodstream, mainly to organs expressing ACE2 and patients began to experience mild symptoms. Four to seven
days from the initial symptoms, the patient's condition began to deteriorate marked by the onset of shortness of breath, decreased lymphocytes, and worsening of the lesions in the lungs. If this phase is not resolved, Acute Respiratory can occur.
Distress Syndrome (ARSD), sepsis, and other complications. Clinical severity is related to age (over 70 years), comorbidities such as diabetes, chronic obstructive pulmonary disease (COPD), hypertension, and obesity. 23 The innate immune system can detect viral RNA through RIG-I-like receptors, NOD-like receptors. , and Toll-like receptors. This will in turn stimulate interferon (IFN) production, as well as trigger the emergence of anti-viral effectors such as CD8+ cells, Natural Killer (NK) cells, and macrophages. Infection with other betacoronaviruses, namely SARS-CoV and MERS-CoV, is characterized by rapid viral replication and delayed production of IFN, mainly by dendritic cells, macrophages, and respiratory epithelial cells, which are then followed by increased levels of pro-inflammatory cytokines as the disease progresses. 4
Covid-19 infection can cause mild, moderate or severe symptoms. The main clinical symptoms that appear are fever (temperature> 380C), cough and difficulty breathing. In addition, it can be accompanied by heavy tightness, fatigue, myalgia, gastrointestinal symptoms such as diarrhea and other respiratory symptoms. Half of the patients develop
239 shortness of breath within one week. In
severe cases rapidly and progressively worsening, such as ARDS, septic shock, metabolic acidosis that is difficult to correct and bleeding or dysfunction of the coagulation system within a few days. In some patients, the symptoms that appear are mild, not even accompanied by fever.5
Most patients have a good prognosis, with a minority in critical condition or even die. The following clinical syndromes can appear if infected This condition is the mildest condition, the patient has no symptoms6
This condition is the mildest condition. The symptoms that appear are non-specific symptoms. The main symptoms still appear, such as fever, cough, may be accompanied by sore throat, nasal congestion, malaise, headache and muscle aches. It should be noted that in elderly and immunocompromised patients the presentation of symptoms is atypical or atypical. In addition, in some cases it is found that it is not accompanied by fever and the symptoms are relatively mild. In this condition the patient has no symptoms of complications including dehydration, sepsis or shortness of breath
The main symptoms can appear as fever, cough, and shortness of breath. But there is no sign of severe pneumonia. In children with non-severe pneumonia characterized by coughing or difficulty breathing7
Adolescent or adult patients with fever or under surveillance for respiratory infections/pneumonia, plus one of:
respiratory rate > 30 breaths/minute, severe respiratory distress, or oxygen saturation (SpO2) < 93% on room air or PaO2/FiO2 ratio < 300 Or Pediatric patient with cough or difficulty breathing, plus at least one of the following:
- central cyanosis or SpO2 <90%
- severe respiratory distress (eg, snoring, heavy chest indrawing)
- other signs of pneumonia are chest wall indrawing, tachypnea: <2 months,
≥60x/minute; 2-11 months, ≥50x/minute;
1-5 years, ≥40x/minute;> 5 years,
≥30x/minute.6
Acute Respiratory Distress Syndrome (ARDS), septic shock and/or multiple organ failure.
Nursing problems are one of the main components in nursing diagnoses and describe the essence of the client's response to health conditions or life processes8. The Indonesian Nursing Diagnosis Standard (IDHS) is the standard terminology used to enforce nursing diagnoses in Indonesia so that they are uniform, accurate and unambiguous to avoid inaccurate decision making and discrepancies in the nursing care provided to clients9.
240 ACKNOWLEDGEMENTS
The author would like to thank the LPPM Universitas Jambi for funding this research,
also wish to thank the clinics and community health centers that have assisted in collecting data for this study.
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