update covid-19: variant danvaksin
TRANSCRIPT
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Update Covid-19: Variant dan VaksinAgung Dwi Wahyu Widodo
Department of Medical Microbiology, Faculty of Medicine, UnairDepartment of Clinical Microbiology, Dr Soetomo Hospitals Surabaya
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Subyek• Pendahuluan COVID-19• Virus Covid-19• Mutasi Covid-19• Vaksin Covid-19• Kesimpulan
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Covid-19 Timeline
Dhama et al, Clin Mibrobiol Rev, October 2020
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Wuhan Wet Market
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Nama Penyakit
Nama Penyebab
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StrukturMorfologiSARS-Cov2
Parks and Smith, NEJM 2020
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Coronavirus Origins
Dhama et al, Clin Mibrobiol Rev, October 2020
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Teori Bat: The Chinese horseshoe bat
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Perilaku virus COVID-19: Stabilitas
• Aerosol di udara: 3 jam• Permukaan Tembaga: 8 jam• Permukaan Kardus: 24 jam (satu
hari)• Permukaan Stainless Steel: 48 jam
(2 hari)• Permukaan Plastik: 72 jam (3 hari) • Dapat bertahan pada kondisi kering
dan basah serta AsamVan Doremalen, NEJM, 2020
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Penularan SARS-Cov-2• Penularan SARS-Cov-2 dapat melalui:• Kontak langsung (Kontak erat, jabat tangan)• Kontak tidak langsung (benda, alat)• Melalui Droplet (percikan Ludah)• Melalui Airborne- melalui aerosol (Tindakan
menghasilkan Aerosol-partikel kecil )• Faecal-Oral (Kotoran manusia)• Zoonosis (Domestic Cat, Bat, Ferret)
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Pintu Masuk Covid-19 ke dalam Tubuh
Mata
HidungMulut
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Komorbiditas (Pemberat) Covid-19• Lanjut Usia• Hipertensi• Diabetes Mellitus• Penyakit Jantung• Penyakit Pembuluh Darah• Penyakit Ginjal• Penyakit Kanker• Perokok• Obesitas
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Jenazah Covid-19: Source of Transmission
Nature and Science Magazine: Jenazah pertama kasus Covid di Amerika Serikat
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TransisiGlobal
strain D menjadi G
danKekuatanInfeksinya(Korber,
2020)
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EfekMutasiD614G padaSpike
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Dari mana asal virus Covid-19 di Indonesia?
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100% Strain G
1% 43% 97% 100%
31 juli 2020
Indonesia
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Strain Asal Rumah sakit Mutasi Nucleotida Mutasi Asam amino Strain
hCoV-19/Indonesia/ JI-ITD-3590NT/2020
RSUD Dr Soetomo C21909G Spike S116C GhCoV-19/Indonesia/ JI-ITD-4859V/2020
RSUD Dr Soetomo - - GhCoV-19/Indonesia/ JI-ITD-12202V/2020
RSUD Sidoarjo C9733T, C25626T - GhCoV-19/Indonesia/ JI-ITD-7398NT/2020
RS Unair C7728T, C17421T, C21627T, C21762T, C26455T, C28045T
E: P71SNS8: A51VS: T22I, A67VOrf1ab: S2488F
G
hCoV-19/Indonesia/ JI-ITD-7061V/2020
RS Sidoarjo C9985T - GhCoV-19/Indonesia/ EJ-ITD-8402NT/2020
RSAL dr Ramelan - - GhCoV-19/Indonesia/ JI-ITD-150Sp/2020
RS Unair - - DhCoV-19/Indonesia/ JI-ITD-136N/2020
RS Husada Utama A20294G Orf1ab: Y6677C DhCoV-19/Indonesia/ JI-ITD-3101NT/2020
RS Adi HusadaUndaan
C82997T, C29218T - DhCoV-19/Indonesia/ JI-ITD-853Sp/2020
RS Siloam C20574T - DhCoV-19/Indonesia/ JI-ITD-1273V/2020
RS Bangil Pasuruan - - DhCoV-19/Indonesia/ JI-ITD-1238Sp/2020
RS Mitra KeluargaKenjeran
A11326G, G14500T, T16419A Orf1ab: V4746L DhCoV-19/Indonesia/ EJ-ITD-3601NT/2020
RSUD Dr Soetomo C13397T, G27163T M: S241I D
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Mutasi Baru COVID-19 (WHO)1. Mutasi VOC 202012/01 varian (Alfa)
Dari Inggris (UK) sejak September 2020Sudah Masuk Ke IndonesiaLebih Infeksius
2. Mutasi 501Y.V2 Afrika Selatan (Beta)Dari Afrika SelatanLebih Infeksius dari Mutasi VOC di Inggris
3. Mutasi P1 Brazil (Gamma)Dari Brazil dan JapanLebih Infeksius dari mutasi B117
4. Mutasi B1.617 (Delta)Dari India terjadi double MutasiLebih infeksius, terjadi lonjakan kasus dan mortalitas
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Mutasi Covid-19 yang masuk Indonesia
• 1. Mutasi D614G– sudah terdapat di Indonesia sejak Maret 2020– Sejak Oktober 2020, Strain dominan di Indonesia– Lebih Infeksius
• 2. Mutasi B 117 (Alfa)– Dari Inggris (UK) sejak September 2020– Lebih Infeksius
• 3. Mutasi E484K (Beta, Gamma dan Delta)– Dari Afrika Selatan, Brazil dan UK serta Amerika– Dapat menghindar dari antibodi
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Fenomena Post Vaksin: Infeksi (bukan dari vaksin)
Vaksin Pertama Vaksin Kedua
RisikoInfeksi Infeksi? Infeksi?
Booster
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Re-Infeksi COVID-19• Kasus di Hongkong (Laporan WHO):• Maret terinfeksi Covid-19: demam dan Pneumoniae• Sembuh Sempurna, dengan hasil Swab PCR negative• Juli melakukan perjalanan ke Eropa (Spanyol)• Awal Agustus 2020, Kembali ke Hongkong dengan Swab
Covid-19 Positif dengan keluhan Demam, batuk dansesak.
• Hasil Sekuensing: Virus bulan Maret (Hongkong) berbeda dengan virus bulan Agustus (Spanyol)
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Stabilitas Sistim Imun• Sistim imun selama pandemic covid-19 perlu di
jaga stabilitasnya dengan cara:• Istirahat (Tidur)• Olah raga (Menjaga Kebugaran)• Nutrisi yang cukup• Hindari Stress• Hygiene sanitasi pribadi• Masker dan Hand Hygiene• Vaccine (?): berbeda-beda bahan
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Apa Vaksin itu ?
• Vaksin adalah suatu zat yang merupakanmerupakan suatu bentuk produk biologi yang diketahui berasal dari virus, bakteri atau darikombinasi antara keduanya yang dilemahkan.
• Vaksin diberikan kepada individu yang sehatguna merangsang munculnya antibody ataukekebalan tubuh guna mencegah dari infeksipenyakit tertentu.
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Tujuan Vaksinasi
1. KekebalanIndividu
2. Kekebalankelompok
(Herd Immunity)
Vaksin Covid-19: Menurunkan angka infeksi, menurunkan angka MRS danmenurunkan angka Mortalitas
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Vaksinasi Covid-19 VS Plasma Convalescence
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Komponen Vaksin Covid-19
• Bahan Vaksin:• Virus inaktif (Sinovac)• Menggunakan vector virus-tidak berbiak
(AstraZeneca dan Gamaleya)• Asam nukleat-RNA atau DNA (Pfizer dan
Moderna)• Protein Virus (Novavax)
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Pengujian Vaksin Covid-19
Kandidat vaksin menurut WHO, 12 Nopember 202048 kandidat : evaluasi Klinis fase 1-3164 kandidat: fase pre klinik
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0,3 ml
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Single Dose
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14 days 0,5 ml
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Penyakit penyerta atau komorbid layak(PAPDI)
• 1. Reaksi anafilaksis (bukan akibat vaksinasi Covid)• 2. Alergi obat• 3. Alergi makanan• 4. Asma bronkial, dengan catatan: jika pasien dalam keadaan asma akut disarankan untuk menunda
vaksinasi sampai asma pasien terkontrol baik.• 5. Rhinitis alergi• 6. Urtikaria• 7. Dermatitis atopi• 8. HIV, dengan catatan: Vaksinasi yang mengandung kuman yang mati/komponen tertentu dari
kuman dapat diberikan walaupun CD4<200. Perlu dijelaskan kepada pasien bahwa kekebalan yang timbul dapat tidak maksimal, sehingga dianjurkan untuk diulang saat CD4>200.
• 9. Penyakit Paru Obstruktif Kronik• 10. Tuberkulosis• 11. Kanker paru• 12. Interstitial lung disease• 13. Penyakit hati• 14. Diabetes mellitus• 15. Obesitas• 16. Nodul tiroid• 17. Pendonor darah• 18. Penyakit gangguan psikosomatis
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Penyakit penyerta atau komorbid belumlayak (PAPDI)
• 1. Penyakit Autoimun Sistemik (SLE, Sjogren, vaskulitis, dan autoimun lainnya)• 2. Sindroma Hiper IgE• 3. PGK non dialysis• 4. PGK dialisis (hemodialisis dan dialysis peritoneal)• 5. Transplantasi ginjal• 6. Sindroma nefrotik dengan imunosupresan/ kortikosteroid• 7. Hipertensi• 8. Gagal jantung• 9. Penyakit jantung coroner• 10. Reumatik Autoimun• 11. Penyakit-penyakit gastrointestinal• 12. Hipertiroid/hipotiroid karena autoimun• 13. Penyakit dengan kanker, kelainan hematologi seperti gangguan koagulasi,
pasien imunokompromais, pasien dalam terapi aktif kanker, pemakai obatimunosupresan, dan penerima produk darah
• 14. Pasien hematologi-onkologi yang mendapatkan terapi aktif jangka panjang, seperti leukemia granulositik kronis, leukemia limfositik kronis, myeloma multipel, anemia hemolitik autoimun, ITP, dan lainnya
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KIPI• 1. Reaksi lokal, seperti:
– a. nyeri, kemerahan, bengkak pada tempat suntikan– b. reaksi lokal lain yang berat, misalnya selulitis.
• 2. Reaksi sistemik seperti: – a. demam, – b. nyeri otot seluruh tubuh (myalgia),– c. nyeri sendi (atralgia), – d. badan lemah, – e. sakit kepala– f. diare– G. nafsu makan berkurang
• 3. Reaksi lain yang berat, seperti: – a. reaksi alergi misalnya urtikaria, oedem, – b. reaksi anafilaksis, – c. syncope (pingsan)
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Variant Sars-Cov-2 and Immunity
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Vaksinasi Bukan Pengganti Masker
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Arigatou Gozaimasu
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