AMINO PCC EAMSC 2017

AMINO AMSA-Indonesia Competition Archive for PCC East Asian Medical Students’ Conference 2017

Scientific Paper Scientific Poster Public Poster Videography Photography

FOREWORD AMINO is a program of AMSAIndonesia’s 2015/2016 tenure which is improvises previous publication: Bundle Regular of AMSA-Indonesia National Competition (BRAINs).

AMINO is a place for archive all works from AMSA member who have participated national competition was held by AMSAIndonesia. With additional audio recording, it is expected that the readers would be to learn more regarding the works published in AMINO and to make AMINO more interactive.

AMINO will also published three times (PCC EAMSC, PCC AMSC, and IMSTC). AMINO will archive all works (i.e. scientific paper, scientific poster, public poster, photography, and videography) and I hope AMINO can make all AMSA member participate more in all competition that held by AMSA-Indonesia.

As a closing, i would like to say thank you to Valdi Ven as a A-Team member, as the person in charge in AMINO project. I would like to say thank you to Ananta Siddhi Prawara as Regional Chairperson AMSAIndonesia 2016/2017 and all Executive Board AMSA-Indonesia 2016/2017 who always help me until AMINO finished. I hope this AMINO will give an inspiration for all AMSA member.

Thank You Best Regards

Edwin Setyawan Secretary of Academic AMSA-Indonesia 2016/2017 Faculty of Medicine 2014 Maranatha Christian University, Indonesia Official Email: academicandresearch@amsaindonesia.com Phone: +6287823988766

CONTENT

All the works publicized here are the works of AMSA-Indonesia’s members who participated in PCC East Asian Medical Students’ Conference 2017 In each section, the first works are acquired the first place in PCC EAMC 2017 consecutively up to the third.

H e re l i ste d b e l ow a re details of the winners.

Sections: Scientific Paper 1st by Julius Albert Sugianto 2nd by Putu Ijiya Danta Awatara 3rd by Raksheeth Agarwal Scientific Poster 1st by Donni Santoso 2nd by Michael Jonatan 3rd Ayuning Tetirah Public Poster 1st by Josephine Djunarko 2nd by Rizka Febriana Fitrie 3rd by Aditia Normalita Sari

Videography 1st by Safara Nurul Laela Wairoy 2nd by Schoollaus Daleru 3rd by Victoria Simanihuruk Photography 1st by Shidi Laras Pramudito 2nd by Athaya Febriantyo Purnomo 3rb by Alfryan Janardhana 4th by Moh. Fauzan

AMSA-Indonesia Competition Archive for PCC East Asian Medical Students’ Conference 2017

SCIENTIFIC PAPER

Retrospective Time Series Analysis of Dengue Fever Incidence and Death Case in Relation to Climate and Weather between January 2012 until May 2016 at Sampang Regency, East Java, Indonesia Julius Albert Sugianto*, Michael Jonatan** *Universitas Airlangga – (+62)89675844351; julius_albert14@yahoo.com **Universitas Airlangga – (+62)82141612191; michaeljonatan1996@gmail.com Background Dengue infection remained the most common arbo-viral infection worldwide. Dengue fever (DF) outbreaks in Indonesia is the largest in ASEAN. The increment were thought to be an indirect effect of high mobility, climate change, and population density. On climate change, three parameters are found to primarily affect rise in DF incidence: temperature, humidity, and rainfall. Increase of those parameters makes the environment more suitable for Aedes mosquitoes to reproduce and thus, increases its population and, consequently, DF incidence.

Sampang is one of the region which have been consistently hit by an epidemic of Dengue despite the strategies that have been implemented to prevent and eradicate DF in Sampang. Temperature in Sampang is consistent all year round at 27.1oC. Rain precipitation fluctuates, peaking at December and hitting the bottom on August.

Aim With the available evidence of the correlation of temperature, humidity, and rainfall to dengue fever incidence and the evidence in variation of climate change in Sampang. We sought to analyze the relationship of dengue fever incidence and death case towards climate change, especially on rainfall and temperature at Sampang Regency, Madura, East Java, Indonesia.

Material and methods Retrospective observational study was conducted. We collected data from all government health facilities in Sampang regency (21 community health centers and 1 government hospital) from January 2012 to May 2016. These data were collected per months and two specific parameters were investigated: (1) DF incidence and (2) death case. We then analyzed the data descriptively and further compare it with the available climate data of Sampang from id.climate-data.org, Statistics Indonesia, and Indonesian Agency for Meteorology, Climatology, and Geophysics.

Results DF incidence monthly cumulative pattern of Sampang followed the monthly rain precipitation pattern with a month delay. DF incidences reached the highest level on January, a month after the rain precipitation peaked on December. Meanwhile, monthly death cases also peaked on January except on 2015. Yearly, DF incidence remained on the rise except on 2014. Additionally, from analyzing the DF

incidence monthly progression from 2012-2016, it is found that the pattern remained relatively the same despite changes in cumulative yearly incidence.

Conclusion The result of our study provides evidence on the relationship between weather and climate in relation to DF incidence and death case. We hope this result can be used as a role model for further research and nationwide strategies in combating dengue fever.

EAST ASIAN MEDICAL STUDENT’S CONFERENCE 2017 ASIAN MEDICAL STUDENTS’ ASSOCIATION - INDONESIA SCIENTIFIC PAPER Retrospective Time Series Analysis of Dengue Fever Incidence and Death Case in Relation to Climate and Weather between January 2012 until May 2016 at Sampang Regency, East Java, Indonesia By: Julius Albert Sugianto, Michael Jonatan FACULTY OF MEDICINE, UNIVERSITAS AIRLANGGA AMSA – UNIVERSITAS AIRLANGGA SURABAYA 2016

Retrospective Time Series Analysis of Dengue Fever Incidence and Death Case in Relation to Climate and Weather between January 2012 until May 2016 at Sampang Regency, East Java, Indonesia Julius Albert Sugianto*, Michael Jonatan** *Universitas Airlangga – (+62)89675844351; julius_albert14@yahoo.com **Universitas Airlangga – (+62)82141612191; michaeljonatan1996@gmail.com I.

Introduction Dengue Infection Dengue infection is one of the most common arbo-viral infection worldwide and the medical and economic buden it causes is large [1, 2]. Dengue infection is caused by dengue virus (DENV) that is transmitted mainly by Aedes aegypti and some by Aedes albopictus mosquitoes. Dengue virus is a single positive stranded RNA virus of the family Flaviviridae; genus Flavivirus. Up until 2015, there are 5 serotypes of DENV that has been found (DENV-1, DENV-2, DENV-3, DENV4, and DENV-5) [3]. The discovery of DENV-5 was found during in a 2007 dengue outbreak from a 37 year old farmer in Malaysia and DENV-5 is the only virus belongs to the sylvatic cycle, meaning that DENV-5 circulates primarily in non-human primates. The other four serotypes (DENV-1, DENV-2, DENV-3, DENV-4) are closely related and share approximately 65% of their genotype, and these serotype is transmitted to human form, not sylvatic form like DENV-5 [3, 4].

The incidence of dengue fever (DF) and dengue hemorrhagic fever (DHF) has increased in recent decades. While the actual numbers of dengue infection and dengue fever are underreported, it is estimated that annually there are 3.9 billion people at risk of infection, with a reported case more than 100 million, and 25,000 deaths annually, mostly in tropical and sub-tropical countries, such as Indonesia, Myanmar, Sri Lanka, India, and Thailand [5, 6].

WHO in (2009) reported that more than 70% of the population at risk for dengue worldwide live in South-East Asia and Western Pacific region. These regions bear approximately 75% of the current global disease burden due to dengue [6].

According to Indonesia’s health ministry, over the last several years, the number of dengue fever outbreaks in Indonesia was the largest in ASEAN region, followed by India and Myanmar [7]. Health ministry (2010) stated that there were a significant increase of DHF cases from 58 cases in 1968 (incidence rate 0.05 per 100,000 population) to 158,192 cases in 2009 (incidence rate 68.22 per 100,000 population). These increment were thought to be an indirect effect of high mobility, climate change, and population density [7].

Dengue Infection and Climate Change Various theories regarding the cause of the rise in DF incidence are available. Carrington LB [8] neatly summarized the theories in his review. In his review, he wrote that there are two main important points to be assessed when studying the virulence of DF: Human factors influencing transmission and mosquito susceptibility to infection. The human factors are the viral titer in human plasma, duration of human infectiousness, and symptomatic vs asymptomatic infections.

Meanwhile, mosquito susceptibility to infection are affected by the relative vector competence, virus concentration in the blood meal, environmental temperature, humidity, mosquito’s genotype and blood feeding behavior [8]. The factors mentioned above focuses on internal factors of mosquitoes and humans. In relation to weather and climate change, this article would focus more on the environmental factors that would affect the mosquito’s life cycle and, consequently, its capability to infect humans which are temperature, humidity, and rainfall.

Aside from the factors mentioned by Carrington LB [8], other authors studying the relation of DF incidence and weather also see temperature and humidity as an important parameter but also highlighted the effect of rainfall [8-13]. Rainfall causes massive stagnant water places, such as in puddle, garbage dumps, open perimeter dumps, and ground depression which would act as the reservoirs and the potential breeding sites of Aedes mosquito. Significant association between

rainfall and DF incidence has been found by previous studies [9, 11, 13, 14] and also the significant association between temperature and DF incidence [10, 11, 13]. Additionally, humidity’s association with DF incidence has been found in one study by Lu L et al [10]. These three parameters would affect mainly on the number of viable mosquitoes in the environment ready to act as a vector for DF. Picture 1 Mosquito Life Cycle [15] With a suitable environment, Aedes mosquito are expected to increase in population starting on day 8-10 after the start of rainy season [15]. Following the increase in population, the next step for dengue transmission is dengue virus incubation in Aedes mosquito. This step requires 10-12 days for dengue virus to incubate after Aedes mosquito bites infected person. The third step will be the incubation period in human body. The incubation period (time between exposure and onset of symptoms) ranges from 4-13 days, some says 4-7 days. The principal symptoms of dengue are high fever (more than 40oC) and accompanied by 2 of the following symptoms: severe headache, severe eye pain, muscle and joint pains, nausea, vomiting, and swollen glands or rash. The symptoms if treated properly last for 2-7 days, after the incubation period after the bite from an infected mosquito. Thus, Carrington and Simmons [8] proposed that the time gap between the beginning of rainy season and incidence of dengue fever is around 24-30 days [8, 10, 16].

DF, Climate, and Geography of Indonesia Indonesia is located between the mainland of South East Asian and Australia. Indonesia is made up of 17,508 island with its 5 main islands and covers an area of 1.9 million km2. Indonesia is located along the equator, making Indonesia a tropical country [17].

As a tropical country, climate in Indonesia is fairly even all year round. The main variable of Indonesia’s climate is the rainfall, rather than temperature or air pressure. The average annual temperature in Indonesia ranges between 23oC (in high mountain areas) up to 32oC (in coastal areas). Two distinct seasons are monsoon wet and dry season. The rainy season usually start from November to April and the wet season from May to October, but season may vary with a little difference in each location and region [17, 18].

Indonesia itself is also affected by the climate change around the world. According to Hulme and Sheard (1999), mean annual temperature in Indonesia has increased by about 0.3 oC annually, and the overall annual precipitation decreased by 2 to 3%. However, Boer and Faqih (2004) stated that there has been a decline in annual rainfall in the south Indonesia, such as in Java, South Sumatera, and South Sulawesi, and an increase in precipitation in the northern region of Indonesia [19]. Such climate changes are predicted to ease nationwide dengue spread [20].

In Indonesia, one of the leading risk factor in DF transmission is rainfall index. Regions with high rainfall index tend to have constantly high incidence rate of DF throughout the year.

Conversely, regions with low rainfall index tend to have high DF incidence rate only after the rainy season starts to begin [7].

DF, Climate, and Geography of Sampang Sampang is located in Madura island, East Java province, between 6° 05' to 7° 13' South Latitude and 113° 08' to 113° 39' East Longitude. It covers an area of 1,233.1 km2. Sampang regency consists of 14 districts and 186 villages [21]. According to Badan Pusat Statistik (Statistics Indonesia) in 2015, the population of Sampang was around 919,825 people with population density per km2 around 733 people per km2 [22].

Sampang regency shares borders with Java sea to the north, Madura strait to the south, Pamekasan regency to the east, and Bangkalan regency to the west. Sampang regency is situated at elevation 0 to 50m above sea level [21].

Dengue hemorrhagic fever has already spread all over Sampang and was one of the leading cause of hospitalization in Sampang, accounting for 455 cases (for Dengue infection 435 cases).

In Sampang, the incidence rate of DF in 2012 was 34.61 in 100,000 populations [23].

Current strategies to prevent and eradicate DF in Sampang is by going hand in hand with the community, inciting their participation. The main strategy is to promote: (1) eradication of mosquito habitats with “Gerakan 3M” (drainage of bathtub, sealing water reservoirs, and burying garbage and junk), (2) monitoring numbers of mosquito larva, and (3) early detection of DHF and the initial management of DHF in house [23].

Looking at the climate, Sampang regency is situated in a tropical climate. Every year, there are 6 wet months and 6 dry ones. Rainy season in Sampang regency started at around October-March with its peak season on December. Dry season is usually from April to September, with the peak season at around August [21]. Temperature are high all year round at 27.1OC with little difference from month to month. Because Sampang regency is mainly consists of coastal areas, the daily range of temperatures is small and nearly the same throughout the year [25]. Average rainfall in Sampang is around 1,415 mm with the lowest precipitation in August, with an average of 16 mm, and the highest precipitation falls in December with an average of 239mm.

Figure 1. Temperature and Rain Precipitation in Sampang [25]

Study Objective With the available evidence of the correlation of temperature, humidity, and rainfall to dengue fever incidence and the evidence in variation of climate in Sampang. We sought to analyze the relationship of dengue fever incidence and death case towards climate, especially on rainfall and temperature at Sampang Regency, Madura, East Java, Indonesia. We hope that this study can be used as a basis for future policy in anticipating dengue fever in Sampang.

II. Material and Methods Study Sites The data is collected from all government health facilities in Sampang regency, which consists of 21 pusat kesehatan masyarakat (Community health centers) and 1 government hospital (Sampang General Hospital).

Study Design The study was conducted with retrospective observational study design. This community based descriptive study was conducted in the identified localities during the period of January 2012 to May 2016. Data were retrieved from Health Service of Sampang Regency. These data were collected per months and two specific parameters were investigated, which is the number of DF incidence and death case caused by dengue infection.

Data regarding the climate and geographical characteristics were retrieved from id.climatedata.org, Badan Pusat Statistik (Statistics Indonesia), and Badan Meteorologi, Klimatologi, dan Geofisika (Indonesian Agency for Meteorology, Climatology, and Geophysics) Statistical analysis The data was analyzed using Microsoft Excel 2016 and was presented in figures, charts, and tables. Descriptive analysis were made based on data and to answer the main problem in this study.

III. Results a. Monthly Cumulative DF Incidence and Death Case Pattern Figure 2. Monthly Cumulative DF Incidence and Death Case Pattern 600

9 8 7

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Jan Feb Mar Apr May Jun DF Incidence 530 343 186 132 74 49 Death Case 6 8 6 1 1 0 DF Incidence

Jul Aug Sep 50 38 34 0 0 0

oct Nov Dec 52 61 64 1 2 0

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Death Case

Total of DF incidence and death case for each month from January 2012 – December 2015 is graphed above. This graph is important to show crude pattern in DF incidence and death case.

From the graph above we can infer the trend of incidence for each month. DF Incidence peaked at January and gradually decline reaching its bottom on September. Afterwards, the incidence slightly rises until December and shoots up on January. Death Rate peaked on February and gradually decline. Reaching another high on November and then dropped again on December. b. Yearly Cumulative DF Incidence and Death Case

700

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Figure 3. Yearly Cumulative DF Incidence and Death Case

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0 2012

2013 DF Incidence

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Death Case

Dengue Fever Incidence and Death Case for 2012 until 2015 is graphed above.

Incidence for 2016 are not included because the data has not been completed.

From the chart above we can see that the number of incidence rose from 2012-2015 except on 2014 where the incidence dropped for approximately 50% in comparison to the 2013 incidence. The incidence then rose again on 2015 approximately three-fold the incidence on 2014 and higher than the incidence on 2013.

Amount of death case followed the DF Incidence where it rise on 2012 to 2013, decreased on 2014, and then jumped on 2015. Death case is much lower in comparison towards the DF Incidence. Happening for only 1.7% of DF incidence on 2015. c. Monthly DF Incidence and Death Case Progression from January 2012 – May 2016 Figure 4 Monthly DF Incidence and Death Case Progression from January 2012 – May 2016

DF Incidence and Death Case of each month from January 2012 – May 2016 is plotted above. From the graph above, we can assess objectively the monthly pattern of DF incidence and death case.

From the graph above we can learn that, the overall pattern of each year’s monthly DF incidence is similar despite changes in yearly cumulative incidence of DF. Reaching its peak on January and then decreases gradually until the lowest incidence of DF between August and November which is a transition months from dry to rainy season. Afterwards, the

incidence surged again on January, a month after the rainy season starts or the peak of rain precipitation (figure 1).

Meanwhile, the pattern of death case caused by DF showed different pattern than in figure 2. In figure 4, the death case caused by DF happened mostly on the same month when the DF incidence rose (January 2012, 2013, and 2016). The difference is caused by the high death case on February 2015 which, in total, made the death case seemed to happen mostly in February.

IV. Discussion Dengue’s infection relied heavily on its vector. Therefore, everything that affects the vector (survival rate, epidemic potential, reproduction rate, etc) would also affect the spread of the virus.

As elaborated in the introduction, there are three main environmental parameters that has been proven to affect dengue infection: temperature, humidity, and rainfall [8-13]. These factors would affect the mosquito’s survival probability and its epidemic potential.

Out of the three main parameters, data regarding historical humidity at Sampang were not found but data on temperature and rainfall were acquired from literature search (Figure 1). For temperature, we can see that the monthly temperature at Sampang is comparable and consistent with little difference throughout the year (figure 1). Therefore, the effect of monthly variation of temperature on DF incidence may be ignored. Meanwhile, rain precipitation differed throughout the year. Rain precipitation gradually decreases from January to August. Rising significantly from September until reaching its year’s peak at December.

From figure 2, the result on this research is consistent with the theory which stated that an increase in rain precipitation is equivalent to the increase in DF cumulative incidence with a time gap approximately 24-30 days [8]. By comparing figure 1 and figure 2, peak of rain precipitation and DF incidence had 1 month delay. This result is as proposed by Carrington and Simmons [8] and the study conducted by Lu et al in Guangzhou [10] which says that there will be approximately 1 month of time gap after the rainy season (indicated by rise in rain precipitation) before the incidence of DF rises. Meanwhile, death case peaked at January, the same month the DF incidence peaked, except on February 2015. Other studies have found that there is 5-8 days of delay from symptom onset to mortality [26, 27, 28]. This explains the difference in death case peak on other years compared to 2015. If the DF incidence surged during the last week of January then the death case will accumulate on February.

We also like to point out that there is an increase in incidence over the years from 2012-2015 which we can look in Figure 3. Other studies evaluating the incidence of DF infection between 2012-2015 also showed an increasing trend of dengue incidence and DF in Asia County with tropical climate (e.g. Malaysia) and subtropical climate (e.g. Japan) [29, 30]. The increase in temperature might contribute to this increase over the years. Globally, due to global warming, data from NASA [31] showed an increase of 37% in global temperature index from 2012-2015.

Nationally, there are no historical data about Indonesia’s or Sampang’s temperature increment but Hulme and Sheard [19] predicted Indonesia’s temperature will increase by 0.3oC annually. Rainfall might also attribute to the increase but more data is needed to affirm this especially data about temperature and rain precipitation yearly differences in Sampang.

Our data also showed that there is relatively no difference in the pattern of monthly DF incidence each year. Although the number of DF incidence may differ from year to year, which may be caused by the climate and weather change, but the pattern of DF incidence is similar in the last 5 years. The data showed that the highest peak of DF incidence always happened on January and gradual decrease on each month after. Reaching the lowest around August and November, which is consistent with the end of dry season and the transition month (October and November) (see Figure 1. for monthly rainfall index in Sampang regency). Out of this, it is necessary for the

government and health provider to anticipate the surge in DF incidence on January and do an active management beforehand.

Like many other surveillance studies that was conducted in different areas and regions [26, 29, 30], we found similar results showing the relation between the DF incidence and death case with weather and climate condition in Sampang regency. This recent analysis’ provides a better insight and understanding about the dengue epidemiology in Sampang regency which may be used to improve current policies and approach in managing dengue fever.

Despite having similar result with previous study, more accurate data on both incidence and climate data are needed to create a holistic model for dengue surveillance programs. Incidence data that we retrieved remains largely from passive surveillance programs, and often underreported than the reality in the field. Therefore, we suggest more active dengue surveillance program which would also be useful in early diagnosis and prompt treatment. Climate data that were included in this study are not acquired from the government agency (Indonesian Agency for Meteorology, Climatology, and Geophysics) which could have provided more accurate data. Therefore, we suggest further study that includes climate data from the government to give even more accurate picture of dengue infection in Sampang.

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Conclusion Dengue fever is still a major challenge and public health concern in South East Asian, mainly in Indonesia. High morbidity and death case rate caused by dengue infection still creates heavy medical and economic burden in Indonesia.

Dengue fever incidence and death case monthly pattern of Sampang followed the monthly rain precipitation, peaking a month after the rain precipitation peaked. Yearly, DF incidence remained on the rise except on 2014. Additionally, from comparing the monthly pattern of DF Incidence and death case each year (2012-2016), it is found that the pattern remained relatively the same despite changes in cumulative yearly incidence.

The result of our study provides evidence on the relationship between weather and climate in relation to DF incidence and death case. We hope this result can be used as a basis for improving our strategy, improving policies in managing dengue fever, and acquiring more data in each local regency to better reduce morbidities and mortalities related dengue infection in Indonesia.

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REVOLUTIONARY MALARIA MALARIA THERAPY USING ALLICIN IN GARLIC EXTRACT (ALLIUM SATIVUM) : BIOMOLECULAR STUDIES USING IN SILICO Putu Ijiya Danta Awatara1, Ajeng Maharani Putri2, Mokhamad Fahmi Rizki3, Gabriela Nativity4 University of Brawijaya

Background: Malaria is a life-threatening disease caused by Plasmodium Falciparum. In 2015, nearly half of the world's population, about 3.2 billion people were at risk of malaria. In fact, progress in malaria control is threatened by the rapid development and spread of antimalarial drug resistance.

Allicin extracted from Garlic (Allium sativum) is a major biologically active component to inhibit cell proliferation and induce apoptosis. Allicin has a important in reducing Plasmodium Falciparum growth and transmission of malaria.

Objective: To show how microtubule of Plasmodium Falciparum plays important role in reducing malaria transmission and to how Allicin blocks these phenomenons.

Method: Biomolecular experimental is conducted by in silico supported by uniprot database, zhanglab, VegaZZ, Pymol, Discovery studio and Pyrex Software. Comprehensive literature search conducted to prove the consistency of in Silico result . It was searched in October 2016 using three main search engines, NCBI, Sciendirect, and Pubchem. Inclusion criterias were used to filter the abstracts and full texts in assessing the eligibility of the trials.The search was limited to trials written in English and published in the last 10 years.

Results : The result from the analysis of in silico (supported by pyrex software) shows Allicin strongly binds and inactivates beta-tubulin microtubule protein of Plasmodium sp. in their active site , Alanine 206, through Alkyl bond. The binding affinity among allicin and microtubule protein is -3.7 kcal/mol as the highest score and the lowest one is -3.3 Kcal/mol. To show a consistent result, We included 3 studies which mentioned Allicin from garlic inhibits Plasmodium Plasmodium Falciparum.

All studies shown positive result towards Allicin from garlic inhibits Plasmodium Plasmodium Falciparum. We also analyze the mechanism of Allicin in inhibiting microtubule of Plasmodium sp. It can block cell division by preventing spindle formation resulting in inhibiton of sporozoite invasion and infectivity of Plasmodium Falciparum in vivo.

Conclusion : Allicin which obtained from Garlic can be a brand new alternative antimalaria medicine by inhibiting microtubule of malaria parasite, Plasmodium Falciparum. Allicin strongly binds and inactivates beta-tubulin microtubule protein of Plasmodium Falciparum in their Active site and block Cell Division by Preventing Spindle Formation resulting in inhibition of Sporozoite invasion and infectivity of Plasmodium Falciparum. Allicin is highly recommended for all of East Asian continents

because garlic is easy to be grown and well-known in East Asia as common daily food seasoning and traditional panacea.

Keywords: Antimalaria, Plasmodium Falciparum., Allicin, Garlic, Microtubule, Insilico Author : 1

Putu Ijiya Danta Awatara 081232270119 ijiyadanta19@gmail.com

2

Ajeng Maharani Putri 081937793105 ajengmputri@yahoo.com

3

Mokhamad Fahmi Rizki S 087856844298 mokhamadfahmi@yahoo.com

4

Gabriela Nativity 085350216424 gabrielanativity98@gmail.com

Regional Chairperson of AMSA Indonesia : Ananta Siddhi Prawara +6281290187030 anantasiddhi@gmail.com

REVOLUTIONARY MALARIA MALARIA THERAPY USING ALLICIN IN GARLIC EXTRACT (ALLIUM SATIVUM) : BIOMOLECULAR STUDIES USING IN SILICO

by: Putu Ijiya Danta Awatara

batch 2014

Ajeng Maharani Putri

batch 2015

Mokhamad Fahmi Rizki S.

batch 2015

Gabriela Nativity

batch 2015

FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY MALANG

2016 1. INTRODUCTION Malaria is a life-threatening disease caused by parasites transmitted to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors." There are 5 Plasmodium species which cause malaria in human, and one of them – P. falciparum – role the greatest threat.

It is the prevailing one on the East Asian continent and responsible for worldwide malaria-related deaths.

In 2015, nearly half of the world's population, about 3.2 billion people were at risk of malaria. The incidence rate was estimated 214 million cases, means 91 new cases per 1,000 people at risk. In 2015, 95 countries and territories had malaria transmission ongoing. Most cases in 2015 are estimated to have occurred in the WHO African Region (88%), followed by the WHO South-East Asian Region (10%). Global financing for malaria control also increased from an estimated US$ 960 million in 2005 to US$ 2.5 billion in 2014.

Malaria is a new and resurgent vector-borne communicable diseases (Tian et al., 2015; Watson et al., 1997; Yu et al., 2015). Transmission of vector-borne diseases may be impacted by climate change such as temperature. The development of malaria parasite (Plasmodium falciparum) increases when temperature exceeds 33°–39 °C (Patz et al., 1996). Rising temperature can influence the reproduction and extrinsic incubation period (EIP) of pathogens (Harvell et al., 2002). Warm climate may facilitate larval development, enhance vector survivorship and reproductive fitness, and increase the blood feeding frequency and parasite sporogonic development rate ( Afran, et al, 2012). Those are some facts about relation among climate conditions and infectious diseases which make malaria as one of the greatest public health concerns and seems likely to be the most susceptible vector-borne disease to long-term climate change.

Progress in malaria control is threatened by the rapid development and spread of antimalarial drug resistance. Resistance to prior medicine generations, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1970s and 1980s. Resistance to quinine, the oldest antimalarial drug, was reported first in Brazil and later in South East Asian. In recent years, parasite resistance to artemisinins has been detected in 5 countries border region of South East Asian: Cambodia,Myanmar, Thailand and Vietnam. Clinical resistance to artesunate, manifested as delayed clearance of parasitemia after therapy was documented in 2008. Most patients are cured when treated with an ACT if there is no resistance to the drug partner. It has been observed that P. falciparum genetic mutations that confer drug resistance are associated with altered biological fettle of the parasite.

As current therapeutics are increasingly ineffective and resistant, there’s an urgent need to develop and pursue new therapeutic strategies. Microtubules, which is the major molecule target for anticancer drugs development, are likely to be potent as antimalarial targets. In recent years, tubulin, the main protein of microtubules, has been recognized as the potential target for antimalarial drug and the selective inhibition of tubulin in parasites has been evaluated. P. falciparum has five single-copy tubulin genes, consisting of αI, αII, β, γ, and δ-tubulin.

Microtubules are main components of the cytoskeleton found in almost all eukaryotic cells. They involved in the establishment and maintenance of the mitotic spindle that is essential for chromosome segregation during cell division.

Garlic is one of the edible plants which has generated a lot of interest throughout human history as a food seasoning and medicinal panacea. As we know, garlic is easy to be grown year-round in mild climates and that is why it can be easily found in East Asian, China is the largest producer of garlic. Analysis of steam distillations of crushed garlic cloves performed over a century ago showed a variety of allyl sulfides. The compound turned out to be an oxygenated sulfur compound which they termed allicin, from the Latin name of the garlic plant, Allium

sativum. Allicin is produced from its inactive precursor, alliin (S-allyl-L-cysteine sulfoxide), upon the release of the enzyme alliinase from its cellular storage compartment, when garlic cloves are crushed . Allicin (diallyl thiosulfinate) is a major biologically active component of garlic that is known to inhibit cell proliferation and induce apoptosis. Furthermore, the effects of Allicin on cell proliferation and apoptosis can also be explained in terms of its microtubule-disrupting activity.

We demonstrated herein that allicin arrests cells in an abnormal C-mitosis state, known for years induced by colchicin, nocodazole and other microtubule depolymerizing agents [Rieder and Palazzo, 1992]. It is well-documented that these drugs also cause a variety of cell cycle abnormalities, including delay in G2-M transition [Rieder and Cole, 2000] and sometimes G1 arrest [Blajeski et al., 2002].

There is still no further research or literature studies about allicin effect to inhibit microtubules of Plasmodium falciparum until now. Therefore, we’re going to prove that Allicin may bond the active site of microtubule by in silico method, using computer simulation on biomolecular level. We also use in vitro method to show Allicin potency that blocks the active site of tubulin in microtubule. In conclusion, we are going to discuss about Allicin as one of the new potential revolutionary therapy for Malaria, and we’re expecting this paper will be the basic knowledge for further experimental research in the future.

2.

RESEARCH METHODOLOGY

2.1 Biomolecular Experimental Studies using In Silico Microtubule protein sequences are obtained from UniProt database named Tubulin β-chain (http://www.uniprot.org/uniprot/W4IG67). Domain code with microtubule stored in PDB format.

We use Pymol and VegaZZ software to stabilize the Tubulin β-chain proteins because it may contain another molecule. Then, predictions of the active site sequence from the stabilized proteins can be seen via online software, called zhanglab (http://zhanglab.ccmb.med.umich.edu/).

After that, we can download computerized protein structure of allicin via pubchem database. We use computational study, called in silico, to show that Tubulin β-chain can interact with Allicin ligand by explisit docking using Pyrex. The result of the docking has to be saved. The docking results have been stored unlocked through software Pymol which shows bonds and its strength between Allicin ligand and microtubule. But not all of them are bonding with the active site of microtubule. We should open one by one and choose the bond with the active site of Tubulin β-chain. Then, the data merger between Allicin with protein has to be saved. Then, we analyze the results through discovery studio software to view the proteins and their active site in a 3D picture.

2.2. Search Strategies A Systematical literature search conducted to prove the consistency of In Silico result . It was searched in October 2016 using three main search engines, NCBI and Sciendirect, Pubchem.

The combinations of terms used for the search included “Allicin”, “Garlic”, “Plasmodium sp”, “Plasmodium falciparum” , “Antimalaria” , “in vivo”, in vitro”. Limits were applied and only studies published in the last 10 years (2006-2016), and written in English were included. Studies outside of the ten year range were excluded to avoid subjectivity and bias in conducting this review.

2.3. Inclusion and Exclusion Criteria Inclusion Criteria: In Vivo and In Vitro studies of Plasmodium involving Allicin and Garlic as antimalaria Studies published in the last 10 years Literature written in English

Exclusion Criteria: Studies not using Allicin Studies not using Garlic Studies not using Plasmodium Other Languange than English 3.

RESULT AND DISCUSSION

3.1 Analysis of Biomolecular Studies of Allicin and Plasmodium falciparum using In Silico 3.1.1 Biomolecular Analysis of Allicin

Table 1. Computed Properties of Allicin

alliinase alliin

allicin

Figure 1. Biomolecular Structure of Allicin Production Process Allicin (S-allyl-2-propenyl thiosulfinate) have molecular formula C6H10OS2 is the main biologically active component of garlic extracts. It is produced during the crushing of garlic by the interaction of alliin, a non protein amino acid, with the pyridoxal phosphate containing enzyme, alliinase.

3.1.2 Prediction of Active Site

‘

Figure 2. Protein Active Site The result from the analysis of the active site (supported by zhanglab software) shows that the active site of P. falciparum Tubulin β-chain protein is Alanin 206. It will be inhibited if it makes a bond with Allicin.

3.1.3 Result of The Bonds between Plasmodium falciparum Tubulin β-chain Protein and Allicin

Table 2 . Binding Affinity among Allicin and Tubulin β-chain protein The binding affinity among Allicin and Tubulin β-chain protein is -3.7 kcal/mol as the highest score and the lowest one is -3.3 Kcal/mol. The stronger the binding affinity, shows more negative score.

Figure 3. Red Cicle : The bond between allicin and Tubulin β-chain protein P. falciparum From the picture above, we can see clearly that Allicin can bind to P. falciparum Tubulin β-chain protein protein so that it may influence the protein. Seen from its sequences, allicin has to bind with the active site of protein. The active sites of protein which bonded with allicin are Alanin 206. We can see the bonds molecularly from the picture above.

Figure 3. Molecular Analysis of The Bonds between Allicin and Tubulin β-chain protein Protein P. falciparum Seen from the Figure above, Allicin binds to Alanin 206 active site through Alkyl bond. The alkyl group has strong bonding with molecule because it releases electrons to carbon, bearing positive charge and thus stabilizes the ion. Increasing the number of bonds adjacent to the carbocation by increasing the number of alkyl groups attached to the carbocation carbon results in an increase in carbocation stability. ( Young, 2011). As a result of inhibiting Plasmodium falciparum microtubule sequence (Tubulin β-chain protein) , Allicin will prevent the formation of microtubule thread spindle and inhibit the cell proliferation in Plasmodium falciparum.

3.2 Research Findings The initial search that was conducted yielded a total of 46 trials. After reading the titles, 40 results were excluded as they did not fulfill the inclusion criteria, and a further 2 trials were excluded after reading the abstract. From the resulting 4 texts, 1 did not have a full available article. Thus, a total of 3 resulting trials were used. This information can be seen in the flow chart below:

Initial Initial Search Searchn= n=4646

Trial For Trial ForWhich WhichTitle Title were read were readn= n= 4646 Trial Trial For ForWhich WhichAbstract were read were n= 6 read n= 6 Abstract Trial For Which Full Paper were read n =4 Trial Included in This Review n= 3

Trial Excluded after reading the title n= 40 Trial Excluded after reading the Abstract n=2

First Author and Reference Year Coppi, et

al (2006)

Govindan, et al (2016)

Method

Pure allicin was prepared by passing the synthetic substrate alliin through an immobilized alliinase column Plasmodium berghei (NK65 and ANKA strains) and Plasmodium yoelii (17XNL) sporozoites were grown in Anopheles stephensi and were obtained from infected salivary glands on the day of the experiment.

Assay for sporozoite infectivity in vivo.

Female Swiss Webster mice, were injected intravenously (i.v.) with either 5 or 8 mg/kg of body weight of allicin 60 min, 30 min, or immediately before i.v. injection of P. yoelii sporozoites. Forty hours later, livers were harvested, total RNA was isolated, and malaria infection was quantified using reverse transcription followed by real-time PCR .

For allicin preincubation experiments, P. Yoelii sporozoites were preincubated with or without allicin for 10 min at 28°C and diluted 12-fold with medium before i.v. injection into mice. All in vivo data were analyzed using the Student t test for unpaired samples.

Sporozoite invasion assays. P. berghei sporozoites were preincubated with the indicated concentrations of allicin for 10 min at 28°C, diluted 12-fold with DMEM-BSA, and added to Hepa 1-6 cells.

Sporozoites were plated in each well of semiconfluent cells . After 1 h at 37°C, cells were washed and fixed, and sporozoites were stained with a double staining assay that distinguishes between intracellular and extracellular sporozoites Swiss mice (25±5 g) were used in the study were obtained from the Central Animal Facility, Indian Institute of Science, Bangalore,India.

Malaria parasite P.berghei-infected blood with 60–70% parasitemia was collected and

Trial Excluded after reading the Full paper n= 1 Result

Allicin inhibits sporozoite invasion of host cells.

Inhibition of invasion was calculated based on the invasion rate for sporozoites which was 57%.

Allicin decreases sporozoite infectivity in vivo.

When allicin was administered just before injection of sporozoites and 30 min prior to injection of sporozoites ,it significantly decreased sporozoite infectivity compared to untreated controls (P ≤ 0.001).

Conclusion

Allicin significantly inhibits sporozoite infectivity in vivo and decreases parasite loads in mice with blood-stage infections. These journal demonstrate the feasibility of using the same Allicin to target two different life cycle stages in the vertebrate host and support th-e idea that Allicin may be useful drugs for the prophylaxis and treatment of malaria.

Administration of 50 mL/mouse of garlic pearl oil resulted in the survival of animals up to Day 8 (20%).

The study shows that garlic pearl oil therapy provides complete protection in P.berghei-infected mice.

injected intraperitoneally into experimental mice on Day 0 (start of experiment). After 72h (Day 3) , when the parasitemia was about 2– 4%, infected mice were treated with three oral doses of garlic pearl oil. Blood was drawn from tail vein to check the parasitemia progression or inhibition at regular time intervals and mouse mortality was noted daily by staining blood smears with Giemsa.

Analysis of parasite specific Immunoglobulin G (IgG) responses by using ELISA DS-PAGE and western blot analyses Statistical analysis A value of P ≤ 0.05 was considered ssignificant.

Waag, et al (2010)

Increasing the garlic pearl oil quantity from 50 mL/ mouse to 100 or 150 mL/mouse in combination with α-β arteether at 750 mg resulted in complete protection of animals from malaria infection.

These results clearly indicate that by adding garlic pearl oil to arteether therapy as a partner drug antimalarial activity can be enhanced.

The inhibitory effects of Allicin and its derivates Allicin showed a were tested against the parasite enzymes significant effect on the falcipain 2 from Plasmodium falciparum, inhibition of falcipain Ki the protozoa causing malaria. and P. falciparum IC50 (1.04 ± 0.08 and 5.21 ± 0.96 µM)

Allicin apparently contribute to their antiparasitic activity, as two of the most potent falcipain inhibitors display potent antiplasmodial activity.

All studies shown positive result towards Allicin from garlic inhibits Plasmodium sp .(especially Plasmodium Falciparum and Plasmodium Berghei) through in vivo and in vitro method and has potential activity as antimalaria medicine.

3.2.1 Microtubule as a potential target for antimalarial Microtubules, which are filamentous polymers, are central components of the cytoskeleton found in almost all eukaryotic cells. Tubulin, the main protein of microtubules, has been recognized as the potential target for antimalarial drug and the selective inhibition of tubulin in parasites has been evaluated. P. falciparum has five single-copy tubulin genes, consisting of αI, αII, β, γ, and δ-tubulin. Microtubules are involved in the establishment and maintenance of the mitotic spindle that is essential for chromosome segregation during cell division . They are the basic polymers in eukaryotic flagella and cilia, playing a major role in cell motility. Furthermore, they act as tracks for the intracellular transport of vesicles and organelles. Accordingly, microtubules also play important roles in cell division, motility and structural integrity of the malarial parasite P. falciparum. In the asexual erythrocytic stage of the parasite, microtubules are required for nuclear division, partitioning of organelles and cytosol into merozoites, and for the invasion of erythrocytes by newly formed sporozoit and merozoites (Kappes and Rohrbach, 2007). The presence of the microtubule motor proteins, kinesin and dynein are identified in P. falciparum sporozoit and merozoites. The kinesins form a large family of proteins, with different tasks within the cell. Cytoplasmic dynein, of which there at least three types has a multi-chain structure and also complexes with several other proteins. It consists of two HCs, two ICs, four light ICs and multiple light chains. Both kinesins and c dynein are known to play major roles in mitosis. What

is striking is the paucity of dynein in comparison to the extremely strong signal apparent in late merogony and free merozoites. This suggests that dynein has a role to play in constructing the sporozoit and merozoit, or the invasion process, or both. (Prager-Khoutorsky, et al, 2007).

Microtubules were also found in Plasmodium berghei sporozoites. The microtubules on the cell walls of Plasmodium berghei sporozoites are extended at the luminal side by an additional 3 nm in comparison to the microtubules of mammalian cells (de Souza and Attias, 2010).

3.2.2 Allicin Blocks Cell Division by Preventing Spindle Formation of Microtubule in Plasmodium falciparum Research showed the relationship of allicin administration on the mechanisms of mitosis in NIH-3T3 cells (Prager-Khoutorsky, et al 2007). Allicin-treated cells didn’t complete division during the 12-h observation period. The majority of these cells remained rounded in shape; formation of irregular transient pseudo-cleavage furrows was sometimes seen. The drug-treated fibroblasts were subjected to fluorescence staining, in order to visualize chromosomes (with DAPI), the mitotic spindle (with a-tubulin antibody), and centrosomes (with g-tubulin antibody).

Examination of the resulting images indicated in both allicin treated cells, mitotic spindles were not formed, and chromosomes not only failed to organize into metaphase plates, but also appeared more condensed than those of control cells. Taken together, these results demonstrate that, within the context of its role as a microtubule-disrupting drug, allicin produces mitotic arrest.

3.2.3 Allicin inhibits sporozoite invasion

Figure 4. Allicin inhibits sporozoite invasion of host cells (Coppi, et al, 2006).

Since allicin inhibited Microtubule and our previous studies showed that Microtubule is associated with cell invasion, we next disscused whether allicin would inhibit invasion of host cells. From Coppi, et al (2006) experiment, Plasmodium berghei. sporozoites were pretreated with 10, 25, and 50 M allicin for 10 min, the allicin was diluted 12-fold, and then sporozoites plus the diluted allicin were added to cells. As shown in Figure 4, allicin inhibited sporozoite invasion of cells in a dose-dependent manner. Increased concentrations of Allicin is also accompanied by an inhibition of invasion of Plasmodium berghei. (Coppi, et al, 2006). This is most likely due to microtubulus which is inhibited by Allicin in the process of undergoing mitosis in Plasmodium

berghei. Therefore, spindle, that play a role in cell division sporozoites, didn’t form when asexually cell division in human liver. Furthermore, allicin also inhibits microtubule formation in vitro by modifying certain SH groups on the tubulin molecule, which are essential for polymerization. (Prager-Khoutorsky, et al, 2007). However, depolymerisation of microtubules (mt) in P. falciparum sporozoit and merozoites, has also been shown to inhibit invasion.

Depolymerisation of these structures reduced invasion rates in assays initiated with post-mitotic schizonts (Fowler, et al, 2001).

3.2.4 Allicin inhibits sporozoite infectivity in vivo.

‘ .

Figure 5. Inhibition of sporozoite infectivity in vivo.

Coppi, et al (2006) test the ability of allicin to inhibit sporozoite infectivity in vivo using the rodent malaria parasite Plasmodium berghei. Mice were injected with allicin or buffer alone at different times before injection of sporozoites. As shown in Figure 5, mice injected with allicin had decreased levels of infection, and inhibition of infection was correlated with the length of time between allicin injection and sporozoite injection. The decrease in efficacy of allicin over time is also likely a consequence of its rapid decomposition in vivo. They found that allicin inhibited proteolytic cleavage of Microtubule as well as cell invasion, suggesting that it is an inhibitor of the sporozoite microtubule required for infectivity in the mammalian host 3.2.5 Feasibility of Allicin from Garlic Plant as a Brand New Antimalaria Medicine Garlic is one of the edible plants which has generated a lot of interest throughout human history as a daily food seasoning and medicinal panacea. With a history of over 7,000 years of human consumption and use, garlic is native to Central Asian. Garlic is grown globally, but China is by far the largest producer of garlic, with around 19 million tonnes (42 billion pounds) grown annually, accounting for over 79% of world output. India (5.2%) and South Korea (1.7%). This leaves 11% of global garlic production in countries that each produce less than 2% of global output. Garlic is easy to grow and can be grown year-round in mild climates. Garlic plants are usually very hardy, and are not attacked by many pests or diseases. Garlic plants are said to repel rabbits and moles. Garlic plants can be grown closely together, leaving enough space for the bulbs to mature, and are easily grown in containers of sufficient depth. It does well in loose, dry, well-drained soils in sunny locations. Garlic plants prefer to grow in a soil with a high organic material content, but are capable of growing in a wide range of soil conditions and pH levels.

Garlic has an unusually high concentration of sulfur-containing compounds. Allicin is produced from its inactive precursor, alliin (S-allyl-L-cysteine sulfoxide), upon the release of the enzyme alliinase from its cellular storage compartment, when garlic cloves are crushed (Stoll and Seebeck, 1951; Rabinkov et al., 1994). Allicin, one of the active principles of freshly crushed garlic homogenates was found to exhibit antibacterial activity, antifungal activity, anticancer

activity, antiviral activity, and antiparasitic activity. Therefore, garlic which is easy to grow everywhere, commonly used as daily food seasoning and traditional panacea. We have shown that allicin, in freshly crushed garlic cloves is able to bond the active site of tubulin polymerization in microtubule formation, so that allicin is feasible as the Potential Antimalarial Therapy in East Asian.

4. CONCLUSION Allicin which obtained from Garlic can be a brand new alternative antimalaria medicine by inhibiting microtubule of malaria parasite, Plasmodium falciparum. Allicin strongly binds and inactivates beta-tubulin microtubule protein of Plasmodium falciparum in their active site, Alanine 206, through Alkyl bond and block Cell Division by Preventing Spindle Formation resulting in inhibition of sporozoite invasion and infectivity of Plasmodium falciparum. Allicin is highly recommended for all of East Asian continents because garlic is easy to be grown and well-known in East Asian as a common daily food seasoning and traditional panacea.

5. SUGGESTION We realize there are some aspects that could be further developed on this paper, so we recommend the other authors to develop therapies to the clinical trial because eventually Allicin will be applied as antimalarial for humans. We also suggest to conduct a trial in other Plasmodium species such as Plasmodium vivax and Plasmodium ovale because both are also has the potential transmission of malaria in the world.

6.

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The Immunogenicity and Safety of the Live-Attenuated CYD-Tetravalent Dengue Vaccine (CYD-TDV) in Children and Adolescents: A Systematic Review of Randomized Controlled Trials Raksheeth Agarwal a, Oliver Emmanuel b, Sharon Hanmy Angel c, Angga Wiratama d a) Universitas Indonesia – (+62) 85777808310, raksheeth@hotmail.com b) Universitas Indonesia – (+62) 818635925, oliveremmanuel@hotmail.com c) Universitas Indonesia – (+62) 81362873803, sharonhanmyangel@gmail.com d)

Introduction: The incidence of dengue disease is increasing dramatically across the world, with about 3.9 billion people from 128 countries at risk of infection. Indonesia, an endemic region, experienced dengue outbreaks in 12 regencies that resulted in 608 cases and 34 deaths in early 2016. Moreover, studies show that the constantly increasing global temperatures enhances the growth and spread of both virus and its vector. This calls for a more effective prevention strategy for dengue disease. Vaccination, when integrated into current vector control methods, has the potential to significantly improve dengue prevention. A tetravalent dengue vaccine, CYD-TDV (Dengvaxia), has the antigens of all 4 serotypes of dengue virus. The purpose of this review is to assess the immunogenicity and safety of CYD-TDV in children.

Methods: Comprehensive literature searches were conducted on databases Pubmed, The Cochrane Library, Scopus, ProQuest, EBSCOhost and ScienceDirect. Randomizedcontrolled trials on children with CYD-TDV as intervention were selected. Trials were further filtered using inclusion and exclusion criteria. Data extracted from selected trials include safety of vaccine and immunogenicity in terms of Geometric Mean Titres (GMT) of antibodies.

Results: Six clinical trials were selected based on preset criteria. GMT values were obtained using 50% Plaque Reduction Neutralization Test (PRNT) and safety was semiquantitatively assesed based on adverse effects. Additional processing of data was done to better understand the trends among trials, including fold increase of GMT from baseline to post dose 3 and peak GMT values achieved.

Discussion: The fold increase in GMT was higher in test group as compared to control in all trials, indicating effective immunogenicity of CYD-TDV. Another trend found in all trials is that the third dose of CYD-TDV elicited only a slight increase in GMT from the second. Finally, patients in some trials exhibited a more robust immune response (higher peak GMT) than others. These trials had higher baseline seropositivity rates, which led to stimulation of secondary immune response by the vaccine. Safety results were satisfactory in all trials in which most severe side effects were unrelated to the vaccine.

Conclusion: CYD-TDV is both effective and safe for patients in endemic regions. This gives promise for further development and large-scale research on this vaccine to assess its efficacy in decreasing dengue prevalence and, its pervasive implementation in Indonesia.

East Asian Medical Students’ Conference Asian Medical Students’ Association, Indonesia

Scientific Paper

The Immunogenicity and Safety of the Live- Attenuated CYD-Tetravalent Dengue Vaccine (CYD-TDV) in Children and Adolescents: A Systematic Review of Randomized Controlled Trials

By: Raksheeth Agarwal (Universitas Indonesia) Oliver Emmanuel (Universitas Indonesia) Sharon Hanmy Angel (Universitas Indonesia) Angga Wiratama (Universitas Indonesia)

The Immunogenicity and Safety of the Live-Attenuated CYDTetravalent Dengue Vaccine (CYD-TDV) in Children and Adolescents: A Systematic Review of Randomized Controlled Trials

Raksheeth Agarwal a, Oliver Emmanuel b, Sharon Hanmy Angel c, Angga Wiratama d a) Universitas Indonesia – (+62) 85777808310, raksheeth@hotmail.com b) Universitas Indonesia – (+62) 818635925, oliveremmanuel@hotmail.com c) Universitas Indonesia – (+62) 81362873803, sharonhanmyangel@gmail.com d) Universitas Indonesia – (+62) 81291004704, lokeswaraangga@gmail.com 1. Introduction Dengue disease is caused by one of the four serotypes of dengue virus, namely DENV-1, DENV-2, DENV-3, and DENV-4. The transmission of the four serotypes is arthropodborne, with the main vector being the mosquito Aedes aegypti. Most of the infections of dengue virus are asymptomatic, but infections can also cause diseases ranging from a mild fever to a shock syndrome, which can be lethal. Even though infection with one serotype provides immunity against it for life, disease can subsequently be caused again by other serotypes in later life. 1 In recent decades, the incidence of dengue has increased dramatically across the world.

An epidemiological study estimates that 3.9 billion people from 128 countries are at risk of infection with dengue viruses.2 One recent estimate reports that there are 390

million dengue infections per year, of which 96 million cases progressed to manifest clinically.3 Indonesia experiences a high burden of disease from dengue virus, and is considered an endemic region. The National Health Ministry reports that in 2015, the incidence of dengue disease amount to 126,675, with 1229 deaths in Indonesia. This is a drastic increase from 100,347 cases with 907 deaths reported in 2014. 4 In January and February of 2016, Extraordinary Outbreak Events (Kejadian Luar Biasa; KLB) occurred in 12 regencies in Indonesia.5 This outbreak resulted in 492 cases and 25

deaths in January 2016, while in February 2016 there were 116 cases with 9 deaths.5 The term Extraordinary Outbreak Events refers to the outbreak of a disease based on the following criteria: The number of new cases of dengue in a particular month shows an increase of two-fold or more than the average number per month in the previous year; The incidence of dengue cases in an area that had never occurred; or The mortality rate of dengue in a specified period showed an increase of 50% or more compared to the previous period. 5

Recent trends in climate change have led to increasingly warmer temperatures worldwide. According to the latest data from NASA, the global temperature in 2015 ranks as the warmest on record with 0.87°C above the average temperature in 1951-1980.6 In Indonesia, WHO estimates that the mean annual temperature may rise by 3.8oC by the year 2100 due to increased carbon emissions. 7

Studies show that with this increase in temperature, the spread of the vector and the virus will be at a larger extent, potentially increasing the global burden of dengue.8

Warmer temperatures have been known to affect transmission of dengue in at least 2 ways; by affecting the vector mosquitos and by affecting the virus itself. One study explains that as temperature increases, the rate of larval development increases, the emergence of mature mosquitos quickens, the biting rate of mosquito increases, and the viral replication time within the mosquitos shortens.9 A study by Rohani et al. in 2009 found that the time between feeding and viral detection decreased in higher temperature, from 9 days at 26°C to 28°C to 5 days at 30 °C for DENV-1 and DENV-4.10

Another study explains that a rise in temperature results in a shorter extrinsic incubation period (EIP), that is, the time needed for DENV to become transmissible to another host after initial infection of a mosquito.11 The study by Chan and Johansson in 2012 estimated that the average EIP shortens from 15 days at 25°C to 6.5 days at 30°C.12

Currently, vector control has been the main strategy in managing dengue. According to WHO, countries should adopt an integrated management approach to vector control in order to optimize the use of resources, efficacy, cost effectiveness, ecological safety and sustainability.13 Current control measures target different stages of development of A. aegypti.14 In Indonesia specifically, dengue prevention is carried out through both vector control and early warning system.15 Vector control includes source reduction and

elimination of adult mosquitos. The source reduction program is commonly known as “3M – Menguras, Menutup dan Mengubur” which means to drain, to close and to bury potential breeding sites of dengue. Additional methods include the utilization of larvacide powder, and controlling lighting and ventilation in the house.16 Despite all the existing vector control measures, the global spread of the disease still persists.13 The current rise in global temperature may eventually incapacitate these

vector control measures to manage dengue incidence. This calls for a more urgent need to introduce a vaccine into the prevention scheme. When integrated with the current vector control, a safe, efficacious and cost-effective vaccine has the potential to significantly improve dengue prevention.

Several dengue vaccines have been developed in the past. However, the one that has shown most promise is the CYD-TDV (Trade name: Dengvaxia), which is a Tetravalent Dengue Vaccine developed by Sanofi Pasteur. This is a live-attenuated chimeric vaccine that contains all four dengue virus antigens (DENV 1-4) with a yellow fever backbone.

WHO recommends the introduction of this vaccine in areas where there is a high burden of dengue disease.17 As of April 2016, CYD-TDV has been licensed in Mexico, Brazil, El

Study Purpose This review aims to discuss whether or not the CYD-TDV is a viable preventive measure for Dengue through a systematic review. The objective of this systematic review is to assess the efficacy (in terms of immunogenicity) and safety (in terms of reactogenicity) of the newly developed CYD-TDV. 2. Research Methodology 2.1. Search Strategies A comprehensive literature search was conducted in October 2016 using the databases PubMed, The Cochrane Library, Scopus, ProQuest, EBSCOhost, and ScienceDirect. The combinations of terms used for the search included “T etravalent Dengue V accine”, “CYD-TDV”, “children”, and “immunogenicity”. Where applicable and available, appropriate advance search techniques were applied to narrow the search.

2.2. Selection of Trials Inclusion Criteria: Randomized, controlled clinical trial studies Subjects aged 2 to 18 years old Use of the 3-dose CYD-TDV regimen as an intervention Humoral immunogenicity and safety of CYD-TDV as outcomes Exclusion Criteria: Studies involving subjects of all age groups (children and adults) in the same treatment group Studies that do not measure baseline characteristics of patients 2.3. Data Extraction The following data was extracted from the studies: 1. Geometric Mean Titers of neutralizing antibodies against DENV 1, DENV 2, DENV 3, and DENV 4 at baseline and after each dose of CYD-TDV and Control (Immunogenicity as a measure of efficacy) 2. Adverse reactions and safety profile of CYD-TDV and Control injections 3. Study Design: Population characteristics (Age, Region, Sample size, Baseline Seropositivity*), Intervention, Control, and Outcome measurements. * Baseline seropositivity refers to the percentage of the population that has antibody titers ≥ 10 1/dil for any one of the four dengue serologies (measured using Plaque Reduction Neutralization Test)

2.4. Quality Assessment The quality of included studies was assessed using “Quality Assessment of Controlled Intervention Studies”19 developed by The National Heart, Lung, and Blood

Institute (NHLBI) and Research Triangle Institute International Jointly. It includes 14 criteria that need to be assessed, which refer to the internal validity of each of the included studies based on their methodology. All of the criteria were scored with either yes, no, Cannot Determine (CD), or Not Applicable (NA). A “yes” was given one point, whereas a “no” was given a score of 0.

No standard for a good, moderate, or poor study was given. Hence, a study obtaining a score of 11/14 or higher was defined as a good quality study, meanwhile studies receiving a score of 7/14 or less were defined as poor studies. A score between 7 and 11 out of 14 was defined as moderate.

Two reviewers (RA, OEY) independently analyzed the included studies based on the quality assessment criteria. If the ratings differed, the articles were discussed until a common consensus was reached.

3. Results 3.1. Research Findings and Study Selection The search terms were applied to all of the 6 search engines and databases mentioned earlier. Titles and abstracts were screened and relevant titles were selected. After removal of duplicates, a total of 61 studies were obtained from the database search. Initial screening of abstracts against eligibility criteria excluded 41 studies. A further 14 trials were excluded after reading full text articles as they did not have a viable study design based on preset inclusion and exclusion criteria. The comprehensive data on the study selection process can be seen in Figure 1.

The six clinical trials selected in this systematic review were conducted by Dayan, et al. (2013),20 HSS, et al. (2013),21 Lanata, et al (2012),22 Sabchareon, et al (2012),23 Villar, et al (2013),24 and Leo, et al (2012).25

Figure 1: Flow Chart of Search Strategy

3.2. Quality of the Included Studies From the result of this quality assessment, all 6 studies were defined as good quality studies, and can be seen in the table below: Table 1: Results of Quality assessment for the four studies.

Dayan, et Lanata, Sabchare Villar, et Criteria HSS, et al al et al on, et al al 1. Was the study described as randomized, a randomized Yes Yes Yes Yes Yes trial, a randomized clinical trial, or an RCT?

Leo, et al Yes

Table 1: Results of Quality assessment for the four studies.

Dayan, et Lanata, Sabchare Villar, et Leo, et Criteria HSS, et al al et al on, et al al al 2. Was the method of randomization adequate (i.e., Yes Yes Yes Yes Yes Yes use of randomly generated assignment)?

3. Was the treatment allocation concealed (so that Yes Yes Yes Yes Yes Yes assignments could not be predicted)?

4. Were study participants Yes Yes Yes Yes Yes Yes and providers blinded to (subject (subject (subject (subject (subject (subject treatment group assignment? blinded) blinded) blinded) blinded) blinded) blinded) 5. Were the people assessing Yes Yes Yes Yes Yes the outcomes blinded to the (observer (observer (observer (observer (observer No participants' group blinded) blinded) blinded) blinded) blinded) assignments?

6. Were the groups similar at baseline on important characteristics that could Yes Yes Yes Yes Yes Yes affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?

7. Was the overall drop-out Yes Yes rate from the study at Yes (10% Yes (2% Yes (7% No (10% (7.26% endpoint 20% or lower of the dropout) dropout) dropout) number allocated to dropout) dropout) treatment?

8. Was the differential dropYes Yes Yes Yes (3% Yes (3% Yes (1% out rate (between treatment (0.5% (0.2% (0.3% points points points groups) at endpoint 15 points points points diff.) diff.) diff.) percentage points or lower? diff.) diff.) diff) 9. Was there high adherence Yes Yes Yes Yes Yes Yes to the intervention protocols for each treatment group?

10. Were other interventions avoided or similar in the No No No No No No groups (e.g., similar background treatments)?

11. Were outcomes assessed using valid and reliable Yes Yes Yes Yes Yes Yes measures, implemented consistently across all study participants?

12. Did the authors report that the sample size was sufficiently large to be able Yes Yes Yes Yes Yes Yes to detect a difference in the main outcome between groups with at least 80% power?

Table 1: Results of Quality assessment for the four studies.

Dayan, et Lanata, Sabchare Villar, et Criteria HSS, et al al et al on, et al al 13. Were outcomes reported or subgroups analyzed Yes Yes Yes Yes Yes prespecified (i.e., identified before analyses were conducted)?

14. Were all randomized participants analyzed in the group to which they were Yes Yes Yes Yes Yes originally assigned, i.e., did they use an intention-to-treat analysis?

Score 13/14 13/14 13/14 12/14 13/14

Leo, et al Yes

Yes

12/14

3.3. Study Designs and Characteristics Table 2 provides the summary of the study design of all of the included studies. All of the studies followed a similar study design, and hence can be compared reliably. All studies were double-blinded (except for Leo, et al. 25) and adequately randomized the patients. In all studies, only healthy patients were selected.

There are some differences in the control group of the studies, as some use 0.9% NaCl and others use other vaccines. However, we consider that this does not significantly affect the results as none of the control vaccines contain antigens for Dengue Virus. The study conducted by Leo, et al. 25 separated the data for different age groups, hence the data will be presented separately in Tables and charts.

3.4.1. Study Outcome: Efficacy of Intervention The efficacy of CYD-TDV was primarily measured by analyzing the immunogenicity of the interventions, indicated by the geometric mean titers (GMT) of neutralizing antibodies (antibody titer) against each of the four antigens (DENV-1, DENV-2, DENV-3, DENV-4). The GMT represents the average antibody titer in a population of people.

Plaque reduction neutralization test (PRNT) was used to quantify the titer of antibodies in all trials. The data is represented on Figures 2-5, and also in Tables in the appendix.

The data is extracted for GMTs of antibodies against each antigen at baseline, after dose 2, and after dose 3 of both test and control groups in all 6 trials (except for the study by Leo, et al.,25 which only presented data for immunogenicity at baseline and post-dose 3).

Study

Population

Intervention

Three doses of NaCl 0.9% at 0, 6, and 12 months Enrollment and Dropout: 50 enrolled, 46 completed

Control

Efficacy: Immunogenicity against DENV 1-4 measured at baseline and 28 days after each dose using PRNT50 and calculation of GMT Safety: Unsolicited systemic reaction, solicited injection site reactions, solicited systemic reactions, and Serious Adverse Effects (SAEs) were recorded

Outcome Measures

Table 2: The summary of Experimental Designs of the Six Studies

Three doses of CYD-TDV at 0, 6, and 12 months Enrollment and Dropout: 100 enrolled, 89 completed

Three doses of placebo at 0, 6, and 12 months Enrollment and Dropout: 51 enrolled, 50 completed

Efficacy: Immunogenicity against DENV 1-4 measured at baseline and 28 days after dose 2 and 3 using PRNT50 and calculation of GMT Safety: Unsolicited systemic reaction, solicited injection site reactions, solicited systemic reactions, and Serious Adverse Effects (SAEs) were recorded

Lanata, et al (2012)

HSS, et al (2013)

Age: 9-16 Participants: 150 Mean Age: 12.7 Dayan, et al Country: Brazil Baseline Seropositivity: (2013) 69% in test group 71% in control group

Three doses of CYD-TDV at 0, 6, and 12 months Enrollment and Dropout: 199 enrolled, 196 completed

Age: 2-11 Participants: 250 Mean Age: 6.4 Country: Malaysia Baseline Seropositivity: 44.9% in test group 48% in control group

Efficacy Immunogenicity against DENV 1-4 measured at baseline and 28 days after dose 2 and 3 using PRNT50 and calculation of GMT Safety: Unsolicited systemic reaction, solicited injection site reactions, solicited systemic reactions, and Serious Adverse Effects (SAEs) were recorded Three doses of CYD-TDV at 0, 6, and 12 months Enrollment and Dropout: 200 enrolled, 186 completed

Two doses of placebo at 0 and 6 months, pneumococc. vaccine at month 12 Enrollment and Dropout: 100 enrolled, 90 completed

Age: 2-11 Participants: 300 Mean Age: 6.29 Country: Peru Baseline Seropositivity: 37.2% in test group 48.5% in control group

Control

Efficacy: Immunogenicity against DENV 1-4 measured at baseline and 28 days after each dose using PRNT50 and calculation of GMT Safety: Unsolicited systemic reaction, solicited injection site reactions, solicited systemic reactions, and Serious Adverse Effects (SAEs) were recorded

Outcome Measures

Table 2: The summary of Experimental Designs of the Six Studies Intervention

Three doses of NaCl 0.9% at 0, 6, and 12 months Enrollment and Dropout: 99 enrolled, 48 completed

Efficacy: Immunogenicity against DENV 1-4 measured at baseline and 28 days after each dose using PRNT50 and calculation of GMT Safety: Unsolicited systemic reaction, solicited injection site reactions, solicited systemic reactions, and Serious Adverse Effects (SAEs) were recorded

Population

Three doses of CYD-TDV at 0, 6, and 12 months Enrollment and Dropout: 197 enrolled, 95 completed

Two doses of NaCl 0.9% at 0 and 6 months, and a dose of DPT at 12 months Enrollment and Dropout: 199 enrolled, 180 completed

Study Age: 4-11 Participants: 296 Mean Age: 8.21 Sabchareon Country: Thailand et al (2012) Baseline Seropositivity: 70% in test group 68% in control group

Three doses of CYD-TDV at 0, 6, and 12 months Enrollment and Dropout: 401 enrolled, 364 completed

Efficacy: Immunogenicity against DENV 1-4 measured at baseline and 28 days after third dose using PRNT50 and calculation of GMT Safety: Unsolicited systemic reaction, solicited injection site reactions, solicited systemic reactions, and Serious Adverse Effects (SAEs) were recorded

Leo, et al (2013)

Villar, et al (2013)

Age: 9-16 Participants: 600 Mean Age: 12.56 Region: Latin America Baseline Seropositivity: 75.1% in test group 77.9% in control group

Three doses of CYD-TDV at 0, 6, and 12 months Enrollment: 236 enrolled (2-11 y.o) 141 enrolled (12-17 y.o) 93% pts completed the trial

One dose of NaCl 0.9% at 0 months, followed by two doses of either Hep-A or Influenza vaccines at months 6 and 12 (based on age) Enrollment: 80 enrolled (2-11 y.o) 46 enrolled (12-17 y.o) 92% pts completed the trial

Age: 2-45 (results were separated for all age groups, & data for ages 2-17 was extracted) Participants: 316 (2-11 y.o) 187 (12-17 y.o) Country: Singapore Baseline Seropositivity: 16.6% in test group 20.8% in control group

Figure 2a: Geometric Mean Titre (1/dil) of DENV-1 neutralizing antibodies in Test and Control Groups 500 450

Geometric Mean Titer

400 350 300 250 200 150 100 50 0 Baseline Post Dose Post Dose 1 3

Baseline Post Dose Post Dose 1 3

Dayan et al

Baseline Post Dose Post Dose 1 3

HSS et al

Lanata et al

Figure 2b: Geometric Mean Titre (1/dil) of DENV-1 neutralizing antibodies in Test and Control Groups 500 450

Geometric Mean Titer

400 350 300 250 200 150 100 50 0 Baseline Post Post Dose 1 Dose 3 Sabchareon, et al

Baseline Post Post Dose 1 Dose 3 Villar, et al test

Baseline Post Dose 3 Leo, et al (2-11)

Baseline Post Dose 3 Leo, et al (12-17)

control

Figure 2: Geometric Mean Titre (1/dil) of DENV-1 neutralizing antibodies in Test and Control Groups

Figure 3a: Geometric Mean Titre (1/dil) of DENV-2 neutralizing antibodies in Test and Control Groups 700

Geometric Mean Titer

600 500 400 300 200 100 0 Baseline Post Dose Post Dose 1 3

Baseline Post Dose Post Dose 1 3

Dayan et al

Baseline Post Dose Post Dose 1 3

HSS et al

Lanata et al

Figure 3b: Geometric Mean Titre (1/dil) of DENV-2 neutralizing antibodies in Test and Control Groups 600

Geometric Mean Titer

500

400

300

200

100

0 Baseline Post Post Dose 1 Dose 3 Sabchareon, et al

Baseline Post Post Dose 1 Dose 3 Villar, et al test

Baseline Post Dose 3 Leo, et al (2-11)

Baseline Post Dose 3 Leo, et al (12-17)

control

Figure 3: Geometric Mean Titre (1/dil) of DENV-2 neutralizing antibodies in Test and Control Groups

Figure 4a: Geometric Mean Titre (1/dil) of DENV-3 neutralizing antibodies in Test and Control Groups 1200

Geometric Mean Titer

1000

800

600

400

200

0 Baseline

Post Dose 1

Post Dose 3

Baseline

Dayan et al

Post Dose 1

Post Dose 3

Baseline

HSS et al

Post Dose 1

Post Dose 3

Lanata et al

Figure 4b: Geometric Mean Titre (1/dil) of DENV-3 neutralizing antibodies in Test and Control Groups 700

Geometric Mean Titer

600 500 400 300 200 100 0 Baseline Post Post Dose 1 Dose 3 Sabchareon, et al

Baseline Post Post Dose 1 Dose 3 Villar, et al test

Baseline Post Dose 3 Leo, et al (2-11)

Baseline Post Dose 3 Leo, et al (12-17)

control

Figure 4: Geometric Mean Titre (1/dil) of DENV-3 neutralizing antibodies in Test and Control Groups

Figure 5a: Geometric Mean Titre (1/dil) of DENV-4 neutralizing antibodies in Test and Control Groups 500 450

Geometric Mean Titer

400 350 300 250 200 150 100 50 0 Baseline Post DosePost Dose 1 3

Baseline Post DosePost Dose 1 3

Dayan et al

Baseline Post DosePost Dose 1 3

HSS et al

Lanata et al

Figure 5b: Geometric Mean Titre (1/dil) of DENV-4 neutralizing antibodies in Test and Control Groups 350

Geometric Mean Titer

300 250 200 150 100 50 0 Baseline Post Post Dose 1 Dose 3 Sabchareon, et al

Baseline Post Post Dose 1 Dose 3 Villar, et al test

Baseline Post Dose 3 Leo, et al (2-11)

Baseline Post Dose 3 Leo, et al (12-17)

control

Figure 5: Geometric Mean Titre (1/dil) of DENV-4 neutralizing antibodies in Test and Control Groups

In order to better analyze the trend, the fold increase in GMTs from baseline to post-dose three were calculated for all 4 antigens in all studies for both test and control groups. This data can be seen in Table 3 and Figure 6 below: Table 3: Fold Increase in GMT of each serotype from Baseline to the end of Third Dose Dayan, HSS, et Lanata, Sabchareon, Villar, et Leo, et al Leo, et al et al al et al et al al (2-11) (12-17) (2013) (2013) (2012) (2012) (2013) (2013) (2013) DENV - 1 (Test) DENV - 1 (Control)

6.45

9.87

10.29

3.41

4.31

10.62

4.40

1.68

1.02

1.67

0.90

1.29

1.12

1.16

DENV-2 (Test) DENV-2 (Control)

8.12

11.32

12.36

5.46

5.25

17.26

6.54

1.93

0.88

1.19

1.19

1.33

1.14

1.11

DENV - 3 (Test) DENV - 3 (Control)

9.05

12.37

11.59

12.86

6.99

21.79

10.44

1.48

1.03

1.66

1.70

1.36

1.10

1.19

DENV-4 (Test) DENV-4 (Control)

28.80

11.49

22.66

5.52

7.42

18.44

13.58

1.91

0.89

1.87

0.84

1.07

1.34

1.27

35

30

25

20

15

10

5

0 DENV - 1 (Test)

DENV - 1 (Control)

Dayan, et al

HSS, et al

DENV-2 (Test) Lanata, et al

DENV-2 (Control) Sabchareon, et al (2012)

DENV - 3 DENV - 3 (Test) (Control) Villar, et al

Leo, et al (2-11)

DENV-4 (Test)

DENV-4 (Control)

Leo, et al (12-17)

Figure 6: Fold Increase in Geometric Mean Titres of each serotype from Baseline to the end of Third Dose

We also collected data for the peak GMT values in test groups of all trials. This represents the highest GMT value recorded for the test groups for all serologies either at baseline, after dose 2, or after dose 3. These results would help us compare immune responses against CYD-TDV in different trials. This data can be seen in Table 4 and Figure 7 below.

Table 4: Peak GMT Values (1/dil) in Test Groups of all trials

DENV 1

Dayan, et al (2013) 436

DENV 2

647

180

178

326

504

101

48.7

DENV 3

1031

196

190

405

594

136

71.4

DENV 4

432

114

184

159

305

104

79.2

Peak GMT values of

151

Lanata, et al (2012) 179

Sabchareon, et al (2012) 146.1

Villar, et al (2013) 320

Leo, et al (2-11) (2013) 56.6

Leo, et al (12-17) (2013) 28.5

HSS, et al (2013)

1200

Peak GMT Values

1000 800 600 400 200 0 DENV 1 Dayan

DENV 2 HSS

Lanata

Sabchareon

DENV 3 Villar

leo 1

DENV 4 Leo 2

Figure 7: Peak GMT Values (1/dil) in Test Groups of all trials

3.4.2. Study Outcome: Safety of Intervention All of the studies collected data for unsolicited systemic reactions, solicited injection-site reactions, solicited systemic reactions, and severe adverse effects.

All studies observed any immediate AEs that occurred within 30 minutes of injections (except for Lanata, et al). 22 Solicited injection-site reactions include erythema, swelling, and pain, among others, and were observed for up to 7 days after the injections in all trials. Solicited systemic reactions are systemic reactions which are expected from the injections, and include fever, headache, malaise, myalgia, and myasthenia, and were observed for up to 14 days after injections. Unsolicited systemic reactions are any systemic reactions in response to the vaccine that are not expected, and were observed for up to 28 days after each injection in all trials. Severe Adverse Effects were any serious illnesses or reactions contracted during the course of the trial that needed hospitalization. This included symptomatic dengue disease. All of the trials graded solicited and unsolicited reactions from 1-3 The data for safety of the vaccine is presented semi-quantitatively in Table 5

HSS, et al (2013)

Dayan, et al (2013)

Study

5.5% patients in test groups and 11.8% patients in placebo group experienced SAEs; All were unrelated to treatment (except for one case in Placebo group)

6 Severe Adverse reactions in CYD-TDV and 5 adverse reactions in control groups; none considered to be related to the intervention

Severe adverse effects

Injection-site reactions were similar in test and placebo groups in terms of incidence

89.4% and 94.1% patients in test and placebo groups respectively experienced solicited reactions (both injection site and systemic). Injection site reactions included pain, erythema and swelling, whereas systemic reactions included malaise and headaches among others.

These were reported frequently but at Grade 1 intensity and were transient

Pain was the most common injection-site side effect (40-41% patients in both groups).

Most solicited injection site AEs were low grade and transient

Solicited injection site AEs

Solicited systemic reactions such as fever, malaise, and headaches occurred in comparable rates in both placebo and test groups, and were of low grade.

Headache was the most common solicited systemic AE (61% patients in test; 51% patients in placebo).

Most solicited systemic AEs were low grade and transient

Solicited Systemic AEs

Unsolicited adverse effects were considered unrelated to the injections (Upper respiratory tract infections, gastrointestinal disorders, etc)

About half (53.8% CYD-TDV and 49% Placebo) experienced unsolicited AEs, these were unrelated to vaccine

No difference in occurrence of unsolicited systemic AEs in test and control groups.

Unsolicited AEs were not related to the interventions / control studied.

Unsolicited AEs

The vaccine had a good safety profile and was well tolerated in general

In general, the vaccine had a satisfactory safety profile and was well tolerated

In general, the vaccine was well tolerated and did not cause any severe adverse effects

Overall Comments

Table 5: Safety and Reactogenicity of the CYD-TDV as compared to control in the 6 trials

Lanata, et al (2012)

2 SAEs were reported in the test group, and 5 were reported in the placebo group. None of them were considered to be related to the vaccine/ intervention and all continued the study

Villar, et al (2013)

Sabchareon, et al (2012)

Study

10 (2.5%) patients in study group, and 15(7.5%) patients in control group experienced SAEs, none of which were considered vaccine related

No severe adverse effects were vaccine related n test group, but one was in placebo group

Severe adverse effects

32% CYD TDV group and 27% Placebo group experienced solicited injection site reaction (mild or moderate severity)

Injection site reactions occurred in 61.6% patients in test groups, and in 63.2% of patients in control group

Solicited injection site AEs

58% CYD-TDV group and 54% Placebo group experienced solicited systemic reaction (mild or moderate severity)

Solicited systemic side effects such as malaise and fever occurred in 77.7% of patients in test group, and 74.3% patients in control group, but were mostly low grade and transient

Solicited Systemic AEs

Unsolicited Adverse effects occurred at similar effects in both groups (45% of patients in vaccine group, 47% of the patients in control group)

Unsolicited AEs

Favorable safety profile, with vaccine being well tolerated

The vaccine was well tolerated and there were no SAEs related to the vaccine in a two year follow up

Overall Comments

Table 5: Safety and Reactogenicity of the CYD-TDV as compared to control in the 6 trials

Leo, et al (2013)

55% patients in the CYDTDV group and 67% in control group had solicited injection-site reactions after vaccination

Relatively safe overall profile in terms of reactogenicity and AEs

1(0.3%) discontinuation after AE in the control group and 3(0.3%) for AEs related to vaccination in the CYDTDV group: Fever, rash, and worsening cervical spondylosis

Unsolicited AEs were reported by 17.0% of participants in the CYD-TDV group and 20.7%, most frequent of which were infections and infestations of upper respiratory tract infections, which were considered not related to vaccination

More solicited systemic reactions reported after first CYD-TDV vaccination (45.9%) than after the placebo control (37.0%). Headache, myalgia, and malaise most frequently reported solicited systemic reactions, followed by fever and asthenia

4. Discussion

4.1. Analysis of Results Immunogenicity in trials was analyzed by fold increase of Geometric Mean Titer from baseline to post dose 3 (Figure 6). The fold increase of all antibody titers in patients injected with CYD-TDV vaccine is larger when compared to control groups in all trials. For example, in HSS et al 21, the antibody titer against DENV3 increased 12.37 fold in test group and only 1.03 in control group. This trend is seen across all trials for antibodies against all 4 antigens. This indicates that the CYD-TDV is more effective in eliciting a protective immune response against the four dengue virus serotypes.

Another trend common to test groups in all trials is that the antibody titers reached high levels after dose 2, but the subsequent dose (dose 3) failed to increase it further substantially. This presents as a plateau-shaped pattern in Figures 2-5. In HSS et al, 21 the GMT for DENV 1 antibody increased from 15.3 at baseline, to 119.0 post dose 2, which is an increase of 114.3. However, at the end of dose 3, the GMT only reached 151.0, which is a meagre increase of 32.0 from post dose 2. This trend is consistent in all trials, as seen in Figures 2-5.

This plateau pattern implies that 2 doses of CYD-TDV vaccine are more immunogenic, hence more effective, than the third dose. However, the three dose regimen is still supported. Observations from some trials 21, 22, 24 stated that the third dose significantly increased GMT levels in patients who were flavivirus seronegative at baseline, but not in patients who were flavivirus-seropositive at baseline. This means that the third dose is still effective for previously flavivirus seronegative patients. Moreover, in a clinical setting, it is impractical to assess antigen seropositivity before vaccine administration.

Therefore, it is still most efficient to standardize a three dose regimen for this vaccination.

Finally, we also observed that the magnitude of immune response in test groups is different between trials, as some trials show more robust immune responses than others. We can compare the strength of immune responses in each study by comparing the peak antibody titers (GMT) recorded (Figure 7). In all 4 serologies, the highest and second highest peaks were achieved by Dayan, et al.20 and Villar, et al.

24 respectively.

A possible explanation for this is that the populations in these studies had high baseline DENV seropositivities (Table 2). High baseline seropositivity rates imply that a large portion of the population selected in these trials have had previous exposure to dengue virus. The baseline seropositivity in the test group of Dayan et, al.20 and Villar et, al 24 was 69% and 75.1% respectively. This is much higher than the values reported by Leo et al (16.6%),25 HSS, et al 21 (44.9%), and Lanata, et al.22 (37.2%), all of whom had a relatively low peak antibody titer for all serologies. In previously seropositive patients, the dengue vaccine would elicit a secondary, instead of a primary, immune response. This explains the more enhanced peak GMT levels found in Dayan, et al.20 and Villar, et al.

From the safety and reactogenicity reports in all trials (Table 9), CYD-TDV vaccine is well tolerated and has a relatively good safety profile. As reported, all solicited injection-site or systemic adverse effects were similar in both test and control groups in all trials. Systemic and injection-site adverse effects were generally described as low grade in all trials. Unsolicited systemic adverse reactions occurred in similar rates between test and control groups in all studies, but were generally described to be unrelated to the injections.

The safety profile of the tested CYD-TDV is similar to that of other vaccines commonly used. The study by Villar, et al. 24 used DPT as the injection in control group (Table 2). From Table 9, we see that in this study, the rate of incidence of adverse effects is similar in test and control groups, which implies that the safety profile of the CYD-TDV is similar to that of the DPT vaccine. The control groups of studies by Lanata, et al.22 and Leo, et al.25 also used alternative vaccines. Hence, the similarities in the data for reactogenicity in control and test groups of these studies also implies a similar safety profile between the CYD-TDV and the vaccine they used for their control group.

Severe adverse effects were reported in all trials. However, they occurred in similar rates between control and test groups. The incidence of severe adverse effects is not unexpected as the trials lasted for

a year in all studies, and SAEs were recorded throughout the trial period. In all of the trials except for Leo, et al.,25 none of the cases of severe adverse effects were considered to be related to the vaccine in test groups. Three patients (0.3%) from Leo, et al’s 25study experienced relatively severe AEs (fever, rash and worsening of cervical spondylosis related to vaccination) such that they had to be withdrawn from the study.

4.2. Limitations of the Study The efficacy measured in this systematic review is based solely on the induction of the immune system due to the dengue vaccine, which is expected to protect the subjects from the virus in the future. However, this systematic review does not provide concrete evidence on the long term efficacy of the vaccine. Several studies have been started on the long term efficacy of the vaccine, but they are still on-going as of July 2016. 17

4.3. Future Research and Applications The main purpose of developing the CYD-TDV is to prevent the onset of symptomatic dengue disease.

Because this systematic review shows that the CYD-TDV is effective and safe in children, this opens possibilities for further exploration of this vaccine in large-scale long term studies to assess its longterm efficacy in decreasing the prevalence of symptomatic dengue disease.

Additionally, from the discussion, it is seen that the high baseline dengue seropositivity rates in populations of Dayan, et al.20 and Villar, et al. 24 expressed a stronger immune response to the CYDTDV. It is plausible that this high baseline seropositivity is attributed to the fact that these studies were conducted in the highly endemic regions of Latin America. Indonesia is also considered to be a highly endemic region for dengue virus. Hence, this review gives promise for high efficacy of this vaccine when applied in Indonesian populations.

5. Conclusion In conclusion, this systematic review confirms that the efficacy (in terms of immunogenicity) and overall safety profile (in terms of reactogenicity) of CYD-TDV are satisfactory. Hence, this review supports the continued development and widespread use of CYD-TDV for the prevention of dengue disease for children and adolescents.

References 1.

Bäck A Lundkvist Å. Dengue viruses – an overview. Infection Ecology & Epidemiology.

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Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis. 2012 Aug; 6(8):e1760.

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Wilder-Smith AByass P. The elusive global burden of dengue. The Lancet Infectious Diseases.

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Indonesian Health Ministry. Situasi DBD [Internet]. Jakarta: Pusat Data dan Informasi Kemenkes RI; 2016 [cited on 2016 October 20]. Available from: http://www.depkes.go.id/resources/download/pusdatin/infodatin/infodatin-dbd-2016.pdf

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Indonesian Health Ministry. Wilayah KLB DBD ada di 11 Provinsi [Internet]. Jakarta: Biro Komunikasi dan Pelayanan Masyarakat Kemenkes RI; 2016 [cited on 2016 October 20].

Available from: http://www.depkes.go.id/article/print/16030700001/wilayah-klb-dbd-ada-di-11provinsi.html 6.

NASA Global Climate Change. Vital signs of the planet [Internet]. [cited 17 October 2016].

Avaliable from: http://climate.nasa.gov/vital-signs/global-temperature/

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World Health Organisation. Climate and Health Country Profiles - Indonesia 2015 [cited on 2016 October 20] [Internet]. Geneva, Switzerland; 2016. Available from: http://www.who.int/globalchange/resources/country-profiles/PHE-country-profileIndonesia.pdf?ua=1

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Ebi KL, Nealon J. Dengue in a changing climate. Environmental Research. 2016 Nov 30;151:115-23.

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Naish S, Dale P, Mackenzie JS, McBride J, Mengersen K, Tong S. Climate change and dengue: a critical and systematic review of quantitative modelling approaches. BMC infectious diseases.

2014 Mar; 14(1):1.

10. Rohani A, Wong YC, Zamre I, Lee HL, Zurainee MN. The effect of extrinsic incubation temperature on development of dengue serotype 2 and 4 viruses in Aedes aegypti (L.). Southeast Asian Journal of Tropical Medicine and Public Health. 2009 Sep; 40(5):942.

11. Morin CW, Comrie AC, Ernst K. Climate and dengue transmission: evidence and implications.

Environmental Health Perspectives (Online). 2013 Nov 1;121(11-12):1264.

12. Chan M, Johansson MA. The incubation periods of dengue viruses. PloS one. 2012 Nov 30;7(11):e50972.

13. World Health Organization. Global Strategy for Dengue Prevention and Control [Internet].

Geneva: WHO; 2016 [cited on 2016 October 20]. Available from: http://apps.who.int/iris/bitstream/10665/75303/1/9789241504034_eng.pdf 14. Achee NL, Gould F, Perkins TA, Reiner RC, Morrison AC, Ritchie SA, et al. A critical assessment of vector control for dengue prevention. PLoS Negl Trop Dis. 2015; 9(5): e0003655.

15. Indonesian Health Ministry. Demam Berdarah Dengue. Jakarta: Pusat Data dan Surveilans Epidemiologi Kemenkes RI; 2016. [cited on 2016 October 20] 16. Karyanti MR, Uiterwaal CS, Kusriastuti R, Hadinegoro SR, Rovers MM, Heesterbeek H et al.

The changing incidence of Dengue Haemorrhagic Fever in Indonesia: a 45-year registry-based analysis. BMC Infect Dis. 2014 Jul 26;14:412.

17. World Health Organisation. Dengue vaccine: WHO position paper – July 2016 [cited on 2016 October 20] [Internet]. Geneva, Switzerland; 2016. Available from: http://Dengue vaccine: WHO position paper – July 2016 18. World Health Organization. Background Paper on Dengue Vaccines [Internet]. WHO; 2016. [cited on 2016 October 20]. Available from: http://www.who.int/immunization/sage/meetings/2016/april/1_Background_Paper_Dengue_Vac cines_2016_03_17.pdf

19. Quality Assessment of Controlled Intervention Studies - NHLBI, NIH [Internet]. National Heart, Lung, and Blood Institute. 2016 [cited 19 October 2016]. Available from: http://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/rct 20. Dayan GH, Garbes P, Noriega F, de Sadovsky AD, Rodrigues PM, Giuberti C, et al.

Immunogenicity and safety of a recombinant tetravalent dengue vaccine in children and adolescents ages 9–16 years in Brazil. The American journal of tropical medicine and hygiene.

2013 Dec; 89(6):1058-65.

21. Amar-Singh HS, Koh MT, Tan KK, Chan LG, Zhou L, Bouckenooghe A, et al. Safety and immunogenicity of a tetravalent dengue vaccine in healthy children aged 2–11 years in Malaysia: A randomized, placebo-controlled, Phase III study. Vaccine. 2013 Dec; 31(49):5814-21.

22. Lanata CF, Andrade T, Gil AI, Terrones C, Valladolid O, Zambrano B, et al. Immunogenicity and safety of tetravalent dengue vaccine in 2–11 year-olds previously vaccinated against yellow fever: randomized, controlled, phase II study in Piura, Peru. Vaccine. 2012 Sep; 30(41):5935-41.

23. Sabchareon A, Wallace D, Sirivichayakul C, Limkittikul K, Chanthavanich P, Suvannadabba S, et al. Protective efficacy of the recombinant, live-attenuated, CYD tetravalent dengue vaccine in Thai schoolchildren: a randomised, controlled phase 2b trial. The Lancet. 2012 Nov; 380(9853):1559-67.

24. Villar LÁ, Rivera-Medina DM, Arredondo-García JL, Boaz M, Starr-Spires L, Thakur M, Zambrano B, et al. Safety and immunogenicity of a recombinant tetravalent dengue vaccine in 9– 16 year olds: a randomized, controlled, phase II trial in Latin America. The Pediatric infectious disease journal. 2013 Oct; 32(10):1102-9.

25. Sin Leo Y, Wilder-Smith A, Archuleta S, Shek LP, Chong CY, Nam Leong H, et al.

Immunogenicity and safety of recombinant tetravalent dengue vaccine (CYD-TDV) in individuals aged 2–45 years: Phase II randomized controlled trial in Singapore. Human vaccines & immunotherapeutics. 2012 Sep; 8(9):1259-71.

Appendix: Geometric Mean Titers in Test and Control Groups after each dose of Treatment Geometric Mean Titre (1/dil) of DENV-1 neutralizing antibodies in Test and Control Groups Dayan, HSS, Lanata, Sabchareon, Villar, Leo, et al Leo, et al DENV 1 et al et al et al et al et al (2-11) (12-17) Baseline (Test Group) 41.4 15.3 17.4 42.8 74.2 5.33 6.47 Post Dose 2 (Test Group) 436 119 125 120.7 276 Post Dose 3 (Test Group) 267 151 179 146.1 320 56.6 28.5 Baseline (Control Group) Post Dose 2 (Control Group) Post Dose 3 (Control Group)

47.2 130 79.2

18.6 21 18.9

22.8 26.4 38.1

26.6 21.9 23.9

81.9 102 106

5.42 6.06

5.47 -

6.36

Geometric Mean Titre (1/dil) of DENV-2 neutralizing antibodies in Test and Control Groups Dayan, HSS, Lanata, Sabchareon, Villar, Leo, et al Leo, et al DENV 2 et al et al et al et al (2012) et al (2-11) (12-17) Baseline (Test Group) 67 15.9 14.4 56.8 92.6 5.85 7.45 Post Dose 2 (Test Group) 647 160 151 326 504 Post Dose 3 (Test Group) 544 180 178 310 486 101 48.7 Baseline (Control Group) Post Dose 2 (Control Group) Post Dose 3 (Control Group)

68.3 137 132

18.6 17.9 16.3

18.2 17.3 21.6

43.7 43.5 52.2

100 114 133

5.17

5.54

5.88

6.17

Geometric Mean Titre (1/dil) of DENV-3 neutralizing antibodies in Test and Control Groups Dayan, HSS, Lanata, Sabchareon, Villar, Leo, et al Leo, et al DENV 3 et al et al et al et al (2012) et al (2-11) (12-17) Baseline (Test Group) 81.9 15.6 16.4 31.5 85 6.24 6.84 Post Dose 2 (Test Group) 1031 196 155 195 502 Post Dose 3 (Test Group) 741 193 190 405 594 136 71.4 Baseline (Control Group) Post Dose 2 (Control Group) Post Dose 3 (Control Group)

94.7 227 140

15.9 15.9 16.3

21.8 26.6 36.2

28.7 24.6 48.9

88.8 108 121

5.95

6.83

6.54

8.1

Geometric Mean Titre (1/dil) of DENV-4 neutralizing antibodies in Test and Control Groups Dayan, HSS, Lanata, Sabchareon, Villar, Leo, et al Leo, et al DENV 4 et al et al et al et al (2012) et al (2-11) (12-17) Baseline (Test Group) 15 9.92 8.12 28.1 37.2 5.64 5.83 Post Dose 2 (Test Group) 346 110 144 159 305 Post Dose 3 (Test Group) 432 114 184 155 276 104 79.2 Baseline (Control Group) Post Dose 2 (Control Group) Post Dose 3 (Control Group)

17.5 31.2 33.4

12.3 13.3 10.9

8.94 12.8 16.7

23.2 21.2 19.4

40.1 43.9 42.8

5.39

5.08

7.2

6.45

SCIENTIFIC POSTER

REVOLUTIONARY MALARIA MALARIA THERAPY USING ALLICIN IN GARLIC EXTRACT (ALLIUM SATIVUM) : BIOMOLECULAR STUDIES USING IN SILICO Donni Santoso1, Gabriela Nativity2, Putu Ijiya Danta Awatara3 University of Brawijaya

Background: Malaria is life-threatening disease caused by Plasmodium Falciparum. In 201, half of world population about 3.2 billion people were at risk of malaria. Progress in malaria control is threatened by the rapid development and spread of antimalarial drug resistance. Allicin extracted from Garlic (Allium sativum) is biologically active component to inhibit cell proliferation and induce apoptosis.

Objective: To show microtubule of Plasmodium Falciparum plays important role in reducing malaria virulence and to show Allicin blocks these phenomenons.

Method: Biomolecular experimental is conducted by in silico. Comprehensive literature search conducted to prove the consistency of in Silico . Inclusion criterias were used to filter abstracts and full texts in assessing eligibility of trials.

Results : The result of in silico shows Allicin strongly binds and inactivates beta-tubulin microtubule protein of Plasmodium sp. in their active site, Alanine 206 through Alkyl bond. The binding affinity among allicin and microtubule protein is -3.7 kcal/mol as the highest and the lowest -3.3 Kcal/mol.

All literature studies shown positive result towards Allicin inhibits Plasmodium Falciparum. Allicin can block cell division by preventing spindle formation resulting inhibiton of sporozoite invasion and infectivity of Plasmodium Falciparum.

Conclusion : Allicin obtained from Garlic can be revolutionary malaria therapy by inhibiting microtubule of Plasmodium Falciparum. Allicin strongly binds and inactivates beta-tubulin protein in their Active site and block Cell Division by Preventing Spindle Formation resulting inhibition of Sporozoite invasion and infectivity of Plasmodium Falciparum. Allicin recommended for East Asian continent.

Keywords: Antimalaria, Plasmodium Falciparum., Allicin, Garlic, Microtubule, Insilico

Figure 3. DF and Death Incidence Progression Year by Year 700

12

600

10

500

8

400

6

300

4

200

Death Incidence

Dengue infection is one of the most common arbo-viral infection worldwide and has caused a huge medical and economic burden [1, 2]. In Indonesia, Dengue fever (DF) outbreaks is the largest in ASEAN region [3]. In relation to climate change, incidence of DF is proven to be significantly correlated to temperature, humidity, and rain precipitation in various region [4-8]. An increase in those parameters causes an increase in mosquito’s breeding site and, consequently, mosquito population and DF incidence.

Sampang is one of the region which have been consistently hit by an epidemic of Dengue despite the strategies that have been implemented to prevent and eradicate DF in Sampang. Temperature in Sampang is consistent all year round at 27.1oC. Rain precipitation fluctuates, peaking at December and hitting the bottom on August. A better understanding about the relation between Sampang’s climate and DF incidence will be beneficial to reduce morbidity and mortality rate. [9]

DF Incidence

INTRODUCTION

2

100 0

2012 271 3

DF Incidence Death

2013 494 4 DF Incidence

2014 209 2 Death

0

2015 639 11

Figure 4 DF Incidence Comparison Between Month 300 250

2012 2013 2014 2015 2016

200 150 100 50 0

OBJECTIVES As a pilot project, this study aims to analyze descriptively the relationship of DF incidence and death rate towards climate change, especially on rainfall and temperature at Sampang regency. This study can be used as a basis for future policy in anticipating dengue fever in Sampang and also Indonesia.

MATERIALS & METHODS Retrospective observational study was conducted. Secondary data were retrieved from all government health facilities in Sampang regency. Two specific parameters were investigated: (1) DF incidences and (2) death rate. Data regarding climate and geographical characteristics were retrieved from Statistics Indonesia and Indonesian Agency for Meteorology, Climatology, and Geophysics. These data were analyzed descriptively and presented in charts and figures to answer the main problem in this study.

CONCEPTUAL FRAMEWORK Humidity ↗

Temperature ↗

Rainfall Index ↗ and weather seasons

Increase of mosquitoes population and dengue transmission

Monthly variations in mosquitoes population and dengue transmission

Increase of yearly cumulative DF incidence

Monthly variations of dengue fever incidence

Dengue Epidemiology and Surveillance in Sampang regency

RESULTS 9

Mar

Apr

May

Jun

Jul

Aug

Sep

oct

Nov

Dec

DISCUSSIONS 1. Monthly cumulative pattern & monthly rainfall index in Sampang regency (Fig 1 dan 2) From figure 1, we can see that the rainy season in Sampang is between October-March with its peak on December. Dry season usually start around April to September with its peak on August.

Temperature are consistent all year round at 27.1OC. Average rainfall in Sampang is around 1,415 mm with the highest precipitation falls in December with an average of 239mm [9].

The peak of rain precipitation (December) and the peak of DF incidence (January) had 1 month delay. These findings were consistent with the findings on another studies in Guangzhou, studies in Thailand, and the theories proposed by Carrington [4] that there will be ±24-30 days of time gap after the rainy season begins before the incidence of DF rises. These gap is caused by the total of time for mosquito life cycle, dengue virus incubation in Aedes mosquito, and the dengue incubation period in human body [4-6].

Figure 2 also showed that the peak of DF incidence and the peak of death rate also had 1 month delay. This finding also supported by the study in Malaysia which reported that 38.9% of dengue mortality cases happened with a month gap after the surged incidence of suspected dengue cases from the same area in Malaysia [10].

2. Yearly cumulative pattern of DF incidence (Figure 3) From figure 3, we can observe that there is an annual increase of DF incidence except on 2014 where the incidence dropped for approximately 50%. The increase might be caused by the increase of temperature in Indonesia (0.3oC annually), as predicted by Hulme and Sheard [11], and the shift in rainfall precipitation index in various regions in Indonesia [12]. More climate data specifically on Sampang is needed to ascertain the cause of the increment. These trend were also parallel with other studies conducted in tropical climate (Malaysia) and subtropical climate (Japan) with a gradual increase of DF incidence year to year [13, 14]

Data from figure 4 showed that although the number of DF incidence differs from year to year, but the pattern of monthly DF incidence has not changed in the last 5 years. The highest peak of DF incidence always happens on January which would then decrease gradually until reaching its lowest incidence around August and September, markings the end of dry season, and start to increase slowly on transition months between dry & rainy season (October & November) (Fig 1)

700

8

600

7 6

500

5

400

4

300

3

200

2

100

1 Jan 692 6

Feb 488 8

Mar 297 6

Apr May 209 115 1 1 DF Incidence

Jun Jul Aug 49 50 38 0 0 0 Death Incidence

Sep 34 0

oct 52 1

Nov 61 2

Dec 64 0

Death Rate

DF Incidence

800

DF Incidence Death Incidence

Feb

3. Monthly pattern of DF incidence & monthly rainfall index in Sampang regency (Fig 4 & 1)

Figure 2. DF and Death Incidence Monthly Cumulative Patterns

0

Jan

0

REFERENCES 1. Anders KL, Nguyet NM, Chau NV, Hung NT, Thuy TT, Lienle B, et al. Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam. Am J Trop Med Hyg. 2011: 84:127-34.

2. Coudeville L, Shepard DS, Zambrano B, Dayan G. Dengue economic burden in the Americas: estimates from dengue illness. Am J Trop Med Hyg 2009: 81:127–127.

3. Kementerian Kesehatan RI. Buletin Jendela Epidemiologi. Jakarta: Pusat Data dan Surveilans Epidemiologi Kementerian Kesehatan RI; 2010.

4. Carrington LB and Simmons CP. Human to mosquito transmission of dengue viruses. Frontiers in Immunology. 2014; 5: 1-8.

5. Wiwanitkit V. An observation on correlation between rainfall and the prevalence of clinical cases of dengue in Thailand. Journal of Vector Borne Disease. 2006: 43, 73-76 6. Lu L, Lin H, Tian L, Yang W, Sun J, Liu Q. Time series analysis of dengue fever and weather in Guangzhou, China. BMC Public Health. 2009: 9, 395

CONCLUSIONS We found that DF incidence followed the pattern of rainfall index and the climate in the locals region. Higher precipitation and rainfall promotes the increase of DF incidence within a month gap delay and vice versa.

Our study provides evidence on the relationship between weather and climate in relation to DF incidence and death rate in Sampang regency. Further study and information about these topics in Indonesia would be beneficial to support our findings and give better understanding of dengue epidemiology in Indonesia.

7. Hii YL, Zhu G, Ng N, Ng LC, Rocklov J. Forecast of Dengue Incidence Using Temperature and Rainfall. PLOS Neglected Tropical Disease. 2012: 6(11), 1-9 8. Patz JA, Martens WJM, Focks DA, Jetten TH. Dengue Fever Epidemic Potential as Projected by General Circulation Models of Global Climate Change. Environmental Health Perspectives.

1998: 106(3), 147-153 9. Climate Data. Iklim: Grafik iklim – Sampang, grafis suhu, tabel iklim – Climate-Data.org [Internet]. Climate Data 10. Woon YL, Hor CP, Hussin N, Zakaria A, Goh PP, Cheah WK. A two-year review on epidemiology and clinical characteristics of dengue deaths in Malaysia, 2013-2014.

11. Hulme M, Sheard N. Climate change scenarios for Indonesia. Norwich: Climatic research unit.

12. Boer R, Faqih A. Current and future rainfall variability in Indonesia. Report from AIACC project no. AS21. Washington DC: International START Secretariat.

13. Mudin RN. Dengue Incidence and the Prevention and Control Program in Malaysia. The International Medical Journal Malaysia. 2015: 14(1), 5-9.

14. Fukusumi M, Arashiro T, Arima Y, Matsui T, Shimada T, Kinoshita H, Arashiro A, Takasaki T, Sunagawa T, Oishi K. Dengue Sentinel Traveler Surveillance: Monthly and Yearly Notification Trends among Japanese Travelers, 2006–2014. PLOS Neglected Tropical Disease. 2016: 10(8), 1-14

Retrospective Time Series Analysis of Dengue Fever Incidence and Death Rate in Relation to Climate and Weather between January 2012 until May 2016 at Sampang Regency, East Java, Indonesia Julius Albert Sugianto*, Michael Jonatan** *Universitas Airlangga – (+62)89675844351; julius_albert14@yahoo.com **Universitas Airlangga – (+62)82141612191; michaeljonatan1996@gmail.com Background Dengue fever (DF) is one of the most important disease worldwide and especially Indonesia.

Temperature, humidity, and rainfall increase has been proven to increase DF incidence because it creates a suitable environment for Aedes mosquitoes, the main vector of Dengue Virus, to reproduce. Sampang is one of the region in Indonesia which have been consistently hit by Dengue epidemic.

Aim We sought to analyze the relationship of DF incidence and death rate towards rainfall and temperature at Sampang Regency, Madura, East Java, Indonesia.

Material and methods Retrospective observational study was conducted. DF incidence and death rate were collected from all government health facilities in Sampang from January 2012 to May 2016. The data acquired were analyzed descriptively and compared with the available climate data from Statistics Indonesia and Indonesian Agency for Meteorology, Climatology, and Geophysics.

Results DF incidence’s monthly cumulative pattern is similar to monthly rain precipitation pattern with one month of delay. Rainfall precipitation peaked on December, followed by DF incidence’s peak on January, and death rate on February. Yearly, DF incidence keeps increasing except on 2014. Additionally, each year’s (2012-2016) monthly pattern showed that the monthly pattern on each year remained the same despite changes in cumulative yearly incidence.

Conclusion The result of our study provides evidence on the relationship between weather and climate in relation to DF incidence and death rate in Sampang. We hope this result can be used as a role model for further research and nationwide strategies in combating dengue fever.

Leishmaniasis Accretion as A Climatic Disease: Deforestation Contribute on Temperature Rising and Vector Spread

Rani Fitri, Ayuning Tetirah, Garry Cori, Berliana Nur Faculty of Medicine Airlangga University

These days, deforestation becomes a serious problem in the world, especially for some countries that have many forest areas. It happened quickly with the most common causes such as agriculture, unsustainable forest management, mining, infrastructure projects, and increased fire evidence and intensity. They all refer to the increasing temperature of the surface of earth. This condition makes some animal migrates and spread worldwide because of the climate change.

It also happens to phlebotomine sand flies, which is the vector of leishmaniasis. This fly is really affected with hot, yet humid temperature which can be seen in areas such as central and south America and also Africa with the most number of deserts. As we know, Leishmaniasis, also spelled Leishmaniosis, is a disease that affects either the skin or the internal organ. This disease can present in three main ways; cutaneous, mucocutaneous, or visceral leishmaniasis. Leishmaniasis is a vector-borne disease that are commonly found in thermal country. This disease is transmitted by phlebotomine sand flies vector through their bites. Because of phlebotomine’s spreading, Leishmaniasis is found in tropical, sub-tropical, and southern Europe area.

The increased temperature is related to global warming which is including climate change as its factor, but forest as the fundamental aspect to prevent and reduce this phenomena have been cut down very intensively. So that, forest degradation or deforestation has a big influence of the phlebotomine’s spreading.

Title of poster The urgent need of dengue vaccine in Indonesia Name of University and Authors Faculty of Medicine, Airlangga University and Alifah Fajriyyatul Izzah, Sukacita Yeremia Tehupuring, Nurizzah Farahiyah Sofia, Jihan Kalishah Aim To explain to the public the importance of dengue vaccine in Indonesia.

Background Dengue Fever is a vector-based disease which is the main cause of death in Indonesia.[1] This is compounded by season change. Season change causes irregular weather conditions in dry and rainy season. Which in turn causes an increase in mosquito population. [2] Currently dengue prevention efforts by eradicating the vector has been done but is not yet effective.[3] So, we need an innovation in the form of interventions by dengue vaccine. Many scientists are currently developing a dengue virus vaccine and even some countries have been using it.[4] But Indonesians who really needs it has not been using it.[5] Materials and methods We took an example from the increasing number of dengue vectors found in an entomology research survey conducted by Wijayanti et. Al. in the province of Banyumas, Central Java where dengue cases occur each year. Researchers took samples in four villages during the dry and rainy seasons, of which two villages are endemic, one village is dengue-sporadic and the other village is dengue-free.

Researchers took the data of three different mosquito species. It contains information about the population of larvae and adult mosquitoes of each species.

Results The results are, from the village which had been dengue-endemic there had been an increase in the number of mosquito larvae between 2012 and 2013 compared to the sporadic and dengue-free villages. Differences in the number of larvae population occured between the dry and rainy season, in which the rainy season has higher larvae population than the dry one. The researchers got an interesting data off of adult mosquitoes. There were more adult mosquitoes during the dry season in the dengue-sporadic village.

Discussion The above results indicate that during seasonal change between the dry and rainy season, the number of larvae and adult mosquitoes increases in some areas. Which means that due to season change the indication of dengue cases happening increases.

Conclusion Dengue virus vaccine is desperately needed by Indonesia at this time to address the problem of dengue fever which is getting worse due to season change.

References x

Siwi P. M. Wijayanti, Sunaryo Sunaryo, Suprihatin Suprihatin, Melanie McFarlane, Stephanie M. Rainey, Isabelle Dietrich, Esther Schnettler, Roman Biek, Alain Kohl. Dengue in Java, Indonesia: Relevance of Mosquito Indices as Risk Predictors [Internet]. PLOS. 2016 [cited 29 September 2016]. Available from: http://dx.doi.org/10.1371/journal.pntd.0004500

x

Hilman Zulkifli Amin, Saleha Sungkar. Perkembangan Mutakhir Vaksin Demam Berdarah Dengue [Internet]. Journal Kesehatan Indonesia Vol 1 N o 3. Desember 2013. [cited 20 October

2016].

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from:

http://journal.ui.ac.id/index.php/eJKI/article/viewFile/

3007/2466 x

Amah Majidah Vidyah Dini, Rina Nur Fitrianty, Ririn Arminsih Wulandari. Faktor Iklim dan Angka Insiden Demam Berdarah Dengue di Kabupaten Serang [Internet]. Jurnal Makara

Kesehatan Vol 14 No 1. Juni 2010. [cited on 20 October 2016]. Available from: http://journal.ui.ac.id/index.php/health/article/viewFile/644/629 x

Scott Halstead. Critique of WHO Approval of a Dengue Vaccine [Internet]. Journal of Infectious Diseases Advance Acess. 2016. [cited on 20 October 2016]. Avaiable from: http://jid.oxfordjournals.org/content/early/2016/08/05/infdis.jiw340.full.pdf?papetoc

Omalizumab (A Monoclonal Anti Ig-E Antibody) : Developing Biological Targeted Approach for Allergic Asthma Bronchiale AMSA UNAIR // Faculty of Medicine, Airlangga University By : Ni Made Adnya Suasti, Kania Alawiyah, Alfian Nurfaizi, Rahmawati NurAzizah, Chabib Fachry Albab

AIM To review whether or not omalizumab works on severe asthma bronchiale and to know its effectiveness towards asthma.

BACKGROUND Intergovernmental Panel on Climate Change (IPCC) shows that the average of global temperature has increased by about 0.74 ± 0.18°C (1.33 ± 0.32°F) in the recent 100 years[1].

The health impacts of climate change include increases in asthma, respiratory allergies, and chronic respiratory disorders[2]. Based on WHO, 235 millions people in the world suffered from asthma, 80% is on low and middle-incomes country. According to SIRS (Sistem Informasi Rumah Sakit) in Indonesia, there are 63.584 death because of asthma[3]. The pathogenetic background is characterized by airway inflammation with infiltration of several cells (mast cells, basophils, T-helper(Th)2lymphocytes)[4]. Government and medical professionals the prevention and treatment, but none of them working effectively when it comes to allergic asthma. Then biological targeted comes as a promising approach such as omalizumab. So we as medical students interested to review this topic.

MATERIAL AND METHODS We did a systematic review and used some e-journal sources, mostly from www.elsevier.com/locate/rmed, www.ncbi.nlm.nih.gov, and www.thelancet.com. We also use qualitative approach for the analysis.

RESULTS

Table 1 shows data from the three age groups. BMI was significantly lower (p ¼ 0.049) in younger subjects. No differences in number of allergen sensitizations or serum total IgE values (evaluated before the Omalizumab therapy) were found in the three groups.

Objectives We conduct this research to raise the awareness of the people, government, and health officer about the danger of climate change in Indonesia and to help improving the current Indonesia DHF prevention program.

Background World temperature is increasing. As one of tropical country, Indonesia’s temperature will rise to 27o-28oC in 2020-2050. Those temperatures would accelerate the number of infectious diseases, especially on what we concern, the Dengue Hemorrhagic Fever (DHF). Poor sanitation, bad drainage system, and increased precipitation rate are still haunting Indonesia and further harming Indonesia through increase of DHF cases. Fortunately, our health officers have thought brilliant way, called 3M. However, would that alone will suffice? No! We need better way to counter upcoming DHF outbreak.

Method Through systematical review of selected journals, we tried to found out the best solutions.

Using information gathered, we reviewed the current health policy implementation and the needed improvement.

Result Aedes aegypti and Dengue Virus grow at 27oC optimally (faster virus incubation time and Aedes aegypti lifecyle time). Despite the fact, Indonesian government still holds the belief in 3M and fogging for dengue prevention. However, the other important factors (bad sanitation and drainage system) which bring flood are not included. We strongly encourage the government and Indonesia people, to fix this condition through our solutions : TERMINATOR (Tilting, Enclosing, Rubbing, Minimalize mosquito through Wolbachia, Trapping or Recycling) and role of AMSA as the Health promotion vehicle for DHF prevention.

Conclusion DHF cases will increase in 2020-2050 due to optimal growth temperature for Aedes aegypti and Dengue Virus. The outbreak wouldn’t be prevented by using 3M method only.

Therefore, our solution, TERMINATOR and role of AMSA are the trump cards to suppress the DHF cases.

Malaria University of Brawijaya Ericha Carolyne, Frinny Sembiring, Maria Juliana Dorothy, Puji Astuti

ABSTRACT Malaria is a potentially life-treathening disease caused by infection with plasmodium protozoa transmitted by an infective female Anopheles mosquito. Malaria is one of the health problem of the society that can cause death. Especially high-risk groups in infants, toddlers, pregnant mother. Beside that malaria directly cause anemia and can decrease productivity.

Our scientific poster was made in order to know how malaria can happen, how the spread, the associated with climate change, how many people who is infected and death and how to tackle this disease.

In Indonesia the disease which is more frequently happend are malaria. In many regions in Indonesia malaria was infected or killed so many society. So that until now malaria still be the disease which highlighted.

Based on Direktorat Jendral Pengawasan Pangan dan Pengawasan Lingkungan at 2010, in Riau there is 98 people who is positive malaria and 5 peoples are death. In Aceh there is 30 peoples who is positive malaria and 3 peoples are death. In Central Java there is 240 peoples who is positive malaria.

In Papua there is 142 peoples who is poitive malaria and 36 peoples are death. In North Sulawesi there is 94 peoples who is positive malaria and 3 peoples are death.

Method that we use is systematic review. We take the data from the Direktorat Jendral Pengawasan Pangan dan Pengawasan Lingkungan To decrease the malaria , we must control like: Wearing the mosquito nets, doing larviciding (The control measure Anopheles larvae are chemically, using an insecticide), biological control (using fisheating larvae), management environtment, doing indoor residual spraying, and doing education for many people so that can decrease the malaria.

We hope this case that we discussed can be usefull for many people, so that tha case’s of malaria can be decrease significanly.

Regional chairperson : Ananta Siddhi Prawara anantasiddhi@gmail.com 081290187030

PUBLIC POSTER

You Heat The World, Malaria is Gonna Heat You Diponegoro University Background Malaria is a life-threatening disease caused by parasite called plasmodium which is transmitted by infected female Anopheles’s bite. WHO declared that the incidence of malaria from 2000-2015 has decreased by 37%.1 Riskesdas (Indonesian Basic Health Research) stated that Malaria prevalence in Indonesia has ironically increased two times greater from 2010-2013.2 Climate change is one of several causes that takes charge of malaria's reemerging. WHO also affirmed that the elevation of earth's temperature by 2-3 degree celcius would increase the number of people who are at risk of malaria by 3-5%. Deforestation is an environmental change that affects the occurance of malaria. Deforestation means cutting off the vector's habitat and breeding sites so they will migrate to our territory.3 Early malaria symptom's detection is an important role to eliminate the fatality rate. Malaria's symptoms are: x

Fever

x

Nausea and vomiting

x

Sweating

x

Diarrhea

x

Chills

x

Muscle ache

Objectives To inform people what can we do to keep ourselves, our beloved ones, and our environment safe from malaria, prevention is the key. These prevention is: 1. Identify and understand the symptoms of malaria.

2. Increase the active role of the community around you by creating a public post of malaria. Don't forget to make a clean and healthy environment 3. Use insecticides, insecticide-treated nets, and do fogging at places with high risk of malaria.

4. Use of prophylactic medication when traveling to malaria endemic places.

5. Always consult with the head of your community and your doctor if you find any malaria symptoms.

Sources; 1. WHO. Malaria. Retrieved from: who.int/malaria/en 2. Ministry of Health of Republic Indonesia. 2016. Profil Kesehatan Indonesia 2015 3. WHO. Climate change and infectious disease. Retrieved from: who.int/globalchange/climate/summary/en/index5.html

Contact details of Regional Chairperson : x Ananta Siddhi Prawara x anantasiddhi@gmail.com x +6281290187030

Stop Wildfire - Don't Let the Haze Damage Your Lung Rizka Febriana Fitrie, Ririn Puspita Faculty of Medicine, Universitas Sriwijaya, Indonesia Nowadays, climate change has become an ultimate threat to all regions around the world. Climate change itself refers to the rise in global temperatures. As the global temperature rises, the forest areas are becoming drier and more susceptible to be burned by the fire that started by lightning strikes or human activities. Besides that, climate changes also affect the weather pattern causing more intense El Niño. El Niño increases the likelihood that once wildfires started, they will be more intense and longburning. In Indonesia, Kalimantan (Borneo) and Sumatra are the areas that show the highest prevalence of fire spots. The wildfire causes damage to the trees and produces haze that increases air pollution that can affect human health. It mainly caused by the irritant effects of the haze to the eyes, skin, and respiratory system. This can cause various diseases in human body especially the lung.

Through this poster, we would like to inform the public about the bad impact of wildfire not just to the environment but also our health. This poster also provides several ways to protect the society from the bad impact of the haze. We also want to gain public awareness to fight against wildfire because those who save the lung of the earth also save the lung of the body. So, let’s stop the wildfire, restore the forest, and don't let the haze damage your lung!

Authors: 1

Rizka Febriana Fitrie

+62 812 71569160 rizkafebriana81@gmail.com 2

Ririn Puspita

+62 878 97549292 ririnpuspita54@yahoo.com

ABSTRACT

Wear A Mask that Covers More than Just Your Face Authors : Aditia Nurmalita Sari, Afifa Intifadha Habibatullah, Patricia Arindita Eka Pradipta, Yosefina Sonia Christya Kartika Sebelas Maret University, Surakarta

Background : Rapid industrialization and high population density make Indonesia vulnerable to the likely effects of climate change. Climate change is predicted to delay the monsoon season, which causes overall drier condition and may exacerbate forest fires. As temperature rises and the land becomes drier, not only the incidence of forest fires increases but also their duration and severity.

In Indonesia, forest fire (wildfire) is a very serious problem. According to World Bank, in 2015, more than 2,6 million hectares of forest and peat are burnt in Indonesia alone. This is very harmful, particularly in terms of health. When wildfire smoke is inhaled, it can irritate the respiratory tract and it can worsen chronic heart and lung diseases. Studies show that in the last quarter of 2015, as much as 100.300 cases of deaths are caused by inhalation of wildfire smoke.

The high number of deaths could have been reduced by a cheap way that can easily be done by all people, which is wearing respirators. Respirators are masks designed to reduce exposure to airborne contaminants. However, many people still use surgical masks instead of respirators because they are not aware of the difference. It is not recommended to use surgical masks as alternative because they are not designed to prevent inhalation of small airborne contaminants which are often not visible to the naked eye but still be capable of causing infection.

Objectives : We would like to promote the use of respirators instead of using regular surgical masks in order to reduce the incidence of deaths caused by inhalation of wildfire smoke.

References Kementrian Lingkungan Hidup dan Kehutanan, 2016. Rekapitulasi Luas Kebakaran Hutan dan Lahan Per Provinsi di Indonesia. Jakarta: Direktorat Pengendalian Kebakaran Hutan.

Koplitz et al. 2016. Public Health Impacts of The Severe Haze in Equatorial Asia in September October 2015. Environmental Research Letters. 11 (9). Doi: 10.1088/1748- 9326/11/9/094023 Occupational and Safety Health Administration, U.S. Departement of Labor, 2009. Respiratory Infection Control: Respirator versus surgical mask.

World Bank, 2015. Indonesia's Fire and Haze Crisis.

World Health Organization, 2015. Climate Change and Health Country Profile - Indonesia.

Author : Hadyan Zulfahmi H.H.,M.Rifqi Wiyono,Salma M.

Public Poster Abstract

Title of Poster : Drink Clean Water , Prevent Cholera Name of University : Airlangga University Background : indonesia as a developing country still have problem about sanitation especially in areas near water resource. This poor sanitation system cause the water contaminated. People that live near water resource sometimes drink this contaminated water without cook it first. People that drink this contaminated water will be easily attacked by cholera. Cholera is also an infectious disease, so as far as possible we should prevent it before incurred many casualties.

Objective : we hope this poster can make people know about the dangerous of cholera and how to prevent cholera.

Contact details of regional chair person : Name : Ananta shiddi prawara Email : anantasiddhi@gmail.com Phone Number : +6281290187030

REACH to Prevent Asthma Relapse Airlangga University

Climate change affected a diverse set of physical and biological system on the earth. Climate change encourage allergenic plants growth, so their pollination start earlier and longer. Climate change also make pollutants in the air stays longer, and cause heavier precipitation which carry many allergens.

Climate change is one of the factors that cause the number of asthma prevalence in Indonesia is increasing from 3.5 in 2007 to 4.6 in 2013. That’s why we proposed REACH to prevent Asthma relapse for the Asthma patient in Indonesia. REACH stands for Recognize your trigger, Exercise regularly, Avoid your trigger, Clean your environtment, and Healthy food consumption. We hope, our REACH movement can prevent asthma relapse in asthma patient in Indonesia. To be free of asthma relapse is not hard to REACH!

Regional Chairperson x

Ananta Siddhi Prawara

x

anantasiddhi@gmail.com

x

+6281290187030

Director of Authors x

Andro Pramana Witarto

x

andropramana37@gmail.com

x

+6287851449033

PCC EAMSC 2017 Cholera Simple but Deadly Indira Syahraya, Audi Salman Faza, Airlangga University, Faculty of Medicine, Indonesia

Background The rainy season has come early this year as Indonesian saw their first rain approximately one week ago. The rain has brought us many problems this year as well, and cholera is one of those many problems that usually come with the rainy season. The main problem of cholera is that it is linked to access of safe water and sanitation. The flood which usually occur during the rainy season, is making our water less sanitary than before considering the fact that many of our citizens do not always throw away their garbage in the place provided for them. It should be our concern to prevent this deadly disease before it kills many of our people.

Objective This poster is made in the hope that our citizen becomes more aware about cholera and that if possible it can minimize the number of people infected with it. To make a preventive effort in order to make an even more healthier country.

Contact details of Regional Chairperson Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Changing Climate, Approaching Dengue Airlangga University Dengue is a mosquito-borne disease that has spread widely in the world and especially in Indonesia.

Every year, many people are getting this disease. This disease usually occur during the rainy season. People having this disease usually takes about 10 days to heal completely. This means during that time they are unable to do anything, and this can be very disturbing for most people.

Dengue can’t be annihilated completely, but it can be prevented to reduce its effect. There are many ways to prevent dengue, and some of them are very simple yet usually neglected by most people. This poster can show the public some ways to prevent dengue in hope that it can reduce the number of this disease’s victims, especially in Indonesia.

Preventing Dengue with DR. CWABE AIRLANGGA UNIVERSITY, INDONESIA Lie Leonardo S. NIM. 011611133075 Canti Permata P. NIM. 011611133177 Qonita NIM. 011611133231 Tasca Rizkina M. NIM 011611133116 Dengue Hemorrhagic Fever is an endemic disease caused by mosquitos, such as Aedes Aegepty.

These characteristics are colored striped and usually live in water reservoirs. Number of patients with DHF always increase gradually, especially in the rainy season and in the tropical and sub-tropical country like Indonesia. The data from WHO shows that Asia ranked first in the number of dengue fever patients. It means, the spread of this disease needs more attention. Indonesia in 2014 there were 71.668 people with DHF and 641 of them died. Whereas in 2016, patients DHF more in children aged 5 until 14 years old. Approximately 43,44% of patients are at this age. The symptoms usually fever about 2 to 7 days and raised red spots on the skin. As illustrated in our poster, there are three steps to prevent the distribution of Dengue Hemorrhagic Fever. The first step is draining the bathroom regularly. Drain the bathroom will help you decrease the amount of the wiggler in the bathub, because Aedes Aegepty lives in the clean area, so we need to do it regularly. Second, close the water storage to prevent the mosquitos reproducing. The last one is Bury the unused goods. By eliminating the trash such as plastic, can, bottle, and another trash which is used for mosquitos breeding, we can prevent the Dengue Hemorrhagic Fever spreading. Our poster was created to make people realize that small things could change a big thing, that prevention is better and a lot cheaper than the treatment. Our education targets are housewives and maids, because they are the arranger of the house. By educating the housewives and maids we can help a family, including the father, the childs and the other householder inside. By creating this poster, we hope that people aware about this “simple but dangerous” disease more and they know what to do to prevent the spreading of this disease.

Author: Lie Leonardo S. (089613209999) leonardosoegyono@gmail.com

Abstract 5 Preventive Ways to Avoid Cholera Nabilah Hasna Imami; Fatimatuzzahro ; Finna Permata Putri Our public poster is about how to avoid the transmission of cholera. Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Cholera remains an important public health problem, especially in Southeast Asia Region.

Many countries in the Southeast Asia Region face challenges with known risk factors for cholera outbreaks including poverty, lack of development, and high population density. Additionally, the region is susceptible to extreme enviromental factors, such as frequent and widespread flooding, that can contaminate water sources and dislocate populations.. These conditions, especially in Indonesia, are common and need to be reduced. As medical students, informing people about the preventive ways to avoid the transmission of cholera is believed as one of the methods to prevent the number of cholera cases in Indonesia to increase. With five easy steps, which are drinking safe water, washing hands with soap, using latrines or burying feces, cooking food well, and cleaning up safely, the transmission of Vibrio cholerae could be prevented.

Regional Chairperson Contact Details: Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Schistosomiasis The Third Deadly Tropical Disease Aburizal Dwikatmono Johan NIM 011611133058 Salsabilla Zahra Prasetya NIM 011611133043 Hana Letitia Anjani NIM 011611133084 Schistosomiasis is a tropical disease caused by parasit from genus Schistosoma .This third most devasting tropical disease in the world caused mortality and morbidity. Schistosomiasis in Indonesia is only found in a remote area of Central Sulawesi named Napu Valley – Besoa, Poso Regency and Lindu Plateau, Donggala Regency. Climate changes make some phenomenon such as flood that can make Schistosoma which life in the watery place and use snail as the vector easy to infect human body.

Schistosomiasis is a parasistic disease caused by trematodes of the genus schistosoma. This disease is the third most devastating tropical disease in the world after malaria and intestinal helminthiasis Estimated 700 million people are at risk of infection in 76 countries where the disease is considered endemic as their agricurtular work, domestic chore, and recreational activities expose them to infested water. Schistosomiasis is due to immunologic reactions to schistosoma eggs trapped in tissues.

Symptoms and signs depend on the number and location of eggs trapped in the tissue. Eggs can end up in the skin, brain, muscle, adrenal glands and eyes.

In Brazil and Africa, refugee movements and migration to urban areas are introducing the disease to new locations.

Chairperson : Salsabilla Zahra Prasetya (082141559540) salsabilla.zp@gmail.com

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Prevent Malaria Indonesia (Ayu Maghfira, Chorisma Permata, Putu Gea, Refara Tinezia) Nowadays, climate change becomes a popular topic which everyone most likely to discuss be cause climate change affects humans life directly. We should know that extreme climate changes will give us bad or even dangerous effect.

As we all know, climate change directly affect healthiness, agricultural, and economy sector. I n this context, we would like to describe climate change’s effect on healthiness. There are some diseas e which caused by climate change such as diarrhea, malaria, upper respiratory tract infection, etc. on this poster, we will focus on Malaria which is increasing because of climate change.

Indonesia is a tropical country and very fragile to regional or global climate changes. Macro a nd micro climate change could give some effects on contagious disease’s spreading, especially diseas e with mosquitoes as its vector such as malaria. We know that nowadays the rainfall’s pattern in Indo nesia is very fluctuating. The raising humidity and temperature level increases Anopheles mosquito’s population.

Malaria is a disease caused by protozoa infection from plasmodium genus with Anopheles mo squitos as its vector. There are some symptoms of malaria: high fever, headache, nausea, shortness of breath, unconscious, diarrhea. Actually, in this situation (the extreme climate change) we could preve nt malaria by keeping cleanliness and hygiene that will make Anopheles mosquitos won’t bite us and spread the infection in our body and also reduce their population.

This poster is intended to give people awareness of malaria that is caused by Anopheles mosq uitoes which grow faster because of the climate change. We hope that everyone who see and read this poster comprehensively will get more information to do a preventive action. Hopefully, malaria diseas e will be decreased to zero so people will be free from malaria.

Ananta Shiddhi Prawara (anantasiddhi@gmail.com/081290187030) Putu Gea Rini Dian Pratiwi (rinigea22@gmail.com /085338266669)

BEAT MALARIA WITH READ AND CHECK By :Beny P, Tiffany K, Elsha S University of Airlangga

Climate change affects not only the weather duration, but also animal’s life cycle. Indonesia, being the home of thousands of animal species, is also home to the mosquito Anopheles Sp. which is also known as the malaria’s vector. As climate change my means longer duration on rainy season or sunny season, it also means that more the number of Anopheles mosquito can be doubled or triple. Malaria threatens the life of Indonesia’s population. The mortality rate of malaria is one out of ten infected people, and the rate is even higher in East Indonesia. This is why we proposed the READ AND Check act so that we can beat the malaria with READ AND CHECK, which stands for Recognize the vector, AvoiD the bite, understAND the symptoms and CHECK to the doctor. Our main aim is for this four little steps may help to reduce the mortality rate of malaria in Indonesia and erase Indonesian’s mindset that preventing malaria is hard. To better and healthier Indonesia, beat malaria with READ AND CHECK! Chairperson Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

#LETMEBREATHE Poster Abstract

Authors: Amalia Citra (PD2016) Afhama El (PD2016) Fabilla Faiz (PD2016) Meiwinda Rizky (PD2016) Rania Tasya (PD2016)

The title of our poster is #LetMeBreathe followed with the slogan ‘Save the Earth to Save Your Health’.

The theme is about the health-effects of climate change. As we know, nowadays climate change has become a serious issue in Indonesia. The fire in the woods is one of the impact of the extreme climate change that happens in Indonesia, to be specific. And we represent the fire in the woods with the picture of the ‘burning earth’. This fire is really hard to control by the sector area’s fire fighters, and make the smoke grows bigger and bigger in a short period of time. The smoke can really disturb the environment surroundings because it is really hard to distinguish or even to stop it, and this can make a extremely bad impact to people’s health leading to the serious health issue. The health issue caused by it, is the Acute Respiratory Infection or ARI, and in Bahasa mostly known as Infeksi Saluran Pernapasan Akut or ISPA. By using this poster, we set the general public as our target to be educated about this serious issue. Our action plan is that to make people realize that we need to stop the earth from ‘burning’ and producing smoke that can interfere our respiratory system by stressing in the line ‘Save the Earth to Save Your Health’.

small, crawl, fall

SIOSIS E B A B S I MOS S A L P A SE N A E A S I D E S LYM I S O I H C I EHRL

Angelica Diana Vita & Felicia Klarin

ABSTRACT TICKS

by Angelica Diana Vita and Felicia Klarin Nowadays, climate change is one of the biggest issues that we are facing. Climate change refers to a change in regional average weather or the Earth’s average climate. It is very likely that this change is caused by human activities that release excessive green-house gases to the atmosphere.

Apparently, climate change has an impact towards human health. It causes the risk of vector-borne diseases to increase, as the amount of the carriers increases too.

One of the vectors that transmits the infectious diseases is tick. Ticks are small arachnids which require blood meals to complete their complex life cycles. With the uncertain change of climate, mostly in a mild weather, ticks can grow much faster. Ticks can cause several diseases, such as : 1. Anaplasmosis, which is transmitted by blacklegged tick.

2. Babesiosis, which is transmitted by blacklegged tick.

3. Ehrlichiosis, which is transmitted by the lone star tick.

4. Lyme disease, which is transmitted by the blacklegged tick As a way to prevent, we could: 1. Wear bright colour clothes.

2. Cover up your body with long sleeve top and trousers.

3. Check your pet’s hygiene regularly.

4. Spray bug repellents.

When prevention does not work, there are some solutions and ways to treat the bite. The type and dosage of the treatment should depend on which pathogen that has been transmitted to the patient (for instance, Borrelia species of bacteria) and specific treatments –such as antibiotics and local cleaning- are recommended.

Tick-borne disease cases are majorly found in Europe and America, but few cases have been spotted to happen in Indonesia. So, this poster is made to raise public awareness of ticks' harm, so that the anticipation could be in a maximum state.

Abstract Dengue fever is one of the most concerning health problems in Indonesia. For this time, there are no medicines or vaccines found to prevent this disease from manifesting. Rigorous studies are still conducted intensively. Hence, vector prevention and control efforts become very important. Pupa index was the indicator to conduct surveillance, measure Aedes aegypti population density and predict transmission risk. Pupa index was used to measure HPI, CPI, pupae/person, pupae/house, and pupa/ container. This research is aimed to determine the biggest reproduction habitat, population density and pupae percentage in five sub districts in DKI Jakarta; Johar Baru (Central Jakarta), Tanjung Priok (North Jakarta), Kramat Jati (East Jakarta), Kebun Jeruk (West Jakarta), and Cilandak (South Jakarta).

The result of this study showed various reproduction of Aedes aegypti pupae habitat. They were water containers (bathtub, lavatory, drums, jars, buckets, tubs ablution and bath water litters) and nonwater containers (used goods, unused wells, vase, flower pots, pool, and aquarium, drinking birds, dispenser and bath tub) and natural habitats (pieces of bamboo and leaf midrib). The mean value of pupae index in five research regions were CPI=8.45%; HPI=23.98%; pupae/person=0.65; pupae/ house=3.58; and pupae/container=0.96. There’s an index number consistency in all research regions.

If the HPI index is high, the other pupae indexes will be high too. Hence, we offer the awareness poster titled Compass: Concern in the prevention of Aedes Aegypti, which campaigning the 3M program: drain the tub (menguras), close water tank (menutup) and bury tin cans (mengubur).

Keywords: Aedes aegypti, Compass, Prevention, Dengue Fever Written by Ainur Rahmah Trisnawati Margareth Ayu Caroline Pangkerego Ayu Rahmanita Putri Eka Candra Setyawan Alviano Satria Wibawa

L dis yme ea se

WEST NILE VIRUS

MALA RIA

bites by g u b g Avoidin ect repellent s using in

dengue fever

actions

covering expo s

ed skin with long-sleeved shirts, long pan ts, and hats.

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COO RD WITH INATION PUBL IC

PUBLIC POSTER’S SHORT DESCRIPTION

CLIMATE CHANGES INCREASED NUMBER OF INSECTS

We knew that when the climate changes, we confuse that sometimes it is hot outside and sometimes it rains a lot. In that case, so many insects come out from their nest because it is too hot inside or their nest is overflow. Some of those insects are mosquitoes.

Mosquitoes have so many species in this world. They are small, midge-like flies and constitute the Culicidae family. Ober 3500 species of mosquitoes have already been described from various parts of the world. Mosquito can cause so many disease such as malaria, west nile fever, lyme disease, and dengue fever.

That’s why we should avoid that worst case by doing action avoiding bug bites by using insect repellent, covering exposed skin with long sleeved shirts, long pants, and hats, and for the governors should coordinate with their public.

Authors

: 1. Cantika Putri Melyana 2. Kevin Alvaro Handoko

Rise the Temp, Rise the Risk Yohanes Krisnantyo Adi Pinandito Universitas Airlangga, Surabaya, Indonesia Size and Orientation: Size: A3 Orientation: Portrait Global warming is the increase in the average temperature of the Earth's atmosphere and its oceans, a change that is believed to be permanently changing the Earth’s climate. While many view the effects of global warming to be more substantial and more rapidly occurring than others do. The average temperature of the Earth has risen between 0.4 and 0.8 °C over the past 100 years. The increased volumes of carbon dioxide and other greenhouse gases released by the burning of fossil fuels, land clearing, agriculture, and other human activities, are believed to be the primary sources of the global warming that has occurred over the past 50 years The direct impact from global warming is melting the glaciers and rising sea levels. Forest, farms and cities will get new problem such as heat waves and flooding which could impact to disease to human.

And allergies, asthma and infectious disease because higher levels of air pollution, and the spread of

conditions favorable to pathogens and mosquitoes.

In 2015, Indonesia experience one the Worst country’s air pollution because fire forest. And the effect of the fire forest is upward of 75,000 cases of upper respiratory infection.

With this poster, hopefully that public will more careful with the environment. Because what public do in their activity, will impacted to the climate change and global warming. And in long term, the climate change will impacted to the health of public. Don’t underestimate with higher temperature. Because it’s only the sign of the worst disaster that could be happen.

Source: Amato, G.D. et al., 2013. Climate change , air pollution and extreme events leading to increasing prevalence of allergic respiratory diseases. , pp.1–9.

“Major Atmospheric Emissions from Peat Fires in Southeast Asia during Non-Drought Years: Evidence from the 2013 Sumatran Fires,” Center for International Forestry Research, 2014, http://www.cifor.org/library/5025/major-atmospheric-emissions-from-peat-fires-in-southeast-asiaduring-non-drought-years-evidence-from-the-2013-sumatran-fires https://www.nrdc.org/stories/global-warming-101

Dengue Fever The Bone Crusher Authors : Fabilla Faiz Arifin, Nadya Rinda Eka Rana, Reyhana Khansa Mawardi, Sekar Ayu Larasati Hari Subagia Medical Faculty of

Universitas Airlangga

Climatic changes over recent decades have already had numerous damaging impacts on human health. Spreading infectious disease, longer and hotter heat waves, and extreme weather will all claim thousands of additional lives nationwide each year. Likewise, there will be impacts on human health. Dengue is the most rapidly spreading mosquito-borne viral disease in the world.

In the

last 50 years, incidence has increased 30-fold with increasing geographic expansion to

new countries and, in the present decade, from urban to rural settings. An estimated 50 million dengue infections occur annually and approximately 2.5 billion people live in dengue endemic countries. Since 2000, epidemic dengue has spread to new areas and has increased in the already affected areas of the region. In 2003, eight countries -including Indonesia- reported dengue

cases. In Indonesia, where more than 35% of the country’s population lives in urban

areas, 150 000 cases were reported in 2007 (the highest on record) with over 25 000 cases reported from both Jakarta and West Java. The case-fatality rate was approximately 1%.

Dengue fever is transmitted by the bite of an Aedes mosquito infected with a dengue virus.

The mosquito becomes infected when it bites a person with dengue virus in their blood. It can’t be spread directly from one person to another person.Symptoms, which usually begin four to six days after infection and last for up to 10 days, may include high fever, severe headaches, pain behind the eyes severe joint and muscle pain, fatigue, nausea, skin rash, which appears two to five days.

So, by our poster, we want people are more aware of the danger of dengue fever and they can prevent this disease by their actions, they can minimize the area for mosquitoes breeding. Then, Indonesia can decrease this epidemic especially when rainy season comes.

Regional Chairperson : Rendra Dwi Director of Authors

: Sekar Ayu Larasati Hari Subagia

( E-mail : jbeauty77@yahooo.co.id Phone : 085732293250)

SAVING OUR FUTURE GENERATIONS - Climate Change and Medicine Background Climate change is one of the most phenomenal environmental topics to be discussed these days.

As we can see that as time goes by, our environment changes a lot.

We can see it’s happening right now, that air pollution can cause global warming and changing climate for the worse.

These changes are detrimental for the environment. The temperature increased because the global warming is heating up the atmosphere and make a vast amount of ice in the poles melt. On the other hand, climate changes can also cause lifethreatening impact, such as stronger hurricanes and more severe hurricanes Climate changes are threatening global population’s health. Many fatal diseases can be directly or indirectly influenced by the climate changes.

For example: climate change can cause the air pollution, and the air pollution itself can cause a lot of diseases, such as respiratory infection disease, pneumonia, pleurisy and many more.

Therefore, we want to warn people, especially around us to be more concern about the effects of climate change now and in the future.

Objective With our poster, we are aiming to increase the awareness of the masses concerning climate changes and its effect on human health. We hope that numbers of people who suffered from the climate change diseases will decrease each year.

Authors: 1.

Ayu Maghfira Nida Putri 2.

Denilia Limawan 3.

Fatimah Zahra 4.

Ferdiansyah Sultan Ayasasmita Rusdhy as the regional chairperson and director of authors 5.

Indira Huvi Contact information: fardiasultan7@gmail.com 0811398093

(011611133017) (011611133098) (011611133067) (011611133171) (011611133202)

WARRIORS WARY OF LEPTOSPIROSIS IN THE RAINY SEASONS Airlangga University Leptospirosis is the most wide spread zoonosis worldwide; it is present in all continents except Antarctica and evidence for the carriage of Leptospira has been found in virtually all mammalian species examined especially rodents. Humans most commonly become infected through occupational, recreational, or domestic contact with the urine of carrier animals, either directly or via contaminated water or soil. Leptospires are thin, helical bacteria classified into at least 12 pathogenic and 4 saprophytic species, with more than 250 pathogenic serovars. Immunity following infection is generally, but not exclusively, mediated by antibody against leptospiral LPS and restricted to antigenically related serovars. Vaccines currently available consist of killed whole cell bacterins which are used widely in animals, but less so in humans. Current work with recombinant protein antigens shows promise for the development of vaccines based on defined protective antigens. The cellular and molecular basis for virulence remains poorly understood, but comparative genomics of pathogenic and saprophytic species suggests that Leptospira expresses unique virulence determinants.

However, the recent development of defined mutagenesis systems for Leptospira heralds the potential for gaining a much improved understanding of pathogenesis in leptospirosis.

Leptospirosis is spread almost in the whole territory of Indonesia, lying in the province of West Java, Central Java, Yogyakarta, Lampung, South Sumatra, Bengkulu, Riau, West Sumatra, North Sumatra, Bali,NTB, South Sulawesi, North Sulawesi, East Kalimantan and West Kalimantan.

Death rate of leptospirosis in Indonesia, reaching 2.5 to 16.45%. On age more than 50 years of death rate reaches 56%. In some publications death rate reported between 3-54% depending the infected system organs (Zulkoni, 2011). Recorded outbreak occurred in Riau (1986), Jakarta (2002), Bekasi (2002), and Semarang (2003) (Kunoli, 2013). In 2010 there were 54 cases with 10 people dead, and the highest incidence occurred in 2007, with 667 cases (Nurhadi, 2012) Leptospirosis is environmental problems that exist around us. Environmental conditions especially the condition of the river in the city of Surabaya were very poor condition, the amount of garbage and waste from the careless disposal plant polluting the river water. Coupled with the weather conditions of late are often rains. thus causing a lot of puddles, rivers were overflowing and the rat population that tends to have a lot in Surabaya worsen causing leptospirosis. Our goal to make a public poster on the theme of leptospirosis in order to increase public awareness on the importance of maintaining personal and environmental hygiene in order to minimize the disease's particularly leptospirosis.

Keywords Indonesia; Leptospira; Leptospirosis Reference : http://cmr.asm.org/content/14/2/296 Suhella M. Tulsiani, et all. Attenuation in Leptospira strain collections. Veterinary Microbiology, Volume 148, Issues 2–4, 24 March 2011, Pages 453-454 http://eprints.ums.ac.id/41309/5/BAB%20I.pdf Author : 1. Anggita Putri Samara 2. Dinda Chandra Yuliantari 3. Karina Ayu Nilamsari 4. M. Hanun Mahyuddin

AMSA : Aware of Melanoma Skin-cancer with ABCDE Airlangga University Surabaya, East Java, Indonesia Indonesia is one of tropical countries. This tropical climate has impact in Indonesia, therefore there are two seasons in Indonesia, rain and dry season. Recently, the changing of seasons in Indonesia become uncertain, so there is a time when long dry season occurred in Indonesia. The long dry season with unusual heat of the sun makes impact likes drought, wildfire, and one of all impact is melanoma skincancer. The heat of the sun contain of Ultraviolet (UV) exposure which very dangerous for human’s skin and could cause melanoma skin-cancer. Melanoma cancer is in number five of the most dangerous cancer in Indonesia, which every year causes a lot of death.

In this poster, we wanna tell how to aware the melanoma skin-cancer with simple and easy way.

The method is basically just observing. But in this observation we made it more clear by show what should be observed specifically. What should be observed to aware of melanoma easier, in this poster, we call it ABCDE checklist. ABCDE checklist is defined as Asymmetrial Shape, Border, Color,, Diameter, and Evolution. By observe those five indicators we will able to tell whether it is normal moles or melanoma skin-cancer which those two look similar.

Team : Wega Yusan Wira Perdana Yunita Ratri Adhiningsih Agnes Ilene Suprapro Puteri

Title of Poster

: Be “SAFE” to Keep Malaria Away

Name of University

: Airlangga University

Created by

: Adinda Sandya Poernomo Margareth Ayu Caroline Pangkerego Abstract

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. In 2015, 95 countries and territories had ongoing malaria transmission; about 3.2 billion people – almost half of the world’s population – are at risk of malaria.

Children under 5 years of age and pregnant women are the worst affected by malaria. It is one of leading causes of death among children. Together with pneumonia, diarrhea, measles and malnutrition, malaria is responsible for over 70% of deaths in children, especially in developing countries. Malaria during pregnancy causes severe maternal illness and anemia, and is also associated with low birth weight among newborn infants, a leading risk factor for infant mortality. Despite its negative sides, malaria is preventable and curable. Increased efforts are dramatically reducing the malaria burden in many places.

Therefore, hereby we present a poster called Be SAFE to Keep Malaria Away. Our tagline, SAFE stands for: x

Stay covered by wearing protective clothing (long pants and long-sleeved shirts) to avoid mosquito bites

x

Anticipate mosquito by using insect repellent with DEET (N, N diethylmetatoluamide). The American Academy of Pediatrics (AAP) and other experts suggest that it is safe to use a repellent that contains 10% to 30% DEET on children older than age 2 months

x

Fully closed by sleeping under bed nets (mosquito netting) sprayed with or soaked in an insecticide, staying inside when it is dark outside and keep the doors closed.

x

Eliminate mosquito by draining the tubs, burying unused tin cans and closing water tanks that where mosquito possibly lays eggs.

Keywords: mosquitoes, malaria, malaria preventions

Sources: UNICEF. 2000. The Presciber: Malaria Preventions and Treatment. New York : UNICEF, Programme Division, 3 UN Plaza http://www.webmd.com/a-to-z-guides/tc/malaria-prevention#1. Accessed on October, 21th 2016 5.25 PM http://www.who.int/gho/malaria/en/ Accessed on October, 21th 2016 6.03 PM http://www.who.int/malaria/publications/world_malaria_report_2013/en/ Accessed on October, 21th 2016 6.08 PM

How to check melanomas

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B

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Know your ABCDE'S

C D E What Cause

SKIN CANCER Afra Jufri - Afiel Nadhifa - Crysciando

preventions

Use sunscreen with minimun of SPF15 to prevent uv rays to attack you at all times Wear umbrella to avoid sun rays on a little to sunny weather Use sunglasses with UV protection

ABSTRACT Skin cancer is the most common of all human cancers, with 1 million people in the U.S. diagnosed each year with some type of the disease. Like many cancers, skin cancers start as precancerous lesions. These precancerous lesions are changes in skin that are not cancer, but could become cancer over time. Medical professionals often refer to these changes as dysplasia.

There are three major types of skin cancers: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. The first two skin cancers are grouped together as non-melanoma skin cancers. Other unusual types of skin cancer include Merkel cell tumors and dermatofibrosarcoma protruberans.

Melanoma is the most dangerous form of skin cancer, these cancerous growths develop when unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds) triggers mutations (genetic defects) that lead the skin cells to multiply rapidly and form malignant tumors.

These tumors originate in the pigment-producing melanocytes in the basal layer of the epidermis. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white. Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease. Melanoma kills an estimated 10,130 people in the US annually.

Both UVA and UVB rays are dangerous to the skin, and can induce skin cancer, including melanoma. Blistering sunburns in early childhood especially increase risk, but sunburns later in life and cumulative exposure also may be factors. People who live in locations that have more sunlight — like Florida, Hawaii, and Australia — develop more skin cancers, but some more northern locations with light-skinned populations also have a high number of skin cancers. Avoid using a tanning booth or tanning bed, since it increases your exposure to UV rays, raising your risk of developing melanoma and other skin cancers.

PUBLIC POSTER ABSTRACT Title of Poster : STOP DIARRHEA WITH “ASSES” Name of Chapter : Climate Change in Medicine Background : 2.4% of all diarrhea cases in Indonesia are caused by polluted water which is caused by climate change. Climate change is making heavy intense downpours and increasing water temperature.

Bacteria and viruses thrive this new condition and they come in contact with human causing numerous diseases, including diarrhea.

Objective : Socializing how to prevent diarrhea to the public by following “ASSES”: A : Access to safe drinking water S : Sanitation improvement S : Soap usage in washing hands E : Education about diarrhea and its symptoms S : Sterilize benchtops, stove tops, and chopping boards Authors : • Nathanael Jordan (011611133021) as the Director of Authors • Arlia Ayu (011611133074) • Della Anastasia Candra (011611133078) Contact : Nathanael Jordan nathanael.jordan@outlook.com 085286878777

DENGUE FEVER SYMPTOMPS AND PREVENTION Faculty of Medicine, Airlangga University

Background: Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Dengue is spread by several species of mosquito of the Aedes type, principally Aedes aegypti. An estimated 390 million dengue infections occur worldwide each year, with about 96 million resulting in illness. There are three phase of the symptomps. First, febrile phase. The febrile phase is a phase which the person feels the symptomps early. In ths phase, the person will get diarrhea, followed by nose bleeding, headache, rash, vomiting, and sudden-onset fever. The next phase is critical phase. We can called this phase with “climax phase”. In this phase, the person will get hypotension, ascites, and pleural effusion. The last phase is recovery phase. Recovery phase is a phase that the person will experiencing the stages of healing. In this phase, the person will get a seizures, itching, and a slow-heart rate. After knowing the symptomps, we should know how to prevent the fever too. There are seven ways to prevent the fever; personal protection, reduce mosquito’s habitat, ensure the windows are closed, vector control, empty unused container, natural methods, and top up all detective ground surface.

Objective : The purpose of making this poster is to educate people about the symptomps of dengue fever and how to prevent it.

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Dengue Fever is More Dangerous than You Think

Airlangga University ( Jonathan Alvin Wiryaputra, Sekar Afifah Priandini, Nabila Putri Wardhani, Dinda Puspita Nurlistyani) Aim To give the readers exposure about how widespreaded dengue fever is in Brazil.

Background Clinical indications of dengue shift in various zones of endemicity and between particular age bunches, while indicators of result have stayed dubious. In Brazil, the sickness load overwhelmingly influences grown-ups, with an expanding pattern toward movement to dengue hemorrhagic fever (DHF) noted Methods Patients were ordered by seriousness of their infection. Relationship of counter acting agent reactions, viremia levels (as controlled by ongoing polymerase chain response [PCR]), and serotypes (as dictated by multiplex PCR) with malady seriousness were assessed Results Of the 185 symptomatic patients >14 years old who had an affirmed instance of dengue, 26.5% and 23.2% were named having middle of the road dengue fever (DF)/DHF (characterized as interior drain, plasma spillage, showed indications of stun, as well as thrombocytopenia [platelet number, ⩽50,000 platelets/mm3]) and DHF, individually. The onset of halfway DF/DHF and DHF happened at a late phase of sickness, around the time of defervescence. Patients with DHF had anomalous liver protein levels, with a >3-overlay increment in aspartate aminotransferase level, contrasted and the scope of qualities thought to be ordinary. In general, 65% of patients gave optional contaminations with dengue infection, with such disease happening in comparative extents of patients in each of the 3 ailment classification bunches. Dengue infection serotype 3 (DV3) was the transcendent serotype, and viremia was distinguished amid and after defervescence among patients with DHF or transitional DF/DHF Conclusions Dengue fever is infected so many people, especially in tropical country because of the extreme climate change. http://jid.oxfordjournals.org/content/197/6/817.abstract accessed on October 21st 2016 at 3.45 p.m

UPPER RESPIRATORY TRACT INFECTIONS Lutfia Ariska R, Rizqianisa Burmana, Sarah Fauzia Faculty of Medicine, Airlangga University BACKGROUND Upper respiratory tract infection (URI) is a nonspecific term used to describe the common cold is an acute, communicable, viral infections involving the nose, nasal stuffiness, sneezing, coryza, throat irritation, paranasal sinuses, pharynx, larynx, trachea, and bronchi. The prototype is the illness known as the common cold, which is discussed here, in addition to pharyngitis, sinusitis, and tracheobronchitis. Influenza is a systemic illness that involves the upper respiratory tract and should be differentiated from other URIs. Most URIs occur more frequently during the cold winter months, because of overcrowding.

Transmission of organisms causing URIs occurs by aerosol, droplet, or direct hand-to-hand contact with infected secretions, with subsequent passage to the nares or eyes.8 Thus, transmission occurs more commonly in crowded conditions. Direct invasion of the respiratory epithelium results in symptoms corresponding to the area(s) involved.

OBJECTIVE This poster aims are to engage the community’s interest about upper respiratory tract infection (URI), provide easy ways for people to get information about Upper Respiratory Infection (URI), reveal issues, and raise awareness of URI in a way that is visual, inclusive and fun. This poster provide a visual display of an opportunity to prevent upper respiratory tract infection in general public with the easiest way. We use photo of people use mask because using mask is the easiest way to prevent upper respiratory tract infection (URI) such as sinusitis, influenza, rhinitis, colds, pneumonia, inflammation, and otitis media. The viruses and bacteria that cause respiratory tract infections (RTIs) can spread from person to person.

When someone with the infection coughs, sneezes, laughs or talks, the infection-carrying droplets become airborne and may infect others. So that’s why we suggest to use mask to prevent the viruses and bacteria spread. This will stop any infected droplets being transferred to a surface that others may potentially infecting them.

Sarah Fauzia sa.rahfauzia@yahoo.com +6287755576272

STOP MELANOMA CANCER WITH ABCDE Global warming is happening now! Earth become so totally different than before. There are a lot of changes, escpecially in climates and weather. Whole the world facing same problem because of the climate change. Temperature rising become more unpredictable and one of the impact can causing skin cancer.

Melanoma is a type of cancer that develops from the pigment-containing cells known as melanocytes. The primary cause of melanoma is ultraviolet light (UV) exposure in those with low levels of skin pigment. About 25% develop from moles but there is also melanoma cancer because of gene factor.

Melanoma is the most dangerous type of skin cancer. Globally, in 2012, it occurred in 232,000 people and resulted in 55,000 deaths. Australia have the highest rates of melanoma in the world. Average daily temperature in Australia in range 32 – 40 °C (90 – 104 °F). There are also high rates in Europe and North America while it is less common in Asia, Africa, and Latin America.

Melanoma has become more common since the 1960s and as time goes by, in the 21st century, when the sun become “more fierce”, melanoma will increase rapidly. Some symptoms of melanoma cancer in acronim “ABCDE” such as : x

Asymmetry

x

Borders (irregular with edges and corners)

x

Color (variegated)

x

Diameter (greater than 6 mm (0.24 inch, about the size of a pencil eraser)

x

Evolving over time

Some ways to prevent melanoma cancer are: -

Using sunblocks and long-sleeved shirt

-

Minimize outdoor activity when the sun shine fiercely

If you are a skin cancer suffer, some treatments perhaps can be the best option such as: -

Surgery

-

Chemotherapy

So, let’s STOP MELANOMA CANCER with knowing ABCDE!

Abstract

Disease spread by Aedes aegypti mosquitoes, dengue, is known to be endemic in Indonesia, a tropical country in southeast Asia. In this transition season, followed by climate change, mosquitoes breed faster than before thus making them overwhelmingly troublesome problem. Indonesia which is known as the second largest country with dengue fever case, should be more aware with this situation. Many of us surely have already known how to avoid the disease. But, can you socialize it easily? Can you teach it to your children quickly? We, medical students of Airlangga University, want to socialize '#DengueNever', an interesting and educative poster , to prevent the spread of dengue fever disease by using ‘CLAP’.

‘CLAP’ is our simple yet effective slogan, we're sure that everyone, from children to grandparents, will be educated enough to stop themselves from being infected with dengue fever. We hope that after we socialize this poster, the number of dengue case in every country, especially in the tropicals will decrease, which will make the world a better place to live.

Keywords: dengue, CLAP, mosquito

172 words

Look Around, Don’t Let It Drown Andi Asyura Alikha, Muhammad Arham Harun, Syauqi Darussalam Lutfi, Andi Tiara S. Adam Faculty of Medicine, Hasanuddin University, Makassar, Indonesia Short Description Climate change is real and so is the threat. Warmer temperatures due to climate change evaporate more water into the air as it holds more water, resulting in heavier downpours. In the last decade, floods cause enormous damage all over the world, claiming about 93,000 fatalities. While in Indonesia, within 2014, 108 floods were reported with water levels ranging from 10cm to 5m, affected more than 1,160,000 people with 52 fatalities.

Floods affect tropical countries in Asia the most, victimize 400 million Asians annually. But climate change enable floods to threaten those outside tropical regions. Louisiana for instance, that has not been flooded for decades suffered a nightmarish flood due to a heavy storm in August 2016. The National Oceanic and Atmospheric Administration and the World Weather Attribution said increasing global temperatures driven by human activity caused the Louisiana floods. They even claimed that climate change is doubling the odds of such a storm compared to in our preindustrial past say, 1900.

Increasing floods occurance is a serious issue, especially considering how floods pose terrifying health threats. Flood causes drowning, physical injuries, and even disrupts the supply of health services.

Flood also contaminates freshwater supplies, heightens risk of waterborne diseases like dhiarrhea and hepatitis, it even multiplies disease-carrying insects like mosquitoes.

Best way in facing flood threats is to be prepared and informed regarding possible floods and its consequences. Providing good irrigation and planting trees can prevent flooding in towns by 20%.

Combating climate change as the main contributor to this floods is also an absolute measurement to take.

Simply, adopting anti-climate change behaviors like reducing motor vehicles usage and unplug any unsued electrical devices can help reduce harmful gas and thus reducing the chance of flooding.

Predicting flood is impossible, but reducing the threat is possible.

Contact details Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

SAVE WATER, SECURE THE FUTURE Andi Muh. Firshan Makbul, Dhiya Muthiah Gaffari, Richard Holman Matanta Faculty of Medicine, Hasanuddin University – Makassar, Indonesia Water is one of the most important humans needs, as for 70% of human body is composed by water, and a daily intake of 1,5 liters of water is recommended. Water resource is also essential for producing food, clothing, and computers, moving our waste stream, and keeping us and the environment healthy. Water is undoubtly important for human, but there are still 1,1 billion people globally lack access to consumable water supply. Many of them still consume contaminated water. Unfortunately, this is resulting to deaths of thousands of people annually. Also, it contributes to 88% children death caused by diarrhea in all over the world.

In other hand, humans have proved to be inefficient water users (The average hamburger takes 2,400 liters, or 630 gallons, of water to produce, and many water-intensive crops, such as cotton, are grown in arid regions). While water sanitation is still a global health problem, climate change may exacerbate this effect. Climate change is making heavy intense downpours, droughts and rising water temperatures more common. This can alter the quantity and quality of our drinking and recreational water. Bacteria and viruses thrive in these new conditions and when they come into contact with humans, can cause numerous illnesses.

If we still continue to be an inefficient water users, by 2025, an estimated 1.8 billion people will live in areas plagued by water scarcity, with two-thirds of the world's population living in water-stressed regions caused by use, growth, and climate change. By doing little change like conserving water, can cause a big step towards reducing overall energy use. Because most everything that is made, transported and thrown away requires the use of fuel and water. So, what else are you waiting for? Do it now. Save Water, Secure The Future.

Contact details Andi Muh. Firshan Makbul makbulfirshan@gmail.com +6281242622535

Small Bite, Big Threat Andi Tiara S. Adam, Andi Asyura Alikha, Muhammad Arham Harun, Syauqi Darussalam Lutfi Faculty of Medicine, Hasanuddin University, Makassar, Indonesia Short Description Climate change projections show that both temperature and precipitation levels will increase and accelerate in the future over all of Southeast Asia. This process started in the 1980s, and has been increasing each year with ideal conditions for world's deadliest mosquito-borne diseases such as the Zika virus, dengue fever, and malaria. Even slightest changes in climate can increase disease transmission.

Research suggests that climate change directly affects mosquito-borne diseases by altering the immature mosquito development process, virus development and mosquito biting rates.

As an effect, transmission rates have increased since the 1980s. Nowadays, approximately 3.8 billion people are exposed to mosquitoes, with Indonesia as the ultimate hot spot for mosquito-borne diseases.

These diseases affect around 700 people, and even causing 1 million deaths each year. It could be disastrous for Southeast Asia, a home to more than 25 percent of global population, and this puts all their lives in jeopardy. Although transmission is common in tropical regions, with warmer climate, mosquito vectors and mosquito borne-diseases would increase in North America and Europe.

The best way to avoid mosquito-borne diseases is preventing mosquito bites and development process, for example by applying mosquito repellent, and cover or clean potential mosquito breeding sites. But now with our constantly changing climate, we must remember that climate change would lead to serious consequences, which makes combating climate change most essential in fighting mosquitoborne diseases. Therefore by replacing regular light bulbs to low-energy LED bulbs, replacing outside lights with specially designed low-energy “anti-bug” lights, and planting natural mosquito-repellent plants on your front porch will not only stop mosquitoes from entering your home, they also can combat climate change as well. It is best to start prevention from now, because one small bite is all it takes to cause big threats against human health.

Contact details Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Solution For Pollution Muhammad Arham Harun, Syauqi Darussalam Lutfi, Andi Asyura Alikha, Andi Tiara S. Adam Faculty of Medicine, Hasanuddin University, Makassar, Indonesia Short Description “I’m going out for a breath of fresh air” seems to be a phrase we often hear. Unfortunately today, that “fresh air” isn’t exactly fresh, thanks to the number of motor vehicles emitting deadly pollutants.

According to the Environmental Protection Agency, motor vehicles produce dangerous pollutants like NO, NO2, CO, and etc. Research suggests that motor vehicle emissions contribute to about 90% of air pollution as well as climate change.

The exposure from these pollutants will not only affect our environment, but also our health, by creating mild symptoms such as watery eyes, coughing, or wheezing. But, long term exposure will lead to severe respiratory irritation and diseases, including asthma, lung cancer, and COPD. As the result, air pollution created 3.7 million deaths globally, and 1.67 million of it occurred in Western Pacific and South East Asia. From the perspective of a citizen from this area, combatting this issue must become our priority.

Unfortunately, tackling this issue has become difficult especially for high risk countries such as Indonesia. Motor vehicles has grown by 10 percent every year, bringing the total of 16 million in 2016.

Secondly, vehicle owner are extremely dependent toward their vehicle even in short trips. Both factors combined in making unhealthy living pattern and even more polluted air.

However, there is one way to combat both the health and environmental issues air pollution created, which is bicycle. The Copenhagen cohort study stated that cycling reduced the risk of all-cause mortality by 28%, including the risk of developing cardiovascular and metabolic diseases, even cancers.

Not to mention that we can improve our air quality, reduce transport-related greenhouse emissions by 0.4%, and lower noise levels. With all these benefits, we believe that we can bring back the fresh air by reducing the use of motor vehicles, and start biking.

Contact details Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Put Your Sunscreen On Muhammad Reyhan, Richard Holman Matanta, Sari Miftahul Jannah Faculty of Medicine, Hasanuddin University Makassar, Indonesia

Abstract In the recent 50 years (1960-2010), earth’s temperature have been increased approcimately 0,6oC, while it has only been increased by 0,4oC in the preceding 100 years (1860-1960). This increase has some adverse effects to humans. Changes in temperature affects the weather, and results in the crops and food depletion Even more, it may affects the skin which is continously exposed to the enviroment- especially sunlight.

A clear correlation between skin cancer and climate change is proved by the increasing incidence of skin cancer, starting from 1960s. Skin cancer is a group of malignancy which may arrive from any types of cell in the skin (basal cell, melanocyte, etc) Ionizing radiation such as UVR may results in DNA damage and cause malignancy. Even more, immunosuppresive effect of UVR will worsen and assist the tumor metastasis.

One type of skin cancer which contributes to 75% of all deaths related to skin cancer is malignant melanoma Malignant melanoma has a poor response to chemotherapy. Poor prognosis results from this property, and difficulty of surgical therapy due to metastasis. Even in non-malignant melanoma, large freckles may causes aesthetical issue.

Because of its resistance to current therapeutic options, prevention is highly recommended rather than curative approach. It is recommended to minimalize direct sun exposurs. This method is effective, but would not meet people’s high activity. The simplest way to lower the risk of melanoma in climate change times while staying active, is by simply using the sunscreen. Recommended sunscreen with at least SPF 15 is enough to block 94% of UVR to the skin. Some study have shown that using the recommended sunscreen would lower the risk of melanoma by 50%. This cheap and easy method will for sure protects you from the emerging problem. So remember whenever you go outside, put your sunscreen on!

Source: 1.CDC - Sun Safety - Skin Cancer. (2016). Cdc.gov. Retrieved 4 October 2016 2.Sunscreens, E. (2016). EWG's 10th Annual Guide to Safer Sunscreens. Ewg.org. Retrieved4October 2016 3.Van der Pols, J., Williams, G., Pandeya, N., Logan, V., & Green, A. (2006). Prolonged Prevention of Squamous Cell Carcinoma of the Skin by Regular Sunscreen Use 4.Volkovova, K., Bilanicova, D., Bartonova, A., Letašiová, S., & Dusinska, M. (2012). Associations between environmental factors and incidence of cutaneous melanoma. Review.

Contact Details Director of Author, Muhammad Reyhan Rehangajah@gmail.com +628970232323

Think Before You Drink Syauqi Darussalam Lutfi, Muhammad Arham Harun, Andi Asyura Alikha, Andi Tiara S. Adam Faculty of Medicine, Hasanuddin University, Makassar, Indonesia Short Description Water is essential for our life. Living without water for more than 3 days is impossible. But the painful truth is that, we are unconsciously changing our source of life into the cause of death of millions of people by doing simple actions. As we drive our car or even charge our gadgets, we give constant contribution to climate change which apparently is the cause of water contamination.

Water contamination has worsen due to climate change. Climate change has risen the temperature, creating a warm and more hospitable environment for harmful microbes to grow in water. It has also led to heavier downpours and floods which often contain contaminants that can overwhelm water sources, and later increase the risk of exposure to microbes and other unhealthy pollutants. This contaminated water comes out of our taps everyday, known as ‘clean water’. It proves that our tap water is not always safe to drink. In fact in Indonesia, ‘clean water’ received by 1 of 5 does not meet WHO’s criteria for safe drinking water. As a result, consuming contaminated water has become the leading cause of numerous water-related diseases. According to WHO, 3.4 million people, mostly children, die from water-related diseases like diarrhea and thyphoid. While in Indonesia, diarrhea kills more than 100.000 children under five annually.

The best way to prevent those water-borne diseases is by preventing the contamination of the water we consume. We can start by reducing pollution, eliminating dumping and minimalizing the release of hazardous chemicals and materials. But tackling water pollution issues is not enough, we should also combat climate change as the main contributor. Simply adopting anti-climate change behaviors like reducing the use of motor vehicles and unpluging unsued electrical devices can help reducing harmful gas emissions. Act now, protect our water, secure our future.

Contact details Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Title of Poster You Heat More, You Kill More

Name of University Universitas Pelita Harapan

Authors 1. Sylvia Wijaya 2. Novia Lauren Sieto

Contact details of Regional Chairperson (Name, e-mail, and phone number) Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Background A 2007 World Wide Foundation (WWF) report suggest that there is an increase of mean annual temperature of about 0.3◦C in Indonesia each year.1 The climate change may translate into various health impacts such as droughts during times of decreased rainfall, leading to cases of undernourishment due to uncertainty in water and food provision.2 The increase in rainfall during wet season may lead to flooding, for example the Jakarta flood on 2 February 2007 that destroyed 70,000 houses and killed 69

people with losses amounted to Rp 4.1 trillion (US$ 450 million).3 The increase in temperature also favors mosquitoes to reproduce at faster rate, their eggs to hatch faster, and increases their blood-feeding frequency, resulting an increased transmission of vector-borne diseases such as malaria and dengue fever.4

Objective The aim of this poster is to enhance the understanding of impact of climate change among general public. The hourglass containing the melting earth aims to depict the situation in which we are trapped in a timeframe whereby we cannot avoid the consequences of global warming that has already taken place. However, as our tagline suggests, we could even make it worse by ‘heating’ it more through irresponsible carbon emission, causing even more massive consequences in a faster rate. The dry land, flooded house and mosquitoes represent consequences of climate change often faced especially in

Indonesia: drought, flooding, malaria, and dengue fever. By ‘heating’ more, we might exacerbate these consequences at a faster rate. All in all, through this poster we aim to increase public understanding of the dangerous health impacts of climate change that cost human lives and inspire them to reduce their carbon emission in order to slow down global warming and thus, minimizing its health impacts.

Reference 1

M. Case, F. Ardiansyah, E. Spector. 2007. Climate Change in Indonesia: Implications for Humans and

Nature. WWF International Climate Change Programme. Available online: http://awsassets.panda.org/downloads/inodesian_climate_change_impacts_report_14nov07.pdf 2

Wang, X., F. Chen and Z. Dong. 2006. The relative role of climatic and human factors in desertification

in semiarid China. Global Environmental Change 16: 48-57.

3

WHO (World Health Organization). 2007. Emergency and Humanitarian Action News Update,

February and March 2007. World Health Organization Regional Office for South-East Asia. Available online: http://www.searo.who.int/LinkFiles/Newsletter_EHA_February_and_March_2007.pdf 4

Epstein, P.R., H.F. Diaz, S. Elias, G. Grabherr, N.E. Graham, W.J.M. Martens, E. Mosley-Thompson

and J. Susskind. Biological and Physical Signs of Climate Change: Focus on Mosquito-Borne Diseases.

Bulletin of the American Meteorological Society 79: 409-417.

Title of Poster Leptospirosis UBD Authors 1st

: Gisela Winata

2

nd

: Tizander Mayvians

3

rd

: Thurain Leo

4

th

: Edward Edwin

Name of University Universitas Tarumanagara Background Climate change can be defined as a long-term change in the statistical of weather patterns includes temperature, precipitation, humidity, wind, and seasons as a result of the increase in average global temperature that last of extended period of time. And as we all know, Indonesia is best known for its raining season, in which flood is one of the common result to show the effect of raining season.

Leptospirosis is, one of the illness that might happened due to flood, a worldwide zoonotic infection with a much greater incidence in tropical regions and has now been identified as one of the emerging infectious diseases. Leptospirosis is caused by pathogenic spirochetes of the genus Leptospira, which is transferred to human by rats. As one of the illness that might happen due to flood, Leptospirosis also shows some signs and symptoms (example: fever, dry cough, diarrhea). According to Indonesian Health Department, untill November 2014, there were around 435 recorded cases of leptospirosis with 62 of them are death cases. In conclusion, the reason why we choose leptospirosis as our main theme is because as one of the tropical country, there are still many people who are not aware of the signs and symptoms of Leptospirosis while they are risking their life with their own behaviour towards flood.

Objectives We want to emphasize people’s awareness to flood as an effect to climate change in order to prevent Leptospirosis.

Contact details of Regional Chairperson Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Control Vector!

Imam Rahadian S Universitas Indonesia Our earth now is having a phenomenon named climate change. This phenomenon often called global warming where the climate on earth are changing caused by green house effect causing increased of earth temperature in a few decade. This condition is makes the vector (pathogen carry agent) in a good position.

In this case, the vector was the mosquitoes because they grow better on warm environment. Why mosquitoes? Because in WHO (World Health Organization) data, mosquitoes are killing more than one million people a year from their transmitted virus like malaria, dengue and yellow fever.1 recently we got a hot issue about zika virus who is transmitted by mosquito as a vector.

They are several easy things we can do to controlling vector. We can control mosquito breeding cycle or our behavior itself. To control mosquito breeding cycle we can remove anything that collect water. When I said about out behavior is taking care of ourself from mosquito bitten. For prevent mosquito bitten we can cover up our skin from mosquito by wearing proper suit.

I hope this poster might increasing our awareness for controlling population of the vector itself .

Refrence: 1.

WHO | Executive summary [Internet]. Who.int. 2016 [cited 23 October 2016]. Available from:

http://www.who.int/whr/1996/media_centre/executive_summary1/en/index9.html

ARE MICE WORTH YOUR LIFE? NADIFA KARTIKA DEWI, WORO AYU SEKARARUM, SYLVIA SUPARNO UNIVERSITAS PEMBANGUNAN NASIONAL ‘VETERAN’ JAKARTA

Climate change is a global problem requiring global solutions. It happens and felt in many regions, especially in Indonesia. Flood is one of the impacts of climate change. It is the most recent disaster in Indonesia that happens every year, causing devastating consequences to the environment and to the people. Flood can also transmit several diseases, one of them is leptospirosis. It is an infectious disease of humans and animals that caused by pathogenic spirochetes of the genus Leptospira. It is considered the most common zoonosis in the world and is associated with rodents in settings of poor sanitation involving fresh water, mud, or soil exposure. In humans, leptospirosis can cause a wide range of symptoms some of which may be mistaken for other diseases. Some infected persons, however, may have no symptoms at all. Without treatment, leptospirosis can lead to chronic illnesses and even death.

Indonesia is the 3rd highest in the world with Leptospirosis by flooding, in fact 435 cases in years and 62 childrens death caused by leptospirosis disease. The high incidence of leptospirosis and the late diagnosing of leptosirosis need special attention in the community, especially areas which are being beset by flooding. Therefore, we decide to make a poster about flood and leptospirosis in the hopes that it could raise people awareness about the danger of the flood in causing loss of life and also transmitting leptospirosis infection.

The main tagline of our poster is ‘are mice worth your life?’ which means leptospirosis can cause death. The background describes heavy rainfalls that caused flooding, where the number of leptospirosis is high. There is a water level indicator in the left side of the poster. The flood reached 2500, indicating that it is so severe; it could drown a whole city and caused loss of life. We picture a baby drowning to the flood to give a message that preventing the flood is important since it can cause the loss of the future of Indonesia. The loss of life can also cause by the leptospirosis disease, which is why we put mice in the bottom of the flood.

Name: Nadifa Kartika Dewi E-mail: nadifakartikadewi@gmail.com Phone: 087734054539

I Am Not On A Diet Malnutrition and World Hunger Due to Climate Change Shahnaz Medina, Tiara Nadya Putrianda, Regia Anadhia Pinastika Faculty of Medicine, Pembangunan Nasional University Jakarta, Indonesia Abstract : Climate change in the 21st century is progressing rapidly and has cause not only subtle changes in our world but also on human health. The impact of climate change on medicine is one of the most common etiology that worsen and created a vicious cycle in the progress of climate change. One of the most prominent impact is severe malnutrition, it has been linked to extreme-climatic events and one of the most important consequences of climate change.

The more severe and more frequent natural disasters and the unpredicted changes of weather have cause food crisis and water shortage and as a result malnutrition happens. In recent findings, The IPCC estimate, there will be 30 million more malnourished children as a result of climate change by 2050 and with temperature increases of 2OC an additional 30 to 200 million people will be placed at risk of hunger across the world.

Malnutrition have caused a domino effect and has been known as one of the “killer” trifecta of climate change along with other diseases like malaria and diarrhea. With malnutrition, not only it causes millions of death from lack of sufficient nutrients to sustain life, but it’s also increases the vulnerability to infectious diseases such as malaria and respiratory illnesses. This affect a lot of aspects even broader than the health itself, such as education and the world’s economy on the long term.

The purposed of this poster is to remind the public and future health practitioners to set their priorities straight, to raise awareness on the forgotten crisis that is malnutrition and to point out the importance of finding solutions for malnutrition as soon as possible. The sentence “i’m not on a diet” represents those who doesn’t have the liberty to choose their food, simply because the don’t have any.

Is The Sun Safe? Think Again.

Desiani, Mareta Kurnia. Lestari, Andani. Anisa, Nurul.

Sriwijaya University Background Global warming is a term to described gradual increase in the overall temperature of earth’s atmosphere generally attributed to greenhouse effect. Generally, this phenomenon caused by increased level of

CO2, chlorofluorocarbons, and other

pollutants. One of the result of global warming is ozone layer depletion.

Ozone layer is defined as colorless layer which chemically protect the earth and all living creature on it’s surface from damaging component of sunlight such as UV, especially UV C and most of UV B. Ozone layer has been become more depleted by years and formed an area called ozone hole. According to NASA, up until October 2016, ozone hole has reached 21 million km2 and might become wider if this phenomenon not given special attention.

Increasing of ozone hole can give impact on human health. One of the most specific impact is increasing skin cancer incidence. In this case, UV radiation is not the only predisposing factor towards skin cancer, indeed. But also lifestyle as people around the world bound more in sun-seeking activity without protection and tendency of people nowadays to consume junk food.

UV radiation (UVR) specifically is one of the predisposing factor for squamous cell carcinoma, basal cell carcinoma, malignant melanoma, and other skin cancers. Study in United Kingdom stated, most likely 86% of melanoma associated with UVR. WHO also stated that approximately 90% of non-melanoma skin cancer associated with UVR. This number might increase as global warming is getting worse.

Objective With this poster, the authors hope can educate people about the damaging effect of UVR and make them aware of skin cancer threat. Also to educate them to use some protection like hat, umbrella, or sunscreen to decrease risk of skin cancer.

“Don’t Let the Cold Burn You!” Tania Prima Auladina, Verrell Christopher Amadeus, Kriswahyu Yudo Wirawan AMSA-Universitas Gadjah Mada Technology advancement has brought many changes to our lives. The rapid pace of development and industrialization becomes something that is inevitable. Besides contributing to global warming, it also affects the culture and lifestyle of humans.

With the increasingly high demands of human comfort, increasing number of air conditioned buildings and factory is the fact that we are facing now. However, the uncontrolled use of air conditioner is actually exacerbating the state of the global climate.

Air conditioner uses material named chlorofluorocarbon or CFC. This substance can disrupt the nature balance because its accumulation in the atmosphere can cause ozone depletion. In fact, ozone is the main protector for the Earth from excessive exposure of UV light. Ozone depletion increases the risk of getting skin cancers, one of which is melanoma.

Skin cancer is abnormal growth of skin cells. The cause and malignancy of skin cancer may vary. Skin cancer most commonly occurs on squamous cell, basal cell, and melanocyte.

The exact cause of all skin cancer isn't clear, but exposure to ultraviolet (UV) radiation from sunlight or tanning lamps and beds increases your risk of developing melanoma.

The greater the exposure of UV light, the greater the risk of getting skin cancer. In Jakarta, Department of Dermatology and Venereology Polyclinic of dr. Cipto Mangunkusumo Hospital reported 261 cases of basal cell carcinoma, 69 cases of squamous cell carcinoma, and 22 cases of melanoma during 20002009. In contrast to previous data, Dharmais Cancer Hospital recorded that the most commonly occurred non melanoma skin cancer was squamous cell carcinoma followed by basal skin carcinoma and melanoma during 2005-2007.

Surely, we do not want it getting worse. So, the wisest solution we can do is to pay a great attention to the use of air conditioning. Immediately turn off the air conditioner when it is not needed or when we leave the house or room. Unwise usage of air conditioning can lead to harmful effects for ourselves.

Don’t let the cold burn you!

“SAVE THE WORLD, SAVE YOUR TOILET!” Verrell Christopher Amadeus, Tania Prima Auladina, Kriswahyu Yudo Wirawan AMSA Universitas Gadjah Mada

The world has now changed. The increase in exhaust emissions, both from vehicles and factories, land conversion, and many other things, lead to environmental imbalance, one of which is global warming.

Global warming not only causes the melting of polar ice caps and rising sea levels. But more than that, global warming also the reason for the occurrence of extreme weather lately, especially in Indonesia.

Rising temperatures could have some effect on the factors involved in the weather. They raise the level of evapotranspiration, which is the total evaporation of water from the soil, plants and water bodies.

The warm atmosphere can hold more water vapor. The ambiance now hold more water vapor than 4% of the 40 years ago as a result of rising temperatures. Changes in sea surface temperatures (SSTs) were also influential with the associated changes in atmospheric circulation and precipitation. This increases the risk of extreme rainfall events. And the direct impact of this is that flooding can not be predicted.

The health aspect was not able to escape from it. Increased incidence of water-born diseases, such as diarrhea, a problem which must be faced. If this continues to be ignored, it could have a more serious impact. Multiple infection, even death could be the worst risks.

There is no other way than we change the way we live now. Disposing of waste in place and reduce the use of motor vehicles when not necessary is too small habits that we can do to reduce the effects of extreme weather conditions occur.

gUILTY PLEASURE of mankind

INDUSTRIAL WASTE

DEFORESTATION polLution

RESPIRATORY DISEASE Irregular seasonal changes and polluted air exacerbate the incidents of asthma and COPD.

Prolonged summer and dry season Increased temperature in a long time induce mental stress and decrease the quality of life. It also promotes the growing of water patogenes and reduce water quality.

damage on marine ecosystem Increased temperature promote the growth of algae & toxin producing organism that could reduce the quality of seafood.

Damage on coral reefs which are the home of many sea creatures that consequently destabilize the ecosystem and eventually contaminate the water.

heat stroke From 2000-2013 the number of deaths due to heat stroke have doubled among students & athletes. The symptoms of heat stroke (Fainting, dehydration, dizziness, nausea, vomiting & neurologic dysfunction) decrease the quality of life.

S K I N

C A N C E R

Climate change induce prolonged exposure to UV radiation that damages skin DNA. Hence, promoting the development skin malignancy. In 2050 the excess cases of skin cancer would increase to 200 cases/million/year.

“Guilty Pleasure of Mankind” AMSA Universitas Sam Ratulangi Background: In this poster, our main illustration was inspired by ice cream and its toppings. We symbolize the Earth as an ice cream that is currently melting because of the sunlight, that promoted by human behaviour to increase their pleasure in life. Industrial waste, motor vehicle pollution and deforestation, were originally enfored to increase human comfort and pleasure in life (the toppings were added to make the ice cream tastier).

We came to this philosophy because of our awareness that all this mess of global warming and climate change derived from human’s attempt to make this life become more prosper and comfortable. At first we did feel the benefit and we feel that our life has become better. However, from time to time we see that the climate change have caused so many serious events. Hence, we call this the “Guilty Pleasure of Mankind”.

Objective: The health impacts of climate change are very wide and founded in all health aspects. For example respiratory disease, heat-related disease, skin cancer, mental illness, impaired food quality and safety, and decreased water quality. As the future leaders in health sector we are responsible on educating and mobilizing the people to be aware of this upcoming problem and take action to tackle those challenging health problems.

Through this poster, we would like to remind the people that our time is running out. Our earth is keep “melting” day by day, and the sustainability of the mankind is being threatened by now. All those “toppings” in our life may bring pleasure to us, but at the same time they are destroying our civilization. Therefore, we should act NOW.

Defeat Dengue, Worry Free

Anugerahaning S, Putri Raudina A, Muhammad Fathi B A F Universitas Gadjah Mada The negative impacts of climate change to our daily activities are getting real. Medicine is no exception. Dengue fever, a disease of the tropic and subtropic, is carried by the mosquito called Aedes sp. The increase of the global temperature has given advantage for these little disease-borne mosquitos to expand their territories to other area they’ve never been before, due to the (used to be) low temperature. This means, dengue fever can occur in new places where dengue never occur before. The fact that dengue is a disease of only several tropical and subtropical countries will be a story of the past.

Currently, there are 2.5 – 3 million people at risk of getting dengue fever, and as climate change continues to exist, at 2085 it is estimated that 70% of the earth population is at risk of getting dengue.

Dengue fever is a deadly disease, late symptomp recognition and poor management could lead to death. Therefore the best way to defeat dengue is to prevent getting mosquito bites.

As the wise men say “an ounce of prevention is

worth a pound of cure”, the international community should be given insight and knowledge on how to defeat dengue at individual-community level starting from now. We are racing against time to elude the increasing mortalities due to the climate change. The poster carries a light but vital message of simple preventive measures that everyone can do to defeat dengue with an easily memorized mnemonics : DEFEAT. We hope by implementing these easy steps, we could defeat dengue altogether.

“If you think you are too small to make a difference, you haven’t spent a night with a mosquito,” —African proverb.

Judul Poster

: Your little one is at risk of Asthma

Nama Perguruan Tinggi : Fakultas kedokteran Universitas Brawijaya Pembuat

: Galih Cakrayuda T Anditri Weningtyas Wanda Fenny O Ni Putu Lisa M

Latar Belakang

:

Dalam tiga puluh tahun terakhir terjadi peningkatan prevalensi (kekerapan penyakit) asma terutama di negara-negara maju. Kenaikan prevalensi asma di Asia seperti Singapura, Taiwan, Jepang, atau Korea Selatan juga mencolok. Kasus asma meningkat insidennya secara dramatis selama lebih dari lima belas tahun, baik di negara berkembang maupun di negara maju. Beban global untuk penyakit ini

semakin

meningkat.

Dampak

buruk

asma

meliputi

penurunan

kualitas

hidup, produktivitas yang menurun, ketidakhadiran di sekolah, peningkatan biaya kesehatan, risiko perawatan di rumah sakit dan bahkan kematian. (Muchid dkk,2007) Asma merupakan sepuluh besar penyebab kesakitan dan kematian di Indonesia, hal ini tergambar dari data studi survei kesehatan rumah tangga (SKRT) di berbagai propinsi di Indonesia.

Survey Kesehatan Rumah Tangga (SKRT) tahun 1986 menunjukkan asma menduduki urutan ke-5 dari 10 penyebab kesakitan (morbiditas) bersama-sama dengan bronkitis kronik dan emfisema.

Pada SKRT 1992, asma, bronkitis kronik dan emfisema sebagai penyebab kematian ke- 4 di Indonesia atau sebesar 5,6 %. Tahun 1995, prevalensi asma di seluruh Indonesia sebesar 13/1000, dibandingkan bronkitis kronik 11/1000 dan obstruksi paru 2/1000. Studi pada anak usia SLTP di Semarang dengan menggunakan kuesioner

International

Study

of

Asthma

and

Allergies

in

Childhood

(ISAAC), didapatkan prevalensi asma (gejala asma 12 bulan terakhir/recent asthma) 6,2 % yang 64 % diantaranya mempunyai gejala klasik.

Tujuan

: Menjelaskan definisi Asma Bronchial, Menjelaskan etiologi Asma

Bronchial, Menjelaskan patofisiologi Asma Bronchial, Menjelaskan gejala klinis Asma Bronchial, Menjelaskan diagnosis Asma Bronchial, Menjelaskan pencegahan Asma Bronchial

Kontak ketua wilayah

: Ananta Siddhi Prawara / anantasiddhi@gmail.com/ 081290187030

ABTRACT Asthma is a chronic inflammatory airway disease characterized by episodic wheezing, coughing, tightness in the chest as a result of airway obstruction. The incidence, prevalence, and mortality of asthma have increased in children over the past three to four decades, although there has been some decline in the most recent decade. These trends are particularly marked and of greatest concern in preschool children. In general, asthma rates were highest in English-speaking countries (UK, New Zealand, Australia, and North America) and the lowest in South Korea, Russia, Uzbekistan, Indonesia, and Albania. There is currently no unifying hypothesis to explain these trends or any associated risk factors. The general risk factors that can trigger asthma is divided into genetic and environmental factors. Environmental factors that may lead to asthma include air pollution; genetic factors, the hygiene hypothesis, and lifestyle differences also play potentially causative roles.

One way to reduce the number of patients with bronchial asthma height is to educate people about bronchial asthma. Asthma may develop as a result of persistent activation of the immune system alone or in combination with physiologic airway remodeling in early childhood. Further studies are needed to confirm this hypothesis.

Key word : asthma, children....

Title of Poster : Let’s SURVIVE! Author : AMSA Brawijaya University, Malang, INDONESIA Chrisandi Yusuf Rizqiansyah, Athaya Febriantyo Purnomo, Camelia Ijaya, Raehani Ajeng

Floods are also increasing in frequency and intensity, and is expected to continue to increase throughout current century. Floods contaminate freshwater supplies, heighten the risk of water-borne diseases, and also cause drownings and physical injuries, damage homes, and disrupt supply of medical and health services. Rising temperatures and variable precipitation portrayed by polar bear in a tiny white land are likely to expand whole water volume of ocean and many island got drown and instability of weather. It leads also to decrease production of staple foods in many of the poorest regions, especially in rural area of Indonesia. This will increase the prevalence of malnutrition and undernutrition, which currently cause 3.1 million deaths every year.

Lack of safe water can compromise hygiene and increase risk of diarrhoeal disease, which kills approximately 760,000 children aged under 5, every year. By late 21st century, climate change is likely to increase frequency and intensity of drowning at regional and global scale. We are using tall animal like giraffe to portray to public how severe the flood time goes by, and impact is going to be drowning, difficulty to have clean water, and even died at last.

Consider these complex impacts, we hope public can do really simple things in life with SURVIVE as catchphrase, which means survive from climate change impacts too. SURVIVE strategy stands for: Start physical activity; Use public transportation; Reforestation; Volunteeraly compensate heat production; Improve home insulation; Vehicle’s emission lowering; and Enhance renewable energy. Helicopter in upper right poster, is a metaphor to hope for every person underneath it whose looking for help and still have chance preventing flood in future by SURVIVE steps. Thus, it is necessary for public to take responsibility as well for having better life in future in terms of climate change impacts prognosis.

Dengue Kills Brawijaya University, Malang Background : The World Health Organization rates dengue as the most dominant mosquito-borne viral disease in the world as its incident rates have increased 30-fold in the past 50 years.

And new research shows how climate change, bringing hotter and wetter weather, is creating a more ideal home for these disease-spreading pests. Beside, it’s known that climate change has contributed to the increasing number of natural disasters such as flood. Flood can lead to many potential breeding places for Aedes aegypti.

Apart from climate factors other important issues that potentially contribute to global changes in dengue incidence and distribution include population growth, urbanisation, lack of sanitation, increased human travel, ineffective mosquito control, and increased reporting capacity.

Everyone is vurnerable to dengue fever . However, there are no vaccines for it and the best preventative measures appear to be avoiding being bit by an infected mosquito.

Goals : Our goal is that people can be aware of the danger of dengue outbreak. By raising awareness, people can avoid getting bitten by the vector (Aedes aegypti) and eventually we can reduce the incidence of dengue fever.

Regional chairperson : Ananta Siddhi Prawara anantasiddhi@gmail.com 081290187030

Poster Title: We don’t need more signs, we need more acts to save global warming.

College: Universitas Brawijaya Background: 'Global warming' is a phrase that refers to the effect on the climate of human activities, in particular the burning of fossil fuels (coal, oil and gas) and large-scale deforestation, which cause emissions to the atmosphere of large amounts of 'greenhouse gases', of which the most important is carbon dioxide. Such gases absorb infrared radiation emitted by the Earth's surface and act as blankets over the surface keeping it warmer than it would otherwise be.

Human-caused global warming occurs when human activity introduces too much of certain types of gas into the atmosphere. More of this gas equals more warming. The atmospheric gases primarily responsible for the greenhouse effect are known as "greenhouse gases" and include water vapor, carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O). The most prevalent greenhouse gas is CO2.

There are too many signs but so little acts to prevent global warning. We can help to reduce the demand for fossil fuels, which in turn reduces global warming, by using energy more wisely. Such as reduce waste by choosing reuseable products instead of disposable ones, use less heat and air conditioner, buy energy-efficient products, and many more.

Goal: If left unchecked, climate change will undo a lot of the progress made over the past years in development. It can also exacerbate, as we are already seeing, current threats such as food and water scarcity, which can lead to conflict.

The goal is to bring global warming under control by curtailing the release of carbon dioxide and other heat-trapping “greenhouse” gases into the atmosphere. We can contribute to this global cause with personal actions. We can help immediately by becoming more energy efficient. Reducing our use of oil, gasoline and coal also sets an example for others to follow.

Doing nothing will end up costing us a lot more than if we take actions now that will lead to more jobs, greater prosperity, and better lives for all while reducing greenhouse gas emissions and building climate resilience.

“HIDE” Climate Change Impact on Health Fakhriyah Iffatunnisa, Rafi Yusuf, Nadya Aninditha, Savira Indah Brawijaya University Abstract The combination of high population density and 95,181 (world resources institute) km of coastline with 13,466 islands (Bakorsurtanal), make Indonesia become one of the most vulnerable countries to the impact of climate change. Surface temperatures are increasing by about 0.1-0.3°C per decade. Mean annual rainfall has decreased by 1-3.6% per decade since 1960. Besides the changing of the environment, the consequences of climate change also affect our health. Climate change apparently has an impact on the spread of the disease, which is its continued warming temperature directly affects human health. The consequences of the warmer temperature is increasing the number of mosquito-borne diseases (malaria and dengue fever), water-borne diseases (cholera and diarrhea), and infectious diseases.

With climate change already underway, as a medical student we must take action to reduce the effects of climate change to human’s health. We need to do HIDE to solve the future climate change health problem. The HIDE does not mean that we literally cover up the health impact of climate change, but it means Healthy lifestyle promotion, Increase public awareness and DisEase control management. The explanation are Healthy lifestyle promotion, such as healthy diet, enough exercise, enough sleep, no alcohol and smoking ; Increase public awareness about climate change impact on health, for example we can make a health campaign about climate change and the following disease; Disease control management, we need to learn about disease control management as a step forward for how we practice medicine in the future.

Contact Details of Directors of Author : Fakhriyah Iffatunnisa Fakhriyahiffatunnisa@gmail.com +6282139239933 Photo credit by : Debajit Dutta

LEPTOSPIROSIS : RAINY SEASON’S NIGHTMARE Fitrah Aulia Lisabilla AMSA – Universitas Brawijaya Climate changes have a great impact for tropical country in the world, especially Indonesia.

Located between 2 oceans, Indonesia must face the climate change in a bigger consequence. Recent heavy rains and flooding are caused by global warming phenomenon, and such events are expected to become more common over time. As average temperatures in regions across the country have gone up, more rain has fallen during the heaviest downpours. This heavy rainy season caused a devastating flooding and water-borne disease will spread.

Floodwater in Indonesia is generally contaminated by various pollutants: sewage, human and animal feces, pesticides and insecticides, fertilizers, and so forth. When flood happen, we suggested to avoid contact with wild animals, rats and rodents that possibly carry viruses and diseases.

Leptospirosis, or Weil's disease – a zoonotic bacterial cause by a bacteria called spirochete, and is transmitted by the urine of an infected animal. This disease associated predominantly with rats – often accompanies floods in developing countries. Although rats, mice and other rodents are important primary hosts, a wide range of other mammals including dogs, deer, rabbits, cattle, buffaloes, sheep, and pigs also carry and transmit the disease as secondary hosts.

Leptospirosis prevention is all activities or actions aimed at reducing the risk of transmission of Spirochete in the water. 1). Do not swim or wade in water that might be contaminated with animal urine. 2). Disinfect contaminated Surface. 3). Do not come into intact with potentially-infected animal. 4). Take the antibiotic prophylaxis. 5). Wear protective clothes and equipment. With this steps, I hope that leptospirosis prevalence’s in Indonesia will decrease.

Keep your body health, Protect your pet, Protect yourself.

Source : Victoriano, Ann Florence B., et al. "Leptospirosis in the Asia Pacific region."BMC infectious diseases 9.1 (2009): 1.

WHO. Leptospirosis, 2006, who.int/zoonoses/diseases/leptospirosis/en/. Accessed 9 October. 2016.

IS THIS THE FUTURE YOU WANT FOR YOUR CHILD? Priscilla Christina Natan, Nafisa Naaz Nisha, Natasya Andia Putri Indigus, Muhammad Ardin Yudhawira Brawijaya University Background Climate change is projected to harm human health by increasing ground-level ozone and particulate matter air pollution. Exposure to air pollution such as smoke is thought to cause asthma by affecting the size and structure of the developing lung as well as the developing immune system.

All populations will be affected by climate change, but some are more vulnerable than others. As for children they are more vulnerable to the resulting health risks and will be exposed longer to the health consequences. It’s also possible that children growing up near major, heavily trafficked roadways, who are at the greatest risk for exposure to air pollution, may differ from kids who grow up in other locations like suburbs in other respects, such as lower socioeconomic status, that also increase asthma risk. In addition, factors that play a role in climate change, such as emissions from vehicles and factories, significantly harm children’s health.

As we’ve known, deaths from asthma, which is the most common chronic disease among children, are expected to increase by nearly 20 percent by 2016 unless urgent action is taken.

Objective So here we are trying to raise awareness about asthma cases in children due to climate change that keeps on increasing year by year. We want to say that one of the reasons why our air environment is getting worse is because our reckless behaviour and unawareness towards the earth that we are living in. And it’s actually because of action of humans that these diseases find their way to innocent children. We bring this poster into public eyes in order to stop this continous cycle of disaster and help make a better future for our children.

Contact details of Regional Chairperson Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Title of Poster : If You Want To Live in Today’s World, MASK YOURSELF. Author : AMSA Brawijaya University, Malang, INDONESIA Raehani Ajeng, Camelia Ijaya, Athaya Febriantyo Purnomo, Chrisandi Yusuf Rizqiansyah Climate change become global health issue with so many intervention in every sector of each country has, including health sector. Global carbon emissions have increased approximately 60% equal to 9.7 Gigatones of gas from 1990-2015 and still on going to be abundant. WHO estimated, 7 million people worldwide died every year because of air pollution since 2014. In Indonesia, there are so many respiratory diseases worsen caused by urban heat increasing. Upper and lower respiratory tract diseases such as bronchitis and pneumonia, become top 10 cases prevalence until now reached over 20% per year in adult and baby based on Indonesian Basic Health Research. Moreover, another example like tuberculosis infection, when incidence reach 399/100.000 people because bad humidity in house as one of millions concequences of climate change. Therefore this is a tangible problem to solve by whole kind of people because the risks of health disorders do not even choose what job are you and who you are.

Many movements have been done by government, such as regulating emissions production like Kyoto Protocol agreement, advocacy toward Corporate Social Responsibility of emission-producing industries, regulate the circulation of private motor vehicle in country, doing reforestation, and even providing health insurance for every person to make sure society is taken care of diseases. However it is way far better for health sector doing promotive and preventive action to mitigate the disease prevalence become unaffordable by health budget as another problem of Indonesia. Thus, after we enhance understanding about these complex impacts, our efforts is going to propose really simple and applicable strategy for any kind of people to engage with health-effects of climate change, specifically to air borne diseases. Cut the transmission, avoid the risks of air pollution, start from individuals, Mask Yourself! If you want to live in today’s world.

You Choose!

Tjiauw Erlyn Jayadi, Universitas Brawijaya, Malang, Indonesia In Indonesia, the number of vehicle keeps increasing each year. According to Data Korps Lalu Lintas Kepolisian Negara Republik Indonesia (Indonesian National Police’s Traffic Corps Data), there are more than 114,7 million cars & motorbikes actively operated in Indonesia. Many people choose to use their private vehicle instead of the public transportation. People don’t know that a bus emits 23 g CO2/pkm (gram of CO2 per person kilometers), a motorbike emits 153 g CO2/pkm, and a car emits 191 g CO2/pkm. The higher CO2 emissions from the vehicle contribute in the climate change. It wreaks havoc on the environment, lifestyle, and health.

CO2 is considered as a component of the air pollutant, which means that can determine the air quality.

Long exposure of poor air quality may cause respiratory diseases like asthma, bronchitis, and cancer.

The high emissions of CO2 also cause the day gets hotter. The hot weather makes people tend to be lazier to move their body and do physical activity which is one of the risk factor of obesity. In the end, it will make a cycle where people will not be able to choose environment-friendly transportation and make the climate change even worsen day by day.

Don’t you want to enjoy fresh air, outdoor physical activity, and healthy life?

So now, you choose! Your choice today, your health tomorrow!

Source: 1. http://www.bps.go.id/linkTableDinamis/view/id/1133 2. http://shrinkthatfootprint.com/shrink-your-travel-footprint 3. http://www.who.int/globalchange/resources/country-profiles/PHE-country-profileIndonesia.pdf?ua=1 4. http://www.who.int/mediacentre/news/releases/2015/reducing-climate-pollutants/en/ Authors: 1. Tjiauw Erlyn Jayadi erlynjayadi@gmail.com +6281336464512 2. Raehani Ajeng Prabaswaratna Nindyasti raehani.ajeng@gmail.com +6281233867528

ABSTRACT Some countries located in the tropics with sun exposure throughout the season with the majority of the population who work under the sun exposure even when the sun was blazing. Sunlight itself actually consists of visible light and invisible light. Visible light is between the red light to violet purple. At the moment we go beyond this light we face is not visible rays are ultraviolet rays. UV-A has a more rays identity to the surface of the earth and will cause discoloration of the skin becomes reddish brown.

The existence of global warming phenomenon which affects the climate exchange and ozone layer depletion in the earth can cause UV-C radiation to the earth's surface and adverse effects on living beings. UV-C rays are the rays with the highest energies, the most dangerous ultraviolet rays among others. In humans, prolonged exposure to UV rays that can cause health problems.

The toxic effect of UV radiation contained in sunlight or UV light is a serious health problem, a major acute effects that occur due to UV radiation on normal human skin can be either inflammation (erythema), tanning, and local or systemic immunosuppression. While the chronic effects of UV radiation can cause aging, immunosuppression, and photocarcinogenesis.

Adverse effects of sunlight can be prevented by avoiding exposure to UV light or wear sunscreen when in the sun. Sunscreen compound is needed to protect the health of human skin from the effects of UV rays.

Sunscreen is a cosmetic preparation that is used on the surface of the skin to withstand the adverse effects of sunlight. The effectiveness of a sunscreen is described by the parameters of Sun Protection Factor (SPF) and UV Protection Factor A (UVA-PF). Parameter UV-A PF indicates the ability of a sunscreen to provide protection against UV radiation, while the SPF rating refers to the FDA provisions that classify the effectiveness of preparations.

Abstract Climate Change Bites Fenska Seipalla, Henry Timothy, Ardhin Marthdana Faculty of Medicine, Universitas Airlangga The world is getting warmer. An ongoing temperature analysis by NASA’s Goddard Institute for Space studies (GISSS) report that there is an increase about 0,8’ Celsius of the average global temperature on earth since 1880. But, why should we care about one degree of warming? You may though that the temperature always change every day in our life. But what does it mean? When We talk about Climate change, it simplify not only refer to the rising temperature of the world but also affects to the weather patterns, increase of the natural disaster that hard to predict, plants and animals.

The warmer it gets, the more severe the impacts on people and the environment will be. Climate change carry big contribution to create a suitable habitat for mosquito thrives and transmission. As the the increase of mosquitos bite risk and so do the diseases they carry. Indonesia as a tropical country is one of the largest populations at risk on infectious diseases including malaria, dengue fever, yellow fever and recently the world hot news about zika virus transmission. Furthermore, to response this problem, we would like to create an action to promote education and awareness about the consequences of climate change for human life, not only for the certain government major sector of health but also for the public to realize that a small action to reduce the using of facilities which promote climate change can affect the entire of world society's health. The choices we make now and in the next few decades will determine how much the planet's temperature will rise. Remember, climate change bites.

References: National Aeronautics and Space Administration. 2015. Global Temperature. Available at: http://climate.nasa.gov/vital-signs/global-temperature/ Contact details of Regional Chairperson : Name : Ananta Siddhi Prawara Email : anantasiddhi@gmail.com Phone Number : +6281290187030

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Short Description Leptospirosis is a zoonosis of worldwide distribution, a waterborne disease that can also occurs through a great likelihood of contact with a Leptospiracontaminated environment, for example, poor housing and waste disposal which attract the causal agent such as rats, dogs, etc. It often peaks seasonally, sometimes in outbreaks, and is often linked to climate changes, to poor urban slum communities, to occupation or to recreational activities. It has a great possibility to have an outbreak yet it is still overlooked and underreported causing Indonesian society unaware about this.

VIDEOGRAPHY

Water For The Future Hasanuddin University

by Safara Nurul Laela Wairoy, Karina Jesslyn Sung, Richard Holman Matanta, and Esther Yuliana Natalia Background Human’s body is 60% consist of water, which make it necessary for our survival. With almost everything we do is related to water, contaminated or lack of water is a real threat. Properr water safety planning is highly needed to ensure availability and sustainable management of health and sanitation for all. Even so, WHO stated that 663 million people (1 of 10 people in global population) lack access to safe water that could lead to water transmitted disease.

Diarrhea, cholera, dysentry, typhoid, and polio are some water transmitted disease and contaminated drinking water is estimated to cause 502.000 diarrheal deaths each year.

Indonesia as the 4th most populated country has to improve concern in water problem. It is already proved that 80% of illness in developing country are linked to poor water and sanitation problems. However, common people still have low awareness in conversing water we use everyday. Realising it’s a problem, water safety is urgent problem to save not only for now, but also for future needs of human race.

Objective 1. To make people realise how important water is and imform the impact of lacking water 2. To raise awareness about conserving water 3. To show people some simple way to conserve the water 4. To decrease the prevalence of water transmiteed disease

CLIMATES CAROL Author: Schoollaus Daleru (eru.gabriel@gmail.com) - +6281282853531 Name of University: Tarumanagara University Contact details of Regional Chairperson: Ananta Siddhi Prawara (anantasiddhi@gmail.com) - +6281290187030

Carol: a song sung during the Christmas season.

Jordy is a young medical doctor who is ignorant about global issues and being sceptical about anything beside the patients’ symptoms and diseases. One day, a phantom pursued Jordy and brought him to the future. He showed Jordy the beauty of nature and how mankind recklessly exploit Earth without any concern about further risk such as climates change. He told Jordy about the immeasurable risks of climates change, such as lack of clean water and food crisis which lead to malnutrition. Increase of vector & water-borne disease, tropical infection, respiration & heat-related illness. Land degradation would induce huge urbanization, which could improve the imbalance of socio-economic status. He tried to convince Jordy that all of those things weren’t only the responsibility of socio-environmental activists, but also himself as a doctor. There were things that as important as curing the diseases, such as promotion and prevention, not only curative and palliative. He also told Jordy what to educate them.

But Jordy was too stubborn to understood. So he brought Jordy further to the future. There, Jordy found himself and his house burned with fire as the cause of climates change. Jordy finally realized that the phantom was Jordy himself that comeback for him to change their future. Will Jordy survive? Or is it only just a bad dream?

This movie’s made to enhance the understanding of climate change’ various impacts and propose strategies to engage the public in tackling the health-effects of it.

Name of Regional Chairperson : Ananta Siddhi Prawara, anantasiddhi@gmail.com, +6281290187030 Name of Chapter

: Indonesia

Authors

: Bella Patricia Simanjorang, bellaptrcia@gmail.com, +6285248441267 Victoria Simanihuruk, vsimanihuruk@yahoo.co.id, +6287839868618 Nong Nabila, nongnabila1995@gmail.com, +6281249931838

Name of University

: Airlangga University

Title of Video

: Start the DAL, Stop the Diarrhea

Background

:

Climate change is affecting the timing of seasons in Indonesia (NASA, 2016). Extreme rain causes floods and increases the incidence of water-borne diseases such as cholera and dysentery (Measey, 2010). 12,9% Indonesian population doesn't have toilet and 13% of ground water in Indonesia which consumed by people is contaminated by bacteria because of the bad waste disposal system and people habit to defecate at random places (Riskesdas, 2013). According to UNICEF data on 2015, Indonesia is the second highest with 51 millions of people who have this habit. This bad behavior is affected by the lack of defecation risk knowledge and low in financial so they can't make a proper toilet.

Objective

:

In this video we show that DAL (Disposal Amphibian Latrine) from dr. Budi Laksono can be the solution. DAL are toilets that can be made quickly and cheap. The effectiveness of DAL has been proven in 14 hamlets in Semarang. Before the program, hamlets defecated into the river and after the program they have latriens themselves and 99% of the residents no longer defecate into the river. As the result number of diarrhea is decreased (AA, 2012). So if more DAL can be applied in many areas, the more people will be free from diarrhea.

Sources

:

Riskesdas, 2013. Riset Kesehatan Dasar, [Online], Available: HYPERLINK “http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013” http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013 [2nd September 2016]

UNICEF, 2015. Annual Report Indonesia 2015. United Nations International Children's Emergency Fund, [Online], Available: HYPERLINK “http://www.unicef.org/indonesia/UNICEF_Indonesia_Annual_Report_2015_EN.pdf” http://www.unicef.org/indonesia/UNICEF_Indonesia_Annual_Report_2015_EN.pdf [15th September 2016] NASA, 2016. Global Climate Change. National Aeronautics and Space Administration, [Online], Available: HYPERLINK “http://climate.nasa.gov/effects/” http://climate.nasa.gov/effects/ [2nd September 2016] Measey. M, 2010, Indonesia: A Vulnerable Country in the Face of Climate Change. Global Majority EJournal [Online] 1 (1). p.31-45, Available: HYPERLINK “https://www.american.edu/cas/economics/ejournal/upload/global_majority_e_journal_1-1_measey.pdf” https://www.american.edu/cas/economics/ejournal/upload/global_majority_e_journal_1-1_measey.pdf [15th September 2016] AA, 2012. Latrine Campaign All Corners of Villages. Australian Aid: Indonesia Infrastructure Initiative, [Online], Available: HYPERLINK “https://mail.indii.co.id/index.php/en/news-publication/weeklyinfrastructure-news/latrine-campaign-reaches-all-corners-of-villages” https://mail.indii.co.id/index.php/en/news-publication/weekly-infrastructure-news/latrine-campaignreaches-all-corners-of-villages [2nd September 2016]

Climate Changes, Health Standards Should Not by: K. Marfian, P. Agatha, M. Gracella, J. Tampi Maranatha Christian University, Bandung, West Java, Indonesia

Background Climate change is for real. It has been a global issue for quite some time now, and it is affecting many aspects and sectors of humanity. One major issue is in the medical and health realm. A person’s health is determined by a plethora of internal and external factors. With climate change is in full swing, those determinants become somewhat uncontrollable. Anyone could get sick by microbial infections, parasites, extreme temperatures, and natural diseases. Those events are common right now, and it may sounds worrying for most people. They may think that our health standards is understandably going down right now. But actually, they shouldn’t be. We actually have all the resources, the money, the facilities, the technologies, and lots of health workers that this world could ever hope for.

Objectives The main message we want to point out from this video is that although climate change is happening right now, it should not lower humanity’s health standards. We have all the resources we needed, and we can’t take them for granted. The key lies within the very core of us as a moral being. Do we have the heart and the conscience to actively take part in maintaining humanity’s health standards, whatever our field are?

Contact details of Regional Chairperson: Ananta Siddhi Prawara x

anantasiddhi@gmail.com

x

+6281290187030

Let’s BREATHE !

Authors: Pricella Mutiari, Ahmad Fahmi Nugraha and A.M. Akramullah Dendi J. University of Halu Oleo

Climate change is a very serious global issue and cannot be taken lightly, because of its immeasurable risks and impacts to the environment and public health. Whether you live in a rural village, small island or coastal town, even in big cities, climate change threatens everyone’s health. There are many impacts of climate change such as an increase in drought, floods, and heat waves, also vector borne diseases like malaria and dengue virus. Between 2030 and 2050 climate change is expected to cause 250,000 additional deaths per year due to malaria, malnutrition and heat stress. How can we let this come so far? Climate change happens because of our nasty habits that directly harm our environment and health, also polluting and emitting CO2 directly to our atmosphere. Daily activities such as driving a car, riding a bike, using air conditioner, processing red meat, or burning the trashes, are responsible for greenhouse gas emission. This is why we need to raise the public’s awareness about climate change, and what we all can do to stop this dangerous phenomenon. We can start from small and simple things, such as using public transit, walking, cycling and turning off electricity when it’s not needed, will go a long way in reducing greenhouse gas emission, and in turn will reduce even stop the effects of climate change. By making this video, we hope that the public can get a better understanding of the various health impacts of climate change in Indonesia, mainly City of Kendari, and together we can engage the public in fighting the health effects of climate change through “Let’s BREATHE !”

FOREST FIRE Author : Thurain Leo (thurain.work@gmail.com) - +6287843325481 Name of University : Tarumanagara University, Jakarta Contact details of Regional Chairperson : Ananta Siddhi Prawara (anantasiddhi@gmail.com) - +6281290187030

Background Climate change is a change in the usual weather found in a place. Climate changes a serious issues not an abstract things anymore. One of the issues that we faced recently is global warming.

Indonesia is currently entering its dry season, when fires typically spikes and air quality deteriorates.

Indonesia has 98 millions hectares of forest. The forest is a complex ecosystem consisting mainly of trees that buffer the earth and support a myrial of life forms. Of course weather isn’t the only factor determining whether fires will take hold. Most of indonesia forest fires are human caused, but levels of dryness affect whether these fires will spread and surge out of control.

The impact of forest fires in health are URI (Upper Respiratory Tract Infections) caused by the smokes come later after the forest fires occured. URI are illnesses caused by an acute infection in respiratory systems. According to the National Disaster Management of Indonesia. There are 529.527 people who suffered URI. Air pollution of the smokes is linked to increased mortality and morbidity in susceptible persons and increased risk of hospital and emergency admissions.

Objectives 1. To inform people about one of the affect of climate change in medicine.

2. To inform people the affect of forest fires in health.

3. To persuade people to prevent forest fires.

Title of Video U.R.I Authors 1st

: Natasha Anggreani

2nd

: Jeffry Luwito

3rd

: Liman Julianto Siauw

4th

: Edward Edwin

Name of University Universitas Tarumanagara Background Indonesia has two seasons, dry and rainy seasons. Nowadays, it is difficult to predict weather its dry or rainy season. It all happened because Indonesia (especially Jakarta) has a pretty extreme climate changes.

Sometimes Indonesia can be really hot and sometimes it can be rainy. This extreme climate change can create various effects, including health. There’s a lot of disease can appear in this situation. Especially when your environment are not supportive.

That’s what our story are talking about, a mother and her daughter had been through for almost 3 months.

They only use a cardboard to take a rest everyday. The environment around them and also erratic weather weren’t supportive. The environment was very hot and pollutions are around them. They always inhale bad pollutions which carry viruses. That’s why they are vulnerable to diseases. They are not aware about it.

Until one day, they get URTI (Upper Respiratory Track Infection) and someone help them and safe their life from death before it’s too late.

Objectives We want all people (especially in Indonesia) to increase their awareness to pollution as an effect to climate change in order to prevent URTI.

Contact details of Regional Chairperson Ananta Siddhi Prawara anantasiddhi@gmail.com +6281290187030

Vector Control Imam Rahadian S Universitas Indonesia Our earth now is having a phenomenon named climate change. This phenomenon often called global warming where the climate on earth are changing caused by green house effect causing increasing earth temperature in a few decade. This condition is makes the vector (pathogen carry agent) in a good position.

In this case, the vector was the mosquitoes because they grow better on warm environment. Why mosquitoes? Because in WHO (World Health Organization) data, mosquitoes are killing more than one million people a year from their transmitted virus like malaria, dengue and yellow fever.1 Hence, with this video people will understanding and doing all the contents in this video. Also, this video is optimized to be easily understand by all kind of peoples in our society.

Refrence: 1.

WHO | Executive summary [Internet]. Who.int. 2016 [cited 23 October 2016]. Available from:

http://www.who.int/whr/1996/media_centre/executive_summary1/en/index9.html

One Move Can Change the World Author 1: Nafisa Naaz Nisha Author 2: Priscilla Christina Natan Author 3: Muhammad Ardin Co-Author: Natasya Andia Brawijaya University, Indonesia

The world as we know has been changing for the past couple years. And yes numerous disasters along with health threats and diseases starts to emerge around us. Yet we still haven’t take notice and still don’t take it seriously. Everything that happen was actually because of our irresponsibility to take good care of our land.

The climate has changed and it’s our fault. Even though we are Health Workers who’s supposed to be couple of steps ahead others on the knowledge about its affection, we still don’t do much to prevent the climate from changing. And without action, the global impacts of the climate change could just threaten the human race and damage the whole world.

Several impacts caused by the climate change could threat our health by affecting the food we eat, the water we drink, the air we breathe and the weather we experience. The health effects of these disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, malaria, malnutrition, changes in the prevalence and geographical distribution of food and water-borne illnesses and other infectious diseases and threats to mental health.

We don’t need to wait until it strikes our loved ones. So before that happens we need to make a change by doing small things around us and just start taking action! It will always be hard to move other people’s feet, so why not willing to move ours; take a lead and encourage others to join our footsteps.

Contact details of Regional Chairperson AMSA-Indonesia Ananta Siddhi Prawara anantasiddhi@gmail.com +628 129 0187 030

Defeat Dengue, Live Happily Muhammad Fathi B A F, Putri Raudina A, Anugerahaning S Universitas Gadjah Mada The negative impacts of climate change to our daily activities are getting real. Medicine is no exception. Dengue fever, a disease of the tropic and subtropic, is carried by the mosquito called Aedes sp.

The increase of the global temperature has given advantage for these little disease-borne

mosquitos to expand their territories to other area they’ve never been before. This means, dengue fever can occur in new places where dengue never occur before. The fact that dengue is a disease of only several tropical and subtropical countries will be a story of the past.

Currently, there are 2.5 – 3 million people at risk of getting dengue fever, and as climate change continues to exist, at 2085 it is estimated that 70% of the earth population is at risk of getting dengue.

Dengue fever is a deadly disease, late symptomp recognition and poor management could lead to death. Therefore the best way to defeat dengue is to prevent getting mosquito bites. As the wise men say “an ounce of prevention is worth a pound of cure”, the international community should be given insight and knowledge on how to defeat dengue at individual-community level starting from now. We are racing against time to elude the increasing mortalities due to the climate change.

The video carries a light but vital message of simple preventive measures that everyone can do to defeat dengue with an easily memorized mnemonics : DEFEAT. We hope by implementing these easy steps, we could defeat dengue altogether.

PHOTOGRAPHY

Herbs against Climate Change Shidi Laras Pramudito Airlangga University Indonesia

Photo Print Size

: 8.8”x11.8”

Location

: Indonesia, East Java, Malang City, Perum. Janti Regency kav. 34

This photo was taken during a rainy season. I was at my house, and I had a good opportunity to take the picture. In this photography, I used a cup of tea and herbs as the main objects and a window, covered by raindrops, as the background. I also used a flourescent lamp to give an adequate lighting for the object.

Current climate condition has made several people to suffer from a seasonal disease like influenza or colds(especially in tropical region). However, we could prevent ourselves from getting illed by consuming natural remedies, that can boost our immune system. These remedies contain some substances like vitamins and flavonoids that help our body to adapt to a sudden climate change. In Indonesia, it is very common for the local people to consume hot tea and hot remedies during rainy season or when they get illed.

This photography tries to persuade people to consume herbs as an alternative medicine. These traditional medicines are relatively cheap, and more importantly, they almost have no side effects on the consumer. Nowadays, people only rely on sythetic drugs that sometimes give an unpleasant side effects. So, these traditional medicines might have a good prospect in the future.

Title of Photo : HOPE : Portray the Climate Change Impacts, Raise the Health Opportunities.

Author : AMSA Brawijaya University, INDONESIA Athaya Febriantyo Purnomo Knowing health impacts of climate change is tangible thing to do considering the diseases do not even choose who you are. Thus it is necessary for society to be aware of what kind of risks they are heading on. Giving awareness to society would be effective if the message is meaningful for understanding and touching public’s deepest heart about the issue at the same time. Photography would be ideal for that aim. I would like to portray the direct and visible impacts of climate change to environment in the forms of barren tree and brownish meadow, portrayed one of the living creature was dying. Also philosophically, those things would be metaphors for health impacts of climate change in society.

Photo also depicted hand like lifting barren tree which represented our effort as awared society to uplift the opportunities to handle health issues according to climate change. Moreover, I also showed a form of optimism through this photo. Although there was a wide unmodifiable risks existed, represented by brownish meadow, but there was always modifiable rsk that we can optimize to achieve health recovery, analogue to the hand lifting tree. So potential message would be, we are still have a hope to prevent the medical issues, tackling the risks, and mitigate the health impacts by our effort to handle the climate change. Therefore, this photo showed meaningful understanding and beautiful touch philosophically to effective shot on public awareness.

Photograph was taken in Merese Hill, Lombok, Indonesia. Preferred in 10R.

A Sleeping Child Alfryan Janardhana Brawijaya University, Malang, Indonesia

Putri, a child was 8 years old, sleep in unproper bed nets which are considered effective to protect her from the bite of mosquito.

Million of children had fallen sleep in poverty and dengue threat. It correlated with bad culture in garbage management. In Indonesia, there is no policy to recycle the garbage, especially for plastic bottle and cans.

It coupled with erratic weather condition. This year, the dry season called wet dry season, because the dry season is too short this year. This condition automatically increase the incidence of Dengue Haemorhagic Fever (DHF).

It’s possible the DHF become a global disease, not just endemic in tropical regions, because of the hotter earth temperature.

Location : Raya Pakis Street, Kabupaten Malang, Jawa Timur, Indonesia Reference : 1. http://www.beritasatu.com/kesra/380603-bmkg-la-nina-datang-indonesia-masukimusim-kemarau-basah.html 2. http://www.depkes.go.id/folder/view/01/structure-publikasi-pusdatin-buletin.html 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600405/ Technical Data : Fujifilm XT-10. Shutter Speed 1/200sec, f/4,5.

A Mask For Better Future Alfryan Janardhana Brawijaya University, Malang, Indonesia An Indonesian Family on A Motorcycles. It is common in Indonesia. Their parent realize that their children is on the ropes, so they give the children a cute mask.

The traffic pollution is still the biggest problem in developing country, like Indonesia, approximately 70% air pollution caused by vehicles emission. Vehicles’ dangerous substance could cause negative impact against human health and the environment, like lead (pb), and carbon monoxide (co), All of these substance cause many respiratory disease, malignant diseases and recurrent upper respiratory tract infection. Children are prone to this condition.

As long as low nutrient and low protection are given to them, the incidence of pulmonary malignancy are increase along with their age.

Other than health issue, increasing air pollution means accelerate the climate change.

Location : Veteran Street, Malang, Indonesia Reference : 1.

http://www.beritasatu.com/kesehatan/292520-asap-kendaraan-bermotor-tingkatkanrisiko-ispa.html

2.

http://ilmugeografi.com/ilmu-bumi/udara/penyebab-pencemaran-udara

3.

http://www.who.int/topics/climate/en/

Technical Data : Canon EOS 1300 D, Shutter speed 1/800, f/5,6

" TEMPERATURE INSTABILITY " Moh. Fauzan Faculty of Medicine, Hasanuddin University, Makassar, Indonesia According to WHO, climate change can give a huge impact not only to human health, but also to social welfare. Even if the impact of climate change doesnt seem so huge by far, yet this phenomenon actually has lead to several changes.

There are several weird changes that unpredictably occured by this climate change, like the moment when rain only occurs for minutes and suddenly stop, and not to mention also the moment when the weather is terribly hot even if the sky is cloudy. In the worse scenario, these unpredictable types of weather sadly can lead to the growth of particular microorganisms that can eventually lead to certain diseases

Title : Rain in October Author : Agnessia Asian Budi Setyo Airlangga University, Indonesia

This photo is taken during a downpour that happened at 22nd of September 2016 around 12.00 P.M. in Jl. Dr. Moestopo, Surabaya. A few hour before this photo was taken, the sky was clear blue, but all of the sudden a shower started and escalated into a few hour downpour. Right now, Indonesia is in a transition period between dry and rainy season, where in this period the case number of some diseases such as diarrhea, influenza, dengue hemorrhagic fever, and upper respiratory tract infection is increasing.

Although not many people had realized this due to the occurrence of constant rain during last dry season in some area across Indonesia, it became a reminder for people to keep their health at utmost care and to start taking preventive measure to some of the well-known tropical disease whose prevalence shot up during this period, especially dengue hemorrhage fever, cholera, etc., which had become a yearly problem in Indonesia, especially in slumps.

Preferrable printing size : 9”x 8”

INDONESIA’S CLIMATE CHANGES This photograph taken around the center of Surabaya city after rainy day. Surabaya located in west java, Indonesia. Indonesia is a tropical country that means Indonesia only had two climate changes, dry season and rainy season. When this pict had taken was in October, that means this is the time for climate changes from dry season to rainy season. The illnesses in climate changes are various, example : -

Flu

: Indonesian people mostly infected by this illness, almost every person in this country

had been infected by this illness. Flu causes by Influenza Virus. This virus spread out to each other by air, from one people to the others. To avoid this illness we had to make our body stay healthy and you can wear a mask when you go outside your home -

-

Dengue Fever : This illness causes by the bite of Aedes aegypti mosquito, its causes a high fever and sometimes you bleeding in nose. To avoid this illness we must stop the birth of Aedes aegypti, we can do 3M action. Drain, Close, bury a puddle in our home Diarrhea : It is more common in children because the immune system is still weak than adults. Diarrhea caused by consumption of contaminated food by norovirus and rotavirus. This can happen when we do not wash hands before eating

after we know some diseases, we must be more careful in facing climate changes in indonesia

Skin Cancer as The Result of Aridity in The Global Warming Muhammad Rudy Chairudin University of Airlangga Indonesia Photo Print Size : 11.8” x 9.8” Location

: Indonesia, East Java, Surabaya City, Airlangga University Campus A

This photo was taken when the hot weather in Surabaya in transition conditions. at that time I was in campus, I saw the condition of plants that grow in poor soils due to the unusual hot weather. I use twigs are nearby as explanatory that the surrounding conditions were dry and cracked soil as well as the supporting element. besides, I use water droplets to indicate that at least the water received the plant. I also gave a sprinkling of dried leaves in the background as the effect of aridity.

Current world climate that is increasingly hot because one of the reason it happen is a result of the diminished number of trees absorbing and protecting from the light and heat of the sun. As the result, people are now easily exposed to direct ultraviolet rays from the sun that can cause skin to dry up its worst effects, namely skin cancer. Besides, due to the weather gets hot, the plants begin to dry up, wither, and the land becomes barren due to global warming.

This photography is trying to make us aware that the condition of our earth is getting hotter due to global warming. So, we should help each other in an effort to reduce the effects of global warming which is a way to restore the core components that can counteract the global warming that is by planting trees.

Smoke Pollution in Indonesia Yohanes Krisnantyo Adi Pinandito Universitas Airlangga, Surabaya, Indonesia Photo Detail: Print Size: 8’ x 10’ Location: Magelang, Jawa Tengah, Indonesia In the photograph, there is a man who uses mask to prevent respiratory disease by pollution. In 2015, Indonesia experience one the Worst country’s air pollution. On October 14, there were 4,719 hot spot of fire observed burning simultaneously in the forest of archipelago, emitting approximately 80 million metric tons of CO2 in a day-five times average daily emission in the U.S. In a week, the blazes in an Indonesian forest just 5%-10% of Indonesia’s annual greenhouse gas emissions. And the effect of the fire forest is upward of 75,000 cases of upper respiratory infection.

Fire forest in Indonesia is only one case that human activity will impacted to climate change and global warming. Fire forest makes average temperature increase and the hazardous gas will increase case of respiratory infection disease. Stop the global warming with stop do harmful activities.

Reference: Average daily emissions in the United States amount to 15.95 metric tons of CO2 per day. See Nancy Harris, Susan Minnemeyer, Fred Stolle, and Octavia Aris Payne, “Indonesia’s Fire Outbreaks Producing More Daily Emissions Than Entire U.S. Economy,” World Resources Institute, October 16, 2015, http://www.wri.org/blog/2015/10/indonesia%E2%80%99s-fire-outbreaks-producing-more-dailyemissions-entire-us-economy.

“Major Atmospheric Emissions from Peat Fires in Southeast Asia during Non-Drought Years: Evidence from the 2013 Sumatran Fires,” Center for International Forestry Research, 2014, http://www.cifor.org/library/5025/major-atmospheric-emissions-from-peat-fires-in-southeast-asia-duringnon-drought-years-evidence-from-the-2013-sumatran-fires.

Camera Specification: Camera Nikon D5100 Aperture : f/18 ISO 3200 Shutter Speed: 1/1250sec Focal length: 44mm

Title

: Can I Have More Water?

Author

: Andi Muh. Firshan Makbul

University

: AMSA-Univertas Hasanuddin

Contact

: +6281242622535/makbulfirshan@gmail.com

This photograph shows poor children who was in the slum where the water source was polluted and limited.

Climate change challenges conventional reviews these assumptions and may alter the reliability of water management systems[1]. For example, did you know what causes 800 deaths everyday in Indonesia? Sharks?

Cancer? Sadly, it’s water scarcity[2]. We are 70% made of water, which shows the importance of water for our body. Thousands have lived without love, no one without water.

References : 1. Bates, B.C., Z.W. Kundzewicz, S. Wu and J.P. Palutikof, Eds., 2008: Climate Change and Water.

Technical Paper of the Intergovernmental Panel on Climate Change, IPCC Secretariat, Geneva, 210 pp.

2. Ministry of Health (2011): Laporan Nasional: Riset Kesehatan Dasar (Riskesdas) 2010, Jakarta: Ministry of Health, National Institute of Health Research and Development.

GLOOMY EMOTION Dzakiyyah Marsuqah Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Do you know that life isn’t easy like we usually think?

Like that little girl, she is a victim from flash flood in Garut 20 th September, 2016. She lost anything even her family, now she is adopted in orphanage. But when I saw her, I saw something weird in her feet.

They aren’t look simetris, then she told me that because when the accident happen and she swept water and crushed by a big rod. Now because her orphanage can’t get donation to continue her injury treatment then she have an idea to do something, she decided to sell cakes near from her orphanage. Can we imagine that she was one of several victims because of this climate change in Indonesia right now.

There’s many people outside had a same problem like her. Are we just gonna sit in our room or office even we already know that many people need us to help them out ? Let’s open our eyes and heart for better generation.

“Dead Zone of Global Drying” Iin Fadhilah Tamasse Faculty of Medicine, Hasanuddin University, Makassar, Indonesia Explanation: He is Baso. His sister died a month ago due to a chronic diarrhea. He used to see his reflection on the river. But now he couldn’t. Don't you know that climate change have drastically reduced the once-mighty river and human exposure to water-borne infections can occur as a result of contact with contaminated drinking water. The river is running dirty and dry each day. Help Baso to see his reflection back. Save your water, save your earth!

CLEAN WATER CRISIS Sausan Maulida Faculty of Medicine, Hasanuddin University, Makassar, Indonesia The earth is composed of 97,5% water but only 1% of the water is fresh water. Freshwater source comes from rainfall that are deposited into a lake, river and groundwater basins. The potential availability of clean water tends to decline from year to year due to environmental pollution. This condition is exacerbated by climate change and are starting to take effect causing Indonesia to flood in the rainy season and drought in the dry season. Clean water crisis can lead to widespread of diarrhea and skin diseases due to fungi.

EXTREME WEATHER CHANGES Sausan Maulida Faculty of Medicine, Hasanuddin University, Makassar, Indonesia The disease often occurs in extreme weather changes. This virus will target the human immune system. If the body does not have strong immune system, then the virus will easily enter and develop inside the body causing the illness. Although the disease is not dangerous, it can still cause discomfort in activities. Symptoms that usually occur in extreme weather changes among other are flu, headaches, fever, diarrhea, etc.

GREENHOUSE EFFECT Sausan Maulida Faculty of Medicine, Hasanuddin University, Makassar, Indonesia The industrial era has given birth to a new concept in the society and activities. Managing the production of goods using machine in large numbers have a negative and positive impact, one of the negative from industrialization is the water and air waste product. The carbon emission that are produced has filled the air and causing the unhealthy air so that it effects the health. Health related impacts for example are diseases spread air bone and newly created viruses. We can see factories in Makassar region having low management in their waste product.

OXYGEN CRISIS Sausan Maulida Faculty of Medicine, Hasanuddin University, Makassar, Indonesia As technology develops and population increases, the earth is slowly deteriorating. A concrete example in Indonesia is the forest loss that will continue to decrease. Even though the forest function is to control the carbon dioxide in the atmosphere. If more and more carbon dioxide left unprocessed by trees, It will cause the greenhouse effect that can directly impact to the environment and human health

Indonesia's Problem of Flooding Causes Various Health Problems Mokhamad Fahmi Rizki S Brawijaya University

Flood is a natural phenomenon that is common in many areas that are irrigated by river flow.

Flood can be defined as the presence of water in a wide area that cover the surface of the Earth. If we observed, the floods in Indonesia seems have a tendency to increase from year to year. Flood occurred in all over the city in indonesia when the rainy season. It is aggravated by climate change that is happening at the moment. Climate change resulted in an increase in the average temperature of the earth so that an increase in the evaporation temperature of the air, which causes the changing patterns of precipitation and air pressure. If the first flood hit only big cities in Indonesia, especially in Java, at the time of the disaster now floods have plagued various areas across the city in indonesia.

The flood caused loss of properties and a variety of health problems. This is caused by a dirty water caused by flooding which contain a varieties of bacterias that can cause various diseases such as malaria, lepstospirosis filariasis and especially diarrhea.

TANGKASAKI ,Waste Management Icon Dewinsya Medisujiannisa MS Idris AMSA-Universitas Muslim Indonesia, Makassar , Indonesia Photo details : Print size

: 8 x 10 inch

Location

: Bumi Tamalanrea Permai , Makassar -Indonesia

Consent

: As attached

Description & Background : In Makassar, waste transportation is not only done by truck, but the boxcar. Name boxcar was Tangkasaki, short for Our Transport Garbage Trucks. In the native language, Tangkasaki means Clean.

Tangkasaki has been serving Makassar since April 2016

and currently, there are 157 trucks operated.

Definitely not for bulk trash, but for the garbage that has been sorted into TPS 3R. While this used to back up 200 dump truck that already exists.

Makassar considered successful in the national waste management pilot, both the concept of the Five Star Final Disposal, Urban Waste Management System Based Thermal Technology, Waste Bank as well as the movement of people based public participation in supporting the movement of cleanliness.

In addition, Makassar also be the only town in eastern Indonesia which is included in the national scheme of accelerated development of waste-based power plants.

Reference : 1. http://news.detik.com/berita/3183247/tangkasaki-inovasi-makassar-jadikan-mobil-boks-sebagaipengangkut-sampah 2. http://news.rakyatku.com/read/15819/2016/08/05/makassar-raih-adipura-ini-kekurangannya-dimata-dewan