Influenza A, B, C viruses ● Klasifikasi, Struktur, Genom, Kultur dan Sifat Virus - Famili Orthomyxoviridae Influenza A virus tdd : subtipe ~ 15 HA dan 9 NA ( ~ outbreaks in humans : H1-3 dan N1-2 ) - Virion berbentuk spheris, tdd : a. Segmented, minus strand RNA b. Helically coiled nucleocapsid c. Enveloped (hemagglutinin&neuraminidase glycoprotein spikes) 1

Genom :13000-15000 nt, tdd 7-8 segmen (reassortment Genom :13000-15000 nt, tdd 7-8 segmen (reassortment !); menyandi 10-11 macam protein. Influenza C virus : gen NA Ө Dapat dikultur pada a.l. monkey kidney cells Host : Influenza A virus : wild avian, humans, swine, horses Influenza B & C virus : humans : swine, dogs, cats, horse Inaktivasi dgn : radiasi ionisasi, pH <5/>9, >50C, deterjen, drying

● Epidemiologi - Worldwide outbreak tiap tahun pandemik : Influenza A virus H1N1 (swine) 1918, H2N2 (Asian) 1957, H3N2 (Hongkong) 1968, H5N1 (chicken/bird) 1997 1947 : WHO surveillance program - Influenza A virus : > avian; ~ epidemik influenza (peran swine) : non human & human (reassortment!) Influenza B & C virus : ~ milder disease; winter outbreaks - Seasonal : winter / spring (temperate) & rainy (tropic) (Influenza C virus : non seasonal) 3

- Low mortality (~ lower respiratory/ cardiovascular disease) - Transmisi : by airborne droplets (orang ke orang, zoonotik) - Sering reinfeksi - ~ Infeksi nosokomial (Influenza A virus >>) ● Manifestasi Klinis - Gejala/sindroma influenza (all age groups) - Komplikasi : sering ( otitis media/sinusitis, bronchitis, croup, pneumonia, CNS, myocarditis, gagal ginjal akut)

- Isolasi virus dari sputum, usap hidung/tenggorok, ● Diagnosis Lab - Isolasi virus dari sputum, usap hidung/tenggorok, nasal aspirate/washing (kultur sel) & deteksi CPE - Deteksi asam nukleat (RT-PCR) - Uji serologis : deteksi ag & ab (IF, RIA, EIA) ● Prevensi (vaksin, isolasi penderita : di RS, antiviral) ● Terapi (simtomatik dan antiviral) 5

Parainfluenza virus ● Klasifikasi, Struktur, Genom dan Kultur Virus - Genus Paramyxovirus, Famili Paramyxoviridae PIV : tipe 1, tipe 2, tipe 3, tipe 4 - Virion berbentuk pleomorfik (spheris/filamentous) tdd : a. Single stranded of negative sense RNA b. Helical nucleocapsid c. Envelope (spike-like glycoproteins & lipid from host cell) - Genom tdd 15500 nt yg mengkode  6 VP (H=hemaglutinin, N= Neuraminidase) &  1 NSP - Dapat dikultur pada monkey kidney cells

- Worldwide (early childhood) ● Epidemiologi - Worldwide (early childhood) mortalitas : ~ pneumonia (anak <5 tahun) di neg. berkembang - PIV tipe 1 : epidemik croup (~ autumn) 2 : ~ PIV tipe 1 (> ringan) 3 : least predictable (late winter &spring) daerah tropis/subtropis : musim hujan - Transmisi : droplet (port d’entry : hidung dan mata) - Host range : humans. - Faktor inang : usia dan imunodefisiensi - Sering terjadi reinfeksi (PIV tipe 3) - Infeksi nosokomial (PIV tipe 3)

- infeksi sal. napas atas “croup” (laringotrakheobronchitis) ● Manifestasi Klinis : - infeksi sal. napas atas “croup” (laringotrakheobronchitis) dan infeksi sal. napas bawah - Komplikasi : otitis media, pneumonia bakterial ● Diagnosis Lab - Spesimen : nasal wash/ nasal aspirate Isolasi virus dan deteksi CPE dan hemadsorpsi - Deteksi ag dan ab (ELISA, CFT) - Deteksi asam nukleat (RT-PCR)

cuci tangan, glove-goggle-masker) ● Prevensi (vaksin ~ PIV tipe 3, cuci tangan, glove-goggle-masker) ● Terapi (suportif, no licensed antiviral)

Mumps virus ● Klasifikasi, Struktur, Genom & Kultur Virus - Genus Rubulavirus, Famili Paramyxoviridae - Virion berbentuk pleomorfik (irregularly spherical), tdd : a. Linear, ss negative-sense RNA, non segmented b. Helically coiled nucleocapsid c. Envelope tdd : glycoprotein spikes, lipid bilayer, inner structural matrix protein

- Genom tdd 15300 nt yang mengkode 7 protein utama (N, P, M, F, SH, HN, L) - Dapat dikultur pada a.l. Vero cells, HeLa cells, human embryonic kidney cells ● Epidemiologi - Worldwide (> school-aged children : 5-9 years old) - Lifelong immunity - Transmisi : ~ airborne/ droplet sekresi respiratorius - Highly contagious, namun jarang fatal - Human : the only known natural host

● Manifestasi Klinis - Parotitis dan meningitis aseptik-ensefalitis - Komplikasi : gonadal infections, polyarthritis, myocarditis, dll ● Diagnosis Laboratoris - Spesimen : saliva - Isolasi virus (kultur) - Deteksi as. nukleat (PCR) - Uji serologis (CFT, ELISA) : deteksi ab ● Prevensi (vaksin : MMR) ● Terapi (Simtomatik)

Measles/Rubeola virus ● Klasifikasi, Struktur, Genom & Kultur Virus - Genus Morbillivirus, Famili Paramyxoviridae (!! tak memiliki aktivitas neuraminidase) Measles virus : hanya memiliki 1 serotipe : tdd  15 genotipe (~ sekuens gen H & N) - Virion berbentuk spheris, tdd : a. Linear ss, non segmented negative sense RNA b. Helical nucleocapsid c. Envelope (lipid bilayer) carries surface projections 13

- Genom tdd 15900 nt yg menyandi protein N, P, M, F, H, L. - Host : only humans - Dapat dikultur pada human & monkey kidney cells - Inaktivasi : pH <4.5, panas, ether/acetone, deterjen, drying, sinar matahari ● Epidemiologi - Worldwide , endemik (> anak-anak) - Seasonal : late winter & early spring (temperate) hot/dry season (tropics) - Transmisi : via droplet sekresi respiratorius (periode katharal!)

● Manifestasi Klinis (→ mukosa respiratorius) - The most contagious infections of humans, no latent/persistent infections, no animal reservoirs - Morbiditas & mortalitas : ~ infants, elderly adults, low socioeconomic status people - Lifelong immunity - Reinfeksi hampir selalu asimtomatik. ● Manifestasi Klinis (→ mukosa respiratorius) - Prodromal (demam, malaise) → gejala katarhal : coryza, conjunctivitis, sneezing, cough → Koplik’s spot → rash. - Komplikasi : otitis media, diare, pneumonia, ensefalitis. 15

● Prevensi (vaksin MMR, IG, isolasi penderita di RS) ● Diagnosis - Berdasar klinis - Laboratoris : - Spesimen : sekresi respiratorius, swab nasofaring/ conjunctiva, , PBMC, urin Isolasi virus (kultur) & deteksi CPE - Uji serologis : deteksi ag & ab (IF, CFT, EIA) - Deteksi asam nukleat (RT-PCR) ● Prevensi (vaksin MMR, IG, isolasi penderita di RS) ● Terapi (simtomatik, vitamin A, terapi komplikasi) 16

SARS-Coronavirus Coronavirus tdd 4 grup : ● Klasifikasi, Struktur , Genom dan Sifat Virus - Termasuk dalam Coronaviridae Coronavirus tdd 4 grup : I (a.l. canine, feline, porcine, human coronavirus 229E), II (a.l. bovine, murine, rat, human coronavirus OC43), III (only avian virus), IV (SARS-Coronavirus ?)

- Virion berbentuk pleomorfik, tdd : a. Single stranded positive-sense RNA b. Membrane-bound (covered with a distinctive fringe of widely spaced, club-shaped surface projections)

- Genom tdd 27-32 kb Protein struktural (S, E, M, N) & Protein non struktural (replicase polyprotein) - Host : hewan (?) dan manusia Dapat eksis di luar tubuh manusia - Human coronavirus sulit dapat dikultur dgn baik - Lebih stabil daripada human Coronavirus lain Inaktivasi : ether dan kloroform, suhu 56C

● Epidemiologi - Infeksi saluran respiratorius bawah akut - Hongkong, Vietnam, Taiwan, Singapura - Transmisi : lewat droplet respiratorius, lewat kontak langsung dan tidak langsung ~ pasar hewan ?? - Moderately transmissible ● Manifestasi Klinis - Asimtomatis - Simtomatis (SARS = Severe Acute Respiratory Syndrome) : demam tinggi, batuk kering, napas pendek

● Diagnosis Laboratoris - Spesimen : sputum, usap/washing tenggorok, stool Isolasi virus - Deteksi ab (ELISA) - Deteksi asam nukleat (RT-PCR) ● Prevensi (masker N95, cuci tangan) ● Terapi : (antiviral, antibakteri, terapi simtomatik)