Tugas Subbagian Infeksi

VARICELLA
Oleh:
1. Irfan Prasetya Yoga G0006012 (G 4 12)
2. Haris Agung Nugroho G0006088 (G 8 12)
3. ar!een "o#ehan $hah G0006%01 (G 16 12)
4. &ito Pra'i(ta G000)231 (G 18 12)
%. *urnia!an A'i Putranto G
6. "i+,y &ri Nugroho G
). -ri+,son G
Pembimbing:
H. Rustam Siregar, r., S!.A
"EPA#ITERAA# "LI#I" IL$% "ESEHATA# A#A"
&A"%LTAS "E'O"TERA# %#IVERSITAS SE(ELAS $ARET
S%RA"ARTA
)*+)
A. Penahuluan
.ari+e//a 0eru(a,an (enya,it infe,si yang 'ise1a1,an o/eh 2irus
Varicella zoster (.3.) yang 'a(at 1er0anifestasi 0en4a'i 2ari+e//a
(chickenpox) 'an rea,ti2asi /atennya 0eni01u/,an her(es #oster
(shingles).
15253
Ge4a/a ,/inis 2ari+e/a 'a(at 'ite0u,an (a'a ,u/it ,e(a/a5 0u,a5
1a'an5 1iasanya sangat gata/5 1eru(a 0a,u/a ,e0erahan5 yang ,e0u'ian
'a(at 1eru1ah 0en4a'i /esi6/esi 2esi,e/. $e'ang,an5 her(es #oster u0u0nya
0eni01u/,an /esi 2esi,u/ar yang ter'istri1usi uni/atera/ sesuai 'engan
(er4a/anan saraf sensori terinfe,si. iagnosis 2ari+e//a 'a(at 'itega,,an
se+ara ,/inis 0au(un /a1oratoriu0 'engan te,ni, 2iro/ogi 'an sero/ogi.
Pen+egahan yang 'a(at 'iguna,an terha'a( (enya,it 2ari+e//a a'a/ah
2a,sinasi 'an i00unog/o1u/in. 71at (i/ihan uta0a terha'a( (enya,it
2ari+e//a 'an her(es #oster a'a/ah anti2irus. *o0(/i,asi yang 0ung,in ter4a'i
a'a/ah infe,si 1a,teri5 (er'arahan5 'an gangguan saraf.
2
(. $anifestasi "linis
.irus Varicella zoster (.3.) 0enye1a1,an 'ua 0anifestasi (enya,it
yang 1er1e'a5 yaitu 2ari+e//a 'an her(es #oster.
15253
Infe,si (ri0er 'ari .3.
a,an 1er0anifestasi 0en4a'i (enya,it 2ari+e//a atau chickenpox, yang se+ara
u0u0 'a(at ter/ihat (a'a ana, usia 1 sa0(ai 8 tahun. Infe,si (ri0er .3.
(a'a 'e!asa 1iasanya a,an /e1ih 1erat 'an 'a(at 'isertai (neu0onia
interstisia/. 9egitu (u/a infe,si Varicella zoster (a'a (en'erita
immunocompromised, 0anifestasinya a,an /e1ih 1erat 'an 'a(at ter4a'i
'ise0inasi.
3
Penya,it 2ari+e//a 'itan'ai 'engan 'e0a0 yang 'isertai rua0 (a'a ,u/it
atau ter,a'ang 0u,osa. Nyeri ,e(a/a5 0a/aise5 'an nafsu 0a,an 0enurun
sering,a/i 'i,e/uh,an (asien. "ua0 'ia!a/i 'engan 0a,u/a5 ,e0u'ian se+ara
+e(at 1eru1ah 0en4a'i (a(u/6(a(u/5 yang ,e0u'ian 'ii,uti 0un+u/nya
2esi,e/ 'an ,rusta (a'a /esi. *rusta a,an ter,e/u(as sete/ah 1 sa0(ai 2
0inggu. .irus Varicella zoster 0eru(a,an 2irus yang sangat infe,sius 'an
trans0isinya 1isa 0e/a/ui ,onta, /angsung 'engan /esi atau 'ari aeroso/
(ernafasan (asien terinfe,si. *o0(/i,asi (a'a siste0 saraf (usat ter0asu,
ata,sia sere1e//ar5 0eningitis5 0eningoensefa/itis5 'an 2as,u/o(ati.
3
Breakthrough varicella 0eru(a,an infe,si yang ter4a'i 2 0inggu (as+a
infe,si (ri0er atau(un (as+a i00unisasi 'engan 'itan'ai 0un+u/nya ,e01a/i
rua06rua0 ,u/it (1entu, 0a,u/o(a(u/ar) tan(a 'isertai 'e0a05 'i(er,ira,an
'ise1a1,an o/eh .3. ti(e 2iru/en.

Progresif Varicella a'a/ah suatu ,ea'aan
yang 'itan'ai 'engan ,oagu/o(ati5 (er'arahan he1at5 'an terus 0un+u/nya
/esi6/esi 1aru. &i01u/ rasa sa,it yang he1at 'i 'aerah a1'o0ina/ 'isertai
'engan (er'arahan (a'a 2esi,e/. :a,tor resi,o ,ea'aan ini a'a/ah (en'erita
,ongenita/ 'engan i0uno'efisiensi5 ,eganasan5 ,e0otera(i5 'an 4u0/ah
/i0fosit ;%00 se/<00.

Sindroma Varicella Kongenital 'i,etahui hanya 2=
fetus 'engan i1u terinfe,si 2ari+e//a yang 0ena0(i/,an .3. e01rio(ati (a'a
usia 20 0inggu ,eha0i/an. :etus yang terinfe,si (a'a usia 6612 0inggu 'a(at
0enye1a1,an gangguan (a'a (ertu01uhan e,stre0itas. Infe,si (a'a fetus
16620 0inggu 'a(at 0enye1a1,an gangguan (a'a 0ata 'an ota,. Infe,si
(a'a fetus 4uga 'a(at 0enye1a1,an gangguan (a'a saraf si0(atis (a'a
ser2i,a/ 'an /u01osa+ra/ sehingga 0enye1a1,an sin'ro0 horner 'an
'isfungsi 'ari uretra 'an sfingter ana/. Ge4a/a yang ,has 1iasanya ter/ihat
(a'a ,u/it5 e,stre0itas5 0ata5 'an ota,. Ge4a/a (a'a ,u/it si,atri,s5
0a/for0asi e,stre0itas. *e/ainan (a'a 0ata 1eru(a ,atara,> serta afasia 1i/a
0engenai ota, se+ara ,ese/uruhan Pa'a (e0eri,saan histo/ogi 'ite0u,an
a'anya (roses ne,rosis (a'a ota,. iagnosis 'a(at 0engguna,an
(e0eri,saan NA 2irus 'engan 0eto'e P?".
2
"ea,ti2asi .3. 0enye1a1,an (enya,it her(es #oster. Her(es #oster
1iasanya 'ia!a/i 'engan fase (ro'ro0a/ 'itan'ai 'engan nyeri5 gata/5
(arestesi5 'isestesi5 'an sensitif terha'a( sentuhan (a'a satu sa0(ai tiga
'er0ato0. 9e1era(a hari ,e0u'ian a,an ta0(a, rua0 0a,u/o(a(u/ar
uni/atera/ (a'a area yang ter,ena5 yang ,e0u'ian 1er,e01ang 0en4a'i
2esi,e/. 3oster 'a(at 0enyerang se0ua /e2e/ neuroa,sis. *e1anya,an a,an
0un+u/ (a'a 'a'a5 'ii,uti 'engan /esi 'i !a4ah5 se+ara ,has a,an 0engi,uti
'istri1usi saraf ofta/0i,us trige0ina/. Pa'a (asien 'engan status
imunnocompromised, /esi 1isa 0e/i1at,an se0ua 'er0ato0. Her(es #oster
ofta/0i,us sering,a/i 'isertai 'engan ,eratitis #oster 'an 1isa 0enye1a1,an
,e1utaan. 3oster yang 0enyerang gang/ion geni,u/atu0 saraf fasia/is 'a(at
0enye1a1,an (ara/isis otot !a4ah i(si/atera/5 0un+u/ rua0 (a'a ,ana/is
eu'itoris e,sterna. *o01inasi ini 'i,ena/ 'engan Ramsay Hunt syndrome.
3
C. Eti,l,gi
.irus Varicella zoster (.3.> humanherpesvirus 3) 0eru(a,an 2irus
(enye1a1 (enya,it 2ari+e//a (chickenpox) 'an #oster.
1525354
.irus ini
0eru(a,an 2irus her(es (erta0a yang 1erhasi/ 'iuarai /eng,a( 'an 2a,sinnya
'i/isensi serta 'iguna,an se+ara /uas. .3. 0eru(a,an anggota 'ari genus
Varicellovirus 'engan su1fa0i/y !lphaherpesvirus" .3. 0e0(unyai
hu1ungan 'e,at 'engan anggota /ain 'ari genus Varicellovirus5 ter0asu,
suidherpesvirus 1 'an e#uineherpesvirus 15 35 45 85 'an 8. &iga gru( 'ari
.3. te/ah 'i(u1/i,ai,an s,e0a genoti(nya 1er'asar,an single nucleotide
polymorphisms ($NPs).
4
.irus yang (a/ing 'e,at ,e,era1atannya 'engan
human herpesvirus a'a/ah 2irus her(es si0(/e,s.
25354
'. E!iemi,l,gi an Insiensi
@es,i(un 2ari+e//a terse1ar 'i se/uruh 'unia5 ter'a(at (er1e'aan
e(i'e0io/ogi 'i 'aerah tro(is 'an 'aerah 'ingin. Pa'a 'aerah 'engan i,/i0
'ingin5 2ari+e//a 0eru(a,an (enya,it ana,6ana, yang u0u0 'an ang,a
sero(ositifnya 1er,isar antara %3=6100= (a'a u0ur % tahun 'an (a'a u0ur
20630 tahun 1isa /e1ih 'ari 80=. $e0entara (a'a 'aerah tro(is5 insi'ensi
infe,si .3. (a'a usia ana,6ana, a'a/ah ren'ah5 4ustru /e1ih tinggi usia
'e!asa. Ha/ ini 0e0(engaruhi ang,a 0or1i'itas 'an 0orta/itas.
%
A'anya
(er1e'aan ,ara,teristi, e(i'e0io/ogi 'ari .3. ini 'ihi(otesis,an ,arena
a'anya fa,tor i,/i0 se(erti sinar u/tra2io/et5 sehingga 0enye1a1,an
(er1e'aan genoti( 'ari .3. 'i 'aerah tro(is 'an 'ingin.
6
i A0eri,a $eri,at5 se1e/u0 (engena/an 2a,sin 2ari+e//a tahun 188%5
4u0/ah ,asus 2ari+e//a 'ite0u,an se,itar 4 4uta ,asus. Insi'ensi 2ari+e//a
a'a/ah 1%616 ,asus (er61000 (en'u'u,. @ayoritas (en'u'u, yang 0en'erita
2ari+e//a a'a/ah ana,6ana, usia ;1% tahun (8%=) 'an insi'ensi (a'a usia
s(esifi, tertinggi a'a/ah ana,6ana, usia ;% tahun.
1
$ete/ah (engena/an 2a,sin
2ari+e//a5 insi'ensi 2ari+e//a 'i/a(or,an 0enurun. Ang,a varicella rate
hospitalizations sete/ah (rogra0 i0unisasi 2ari+e//a 'i/a(or,an 0enurun
se4a, (rogra0 2a,sinasi tahun 188%.
)5858511
ata active surveillance
0enun4u,,an ang,a (enurunan sa0(ai 80= ,e4a'ian 2ari+e//a 'i A0eri,a
$eri,at 'ari tahun 188% sa0(ai 200%. $e0entara 'ata 'ari passive
surveillance 'ari e0(at negara 1agian 0enun4u,,an (enurunan insi'ensi
se1esar %3=684= sa0(ai tahun 200% 'i1an'ing,an era (re2a,sin.
10
Ang,a
,e0atian a,i1at 2ari+e//a 4uga 'i/a(or,an 0enurun sete/ah (rogra0 2a,sinasi
'iga/a,,an.
12
Pe01erian 2a,sinasi se+ara garis 1esar te/ah 0ening,at,an
res(on i0unitas hu0ora/ 'an se/u/er sehingga 0ening,at,an ,e,e1a/an
terha'a( (enya,it 2ari+e//a.
13
E. Pat,genesis
.irus Varicella zoster (.3.) 0enginfe,si 1anya, ti(e se/ host se/a0a
fase a,ut5 ter0asu, 'iantaranya se/ &5 se/ 95 0onosit 'an se/ 'en'riti+. Infe,si
se/ & o/eh 2irus 'i(er,ira,an 0eru(a,an 0e,anis0e uta0a (enye1aran 2irus.
$e/a0a fase 2irae0i,5 infe,si .3. 'i(er+aya (re'o0inan (a'a se/ &. Pa'a
infe,si (ri0er a,ut5 viral loads (a'a ana,6ana, te/ah 'i/a(or,an se1anya, 1
sa0(ai %000 2ira/ (er 10
%
P9@?s 'an 100 sa0(ai 1000 (er 0/ 'arah. Pa'a
,e1anya,an ,asus infe,si5 'era4at 2irae0ia 'ihu1ung,an 'engan 1eratnya
ga01aran ,/inis.

"es(on s(esifi, se/ & 'i(er+aya 0e0egang (eranan (enting
'a/a0 0engontro/ 2irus 'an 0en+egah rea,ti2asi 2irus. "es(on s(esifi, se/ &
'ite0u,an 0enurun (a'a (asien 'engan i00uno+o0(ro0ise'. &iter anti1o'i
s(esifi, ta0(a,nya ti'a, 1er,ore/asi 'engan 1eratnya ge4a/a ,/inis. 7/eh
,arena itu5 res(on s(esifi, se/ & (a'a a!a/ infe,si 0ung,in 0e/in'ungi
in'i2i'u 'ari 1eratnya (enya,it. $e1uah stu'i yang 'i/a,u,an (a'a (en'u'u,
$ri Aan,a 0enun4u,,an a'anya ,ore/asi antara tingginya 2ira/ /oa's 'an
,urangnya res(on 2ira/ s(esifi, se/ & 'engan 1eratnya ge4a/a ,/inis (enya,it.
%
.3. 0eru(a,an 2irus yang 0enu/ar se/a0a 162 hari se1e/u0 /esi ,u/it
0un+u/5 'a(at 'itu/ar,an 0e/a/ui 4a/ur res(irasi5 'an 0eni01u/,an /esi (a'a
orofaring5 /esi ini/ah yang 0e0fasi/itasi (enye1aran 2irus 0e/a/ui 4a/ur
tra,tus res(iratorius. Pa'a fase ini5 (enu/aran ter4a'i 0e/a/ui 'ro(/et ,e(a'a
0e01ran 0u,osa orang sehat 0isa/nya ,on4ungti2a. @asa in,u1asi
1er/angsung se,itar 14 hari5 'i0ana 2irus a,an 0enye1ar ,e ,e/en4ar /i0fe5
,e0u'ian 0enu4u ,e hati 'an se/6se/ 0ononu,/ear. .3. yang a'a 'a/a0 se/
0ononu,/ear 0u/ai 0enghi/ang 24 4a0 se1e/u0 ter4a'inya rua0 ,u/it> (a'a
(en'erita immunocompromised5 2irus 0enghi/ang /e1ih /a01at yaitu 246)2
4a0 sete/ah ti01u/nya rua0 ,u/it. .irus62irus ini 1er0igrasi 'an 1ere(/i,asi
'ari ,a(i/er 0enu4u ,e 4aringan ,u/it 'an 0enye1a1,an /esi 0a,u/o(a(u/ar5
2esi,u/er5 'an ,rusta. Infe,si ini 0enye1a1,an ti01u/nya fusi 'ari se/ e(ite/
0e01entu, se/ 0u/tinu,/eus yang 'itan'ai 'engan a'anya in,/usi eosinofi/i,
intranu,/ear. Per,e01angan 2esi,e/ 1erhu1ungan 'engan (eristi!a
$allooning, ya,ni 'egenerasi se/ e(ite/ia/ a,an 0enye1a1,an ti01u/nya
ruangan yang 1erisi o/eh +airan. Penye1aran /esi 'i ,u/it 'i,etahui 'ise1a1,an
o/eh a'anya (rotein 7":4)6,inase yang 1erguna (a'a (roses re(/i,asi 2irus.
2
Infe,si .3. (a'a gang/ion 'orsa/is 0eru(a,an a,i1at (en4a/aran /esi
0u,o,utan 0e/a/ui a,son se/ neuron (a'a infe,si (ri0er atau 'ise1a1,an
o/eh (enu/aran 'ari se/ 0ononu,/ear terinfe,si se1e/u0 ter4a'inya rua06rua0
(a'a ,u/it. "ea,ti2asi .3. si0(to0ati, 'a(at 0enye1a1,an ti01u/nya /esi
2esi,u/ar (a'a ,u/it yang ter'istri1usi hanya (a'a 'er0ato0 tertentu
0engi,uti saraf sensori tertentu. &er4a'i (roses inf/a0asi5 ne,rosis5 'an
'isru(si 0orfo/ogi 'ari se/ neuron 'an nonneuron 0enye1a1,an 0ye/itis5
'efisit fungsi 0otori,5 'an neura/gia (osther(eti, (PHN).
2
&e/ah 'ise1ut,an 1ah!a res(on i0un s(esifi, .3. yang 'i(erantarai
se/ 0eru(a,an ,o0(onen (enting untu, ,ese01uhan 'ari inf,esi (ri0er
(2ari+e//a) atau rea,ti2asinya (her(es #oster).
14
Infe,si .3. a,an
0engin'u,si (e01entu,an for0asi inf/a0asi NA"P3 (nucleotide$inding
oligomerization domain %&'()like receptor P*) 'an (roses ini 0e01entu,
sito,in (roinf/a0asi IA61 'engan a,ti2asi ,as(ase61 (a'a se/ yang
terinfe,si.
1%

&. Pemeriksaan &isik
1. Rash
1. $etia( /esi 0u/ai se1agai 0a,u/a 0erah 'an 0e/e!ati taha( (a(u/a5
2esi,e/5 (ustu/a5 'an ,rusta.
2. *e0erahan atau (e01eng,a,an 'i se,itar /esi 0engarah (a'a
,e+urigaan su(erinfe,si 1a,teri.
3. .esi,e/ yang ta0(a, (a'a 'asar /esi erite0 0e01eri,an ga01aran
se1agai 0utiara atau titi, e01un 'i ,e/o(a, 0a!ar (pearl or
de+drop on a rose petal).
4. 9e1era(a /esi 'a(at 0un+u/ 'i orofaring.
%. Aesi (a'a 0ata 0eru(a,an ha/ yang 4arang
6. Aesi 1aru a,an 0enga/a0i eru(si se/a0a 36% hari.
). 9iasanya ,rusta a,an ter1entu, se/a0a 6 hari (,isaran 2612 hari)5
'an a,an 1enar61enar se01uh 'a/a0 16 hari (,isaran )634 hari).
8. -ru(si yang 1er,e(an4angan 'ari /esi 1aru atau ,rustasi 'an
(enye01uhan yang tertun'a 'a(at ter4a'i (a'a gangguan i0unitas
se/u/er.
2. 'emam
1. e0a0 yang 0un+u/ 1iasanya 0e0(unyai gra'iasi yang ren'ah
(1006102B:) teta(i 0ung,in tinggi 106B:.
2. Pa'a ana,6ana, sehat5 'e0a0 1iasanya a,an 0ere'a 'a/a0 !a,tu 4
hari.
3. e0a0 yang 1er,e(an4angan 0en'orong ,e+urigaan atas ter4a'inya
,o0(/i,asi atau i0uno'efisiensi.
-. 'iagn,sis an Peng,batan
iagnosis 2ari+e//a 'itega,,an 'engan a'anya rua0 2esi,u/ar yang
,has. Penanganan 1ertu4uan untu, 0engurangi ge4a/a. Aseta0inofen
'iguna,an untu, 0engontro/ 'e0a05 (e01erian +airan untu, hi'rasi5 'an
(engo1atan to(i+a/ untu, rua0 'engan (ruritus. Pengo1atan 'engan in4e,si
asi,/o2ir 'i(er/u,an (a'a (asien 'engan resi,o atau ter1u,ti se+ara ,/inis
0enga/a0i disseminated disease. In4e,si asi,/o2ir 1isa 4uga 'i1eri,an (a'a
neonatus yang ter(a(ar .3. segera sete/ah /ahir. Pa'a ana, yang sehat5
anti2ira/ ti'a, 'i!a4i1,an5 teta(i se1uah (ene/itian 0enun4u,,an 1ah!a
(e01erian asi,/o2ir ora/ 'a/a0 24 4a0 a!a/ 'a(at 0engurangi 'urasi 'e0a0
satu hari 'an 0engurangi tan'a 'an ge4a/a ,utaneus 0au(un siste0i, yang
1erat.
3
Pengo1atan her(es #oster harus 1er'asar,an status i0un 'an u0ur.
Pa'a (asien i0uno,o0(eten 'engan usia 'i 1a!ah %0 tahun5 ana/gesi,
'i1eri,an untu, 0enurangi nyeri. Anti2ira/ se1enarnya ti'a, 'i(er/u,an5
teta(i (e01eriannya 'a(at 0e0(er+e(at hi/angnya rua0. Pa'a (asien
i0uno,o0(eten 'engan usia 'i atas %0 tahun5 (e01erian ana/gesi, 'an
anti2ira/ 'ire,o0en'asi,an5 'an sangat esensia/ (a'a (asien 'engan #oster
ofta/0i,us.
3
Pe0eri,saan /a1oratoriu0 untu, 'iagnosis 2ari+e//a 'a(at 'i/a,u,an
'engan te,ni, P?" 0au(un sero/ogi. Pa'a (e0eri,saan sero/ogi5 a'anya Ig@
seru0 s(esifi, .3. 0enun4u,,an (asien 1aru sa4a ter(a(ar .3..
*e/e0ahan (e0eri,saan Ig@ seru0 a'a/ah ti'a, 'a(at 0e01e'a,an antara
infe,si (ri0er5 reinfe,si5 atau rea,ti2asi. Pe0eri,saan a2i'itas IgG sangat
1erguna untu, 0eng,onfir0asi a'anya infe,si (ri0er5 yang 'itun4u,,an
'engan lo+avidity (a'a anti1o'y IgG5 a,an teta(i (a'a $reakthrough
varicella (e0eri,saan a2i'itas IgG 0enun4u,,an highavidity se1agai res(on
2a,sinasi. Pe0eri,saan yang (a/ing re/ia1/e 'an sensitif untu, 2ari+e//a
a'a/ah 'engan 0en'ete,si NA .3. 'ari sa0(e/ /esi ,u/it 'engan P?".
1
H. Pen.egahan
!merican !cademy of Pediatrics (AAP) 0ere,o0en'asi,an ana,6ana,
yang ter,ena 2ari+e//a untu, ti'a, 0asu, se,o/ah sa0(ai hari ,eena0
rash 0un+u/. @ung,in ini ti'a, 0en+egah (enye1aran 2ari+e//a ,arena ana, te/ah
terinfe,si se1e/u0 rash 0un+u/.
a. Vaksinasi
1) .a,sin 2ari+e//a ter'iri 'ari 'ka strain 2irus 2ari+e//a hi'u( yang
'i/e0ah,an. .a,sin i ni a0an 'an sangat i0unogeni,. .a,sin i ni
'isetu4ui untu, 'iguna,an 'i A0eri,a $eri,at (a'a tahun 188% 'an
te/ah 1anya, 0engurangi ,e4a'ian 'an ,e0atian a,i1at 2ari+e//a.
2) .a,sin ini te/ah 'ite0u,an 0e0i/i,i efi,asi (rote,tif se,itar )16100=
terha'a( 2ari+e//a. Na0un5 (er/in'ungan terha'a( 2ari+e//a se'ang
'an 1erat 4auh /e1ih tinggi (8%6100=).
3) 9ayi /ahir 0e0i / i ,i anti1o'i 0aterna/ (rote,tif untu, 2ari+e//a.
Ca,tu (aruh anti1o'i i ni a'a/ah se,itar 6 0inggu5 'an se1agian
1esar ana, 0e0i/i,i ,a'ar anti1o'i yang sangat ren'ah sete/ah usia
% 1u/an. Na0un5 2a,sin 2ari+e//a 'ire,o0en'asi,an sete/ah usia
1 tahun. osis tungga/ yang 'i1eri,an a,an 0e01eri,an
(er/in'ungan se,itar 8%= 'ari (eneri0a. I0unitas yang
'iti01u/,an 2a,sin %vaccineconferred immunity) terha'a(
2ari+e//a a,an 1er,urang 'ari !a,tu ,e !a,tu5 yang 0ana ha/ ini
0e01uat (eneri0a 2a,sin /e1ih rentan terha'a( (enya,it ini. !dvisory
,ommittee on -mmunization Practices (A?IP) 'an AAP se,arang ini
0ere,o0en'asi,an 2 'osis 2a,sin ini untu, se0ua ana,. $ete/ah 'osis
(+rta0a (a'a usia 1261% 1u/an5 'osis ,e'ua harus 'i1eri,an (a'a
usia 466 tahun. $e0ua orang yang te/ah 0eneri0a satu 'osis 2a,sin
,a(an (un 'i 0asa /a/u harus 'i1eri,an 'osis ,e'ua.
4). ua 'osis 2a,si n 2ari+e//a 0e01eri,an 88= (er/in'ungan
terha'a( 2ari+e//a5 'an 100= (er/in'ungan terha'a( 2ari+e//a 1erat
(a'a ana,6ana,. Ana, yang 'i1eri,an 'ua 'osis 2a,sin 4uga 0e0i/i,i
insi'en ,ese01uhan yang 1ai, atas 2ari+e//a.
%). $e01uhnya (enya,it ter4a'i sete/ah 42 hari 'ari i0unisasi. *eti,a itu
ter4a'i5 1iasanya (enya,it yang ti01u/ a'a/ah ringan teta(i 'a(at
0enye1ar ,e in'i2i'u yang rentan /ainnya. Ana,6ana, i ni 1iasanya
0e0iii,i ,urang 'ari %0 /esi (a'a ,u/it5 'an 'e0a0 ren'ah 'an +e(at
re'a. $a,it ,e(a/a5 sa,it tenggoro,an5 0a/aise5 'an anore,sia ,urang
sering ter4a'i.
6). 9e1era(a stu'i 0ene0u,an 1ah!a $reakthrough (enya,it /e1ih u0u0
ter4a'i 4 i ,a 2a,sin 'i1eri,an se1e/u0 usia 14 1u/an5 'a/a0 !a,tu 28 hari
2a,sinasi @@"5 'an 4i,a ana, itu se'ang 0eneri0a tera(i steroi' ora/.
urasi antara 2a,sinasi 'an (a(aran 4uga sangat signifi,an. Pene/itian
/ain ti'a, 0ene0u,an hu1ungan terse1ut.
)). Proto,o/ (ene/i/ian 0e0ung,in,an 2a,sin 2ari+e//a 'i1eri,an untu, (asien
'engan /eu,e0ia saat 0ere,a 1era'a 'a/a0 sta'iu0 re0isi. $ero,on2ersi
0enun4u,,an ni/ai yang 1ai, (a'a ana, 'engan /eu,e0ia.
8). Postexpositre prophylaxis, 4 i ,a 'i1eri,an 'a/a0 !a,tu 366)2 4a0 sete/ah
,onta,5 'a(at 0en+egah atau 0e/e0ah,an (enya,it (a'a in'i2i'u yang
ter(a(ar. 71at ini 0e0ung,in,an 'iguna,an untu, 2a,sinasi 'a/a0
0engen'a/i,an !a1ah (a'a ana,6ana, rentan.
8). Ca1ah 'a(at ter4a'i5 1ah,an (a'a ana, 'engan ting,at tinggi
2a,sinasi. Ana, yang te/ah 'i2a,sinasi 'a(at 0enge01ang,an (enya,it
ringan na0un infe,sius. Ca1ah 'a(at 'i,ontro/ 'engan 0e01eri,an
2a,sinasi (a'a ana,6ana, yang immmunized 'an re0a4a 'i 'aerah itu.
1. .ari+e//a6#oster i0un g/o1u/in
1) .3IG 'iguna,an se1agai postexposure prophylaxis (a'a i n'i 2i 'u yang
1erisi,o tinggi. Pe01erian sesegera 0ung,in sete/ah ter(a(ar a'a/ah 4a/an
ter1ai,5 ta(i .3IG 'a(at 0en+egah atau 0e/e0ah,an 2ari+e//a 4i,a
'i1eri,an 'a/a0 !a,iu 86 4a0 sete/ah ,onta,.
2) osisnya a'a/ah 12% unit<10 ,g 1erat 1a'an> 12% unit a'a/ah 'osis
0ini0u0. osis 0a,si0u0 a'a/ah 62% ID.
3) .3IG 'i1eri,an se+ara intra0us,u/ar 'an ti'a, (ernah 'i1eri,an se+ara
intra2ena (I.). urasi yang 'ihara(,an 'ari (er/in'ungan .3IG a'a/ah
se,itar 3 0inggu. Pa'a (asien yang 'i1eri,an -V imunoglo$ulin (I.IG)
ti'a, 'i(er/u,an .3IG 4 i ,a infus I.IG ter1aru 0ere,a te/ah 'i1eri,an
'a/a0 !a,tu 3 0inggu.
4) .3IG 0engurangi ,o0(/i,asi 'an ting,at ,e0atian 2ari+e//a5
1u,an insi'en 2ari+e//a. Penggunaan postexposure profllaksis
2a,sin 2ari+e//a Ie1i h 'isu,ai untu, ,e,e1a/an (asien nor0a/.
.3IG 'iin'i,asi,an untu, orang6orang 1eri,ut 'engan (a(aran
yang signifi,anE
a. 9ayi yang 1aru /ahir 'ari i 1u yang 0enga/a0i 2ari+e//a % hari
se1e/u0 sa0(ai 2 hari setetah (ersa/inan
1. Ana,6ana, 'engan /eu,e0ia atau /i0fo0a yang 1e/u0
'i2a,sinasi 'an 1e/u0 (ernah 0enga/a0i 2ari+e//a
se1e/u0nya
+. 7rang 'engan HI.5 ac#uired immunodeficiency syndrome
(AI$)5 atau gangguan ,e,e1a/an /ain
'. 7rang yang 0eneri0a o1at6o1atan yang 0ene,an fungsi
,e,e1a/an (0isa/nya5 steroi' siste0i,)
e. Canita ha0i /
f. In'i2i'u immunocompromised yang ti'a, 0e0i/i,i ri!ayat (asti
0enga/a0i +a+ar air.
g. -munoglo$iilin intravena ( I .I G) 'a(at 'iguna,an untu,
0en+egah 2ari +e//a s+te/ah (a(aran 4 i ,a .3IG t i 'a, terse'ia.
*e0an4uran ,/ i ni snya 1e/u0 se(enuhnya 'i,etahui.
I. ",m!likasi
a. Infe,si 1a,teri se,un'er
1). .ari+e/ /a 0en4 a'i (re'is(osisi (asien terha'a( infe,si 1a,teri. Infe,si
(a'a ,u/ i t yang 0enga/ a0i /esi 0er u(a,an haF yang sering ter4a'i 'an
ter4a'i (a'a %610= ana,6ana,. Aesi ,u/ i t 0eru(a,an portal of entry
organis0e 2iru/en> 'a(at (u/a ter4a'i se/u/itis yang 0enye1ar +e(at5
se(ti,e0ia5 'an infe,si serius /ain.
2) 7rganis0e yang sering 1ertin'a, se1agai agen infe,sius a'a/ah
stre(to,o,us gru( A 'an Staphylococcus aureus" .ari+e//a 0ene0(at,an
(asien (a'a resi,o tinggi untu, 0enga/a0i (enya,it stre(to,o,us gru( A
in2asif. $e/ain sin'ro0 syo, to,si,5 ,e/o0(o, stre(to,o,us gru( A 'a(at
0enye1a1,an ne+roti#ing fas+iitis5 1a,tere0ia5 osteo0ye/itis5
(yo0yositis5 gangrene5 a1ses su1ga/ea/5 arthritis5 'an 0eningitis (a'a
(asien 'engan 2ari+e//a.
3) $(esies sta(hy/o+o++a/ 4uga 0enye1a1,an infe,si yang (arah (a'a ana,
'engan 2ari+e//a. Infe,si sta(hy/o+o++a/ (a'a (asien ini 'i/a(or,an
0enye1a1,an se/u/itis5 impetiginous pox infections, staphylococcal
scalded skin syndrome, toxic shock syndrome, (eri,ar'itis5 'an
osteo0ye/itis.
4) &an'a 'an ge4a/a infe,si 1a,teri se,un'er 'a(at 'i1e'a,an 'ari 2ari+e//a
tan(a ,o0(/i,asi (a'a 364 hari (erta0a.
%). &ing,at ,e+urigaan yang tinggi 'i(er/u,an untu, (engena/an a!a/ 'an
(era!atan yang te(at !a,tu infe,si se,un'er.
6). &ersang,a infe,si se,un'er a'a/ah 4i,a 0anifestasi siste0i, (a'a (asien ti'a,
0e01ai, 'a/a0 !a,tu 364 hari5 ,e01a/i 'e0a0 atau 0e01uru,5 atau ,on'isi
ana, 0e01uru, sete/ah (er1ai,an a!a/.
)). *e+urigaan a'anya i nfe,si 1a,teri se,un'er seharusnya 0en'orong "$
untu, 0e01eri,an tera(i a!a/ anti1ioti, e0(iris sa0(ai hasi/ ,u/tur
terse'ia. Aeu,ositosis neutro(hi/i+ 'an neutro(hi/ia ter4a'i hanya
'a/a0 1e1era(a ,asus yang 0e/i1at,an infe,si 1a,teri yang serius.
1. *o0(/i,asi $$P
1) !cute postinfections cere$ellar ataxia a'a/ah ,o0(/i,asi $$P (a/ing yang
(a/ing sering ter4a'i5 'engan ,e4 a'ian 1 ,asus (er 4.000 (asien
'engan 2ari+e//a.
a. AtaGia 'a(at ter4a'i ti1a6ti1a5 'an 1iasanya ter4a'i 263 0inggu sete/ah
onset 2ari+e//a. *on'isi ini 1isa 1ertahan se/a0a 2 1u/an.
1. @anifestasinya 'a(at 1eraga05 0u/ai terhuyung6huyung saat 1er'iri
sa0(ai ,eti'a,0a0(uan untu, 1er'iri 'an 1er4a/an5 'engan 'isertai
'is,oor'inasi 'an 'ysarthria. @anifestasi yang 0un+u/ a,an
0a,si0a/ saat onset> a'anya +axing 'an +aning a,an 0enun4u,,an
'iagnosis /ain.
+. $ensoriu0 ti'a, terganggu5 1ah,an ,eti,a ata,sia ter4a'i se+ara 1erat.
'. Prognosis untu, (asien 'engan ata,sia 1ai,5 teta(i 1e1era(a ana,
0ung,in 0e0i/i,i sisa ata,sia5 'i,oor'inasi5 atau 'ysarthria.
2) -nsefa/itis ter4a'i (a'a 15) (asien (er 100.000 ,asus 2ari+e//a (a'a ana,
sehat usia 1614tahun.
a. Penya,it ini 0un+u/ (a'a 2ari+e//a a,ut se/a0a 1e1era(a hari sete/ah
onset rash. Aetargi5 dro+siness, 0engantu,5 'an ,e1ingungan
0eru(a,an ge4a/a yang 1iasa 0un+u/.
1. 9e1era(a ana, 0ung,in 0enga/a0i ,e4ang5 'an ensefa/itis yang
'a(at +e(at 1er,e01ang 0en4a'i ,o0a.
+. *o0(/i,asi yang serius 'ari 2ari+e//a i ni 0e0(unyai ting,at
,e0atian %620=.
3) $in'ro0 "eye 'i,ait,an 'engan 2ari+e//a ,eti,a 0engguna,an as(irin
a'a/ah u0u0. I'entifi,asi asosiasi ini se,arang te/ah 0e01uat
a+eta0ino(hen o1at (i/ihan5 'an sin'ro0 "eye te/ah 0en4a'i /ang,a.
4) *o0(/i,asi neuro/ogis /ainnya ter0asu, 0eningitis ase(tis5 sin'ro0
Gui//ain69arrH 'an (o/ya'i+u/itis.
%) Pneu0onia
a. Pneu0oni a t erut a0a t er4 a'i (a'a ana,6ana, yang / e1i h t ua 'an (a'a
orang 'e!asa serta 'a(at 0e0i / i ,i hasi/ yang fat a/ .
1. Ge4a/a (erna(asan 1iasanya 0un+u/ 364 hari sete/ah rash.
6). Her(es #oster.
a. $e1uah ,o0(/i,asi tertun'a 'ari 2ari+e//a5 her(es #oster infe,si5
ter4a'i 'a/a0 1u/an sa0(ai tahun sete/ah infe,si (ri0er (a'a
se,itar 1%= 'ari (asien.
1. *o0(/i,asi terse1ut 'ise1a1,an o/eh 2irus yang terus60enerus
0eneta( 'a/a0 gang/ions sensori,.
+. Her(es #oster ter'iri 'ari rash 2esi,u/ar uni/atera/5 yang ter1atas (a'a 163
'er0ato0. "ash ini sering 0enya,it,an (a'a ana,6ana, yang /e1ih tua
'an orang 'e!asa. i antara 0anfaat ,esehatan 'ari i0unisasi rutin
2ari+e//a (a'a ana, a'a/ah (enurunan risi,o seu0ur hi'u( untu,
rea,ti2asi 2irus se1agai her(es #oster.
'. 7titis 0e'iaE se,itar %= ana, 'engan 2ari+e//a 'a(at
0enge01ang,an otitis 0e'ia5 yang 'ise1a1,an o/eh (atogen
(enye1a1 yang 1iasa 0un+u/ (a'a otitis 0e'ia.
e. &ro01osito(enia
f. He(atitisE He(atitis 0eru(a,an selflimited accompaniment (a'a
2ari+e//a.
i. He(atitis 1erat 'engan 0aniiestasi ,/inis 4arang ter4a'i (a'a ana,6
ana, sehat 'engan 2ari+e//a.
ii. Pening,atan yang signifi,an atas a/anine a0inotransferase (AA&)
ter4a'i (a'a 206%0= ana,6ana, 'an re0a4a5 na0un (ening,atan ini
a,an ,e01a/i nor0a/ 'a/a0 !a,tu satu 1u/an 'i ha0(ir se0ua
,asus.
i i i . *eter/i1atan hat i t i 'a, tergantung (a'a t i ng,at ,e(arahan ,u/ i t
'an 0anifestasi si st e0i ,.
g. G/ o0eru/ onefri t i s
h. engue 2ar i +e/ / a
/. Pr,gn,sis
Ana, sehat yang 0enga/a0i 2ari+e//a 0e0(unyai (rognosis yang sangat
1ai,. Ana, yang 1era'a (a'a ,on'isi i00uno+o0(ro0ise' 1erisi,o untu,
0enga/a0i (enya,it 1erat 'an ,e0atian (0isa/nya5 ting,at ,e0atian ana,
'+ngan /eu,e0ia a'a/ah )=). Neonata/ 2ari+e//a ting,at ,e0atian 'a(at
0en+a(ai 30=. -(iso'e ,e4a'ian 2ari+e//a a,an 0e01eri,an ,e,e1a/an.
-(iso'e ,e'ua ini sangat 4arang ter4a'i.
a. .ari+e//a ringan 'an se'ang (rognosisnya 1ai,
1. Ang,a ,e0atian (neu0onia 2ari+e//a a'a/ah 10= (a'a (asien 'engan siste0
i0un yang 1ai,5 'an 30= (a'a (en'erita immunucompromised"
+. Ang,a 0or1i'i/as 'an 0orta/itasnya +u,u( tinggi
'. 9i/a seseorang te/ah terinfe,si 2ari+e//a5 a,an 0e01eri,an ,etahanan
seu0ur hi'u( !a/au(un a,hir6a,hir ini reinfe,si se,un'er te/ah
'i/a(or,an.
". Eukasi !aa !asien
9eri,ut ini a'a/ah as(e, e'u,asi (asienE
a. @an'i,an ana, se+ara teratur untu, 0engurangi gata/ 'an 0en+egah infe,si
se,un'er
1. Garu,an 'a(at 0enye1a1,an infe,si se,un'er 'an 1e,as /u,a.
1) Iaga agar ,u,u (en'e,.
2) @e0a,ai sarung tangan atau ,aus ,a,i 'i tangan 'i 0a/a0 hari 'a(at
0e01antu 0en+egah goresan.
+. Iangan guna,an o1at yang 0engan'ung as(irin.
'. 9eritahu/ah orangtua untu, 0e01a!a ana,6ana, ,e ru0ah sa,it 4 i ,a ter4a'i
ge4a/a 1eri,utE
1) *e0erahan yang ti'a, 1iasa5 (e01eng,a,an5 atau nyeri 'i se,itar
'aerah rash
2) @eno/a, untu, 0inu0 +airan
3) &an'a6tan'a 'ehi'rasi5 se(erti ,en+ing se'i,it 'an 1er!arna ,uning5
0engantu,5 0u/ut 'an 1i1ir ,ering5 haus yang 1er/e1ihan5 atau /etargi
4) 9ingung5 /e,as 0arah5 0engantu,5 atau ,esu/itan 1angun
%) *eti'a,0a0(uan untu, 1er4a/an atau ,e/e0ahan yang ti'a, 1iasa
6) *e/uhan sa,it ,e(a/a (arah5 /eher ,a,u5 'an<atau sa,it (unggung
)) $ering 0untah
8) *esu/itan 1erna(as5 nyeri 'a'a5 0engi5 na(as +e(at5 atau 1atu, (arah
8) e0a0 1ertahan /e1ih 'ari 4 hari atau ,e01a/i 'e0a0 sete/ah (enurunan
suhu 1a'an sa0(ai (a'a ting,at nor0a/
10) Pena0(i/an yang /e1ih sa,it 'i1an'ing,an saat tera,hir ,a/i sa,it
se1agai0ana 'i/ihat o/eh 'o,ter
L. $asalah "husus
*eha0i/an a'a/ah !a,tu yang rentan ter,ena (enya,it. .ari+e//a
'a(at 0enye1a1,an 1er1agai ha/ yang 0erugi,an 1agi i1u 'an 1ayi5
tergantung (a'a taha( ,eha0i/an.
Ana, yang i00uno+o0(ro0ise' sering,a/i 0enga/a0i 2ari+e//a yang
1erat 'an 0eni01ui,an ,o0(/i,asi5 'an ting,at ,e0atian 0ere,a /e1ih tinggi
'ari(a'a ana,6ana, yang i0uno,o0(eten. Ana,6ana, i ni 0ung,in 0enga/a0i
'e0a0 tinggi 1er,e(an4angan5 rash /uas5 'an he(atitis. *o0(/i,asi yang (a/ing
serius a'a/ah (neu0onia 2irus5 yang ti'a, res(onsif terha'a( tera(i anti2irus 'an
1isa 0enga,i1at,an ,e0atian.
*ategori atas (asien immunocompromisedE
a. Ana,6ana, 'engan ,eganasan a(a(un
1. Ana,6ana, (a'a ,e0otera(i ,an,er
+. Ana,6ana, 0en4a/ani tera(i ,orti,osteroi' 'osis tinggi
'. Ana,6ana, 'engan 1a!aan immunodeficiencies selular
e. Ana,6ana, (a'a tera(i i0unosu(resif
f. Ana,6ana, 'engan infe,si HI.
g. Ana, 'engan e,si0 atau 'er0atitis 0ung,in 0e0i/i,i 0anifestasi ,u/it
(arah se/arna 2ari+e//a
$. Vaksinasi Vari.ella
i A0eri,a $eri,at se4a, tahun 188% te/ah 'i1er/a,u,an 2a,sinasi
2ari+e//a 1 'osis. Na0un ,e0u'ian5 ,e1i4a,an 2a,sin 1 'osis 'iu1ah 0en4a'i
2 'osis (a'a tahun 2006. &arget 2a,sinasi 2ari+e//a 1 'osis 'itarget,an (a'a
ana,6ana, 12618 1u/an 'an 4uga ter0asu, catchup 1agi ana, yang /e1ih tua
'an orang 'e!asa.
12
$ete/ah 2a,sinasi 'ii0(/e0entasi,an5 ter4a'i (enurunan
se+ara su1stansia/ 'ari segi 0or1i'itas5 0orta/itas5 'an 1iaya (era!atan.
Na0un 'e0i,ian5 se,itar 1%= (eneri0a 2a,sin ti'a, 0en'a(at /e2e/ anti1o'i
yang (rote,tif (a'a (e01erian 1 'osis. i(er,ira,an5 i0unitas terin'u,si
2a,sin se0a,in 1er,urang seiring !a,tu 1er4a/an. Pa'a tahun 20065 A?IP
0enyetu4ui (enggunaan 2a,sin 2ari+e//a 'engan 3 (en'e,atanE 1)
i0(/e0entasi (rogra0 2a,sinasi 2 'osis untu, ana,6ana,5 'i0ana 'osis61
'i1eri,an (a'a u0ur 1261% 1u/an 'an 'osis62 (a'a u0ur 466 tahun> 2)
2a,sinasi 2 'osis untu, catchup ana,6ana,5 re0a4a5 'e!asa yang te/ah
0eneri0a 'osis61> 3) .a,sinasi rutin untu, untu, se0ua orang sehat usia
J13tahun tan(a 1u,ti i0unitas.
16
*riteria i0unitas untu, 2ari+e//a a'a/ah
te/ah ter'o,u0entasi 0en'a(at 2 'osis 2a,sin5 (e0eri,saan /a1oratoriu0
0enun4u,,an i0unitas5 'an ri!ayat ter'iagnosis 2ari+e//a atau her(es
#oster.
1)
.xpert Panel of the -nfectious (iseases Society of !merica (I$A)
te/ah 0enge/uar,an (e'o0an (rogra0 2a,sinasi untu, (eneri0a 2a,sin
i0uno,o0(eten 0au(un immunocompromised 0en+a,u( se0ua usia.
18
$e+ara garis 1esar5 a'a 3 taha( (er,e01angan 2a,sin 2ari+e//a. &aha(
(erta0a a'a/ah (e/e0ahan .3. 'an u4i +o1a a!a/ ,ea0anan5 i0unogenitas5
'an efi,asinya yang 'i/a,u,an se0uanya 'i Ie(ang. &aha( ,e625 stu'i tentang
i0unogenitas 'an ,ea0anan 'i/a,u,an 'i A0eri,a 0e/i1at,an resi(ien
immunocompromised 'an se/an4utnya resi(ien sehat. &aha( ,e62 ini
,e0u'ian 0enghasi/,an 2a,sin 2ari+e//a 'osis61 yang '/isensi 'an 'iguna,an
'i A0eri,a (a'a tahun 188%. Per,e01angan se/an4utnya (a'a taha( ,e63
a'a/ah 0enge01ang,an 2a,sin yang ti'a, hanya 0en+egah 2ari+e//a teta(i
4uga her(es #oster.
18
.a,sin 2ari+e//a 1erasa/ 'ari 2irus hi'u( yang 'i/e0ah,an. .3.
0eru(a,an 2irus yang sangat 0enu/ar 'an (a'a (asien immunocompromised
infe,si .3. 'a(at 0enye1a1,an 'ise0inasi5 (neu0onia5 'an ensefa/itis.
20
Penggunaan 2a,sin 2ari+e//a su'ah 'e0i,ian /uas. $tu'i yang 'i/a,u,an
0enun4u,,an 1ah!a (enggunaan 2a,sin 2ari+e//a se+ara garis 1esar a0an.
21522
.a,sin 2ari+e//a efe,tif untu, 0en+egah 1ai, 2ari+e//a 0au(un her(es
#oster.
23
Breakthrough varicella 'i/a(or,an ter4a'i (a'a ana,6ana, yang
0en'a(at 2a,sin 2ari+e//a. $e,itar 1 'ari % ana, yang 0en'a(at 2a,sin
2ari+e//a 0ung,in 1isa 1er,e01ang 0en4a'i $reakthrough varicella.
24
Breakthrough varicella 'i/a(or,an 1any,a ter4a'i (a'a (e01erian 2a,sin
(a'a usia 'i 1a!ah 14 atau 1% 1u/an5 a,an teta(i (ene/itian 0enun4u,,an
1ah!a se1enarnya ti'a, a'a (er1e'aan efe,tifitas (e01erian 2a,sin
1er'asar,an u0ur 'an 0en'u,ung re,o0en'asi usia (e01erian 2a,sin ini.
2%
Breakthrough varicella ,e1anya,an ter4a'i sete/ah (e01erian 2a,sin 'osis
(ri0er. Pe01erian 2a,sin 'osis ,e'ua 'ihara(,an 0a0(u 0ening,at,an
sero,on2ersi 'an efe,tifitas 2a,sinasi.
26
Pene/itian (a'a i1u ha0i/ yang
0en'a(at 2a,sin 2ari+e//a ti'a, ter1u,ti 0eni01u/,an sin'ro0 2ari+e//a
,ongenita/.
2)
*e4a'ian 2ari+e//a (a'a 1ayi 0enurun se4a, 'i1er/a,u,annya
2a,sinasi 2ari+e//a (a'a tahun 188%.
28
Pe01erian 2a,sin 2ari+e//a 4uga 1u,an
0eru(a,an fa,tor resi,o ter4a'inya stro,e is,e0i, yang 0eru(a,an sa/ah satu
,o0(/i,asi 'ari (enya,it 2ari+e//a.
28
.a,sinasi 2ari+e//a se1ai,nya teta(
'i/a,sana,an se+ara uni2ersa/.
30
'aftar Pustaka
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3. @ue//er5 N.H.5 Gi/'en5 .H.5 ?ohrs5 ".I.5 @aha/inga05 ". K Nage/5 @.A.
2008. .ari+e//a #oster 2irus infe+tionE +/ini+a/ features5 0o/e+u/ar
(athogenesis of 'isease5 an' /aten+y. &eurol ,lin" 2008 August> 26(3)E 6)%L
2iii.
4. 9reuer5 I.5 Grose5 ?.5 Nor1erg5 P.5 &i((/es5 G. K $+h0i'5 .$. 2010. A
(ro(osa/ for a +o00on no0en+/ature for 2ira/ +/a'es that for0 the s(e+ies
2ari+e//a6#oster 2irusE su00ary of .3. No0en+/ature @eeting 20085 9arts
an' the Aon'on $+hoo/ of @e'i+ine an' entistry5 24L2% Iu/y 2008. 0ournal
of 1eneral Virology (2010)5 815 821L828.
%. @a/a2ige5 N.@.5 Iones5 A.5 *a0a/a'asa5 $..5 Ci4e!i+,ra0a5 A.5
$ene2iratne5 $.A.5 9/a+,5 A.P. K 7gg5 G.$. 2008. .ira/ /oa'5 +/ini+a/ 'isease
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hos(ita/i#ations in the Dnite' $tates5 200062006E &he 16'ose 2ari+e//a
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2ari+e//a an' her(es #oster a0ong HI.6infe+te' +hi/'ren fro0 1888 to 2006.
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28. onahue5 I.G.5 *ie,e5 9.A.5 Yih5 C.*.5 9erger5 N.".5 @+?au/ey5 I.$.5 9aggs5
I.5 3ang!i//5 *.@.5 9aGter5 ".5 -ri,sen5 -.@.5 G/an#5 I.@. K the others.
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30. Pere//a5 .5 :i,s5 A.G.5 Iu0aan5 A.5 "o1inson5 .5 Gargiu//o5 P.5 P/et+her I.5
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