BackgroundImperforate hymen is an uncommon congenital anomaly of the female genital tract and is rarely diagnosed in newborns. An imperforate hymen is a cause of primary amenorrhea. Case DescriptionA 12-year-old girl was admitted to the pediatric outpatient clinic with cyclic abdominal pain for eight days. She had lower abdominal pain with dysuria and constipation for the previous six weeks. There is a bulging mass on the perineal that appears when straining. Fever, nausea, vomitus, abdominal enlargement, and leucorrhea were denied; breast enlargement since 12 years old with no history of menarche. The patient vital signs were normal. On physical examination obtained, lower abdominal pain and tender suprapubic mass were palpable. The pubertal status was normally secondary sexual characteristics. An interlabial mass was found protruding from the introitus vagina and the hymen intact on inspection of the external genitalia. Laboratory and urinalyses revealed normal. Hematometra and hematocolpos were found on abdominal ultrasonography, which led to the diagnosis of imperforate hymen. Therefore, a hymenectomy was performed and evacuated 520 ml of dark red blood. The patient’s condition was good, and she had regular menstruation. ConclusionsImperforate hymen is an easy diagnosis, but sometimes clinicians are oblivious to including this in the differential diagnosis of lower abdominal pain in pubescent girls with primary amenorrhea. Also, a lack of awareness about the importance of external genitalia examination as part of routine physical examination in children and adolescents makes this diagnosis easily missed or delayed.

Background Hepatitis B is a viral infection that has a high prevalence in Indonesia. The Ministry of Health of Indonesia has conducted a national vaccination program for hepatitis B. In order to evaluate the success of the hepatitis B vaccination in Indonesia, a community study based on basic health research (Riskesdas) was performed nationwide since 2007 for five year period in 2007, 2013, and 2018. Methods Further statistical analysis was performed specifically for the children under 59 months old (toddlers) immunized in both urban and rural areas in 2007, 2013, and 2018 based on certain characteristics by examining antibodies against HBsAg (anti-HBs), IgG antibodies against the core antigen (HBcAb), surface antigen (HBsAg) of hepatitis B virus (HBV). The data obtained from the data management laboratory of Ministry of Health, Indonesia, was analyzed with Bivariate analysis with continuity correction chi-square or Pearson chi-square using Stata software version 16. Results This study showed an increase in hepatitis B coverage of complete immunization (30% in 2007, 60.3% in 2013, and 57% in 2018), which was also influenced by mothers’ level of education (Pearson chi-square , p ¡ 0.05) and access to health service points within 30 minutes (OR = 1.3–2.8, p ¡ 0.05). The trend of the percentage of immune status (anti-HBs) was increased (41.8% in 2007; 56.1% in 2013; and 79.1% in 2018). The higher anti-HBs was found in complete hepatitis B immunization status (OR = 1.5–2, p ¡ 0.05) and in good nutritional status (p ¡ 0.05). However, the anti-HBs was found decreased with increasing age (p ¡ 0.05). The trend of positive HBcAb (exposure to HBV infection) showed a decrease gradually of almost ten times from 2007 (8.6%-13.5%) compared to 2013 (2.6%-11.1%) and 2018 (1.1%-2%). Urban areas were at higher risk of hepatitis B exposure (OR = 1.4–2.2) than rural areas (OR = 0.37–0.80). The HBsAg data were only available in 2013 and 2018. Riskesdas data analysis showed the prevalence of hepatitis B (HBsAg) was lower in complete immunization status than that in incomplete one (p ¡ 0.05), but with an increase from 3.9% (2013) to 9.3% (2018), possibly due to inappropriate implementation of birth dose immunization or a vaccine-escape mutant from the HBV variants. Conclusions The effectiveness of hepatitis B vaccine obtained from the three Riskesdas periods in Indonesia showed an improvement, with an increase in immune status, reduced exposure to HBV and a lower prevalence of hepatitis B in children with complete vaccination. However, there is still an increase in hepatitis B infection, especially in urban areas. Therefore, a long-term evaluation of immunization coverage especially ensuring that the initial dose of immunization was given within the first 24 h of birth, HBsAg and HBcAb, nutritional status, genomic surveillance of HBV, and other aspects of program quality evaluation are needed to ensure that elimination efforts have been implemented properly.

Hepatitis adalah proses terjadinya inflamasi dan atau nekrosis jaringan hati yang dapat disebabkan oleh infeksi, obat-obatan, toksin, gangguan metabolik, maupun kelainan autoimun.(1) Hepatitis pada anak masih merupakan masalah kesehatan utama baik di negara maju dan berkembang . Etiologi utama penyakit hepatitis adalah infeksi virus hepatotropik ( liver merupakan target organ utama ) dan non-hepatotropik (menyerang sistemik dan organ hati) . Saat ini telah ditemukan virus hepatotropik penyebab utama infeksi akut, yaitu A, B, C, D, E, dan G. V irus B adalah virus DNA , sedangkan jenis lainnya adalah virus RNA . Selain virus hepatotropik ( virus herpes simplek (HSV), virus sitomegalo (CMV), virus epsteinbarr (EBV) , virus varicella -zoster , rubella, virus HIV, adeno, entero, arbo, parvo) dapat memberi kan gejala hepatitis .(2,3) Sekitar 10-15% penyebab kasus hepatitis akut tidak diketahui, termasuk hepatitis akut misterius (unknown hepatitis) yang saat ini sedang marak terjadi di sejumlah negara di dunia termasuk Indonesia. WHO menyatakan dari kejadian luar biasa unknown hepatitis ditemukan terlibatnya Adenovirus type 41 sebagai koinfeksi SARS-CoV-2