7 Imunisasi

8/16/2019 7 Imunisasi

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Childhood Immunization

Hartono Gunardi

Child Health Departement

FKUI-RSCM


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Vaccine Shots Hurt! h do "e need it#

• Vaccines protect!

• Vaccines are the MOST EFFECTIVE

preventive measure against VaccinePreventable Disease


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VPD Case euction a"ter Immuni#ation Program in $S%

Disease Max case(year) 2009report Change(%)

Difteria

Measles

Mumps

Pertusis

Polio

Rubella

Congenital

RubellaSyndrome

Tetanus

Invasive HiB

20!"#"$%"2%&

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Immunization O!ecti"es

$rotect a%ainst &accine pre&enta'le disease

(intermediate goal )

*o # &accine pre&enta'le disease pre&alence(alter V$D epidemiolo%)

V$D eradication (final goal )


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• Smallpo&

• Eraicate


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Me,-anism of .a,,ines

/ ntigens are 1R3I45 substan,es for ourbodies

/ Immune system re,ogni6es 1R3I45

antigens and mounts an immune response7in t-e form of 5TIBDI3S to eliminate it!

/ fter t-e antigen -as been eliminated7immune system retains a M3MR8 of t-atantigen9 53:T TIM3 it appears t-eantibody response is faster and stronger;;


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4erms re ntigens

/ T-e proteins andsugars on t-e

g-tt-em o?


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.a,,ine Types

/ @ive va,,ines9 attenuated7 must reprodu,eto produ,e immune response

/ Ailled Ina,tivated va,,ines9 pie,es$sugars or proteins& of t-e germ


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.a,,ine PreventableDiseases

/ Ailled .a,,ines9 Hepatitis B7Dipt-eria7 Pertussis7 Tetanus7 $olio

/ @ive ttenuated9 Measles7 Mumps7Rubella7 .ari,ella7 BC47 $olio

/ Conugated9 HIB7 PC.


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Passive Immuni6ation

$assi"e immunization antio&y that hasalrea&y per'orme& y other

Maternal antio&y is trans'er through

umilical cor& an& placenta in thir&trimester

xample tetanus toxoi& in pregnantomen ill pre"ent neonatal tetanus

*peci+c Immunogloulin 'or certain ,$D

xample -epatitis ./ tetanus/&iphtheria


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'epatitis (

/ .iral disease spread by ,onta,t ofbody uids9 blood7 seEual uids

/ Infe,ted in younger age -ig-er,-an,e to be,ome ,-roni, ,arrier

,-roni, -epatitis7 liver failure7liver ,an,er7 and deat-

/ Immuni6ation strategies targeting

ne


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Va+sin Hepatitis ,(Uniject®, Engerix-B® , Euvax-B® , Hepvac-B®)


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Hepatitis , Vaccine

• Sur"ace antigen o" hepatitis ( virus

• Scheulle ) *+, an - month.


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,CG Vaccine


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,CG Vaccine ()

/ @ive attenuatedMycoacterium o"is hi&up

• ptimal 9 2 + # mont- old! If F

# mont- tuber,ulin test!

/ Dose 001 m intra&ermal

right &eltoi&

(u/u PeomanImunisasi i Inonesia 0*,1

Vaemecum (io"arma


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,CG Vaccine (.)

• Contra indication 2 'IV+ Immunocompromais+ steroi therap3+imunosupressant+ malignanc3+ severemalnutrition+ acute "ebrile illness

• $rotection

2 Start 4 2 ,0 5ee/ a"ter vaccination

2 E""icac3 106 78'O 9*:;46<

2 Prevent severe T( -*:4*6

• WHO : BCG position paper 2004, 2007.

• Buku Pedoman Imunisasi di Indonesia 2014


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Dipt-eria

Ba,terial9Coryneba,teriumdipt-eriae

Person to person

Severe t-roatinfe,tions7 ,an

obstru,t breat-ing

Myo,arditis ,an befatal


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Pen3a/it Di"teri


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Tetanus

/ Ba,terial infe,tion9 Clostridiumtetani7 o,,urs in deep


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Pertussis

/ Ba,teria9 BortadellaPertussis

/ Starts as a ,old7 mayprogresses to pneumoniaand en,ep-alitis

/ G


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Diptheri *etanus whole cells $ertusis(DTPw)

and *o/oid *etanus (**)

Heat Marker /

Vaccine Vial Monitor

(VVM)


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Di0teri *etanus acellular $ertusis (D*a$)


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Va/sin DTP:'(:'ib


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D*$ &accine

• Diphtheria and tetanus ) to/oid

• $ertusis ) /ille bacteria

Schedulle

,asic 1 0+1+- month 5ith Polio vaccine ,ooster ) ,4+ -* month 7DTP


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Polio

/ .iral7 mostlyasymptomati,7 ,an ,ausemeningitis7gastroenteritis andparalyti, polio

/ @ast


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2ral $olio Vaccine (2$V)

'eat Mar/er

Vaccine Vial Monitor 7VVM<


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Color changes o" oral polio vaccineue to p' changes

Ma3 be aministere


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2ral $olio Vaccine (2$V)

/ @ive attenuated virus

type %7 27 # Sabin strain

/ *che&ulle 9 0727(7 mont- J %'7 0mont-

/ Dosis 9 2 drops

/ 4&"erse reaction 9 mild diarr-ea

.a,,ine sso,iated Polio Paralysis 9 % 9% million doses of P.


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Inacti"ate& $olio ,accine

/ ess immunity in enteralmucosa

/ dverse event 9 5o ris= of .PP

/ Sero,onversion IP. F P.


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Measles

• Viral isease+ rapi person

to person to person

transmission among

susceptibles

• 'igh "ever+ re e3es+ rash+

miser3

• Complication ) pneumonia+

encephalitis+ chronic

iarrhea


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Measles &accine

Heat Marker

Vaccine Vial Monitor

(VVM)


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Measles Vaccine

• 3i&e attenuated &irus

• Tiap *+9 ml menganung

2 ,*** u virus strain C%M ;*

2 ,** mcg /anamisin+ =* mg eritromisin

• Dosis *+9 m>+ su'cutaneousl in deltoid


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Mumps

• Viral isease

characteri#e b3 "ever

an s5elling o" saliva

glans• Orchitis common+

sterilit3 rare

•Sporaic cases anoutbrea/s still occur


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ubella

/ .iral7 -umans only

/ G4erman Measles

/ @o< grade fever7 oint pains7 s


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Va+sin Mumps Mor'ili Ru'ela (MMR)


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MMR Vaccine 7Trimovax®, MMR II ® <

• 3i&e attenuated &irus

Measles Sch"arz virus

Mumps Ura'e &irus

Ru'ela istar virus

Contra indi,ation immuno,ompromi6ed7 malignan,yS,-edulle 9 %2+%) mont- old and

year old

• Seroconversion in ? @96 cases

• 5o eviden,e t-at MMR ,aused

M


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@oring Dales7 Hammer SK7 Smit- 5K! KM 200%L2')9%%'(

MM5 age 26monthMM5 age 78 mo

4utismecases

M M 5 " s

4 u t i s m


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Haemop-ilus Inuen6ae B/

Ba,terial infe,tion9 ,an ,auseear and sinus infe,tions7 s=ininfe,tions $,ellulitis&7pneumonia7 oint and bone

infe,tions7 epiglottitis/ Prior to va,,ines


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Haemophilus influenza b (Hi')Vaccine


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Haemophilus in0luenzae tpe ' Vaccine7 Act-HibA+ Hiberix A<

• Polisa/aria '. in"luen#a tipe bpolisaccharie conBugate to tetanusto&oi.

• Scheulle ) 0+1+- month an ,0:,9 monthol


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Varicella

• Viral+ herpes "amil3

• chic/en po&

• $suall3 mil+ sel"limite )"ever+ rash

• Can get pneumonia+

cerebellitis+

encephalitis+ eveneath


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Varisela Vaccine


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Varisela Vaccine (Varilrix ! "ka#ax )

• 3i&e attenuated Vaccine4 O/a strain

• SC 4 5 ear old

• Contra inication

2 %cute "ebrile illness


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Pneumococcal ConBugate

/ Ba,terial9 Strepto,o,,usPneumoniae

/ Severe invasiveinfe,tions9 pneumonia7meningitis7 s=in7 boneand oint infe,tions

/ Maor ,ause of mortalityin immun,ompromised

and ,-ildren


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$neumococcal &accine(Sn0lori/ $re&enar )

• Con6u%ate &accine 1 $CV 7484 9

• $olisaccharide &accine 1 $$V.9

For hi%h ris+ children e%: asplenia4

immunocompromized:

• $re&ents 1 pneumonia4 menin%itis4 'acteremia

• Schedulle ($CV) 1 .4;4< month and .-= month:

• Schedulle ($$V) 1 5 . ear old

8'O oung In"ant Stu3 roup. (acterial etiolog3 o" serious In"ections In 3oung in"ants in

eveloping countriesG results o" a Multi:center trial. Peiatric In"ect Dis H ,@@@G,4) S,;:00


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*phoid Vaccine


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*phoid 0e&er

• ,acteria 1 S tphi

• *phoid 0e&er 1 0e&er 5 7 das4 GIsmptom4 altered consciousness

• Vaccine protects a%ainst

S tphi

S paratphi C

• Duration o0 protection 1 9 ear


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In0luenza Vaccine (Va/i%rip>4 Fluari/ >)

I 0l


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In0luenza

Viral in"luen#ae+ sprea through airborne

Flu vaccine ) = strain inactivate "lu virus7split virion<

Strain .88

%Cali"ornia;0**@ JMC K:,;@%


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Va+sin Hepatitis ? Vaccine


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Hepatitis ?

• 'epatitis % virus• Foo borne viral hepatitis

• 'ep % vaccine ) inactivate virus

• Scheulle ) *+ -:,0 month


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Human $apilloma&irusHuman $apilloma&irus

/ Causes 9 ,ervi,al ,an,er anogenital dysplasia

genital


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Human $apilloma&irus VaccineHuman $apilloma&irus Vaccine

• Hune 0**-) *etra&alent

('PV t3pe -+ ,,+ ,-+ an ,4<

,i&alent 7'PV t3pe ,- an ,4 <

• 'PV vaccine ) be"ore se&uall3 active

• Indonesia 1 5 8 ears ol girls

,ri%ham KS: $ediatr Re& .88@A98(.)1;7-==


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Rota&irus &accine

• otavirus iarrhea in chilren

• Vaccine )

Monovalent ) , strain

Pentavalent ) ,+ 0+ =+ 1 an -

• Scheulle ) Monovalen t5ice

Pentavalent thrice+

orall3


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Rota&irus &accine

• Monovalent ) ,7P4< strain

• Pentavalent ) ,7P9


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Rota&irus &accine (.)

• Pentavalen are given =&

Dose I 1


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Com'ination &accine

• Vaccine that contain more than ,

antigen

• E&ample. DTP

DTP:'(

DTP:'ib

DTP:'ib:IPV

DTP:'ib:'(:PV

MM


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Va+sin +om'inasi D*"$ (whole cell ) B Hi'


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Va+sin +om'inasi D*$ aseluler B Hi'


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InBection techniLue

Su'cutaneouse.g. measles+ mumps+

rubella+ varicella

Intramuscular e.g. hepatitis % an (+

DTP

Intradermal

(C

2ral

e.g. polio


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ecoring

• (ran name

• Jo. >ot vaccine

• E&pir3 ate

• Date o" vaccination

• InBection location 7 eg. ight eltoi+ right

thigh<

Vaccine storage 7a"ter use


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Vaccine storage 7a"ter use<• ,CG

2 Use "ithin 9 hour 7in . E C)

• $olio

2 Use "ithin 7 das 7in . E C)

• D**

2 $se 5ithin 0 5ee/s 7in . E C)

• Campa+

2 $se 5ithin hour 7in . E C)


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Vaccine storra%e

$ l %$ l %


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$ool %ox $ool %ox

Untu+ Menimpan Va+sinUntu+ Menimpan Va+sin


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Re0ri%erator


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Re0ri%erator (0ront door)


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Vaccine storage

• Temperature 0 2 4 ° C

• /cept 1 OPV

(C

Measles

7 :,9 s 2 09° C


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Safe injection

Sa"e "or

vaccinee

octor

environment

$ " " i


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$nsa"e "or vaccinee

• VaccineE&pose to ? 4 C

E&pire+ ilute longer than recommene time

Fro#en "or ) DPT+ DT+ TT+ 'ep(+ 'ib

• Srin%e

$se isposable s3ringe more than once

• Dilutin%

• 3ocation4 route

$nsa"e "or inBector


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$nsa"e "or inBector • ecapping

• touch the inBection site 5ith bare "inger Do not prepare emergenc3 rug /it

• >eave s3ringe in common ustbin

$nsa"e "or environment

*empat $em'uan%an 3im'ah


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*empat $em'uan%an 3im'ah


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Conclusion

• Immuni#asition protect chilren against

vaccine pretable isease.

• Vaccine bene"its "ar out5eigh the pain an

minor averse e""ects


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Than/ 3ou

8 b


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8ae ebo

VVM VVM Vaccine Vial MonitorVaccine Vial Monitor


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VVM VVM Vaccine Vial Monitor Vaccine Vial Monitor


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