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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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+""!""
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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: $ediatr Re& .88@A98(.)1;7-==
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Rota&irus &accine
• otavirus iarrhea in chilren
• Vaccine )
Monovalent ) , strain
Pentavalent ) ,+ 0+ =+ 1 an -
• Scheulle ) Monovalen t5ice
Pentavalent thrice+
orall3
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Rota&irus &accine
• Monovalent ) ,7P4< strain
• Pentavalent ) ,7P9
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Rota&irus &accine (.)
• Pentavalen are given =&
Dose I 1
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Com'ination &accine
• Vaccine that contain more than ,
antigen
• E&le. DTP
DTP:'(
DTP:'ib
DTP:'ib:IPV
DTP:'ib:'(:PV
MM
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Va+sin +om'inasi D*"$ (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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