Tindakan aspek manajemen kesehatan

15/2014

DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS

DRH.ROSITAWATI, I. MP

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Types of Vaccination Strategies• There are two types of vaccination policies:

– Universal Vaccination – every person is vaccinated in the hope of

eliminating/eradicating the disease from the community

– Selective Vaccination – only individuals in particular risk groups

are vaccinated.

• Both policies are in use for rubella. – The US started off with universal vaccination.

– The UK and HK started off with selective vaccination of primary

school girls but decided to switch to universal vaccination because

the uptake rate was not good enough.

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Characteristics of vaccines

The characteristics of the vaccine used is a major determinant on the outcome of the vaccination strategy. Factors to consider include– Response rate– Type of protection– Duration of protection– Local immunity– Side effects– Route of administration– Stability– Cost

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Developing a vaccination policyThe following questions should be asked when a vaccination policy against a particular virus is being developed.

1. What proportion of the population should be immunized to achieve eradication.

2. What is the best age to immunize?

3. How is this affected by birth rates and other factors

4. How does immunization affect the age distribution of susceptible individuals, particularly those in age-classes most at risk of serious disease?

5. How significant are genetic, social, or spatial heterogeneities in susceptibility to infection?

6. How does this affect herd immunity?

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Coverage Required for eradication• Basic concept is that of the basic rate of the infection R0.

• For most viral infections, R0 is the average number of secondary cases produced by a primary case in a wholly susceptible population. Clearly, an infection cannot maintain itself or spread if R0 is less than 1.

• R0 can be estimated from as B/(A-D);B = life expectancy, A = average age at which infection is acquired, D = the characteristic duration of maternal antibodies.

• The larger the value of R0, the harder it is to eradicate the infection from the community in question.

• A rough estimate of the level of immunization coverage required can be estimated in the following manner: eradication will be achieved if the proportion immunized exceeds a critical value pinc = 1-1/R0.

• Thus the larger the R0, the higher the coverage is required to eliminate the infection.

• Thus the global eradication of measles, with its R0 of 10 to 20 or more, is almost sure to be more difficult to eradicate than smallpox, with its estimated R0 of 2 to 4.

Kapan dilakukan vaksinasi

Sebagai upaya pencegahan penyakit secara in vivo Syarat utama individu harus sehat Daerah endemis Perlu legal formal

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IMMUNISASI/VAKSINASI

• Merangsang organ limpoid membentuk antibodi• Harus sudah cukup umur dan sehat• Dilakukan dengan pengulangan yang benar agar

titer propilaksi tercapai• Pemilihan jenis vaksin harus benar• Sisihkan sisa vaksinasi dengan lege artis

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Vaksinasi

VAKSINASI YANG TIDAK TEPAT JUSTRU MENJADI SUMBER PENYAKIT

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Imunisasi VAKSIN• Live virus• Dead virus• Attenuated virus• Rekombinan

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Respon imun ALAMI• maternal antibodi• genetis• sembuh dari penyakit

EKSTERNAL • vaksinasi• paparan

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Infe

ction

Susceptible

Susceptible

Dynamics of infectiousness

Dynamics of disease

Incubation period

Symptomaticperiod

Non-diseased

Latentperiod

Infectious period

Non-infectious

Infe

ction

Time

Time

(www)

Timeline for Infection

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Apa yang seharusnya kita lakukan ???

KONSEP LEGE ARTIS•Bioetika•Tidak boleh mencemari•Musnahkan dengan bakar atau timbun•Lakukan dengan booster yang disyaratkan

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Perbaikan manajemen

• Pemilihan sistem penggembalaan - unmixed aged group - alternatif grazing : rotational, zero - hindarkan overgrazing - removal of faecal

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Perbaikan manajemen- Pemilihan sistem penggembalaan- unmixed aged group- alternatif grazing : rotational, zero- hindarkan overgrazing- removal of faecal

Future Control Measures

• Better drugs should be available• Anti-viral prophylaxis• Vaccines• More sensitive diagnostic tests would enable the early

detection of cases.• Better surveillance system• Better contingency procedures• Better education and facilities.

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Apa yang seharusnya kita lakukan ???

KONSEP LEGE ARTIS•Bioetika•Tidak boleh mencemari•Musnahkan dengan bakar atau timbun•Lakukan dengan booster yang disyaratkan

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Approach to Managing Dairy Herd Health

• Main health elements– Reproduction– Lameness– Mastitis– Metabolic conditions– Infectious & parasitic disease– Injury– Nutrition– Culling reasons– Young stock– Biosecurity