Imunisasi

Bambang Mulyawan
FK-UMM
 Pendahuluan

 Imunisasi : pemindahan / transfer

antibodi secara pasif
 Vaksinasi : pemberian vaksin
(antigen) yang dapat merangsang
pembentukan imunitas (antibodi)
dari sistem imun di dalam tubuh
 Istilah imunisasi lebih umum
dipakai mencakup kedua pengertian
di atas
 Maksud dan tujuan imunisasi

 Maksud : cara
untuk meningkatkan kekebalan seseorang secara aktif
terhadap suatu antigen, sehingga bila kelak ia terpajan
pada antigen yang serupa tidak terjadi penyakit
 Tujuan : -
mencegah penyakit tertentu pada seorang anak -
menghilangkan penyakit tertentu pd sekelompok masya-
rakat (populasi) -
menghilangkan penyakit tertentu dari dunia (variola)
 Ultimate goal:
- eradication of disease

 Immediate goal:
- prevention of disease
 Terms
5
 Immunization – conferring immunity by artificial
means

 Vaccination – conferring immunity to a disease

using a vaccine or special antigenic material to
stimulate the formation of appropriate antibodies

 Vaccine – preparation of antigenic material

– stimulates Ab production
– confers active immunity vs. disease

 Latin “vacca” = cow (from cowpox)

 Edward6 Jenner

Discovery of small pox vaccine

Milestones in immunization
7

1780AD
 Edward Jenner discovers small
pox vaccine
Immunization saves lives
 Immunization saves
the lives of
approximately 3
million people each
year, all over the
world.
2.3 million still die each year
 Vaccine Truths
 Vaccines are one of the most important public
health achievements
 Public concern about vaccines is pervasive
 Fear of vaccines can lead to public harm
 Vaccines are not 100% safe
 Parents want what is best for their children
 The public has little understanding of the vaccine
development process
 Vaccine Truths continued
 Risk perception is critical
 There are anti-vaccine champions
 Questions remain
 The decision not to vaccinate is an active
decision to accept the risk of the disease.
 (Marshall, G. 2003).
 8888888888888888

 Vaksin merupakan material biologis yang sangat

mudah kehilangan potensinya.
 Dengan kehilangan potensi,berarti akan terjadi
kegagalan vaksin untuk menstimuli respon
imunologi, akibatnya daya proteksi akan berkurang.
 Pencegahan terjadinya penurunan potensi meliputi :
tranportasi,penyimpanan, dan penanganan yang
benar.
Different modes of acquiring immunity

Immunity

Natural Acquired
resistance

Passive Active

Artificial Natural Artificial Natural

 Types of Immunization
 Active immunization :
- vaccine
- live attenuated
- killed inactivated

 Passive immunization
 Characteristics of a Vaccine
 inactivated (killed) antigen: Flu shot, Hep. A
 live attenuated (weakened) antigen: MMR,
Varicella
 synthetic (laboratory synthesized) microbial
materials:Toxoids DTaP
 conjugate vaccines use outer- coats of the bacteria:
Hib, PCV
 recombinant vaccines use the virus genetic
material: Hep B
 Active immunization
17
Penetrate cells
Formulations: - intracell. Ag
processing to
1. Live pathogens – attenuated surface of cells -
2. Killed micro-orgs cytotoxic T cell
response
3. Microbial extracts
4. Vaccine conjugates
5. Toxoids

Do not enter host cells:

1ary B cell-mediated
humoral response
 Active Immunization

Natural Artificial
Attenuated
organisms
killed organisms
exposure to sub- sub-cellular
clinical infections fragments
toxins
others
 Live Attenuated Vaccines

polio* hepatitis A
not used in std. schedule standard 2006
measles, mumps & yellow fever
rubella Military and travelers
Varicella zoster Influenza
children with no history selected age group
of chicken pox (5-49)
tuberculosis
not used in this
country
Killed Whole-Organism Vaccines

polio Q fever
population at risk
influenza typhoid, cholera, plague
elderly and at risk epidemics and travelers
rabies pertussis
post exposure replaced by the
acellular vaccine
Microbial Fragment Vaccines

Bordetella. Pertussis
virulence factor protein
Haemophilus influenzae B
protein conjugated polysaccharide
Streptococcus pneumoniae
Polysaccharide mixture
Neisseria meningitidis
polysaccharide
Microbial Fragment Vaccines

Clostridium tetani (tetanus)

inactivated toxin (toxoid)
Corynebacterium diphtheriae
inactivated toxin (toxoid)
Vibrio cholerae
toxin subunits

Hepatitis B virus
cloned in yeast
Figure 10-17
Passive Immunization

24Microbiology. 1998.
Mims C et al. Medical
 Passive Immunity

Natural Artificia
l
Placental transfer Antibodies or
of IgG immunoglobulins

Colostral transfer Immune cells

of IgA
 Passive Immunization

disease antibody indication

source
diphtheria, tetanus human, horse prophylaxis, therapy
vericella zoster human immunodeficiencies
gas gangrene,
botulism, snake bite, horse post-exposure
scorpion sting
rabies, human post-exposure
hypogamma- human prophylaxis
globulinemia
Advantages and Disadvantages of
Passive Immunization

Advantages Disadvantages
no long term
protection
serum sickness
immediate
protection risk of hepatitis
and Aids
graft vs. host
disease (cell
graft only)
 A generic disease model

Susceptibl Diseased
e

Not at
risk
 A generic disease model

Susceptibl Diseased
e

Not at
risk
 A generic disease model

Vaccination

Susceptibl Diseased
e

Not at
risk
 A generic disease model

Therapy producing
temporary cure

Susceptibl Diseased
e

Not at
risk
 A generic disease model

Therapy producing
permanent cure

Susceptibl Diseased
e

Not at
risk
 A generic disease model

Education

Susceptibl Diseased
e

Not at
risk
 Epidemiologic Triad

Disease is the result of

forces within a dynamic
system consisting of:
agent of infection
host
environment
 Importance of Proper Vaccine
Administration Technique

 Promote optimal antibody response

 Reduce risk of local adverse reactions

 Vaccine Handling and Storage

 Freezer:
- varicella

 Refrigerator (2-8 degrees C):

- use plug guard to prevent accidents
- thermometer in refrigerator and
freezer
- logbook
- fill with bottle of chilled water and icepack
 Administration

 Hand hygiene
 Gloves are not required
 IM - <1y anterolateral aspect of the thighs
- >1y deltoids
 SQ 45 angle
-MMR,Varicella
-IPV, menomune
-Yellow fever
PRETERM AND LOW BIRTH WEIGHT
INFANTS

 They should receive all routinely recommended

childhood vaccine at the same chronologic age as full
term infants.
 Adverse Reactions
 High fever
 Behavior changes
 Seizures
 Allergic reaction:diffic. Breathing, weakness,
hoarseness, wheezing, rapid heart rate, hives,
dizziness, paleness, or mucus membrane swelling.
 Reported by parent and/or provider using a Vaers
form from the CDC.
 Adverse Events Occurring
Within 48 Hours of DTP Vaccination
Event Frequency
local
redness, swelling, pain 1 in 2-3 doses

systemic: Mild/moderate
fever, drowsiness, fretfulness 1 in 2-3 doses
vomiting
anorexia 1 in 5-15 doses
systemic: more serious
persistent crying, fever 1 in 100-300 doses
collapse, convulsions 1 in 1750 doses
acute encephalopathy 1 in 100,000 doses
permanent neurological deficit 1 in 300,000 doses

44
Examples of types & frequency of AEFIs (in some common
vaccines)

Onset Rates per

Vaccine Reaction Interval million doses
Suppurative lymphadenitis 2-6 months 100 to 1000
BCG osteitis 1-12 months 1 to 700
BCG Disseminated BCG-it is 1-12 months 2
Hib Nil known
Anaphylaxis 0-1 hour 0 to 2
Hepatitis BGuillain-Barrè Syndrome (plasma derived) 1-6 weeks 5
Febrile seizures 5-12 days 333
Thrombocytopaenia 15-35 days 33
Measles/MMR Anaphylaxis 0-1 hour 1 to 50
OPV Vaccine associated paralytic polio (VAPP) 4-30 days 1.4 to 3.4
Persistent (>3 hrs) inconsolable crying 0 -24 hours 1000 to 60000
Seizures 0 - 3 days 570
Hypotonic, hyporesponsive episode 0-24 hours 570
Anaphylaxis 0 - 1 hour 20
DTP Encephalopathy 0 - 3 days 0 to 1
400 to 4000 (in
Post-vaccination encephalitis 7-21 days infants <6 m)
Yellow Fever Allergic/anaphylaxis 0-1 hour 5 to 20
WHO/V&B/AVI
•Vaksin Hepatitis B. Paling baik diberikan dalam waktu 12 jam
setelah lahir dan didahului pemberian injeksi vitamin K1. Bayi
lahir dari ibu HBsAg positif, diberikan vaksin hepatitis B dan
imunoglobulin hepatitis B (HBIg) pada ekstremitas yang berbeda.
Vaksinasi hepatitis B selanjutnya dapat menggunakan vaksin
hepatitis B monovalen atau vaksin kombinasi.
Vaksin Polio. Pada saat bayi dipulangkan
harus diberikan vaksin polio oral (OPV-0).
Selanjutnya, untuk polio-1, polio-2, polio-3 dan
polio booster dapat diberikan vaksin OPV atau
IPV, namun sebaiknya paling sedikit mendapat
satu dosis vaksin IPV.
Vaksin BCG. Pemberian vaksin BCG
dianjurkan sebelum 3 bulan, optimal umur 2
bulan. Apabila diberikan sesudah umur 3
bulan, perlu dilakukan uji tuberkulin.
Vaksin DTP. Vaksin DTP pertamadiberikan
paling cepat pada umur 6 minggu. Dapat
diberikan vaksin DTwP atau DTaP atau
kombinasi dengan vaksin lain. Untuk anak umur
lebih dari 7 tahun DTP yang diberikan harus
vaksin Td, di-booster setiap 10 tahun.
Vaksin Campak. Campak diberikan
pada umur 9 bulan, 2 tahun dan pada
SD kelas 1 (program BIAS).
Vaksin Pneumokokus (PCV).
Apabila diberikan pada umur 7-12
bulan, PCV diberikan 2 kali dengan
interval 2 bulan; pada umur lebih
dari 1 tahun diberikan 1 kali.
Keduanya perlu dosis ulangan 1
kali pada umur lebih dari 12 bulan
atau minimal 2 bulan setelah dosis
terakhir. Pada anak umur di atas 2
tahun PCV diberikan cukup satu
kali.
Vaksin Rotavirus. Vaksin rotavirus monovalen diberikan 2
kali, vaksin rotavirus pentavalen diberikan 3 kali. Vaksin
rotavirus monovalen dosis I diberikan umur 6-14 minggu,
dosis ke-2 diberikan dengan interval minimal 4 minggu.
Sebaiknya vaksin rotavirus monovalen selesai diberikan
sebelum umur 16 minggu dan tidak melampaui umur 24
minggu. Vaksin rotavirus pentavalen: dosis ke-1 diberikan
umur 6-14 minggu, interval dosis ke-2, dan ke-3 4-10
minggu, dosis ke-3 diberikan pada umur kurang dari 32
minggu (interval minimal 4 minggu).
Vaksin Varisela. Vaksin varisela dapat
diberikan setelah umur 12 bulan, namun
terbaik pada umur sebelum masuk sekolah
dasar. Bila diberikan pada umur lebih dari 12
tahun, perlu 2 dosis dengan interval minimal 4
minggu
Vaksin Human papiloma virus (HPV).
Vaksin HPV dapat diberikan mulai umur 10
tahun. Vaksin HPV bivalen diberikan tiga kali
dengan interval 0, 1, 6 bulan; vaksin HPV
tetravalen dengan interval 0, 2, 6 bulan.
Vaksin Influenza. Vaksin influenza diberikan
pada umur minimal 6 bulan, diulang setiap
tahun. Untuk imunisasi pertama kali (primary
immunization) pada anak umur kurang dari 9
tahun diberi dua kali dengan interval minimal 4
minggu. Untuk anak 6 – <36 bulan, dosis 0,25
mL