I m u n i s a s i

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)
Edward Jenner
6
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
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).
Vaccine Truths continued
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
Natural
resistance
Artificial
Natural
Passive
Artificial Natural
Active
Immunity
Acquired
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
Formulations:
1. Live pathogens attenuated
2. Killed micro-orgs
3. Microbial extracts
4. Vaccine conjugates
5. Toxoids
Penetrate cells
- intracell. Ag
processing to
surface of cells -
cytotoxic T cell
response
Do not enter host cells:
1ary B cell-mediated
humoral response
Active Immunization
Natural
Artificial
exposure to sub-
clinical infections
Attenuated
organisms
killed organisms
sub-cellular
fragments
toxins
others
tuberculosis
not used in this
country
polio*
not used in std. schedule
measles, mumps &
rubella
yellow fever
Military and travelers
Varicella zoster
children with no history
of chicken pox
hepatitis A
standard 2006
Live Attenuated Vaccines
Influenza
selected age group
(5-49)
polio
influenza
elderly and at risk
typhoid, cholera, plague
epidemics and travelers
rabies
post exposure
pertussis
replaced by the
acellular vaccine
Killed Whole-Organism Vaccines
Q fever
population at risk
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
24
Passive Immunization
Mims C et al. Medical Microbiology. 1998.
Natural Artificia
l
Colostral transfer
of IgA
Placental transfer
of IgG
Antibodies or
immunoglobulins
Immune cells
Passive Immunity
disease
indication
antibody
source
Passive Immunization
human, horse diphtheria, tetanus prophylaxis, therapy
vericella zoster
human
immunodeficiencies
gas gangrene,
botulism, snake bite,
scorpion sting
horse
post-exposure
rabies, human post-exposure
hypogamma-
globulinemia
human
prophylaxis
Advantages
Disadvantages
serum sickness
immediate
protection
no long term
protection
graft vs. host
disease (cell
graft only)
risk of hepatitis
and Aids
Advantages and Disadvantages of
Passive Immunization
A generic disease model
Susceptibl
e
Diseased
Not at
risk
A generic disease model
Susceptibl
e
Diseased
Not at
risk
A generic disease model
Susceptibl
e
Diseased
Not at
risk
Vaccination
A generic disease model
Susceptibl
e
Diseased
Not at
risk
Therapy producing
temporary cure
A generic disease model
Susceptibl
e
Diseased
Not at
risk
Therapy producing
permanent cure
A generic disease model
Susceptibl
e
Diseased
Not at
risk
Education
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.
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 Reactions
Adverse Events Occurring
Within 48 Hours of DTP Vaccination
44
Event
Frequency
local
redness, swelling, pain 1 in 2-3 doses
systemic: Mild/moderate
fever, drowsiness, fretfulness
vomiting
anorexia
1 in 2-3 doses
1 in 5-15 doses
systemic: more serious
persistent crying, fever
collapse, convulsions
acute encephalopathy
permanent neurological deficit
1 in 100-300 doses
1 in 1750 doses
1 in 100,000 doses
1 in 300,000 doses
Examples of types & frequency of AEFIs (in some common
vaccines)
WHO/V&B/AVI
Vaccine Reaction
Onset
Interval
Rates per
million doses
Suppurative lymphadenitis 2-6 months 100 to 1000
BCG osteitis 1-12 months 1 to 700
Disseminated BCG-it is 1-12 months 2
Hib Nil known
Anaphylaxis 0-1 hour 0 to 2
Guillain-Barr Syndrome (plasma derived) 1-6 weeks 5
Febrile seizures 5-12 days 333
Thrombocytopaenia 15-35 days 33
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
Encephalopathy 0 - 3 days 0 to 1
Post-vaccination encephalitis 7-21 days
400 to 4000 (in
infants <6 m)
Allergic/anaphylaxis 0-1 hour 5 to 20 Yellow Fever
BCG
Hepatitis B
Measles/MMR
DTP