CURRICULUM VITAE

Nama Pendidikan : Prof. DR. Dr. Samsuridjal Djauzi, SpPD-KAI, FACP : - Fakultas Kedokteran UI, 1969 - Spesialis Ilmu Penyakit Dalam FKUI, 1976 - Konsultan Alergi-Imunologi, 1986 - Doktor dibidang Alergi-Imunologi FKUI, 1999 - Honorary Fellow of American College of Physician, 2001 - Guru Besar FKUI
: - Pengajar Dept. Ilmu Penyakit Dalam FKUI - Ketua Kolegium PAPDI - Chairman Indonesian Association of Physician in AIDS Care - Honorary Fellow American College of Physician

Jabatan

VALUE OF ADULT VACCINATION: THE NEED FOR IMPLEMENTATION

Samsuridjal Djauzi
Division of Allergy Clinical Immunology Department of Internal Medicine Medical Faculty, University of Indonesia

EVERY YEAR, TENS OF THOUSANDS OF ADULTS AND HUNDREDS OF THOUSANDS MORE ARE HOSPITALIZED DUE TO DISEASES THAT COULD BE PREVENTED BY VACCINATION.

Clin Infect Diseases 2007;44:1529-31

Adult Vaccination

Rationale Key Vaccines Benefits Recommendations Implementation Policies

RATIONALE FOR ADULT VACCINATION

Why Vaccinate Adults?

High risk group: - elderly (>60 y.o.)- waning immunity1 : important in tetanus, pertussis, flu - chronic diseases (diabetes, asthma, heart disease)prone to complications in flu and pneumococcal diseases1-3 - occupational hazards- health workers, laboratory workers, soldiers, college students-transmission of flu,meningococcal diseases,hepatitis A and B, varicella1-3 -pregnant women-increased risk for complications of influenza2,3

1.Zimmerman RK, et. al. ed.Vaccines Across the Life Span. 4th ed. 2007 2. AAP. Pickering LK, ed. Red Book:2003 Report og the Committee on Infectious Diseases. 26th ed. Elk Grove Village,IL: AAP;2003:68 3. CDC. Pink Book, 10th ed, 2008

Waning Immunity: Incidence of Pertussis

Clin Pediatr 2006;45:785-794

Invasive Pneumococcal Disease

Incidence by Age Group, 1998 and 2002
1998 250 200 2002

Rate *

150 100 50 0
<1 1 2-4 5-17 18-34 35-49 50-64 65+

Age Group (Yrs)

* Rate per 100,000 population Source: Active Bacterial Core Surveillance/EIP Network
CDC, Pink Book, 10th ed, 2008

Complications: Influenza Hospitalisation Rates

Hospitalisation rate/10,000 population 60
50 40 30

20
10 0

<5

59

1019

2034 3544 Age (yrs)

4554

5564

65

Glezen et al. 1987

Pneumonia Pada Usia Lanjut

INSIDENS DAN KEMATIAN Insidens : 4 to 8 /1 000 per tahun Angka Kematian : 40 % FAKTOR PENYERTA Penyakit jantung, paru, ginjal, DM Gizi buruk, gangguan imunologis PENGOBATAN SULIT
Gambaran klinik tidak jelas Penggunaan antibiotik harus hati-hati

Precent influenza vaccination in persons 65, Australia, 1997, by state Source: IMS Australia
80 60

40

20

0
Australia NSW Vic Qld SA WA Tas

INFLUENZA SURVEILLANCE

USE OF SEASONAL INFLUENZA VACCINE IN ASIA PACIFIC REGION

Influenza vaccine coverage rates are still insufficient (2010/11)

UK3 Senior adults
General population Chronic ill HCW Children (6m-17y)

Spain2, 4

Poland 4, 5

USA 1

China4*

Korea (south) 4

73%
50% 34%

57%
19% 28%

8%
5-6% 9% 12%

75%
41%

3%
3% 1% 10%

70%
24% 75% 70%

35% (1849 yrs)

56%

7%

46%

6%

30%

1) From Center of Disease Control and Prevention, Behavioral Risk Factor Surveillance System (BRFSS) and National Immunization Survey (NIS). 14 Indonesia 2012 | 14 Coverage estimates by Nov 2010; CDC, USA 2011; 2) Gripometro, 2011; 3) NHS London;4) Sanofi Pasteur internal data; 5) personal communication; *3 main cities

Malaysian National Campaign

Indonesia 2012

15

Why Vaccinate Adults?

High Risk Behavior and Lifestyle smoking predisposes to pneumococcal infections drug abuse-hepatitis B multiple sex partners- hepatitis B, cervical cancer homosexuality- hepatitis A and B Travellers- influenza, meningococcal, typhoid fever, hepatitis A and B

Zimmerman RK, et. al. ed.Vaccines Across the Life Span. 4th ed. 2007

Prevalence of Low Risk and High Risk HPV Types Among Females Aged 14 to 59 Years, NHANES 2003-2004

JAMA 2007;297:813-819

KEY VACCINES FOR ADULTS

Key Vaccines: Adults

Influenza Pneumococcal Tetanus/Diphtheria Human Papillomavirus Hepatitis B (high risk groups) Hepatitis A (travel to endemic areas) Meningococcal (high risk groups) Typhoid (travel to endemic areas) MMR (catch-up) Varicella (catch-up)
1.Zimmerman RK, et. al. ed.Vaccines Across the Life Span. 4th ed. 2007 2. AAP. Pickering LK, ed. Red Book:2003 Report og the Committee on Infectious Diseases. 26th ed. Elk Grove Village,IL: AAP;2003:68 3. CDC, Pink Book, 10th ed. 2008

BENEFITS OF ADULT VACCINATION

Decline of Influenza-Associated Deaths in the Elderly After Flu Vaccination

Retrospective Cohort Study in Netherlands (19922003) Average Influenza-Associated Mortality: pre-vaccination:131/100,000 persons post-vaccination:105/100,000 persons ( Relative Risk: 0.80)

Jansen. Vaccine 2008; 26: 5567-5574

Flu Vaccination in adults provides costeffective benefit

Illness

Visits to physicians Prescribed medications Lost work days due to illness Lost work days due to physician visits
0 0,1 0,2

Vaccinated (N = 582)

Placebo (N = 596)

Bridges CB, Thompson WW, Meltzer MI. Effectiveness of and cost-benefits of influenza vaccnation of healthy working adults: a randomized controlled trial. JAMA 2000; 284: 1655-63

HBV Disease Burden in the United States

Prevaccine era

estimated 300,000 persons infected annually, including 24,000 infants and children estimated 51,000 infections

2005

CDC, Pink Book, 2008

Benefits of mass vaccination

Hepatitis A vaccine is 94100% effective in preventing disease Mass vaccination decreases hepatitis A incidence among children and adults
Controls recurrent outbreaks in areas of moderate to high endemicity

JAMA 1994; N Engl J Med 1992

Qureshi H, dkk 2070 jemaah haji Pakistan 1999 54% mendapat vaksinasi influenza selama pengamatan 33 hari:

Vaksinasi Tidak vaksinasi Influenza Like Illness

Antibiotik

34%
18%

64%
41%

RECOMMENDED IMMUNIZATION SCHEDULES FOR ADULTS

Sejarah Satgas Imunisasi Dewasa

Kongres PAPDI Manado 2003 : Konsensus Imunisasi Dewasa Pembentukan Satgas Imunisasi Dewasa Pelatihan Imunisasi Dewasa di beberapa kota untuk tenaga dokter Pelatihan Imunisasi Dewasa untuk dokter perusahaan Menerbitkan buku Pedoman Imunisasi Dewasa Konsensus bersama : influenza, HPV
ALV/PRN/22/16/07/11

Actions to Strengthen Implementation of Adult Immunization

Increase demand for adult immunization by improving public and provider (doctor) awareness Strengthen health care systems to deliver vaccines to adults and adolescents Surveillance Research studies

Clin Infect Diseases 2007;44:1529-31

Factors that would influence unvaccinated high-risk individuals to accept vaccination

If my doctor suggested it If I knew about its effectiveness If I received a reminder letter If I was provided with free vaccine If I saw information about vaccination If I heard information about vaccination If my pharmacist suggested it If I knew someone who has it yearly If I became at risk None Dont know 0 10 20 30 40 50 60 70

Other % respondents

Health Care Workers, Influenza vaccination

Variation between Asia Pacific countries Hongkong 20-50% Korea, Taiwan 80-90% New Zealand 35%
Singapore 39% Australia 26-38% Indonesia less than 10%

ALV/PRN/22/16/07/11

Klinik Imunisasi Dewasa

Gedung IRM lantai 4 RSUPN - CM Jl. Diponegoro No. 71 Jakarta Pusat 10430 Telpon : 021 3918301 pesawat 6608 021-31902822 Fax. 021-3904546 Dr. Sukamto Dr. Iris Rengganis Prof. Samsuridjal Djauzi Dr. Erwanto (Bogor dan sekitarnya) E-mail : alergi@centrin.net.id sukamto_koesnoe@yahoo.com Website: www.imunisasidewasa.com

Conclusions
Adults also need protection from vaccine-preventable diseases Adult vaccination contribute to decreasing the burden of most infectious diseases Several bodies recognize the importance of implementing immunization policies and schedules for adults

TERIMA KASIH