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Tahun 2012 Jawa Timur mengalami Kejadian Luar Biasa difteri dan ruang
Isolasi Anak khusus difteri mendapatkan kiriman rujukan dari RSUD di salah satu
kabupaten di Madura. Berasal dari kecamatan yang sama. Semuanya berlatar
belakang lingkungan tempat tinggal yang sama, tanpa riwayat imunisasi ,
mayoritas menjadi antivaks dan berasal dari golongan ekonomi menengah ke
bawah. Rujukan tersebut tentu difteri dalam stadium yang memprihatinkan, tidak
jarang indikasi sumbatan saluran nafas didapatkan, tentu bisa diprediksi angka
kematian cukup tinggi.
Health is higher on the international agenda than ever before, and improving
the health of poor people is a central issue in development. Poor people suffer
from far higher levels of ill health, mortality, and malnutrition than do those
better off, and their inadequate health is one of the factors keeping them poor or
for their being poor in the first place. Health is crucially important economic
asset, particularly for poor people. Their livelihoods depend on it. When poor
people become ill or injured, their entire household can become trapped in a
downward spiral of lost income and high healthcare costsa vicious of poverty
and ill health.
The current high level focus on health by the international community
recognizes the strong relationship between poverty and health. Three of eight
Millenium Developmental Goals ( MDGs ) call for spesific health improvements
by 2015 : reducing child deaths, reducing maternal mortality, and slowing the
spread of HIV/AIDS, malaria, and tuberculosis. Moreover, health is increasingly
viewed fundamental to the first Millenium Developmental Goal, eradicating
poverty and extreme hunger. The health of the poor must thus be a matter of
major concern for everyone committed to sustainable development, from
policymakers to service providers.
The past 40 years have shown that innovation and technology are among the
main forces driving improvements in the state of health in the developing word.
Developing countries, according to the Human Development report 2010, have
increased life expectancy as much in half a century as the now-developed
countries did in 300 years. Sick people in developing countries were able to
benefit from innovations thet were not available in the 17th, 18th, and 19th
centuries. Innovations in medicine and oter interventions promoting public
health ( such as sanitations, housing, educations, and nutrition ) become quickly
available in many developing countries, benefitting hundreds of millions of
people. Effective preventionvaccines againts tuberculosis ( TB ), diphteria,
neoaetal tetanus, whooping cough, poliomyelitis, and measlesbecame
available too. Poor countries benefitted from the rapid spread of thesee
improvement when the costs feel dramatically. The Human Development Report
2010 cites a study showing that, since 1950, some 85% of mortality reductions
in 68 countries can be attributed to innovations made globally. ( United Nations
Development Program ( UNDP ). Human Development Report 2010. Basingstoke,
UK: Palgrave-Macmillan; 2010:50 )

LEISINGER, KLAUS M; SCHMITT, KARIN M. Cambridge Quarterly of

Healthcare Ethics 20.2 ( Apr 2011 ): 309-25
Banyaknya keengganan mendapatkan imunisasi difteri kemungkinan disebabkan
oleh beberapa hal, salah satunya nyeri, kehalalan isi vaksin, meragukan

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keefektifan imunisasi karena opini setiap manusia sudah dibekali kekebalan
tubuh. Imunisasi DPT bisa didapatkan pada usia 2 bulan, 4 bulan, 6 bulan.
Booster pada usia 5 tahun, 10-12 tahun, dan 18 tahun untuk imunisasi DT ( IDAI
2015 ). Program imunisasi sekolah rata-rata kurang mendapatkan sambutan
positif di lingkungan tertentu dan biasanya tingkat pendidikan mereka sedikit
banyak berpengaruh untuk memutuskan melakukan imunisasi atau tidak. Letak
geografis Indonesia yang beraneka berpengaruh juga untuk menentukan strata
kesehatan masyarakat, serta perbandingan jumlah pelayanan kesehatan yang
kurang merata di tiap-tiap daerah dengan jumlah penduduk .
Across the literature reviewed ( 1208 articles ), only five ( 0,4% ) used the
actual term hesitancy or hesitant with reference to vaccines/vaccination ( S.
E. Williams, R. L. Rothman, P .A. Offit, W. Shcaffnerr , M. Sullivan , K. M. Edwards,
A Randomized trial to increase acceptance of childhood vaccines by vaccinehesitant parents: a pilot study, Acad Pediatr, Vol. 13, Iss. 5, 2013, 475-480 ) .
their were all found in the peer reviewed literature and were all published in
2013. Only one of this articles evaluated an intervention. This intervention was
carry out in AMR ( WHO Region of the Americas ) and focused on childhood
vaccines, targeting vaccine hesitant parents using multi-component strategy
that focused on education techniques. More often articles used terms such as
refusal, distrust and acceptance to discuss vaccination behaviour. This
reflects the relative newness of the term hesitancy.
Most interventions targeted parents, health-care workers ( HCWs ) and the local
comunity. Intervention in the grey literature from AFR ( WHO African Region )
largerly focused on the local community and religious leaders.
When mapped against the SAGE Working Group model of determinants of
vaccine hesitancy, interventions addressing individual and social group
influences, particularly knowledge and awareness raising, were most common in
both the peer reviewed and grey literature. Vaccine delivey and the role of the
HCWs were the primary focus vaccine and vaccination-spesific interventions. The
engagement of religious and other community leaders was must commonly used
to adress contextual influences such as religion, culture and gender.

Jarrett, Caltin; Wilson, Rose; OLeary, Maureen; Eckersberger, Elisabeth;

Larson, Heidi J. Vaccine 33.34 ( Aug 14, 2015 ): 4180-4190
A single serogical correlate predictive of protection againts pertussis has not
identified ( S. A . Plotkin, Complex correlates of protection after vaccination, Clin
Infect Dis, Vol 56, 2013, 1458-1465 ), hampering estimation of th duration of
protection after pertussis booster vaccination. Decennial diphteria-tetanus (dT)
booster vaccination is recommended in many countries, and the Consensus on
Pertussis Booster Vaccination in Europe Initiative recommends regular pertussis
boosting of adults, achievable by replacing dTpa in national schedules ( F. Zepp,
U. Heininger, J. Mertsola, E. Bernatowska, N. Guiso, J. Roord, Rationale for
pertussis booster vaccination throughtout life in Europe, Lancet Infect Dis, Vol 11,
2011, 557-570 )

Vandermeulen, Corinne; Theeten, Heidi; Rathi, Niraj ; Kuriyakose, Sherine ;

Han, Htay; et al. Vaccine 33.26 ( Jun 12, 2015 ): 3026-3034.

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Stepped-up vaccination campaigns (including campaigns aimed at migrant

families) may be necessary during periods of severe economic downturn in order
to maintain high levels of immunization among vulnerable groups such as
children. This is because severe economic downturn is usually accompanied by
increased migration as some of the unemployed and their families move in
search of jobs to other areas of the country. Compulsory immunizations as
arequirement for participation of economically-distressed people in government
and NGO social welfare programmes can be introduced, e.g. like the Brazilian
Bolsa Familia programme that requires low income parents to get their kids
vaccinated in return for receiving monetary payments every month.

Can we learn from the history of previous economic crises in terms of their impact on the
following?
Changes in patterns of health risk during times of severe economic crisis, e.g. alcoholism
and other forms of substance abuse, domestic violence, suicidesand parasuicides,
malnutrition, immunization levels,homelessness, utilization of health services
Differential impact of economic crisis on the health of more vulnerable groups such as
ethnic minorities, the poor, single women with children, the elderly, the disabled
Changes in demand for health services from the public sector during times of severe
economic crisis
Impact on the private health sector (e.g. as indicated by the experience of nations such as
South Korea, Indonesia, Thailand and Malaysia during the Asian economic crisis of the late
1990s)

Policy responses and strategies from public sector authorities as well as non-governmental
organisations (NGOs) and the private sector that appear to work in terms of helping to meet
the needs of particular groups of people, e.g. targeted feeding programmes for children at
risk, and the pioneering introduction o a prepaid plan for medical care at Baylor Hospital in
Dallas, Texas in 1929 during the Great Depression

Ka- Lit Phua, The open public health journal 2011, Volume 4A surviving birth
cohort of 4 234 000 as reported by the
WHO in 2005 was used to determine total costs, disabilityadjusted life years (DALYs) and
cases averted comparing the vaccination program with the status quo of DTPHep-B
tetravalent vaccination. Coverage of 93% was based on the level achieved in the current
DTPHep-B program. Several epidemiological studies were used in the absence of countryspecific data for Hib disease and consequences. Reports from studies in Lombok were
particularly useful as they report data from observations and a hamlet-randomized trial of
Hib vaccine. Incidence of bacterial meningitis from that study was lower than that reported
previously so the more recent lower estimate was used.2 Studies fromAbdullah et al and Al
Khorasani and Banajeh reported case fatality in Saudi Arabia and Yemen, respectively, and it
was assumed that these figures are comparable to those in Indonesia. Case fatality in

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untreated cases was assumed to be 75%. The incidence of sequela reported by Thomas based
on Australian data was used, assuming that occurrence of permanent disability among
those who develop invasive infections is similar in differentsettings. Incidence data were
assigned wide variation for sensitivity analysis to account for generalizations made from
studies outside Indonesia. Adverse events associated with Hib pentavalent vaccine. Do not
occur in a significantly higher proportion compared to DTPHep B vaccine alone. Side
effects specificallyattributable to the Hib vaccine are generally trivial, and therefore
associated costs were not included. This paper considered the pentavalent vaccine
administered at 6, 10 and 14 weeks according to the WHO schedule for DPT.Vaccine
effectiveness determined by antibodyradioimmunoassay has been reported as high as 99.7%
inclinical trials of three doses in Lombok10 and 8990% with at least one dose for meningitis
in Bangladesh. However, effectiveness measured by cases averted in randomized trial is
reported elsewhere at 80% with plausible variation between 46 and 93%. Effectiveness for
this evaluation was determined at 95% with variation between 46 and 99%,used in sensitivity
analyses. A high estimate was used to partially account for herd immunity, which is known to
decrease carriage of infection among those with no immunity. This paper also considered the
possibility of no herd immunity in sensitivity analyses to account for the slow build-up of herd
immunity that occurs when older siblings are unprotected by vaccination.

Broughton, Edward ( September 17, 2007). The journal of Public Health. Vol
29, no 4, pp 441-448
Theoretical frameworks are key to the design of successful behaviour-change interventions.
Moreover, our data add to the growing body of evidence that theoretical frameworks provide
effective and useful resource tools for understanding the decision-making processes involved
in the practice of health behaviours. As older adults are self-selecting vaccinators, their own
personal reasons for deciding to have or not have the vaccine are essential and have been
examined and captured in this study. The results showed that GPs and family members
appear to be key social facilitators of vaccination for older adults, when they decide to get
vaccinated. Therefore, healthcare providers, significant others and family members should be
targeted to play a pivotal role in encouraging older adults who are at risk of influenza to
receive the annual vaccine. This may involve encouraging older adults to speak to their
families and visit their GP or clinic nurse, to seek advice and be given reassurance about the
efficacy and benefits of the vaccine. Additionally, we have shown that the post-behavioural
feelings that are normally associated with having missed the opportunity to be vaccinated led
to the variable anticipated regret adding substantial percentage increments in explaining
older adults future vaccination intentions. Exploitation of these feelings has the potential for
effective intervention strategies. Governments and health researchers could manipulate these
in large-scale interventions but also at an individual level. GPs could be trained to use
verbal persuasion techniques, or media messengers could use the beliefs associated with
these feelings by highlighting the perils and dangers associated with missing out on the
opportunity to be vaccinated. Finally, another additional variable that added to our
understanding of this decision-making process was the inclusion of past vaccinating
behaviour. Older adults, who have received the influenza vaccination repeatedly or more
than once in the last 4 years, had a higher intention to vaccinate in the coming year. One can

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speculate that for these individuals, having the vaccine has now become a part of their
healthylifestyle behaviours and one which they are willing to perform annually.

Gallagher, Stephen ; Povey, Rachel. Advance Access Publication 26 April

2006