Immunization

Martira Maddeppungeng
Child Health Department
Medical Faculty Hasanuddin University
Dr Wahidin Sudirohusodo Hospital

Introduction

The hepatitis B
virus

Corynebacterium
diphtheriae

The measles virus

Bordetella
pertussis
Clostridium tetani

Immunization
Give protection on specific infection disease

(Vaccine-preventable disease)
The rights of the child
Parents, health employers guaranteed that
immunizations are available for all children

Immunization
Passive
Active

Passive Immunization
Passive immunity : get readymade antibodies
Maternal antibodies are transferred to the fetus

through the placenta (3rd trimester)

Example: tetanus toxoid administered to
pregnant mother will decrease neonatal tetanus

Passive Immunization
Human immunoglobulin to protect from measles
Specific immunoglobulin to protect from

tetanus, diphtheria, hepatitis B, rabies.

(CMV, varicella)

Active Immunization
Administration of antigenic material to stimulate

immune response like natural infection

Long life immunological memory
Long life protection to infection disease

Active Immunization
Used:
Whole organism (live or killed)
Component organism (sub unit vaccine,
polisaccharide vaccine)
Modification of organism product
(toxoid vaccine)
Manufactur of organism component
(recombinant vaccine)

Ideal Vaccine
Give protection on infection disease
Give long-life immunity
No side effect
Single dose
Can be given by combination

Ideal Vaccine (2)

Easy administration, no pain
Stable in many conditions
Can be kept for long time duration
Reasonably priced

Bacteria
Virus
Live : BCG

Inactive: diphteria,

pertussis, tetanus,
cholera,pneumococcu
s, meningococcus,
Hib, Typhoid

Live : OVP, measles,

varicella, parotitis,
rubella, yellow fever
Inactive : influenza,

IVP, rabies, Hepatitis

A, Hepatitis B

PPI
Program Pengembangan Imunisasi :
BCG
Hepatitis B
DTP
Polio
Measles

Recommended Immunization Schedule

(IDAI 2006)

* Administer 2 doses (separated by 4 weeks or longer) to children 9 years who are receiving influenza
vaccine for the first time or who were vaccinated for the first time last season but only received one dose

Recommended Immunization Schedule

2010

BCG

Optimal administered age 2 - 3 months

If age > 3 months : Mantoux / tuberkulin test
If tuberkulin pra-BCG can not be done, BCG can be
administered,
must be observed 7 days
If accelerated local reaction (+), need further
evaluation
(TB diagnostic)

Hepatitis B

Administered first HepB within 12 hours of

birth

DTP Polio
OPV administered when first visit
Baby that was born in hospital : administered OPV
when baby
will discharge from hospital to prevent viral
transmission to
others baby
Continue administer with OPV or IPV.
DTP vaccine for children > 6 weeks.
Can be administered DTwP or DTaP or combination
with Hep B
or Hib.
Repeat dose DTP should be administered at age 18

Measles

Administer the second dose of MMR at

age 5-7 years

BIAS Program : proposed and updated
with recommended immunization
schedule by health department .

BCG

BCG
Baby < 3 months
Dose : 0,05 ml IC / ID
Right deltoid
If age > 3 months : Mantoux / tuberkulin test
Level of protection only 42% (WHO 50-78%)
New TB vaccine

Intradermal injection

KIPI = VAER
Kejadian Ikutan Pasca Imunisasi (Vaccine Adverse

Events Report)
BCG Superficial ulcus 3 weeks
scar 4-8 weeks

crusta

Limphadenitis BCG itis

Disseminated BCG-itis : severe immunodeficiency

DTP

DTP
Prevent diphteria, tetanus, pertussis
Contain: Dipteria toxoid,

Tetanus toxoid,
Pertussis vaccine :
- whole cell
- acellular

DTP
Basic : 3 times since age 2 months

interval 4-8 weeks

Repeat :

- 18-24 months
5-7 years
12 years (BIAS program: DT)

Contraindication DTP
Absolute:
1. History of anaphylaxis reaction
2. Encephalopathy (Acutely severe neurological
disease with long convulsion and/or decrease of
consciousness and/or focal neurological disorder)

Contraindication DTP
Specific precaution:
1. History of hyperpirexia
2. Hypotonic hyporesponsiveness in
48 hours
3. Persistent crying > 3 hours
4. History of convulsion 3 days after
immunization

Recommended DTP
DTP 1 : 2-4 months
DTP 2 : 3-5 months
DTP 3 : 4-6 months
DTP 4 : 1 - 2 years
DTP 5 : 5 years
DT 6 : 12 years

Table 2. Approximate rates of adverse event occurring within 48 hours DTP vaccination

Event

Frequency

Local
1 in 2-3 doses

redness, swelling, pain

Mild/moderate systemic
fever, drowsiness, fretfulness

1 in 2-3 doses

vomiting, anorexia

1 in 5-15 doses
More serious systemic

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

Polio

Polio
Prevent : poliomyelitis

Flaccid paralysis, pain at back and extremity

Polio vaccine :
Live (Sabin) : oral
Killed (Salk) : parenteral

Contraindication Polio OPV

Temperature > 38,5 C
Corticosteroid, radiation
Malignancy
HIV infection or family
Siblings with immunocompromised child

Recommended i Polio
Polio 1 : born
DPT 1 + Polio 2 : 2-4 months
DPT 2 + Polio 3 : 3-5 months
DPT 3 + Polio 4 : 4-6 months
DPT 4 + Polio 5 : 1 - 2 years
DPT 5 + Polio 6 : 5 years
DT
6
: 12 years

Hepatitis B

Hepatitis B
Prevent hepatitis B

Hepatitis B vaccine:
Derivat plasma vaccine
Recombinant vaccine

Hepatitis B
HB-1 administered recombinant vaccine HB 10 mcg

intramuscular, within 12 hours of birth

HB-2 administered age 1 month and HB3 age 3-6
months
If mother is hepatitis B surface antigen (HBsAg)
positive, administer 0.5 mL of hepatitis B immune
globulin (HBIG) (before 1 week)

Contraindication Hepatitis B
No contraindication, except pregnant mother

Measles

Measles
Live attenuated virus
Age 9 months
Dose 0.5 ml SC
Contraindication : High fever, immunosupression,

immunoglobulin or given blood component

Repeat : age 5-7 years

Measles - VAER
Fever 5-15% on 5-6 th day after immunization, for 2

days
Rash 5%, on 7-10th day, for 2-4 days
Encephalitis and encephalopathy = 1 : 1 miilion
dosis within 30 days after immunization

Non PPI Vaccine

Hib
MMR
Typhoid
Hepatitis A
Varicella
Influenza
Pneumococcus

Vaccine Storage
All vaccines should be stored at 0 8 C (WHO)

( Depkes 2-8 C )
Except :

OPV
BCG
Measles
( Freeze : -15 25 C )