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Preceptor

dr. Pulung M Silalahi, Sp.


A

IMMUNIZATIONS
Faculty of Medicine YARSI RS SAID SUKANTO

RM AFFANDI AKBAR 1102011216

Definition :
Immunization or immunisation, is
an active way to improve a persons
immunity from a certain antigen, so
that if in the future she/he is
exposed with the same antigen,
she/he will not be ill because of the
antigen

Purpose :
Prevent disease in someone
Eliminating the disease in the
population , even in the world

Immunization in
Indonesia
In Indonesia , immunization is a national policy
through immunization programs . Immunization is still
very necessary to exercise control Preventable
Diseases Immunization ( PD3I ) , such as Tuberculosis
( TB ) , diphtheria , pertussis ( respiratory disease ) ,
measles , tetanus , polio and hepatitis B.

Resistance
Resistance developed
developed in
in response
response
to
to stimulus
stimulus by
by an
an antigen
antigen
(infecting
(infecting agent
agent or
or vaccine)
vaccine) and
and
is
is characterized
characterized by
by the
the
production
production of
of antibodies
antibodies by
by the
the
host
host

Active Immunity
immunity
Passive
immunity

Immunity
Immunity conferred
conferred by
by an
an
antibody
antibody produced
produced in
in another
another
host.
host. ItIt may
may be
be acquired
acquired
naturally
naturally or
or artificially
artificially (through
(through
an
an antibody-containing
antibody-containing
preparation).
preparation).

Types of vaccines
Live
attenuated
Recombinant
vaccine

Innactivated
Viruslike
particle
vaccine

Live attenuated
Bacteria or viruses live attenuated
Should be retrievable breed immune
response
Given in small doses .
Examples : measles ,mumps ,rubella ,
polio ( virus ) BCG ,oral typhoid fever
( bacteria )

Innactivated
Bacteria
,viruses
/
bacteria
or
components that made inactive
Unable to replikasi entire dose ag
can not cause the disease
example : diphtheria , tetanus ( toxoid )
Haemophilus
influenza
( polysaccharide )

Recombinant
vaccine
Obtained through
the process of
genetic
engineering
The virus inserted
into yeast cells
produce surface
antigen
Example : hepatitis
B,rotavirus,typhoid

Virus-like particle
vaccine
Made
of
virus-like
particles
Antigens
derived
from
viral
proteins are processed
to form a structure
similar to the whole
structure of the virus
example : HPV

PROCEDURE FOR IMMUNIZATION


Before vaccination :
Notify parents when the risks of vaccination and the
risk of unvaccinated Ask the parents' consent
History and check the health condition of children
Are there any contraindications in patients
Check and make sure the vaccine is in good condition
Check the handling preparation
Kipi Adjust the immunization schedule with vaccines ,
immunization offer next
Provide immunization with the correct techniquesien

PROCEDURE FOR IMMUNIZATION


After vaccination :

Give instructions to the parents or caregivers about what to


do in the event of unusual reaction or heavier follow up
reaction
Record the immunization in the personal medical record and
the clinical record.
Immunization record must be submitted to the Health
Department of Communicable Disease Control
Check the immunization status of other family members and
offer the catch-up vaccination (if needed)

STORAGE AND TRANSPORT


VACCINE
The refrigerator can not store food or
drink
Vaccines were taken using specially box
with cooling ( cold chain )
Vaccines are stored in a special place with a
temperature of 2-8*C and not frozen

Which
should be
noticed in
vaccine
Expired date
Liquid colors ( yellow,orange
polio )
Clarity
Sediment
Color vaccine vial monitor
Damage label
The rest of the vaccines that
have been dissolved

VAKSIN VIAL MONITOR

SHAKE TEST VACCINE

The Syringe Angle for


Injection

The Recommended Injection


Location
The anterolateral thigh is a part of
body that is recommended for
vaccination of babies and children
under the age of 12 months.. Regio
deltoid is an alternative for vaccination
in older children (those who can walk)
and adults.

HOW TO GIVE A VACCINE INJECTION

Subcutaneous
It is for MMR, Varicella, Meningitis Immunizations
Note the recommendation for children age

Age

Location

Syringe Size

Syringe Insertion

Babies (0 12 months)

Anterolateral Thigh

Syringe 5/8-3/4 no 23-25

Syringe Direction: 45 to the


skin

1 3 Years Old

Anterolateral thigh / Lateral Syringe 5/8-3/4 no 23-25

Pinch tightly for subcutaneous

Upper Arm

injection

Aspirate syringe before injected

For multiple injections, they are


given at different extremities

HOW TO GIVE A VACCINE INJECTION


Intramuscular
It is for DPT, DT, TT, Hib, Hepatitis A & B and Influenza
Immunization
NoteAge
the recommendation
age Size
Locationfor childrenSyringe

Babies (0 12 months) Vastus lateralis

muscle on the
anterolateral
thigh area

Syringe 7/8-1 no 2225

1 3 Years

Vastus lateralis muscle

Syringe 5/8-1 (5/8

in the anterolateral

for deltoid injection in

thigh area until the

the

deltoid muscle mass is

months) no 22-25

age

of

12-15

big enough (Usually in


the age of three)

Children > 3 Years Old

Deltoid muscle, below


the acromion

Syringe 1-1 no 22-25

The condition of babies or children


before immunization
The baby experienced a severe Adverse
Following Immunization (requiring special
treatment or being hospitalized)
Allergic to materials contained in vaccines
(e.g. neomycin).
The baby is now receiving a long-term steroid
treatment, radiotherapy, or chemotherapy.

The condition of babies or children


before immunization...
Staying with people with medical treatments
that decreases immunity (Radiotherapy,
Chemotherapy or steroid therapy)
Receiving immunization containing a living
virus vaccine (measles, poliomyelitis,
rubella vaccines) in the previous month
Receiving immunoglobin or blood
transfusion in the last three months
The baby has central nervous system
diseases

Recording Immunization and


Immunization card
The data that must be recorded on
immunization card are as follows:
Kinds of vaccines given, including batch
numbers and trademarks
The date of vaccination
Side effects (if any)
The date of the next vaccination
The officers name (who administered
the vaccine)

Adverse Following Immunization (AEFI)


Kejadian Ikutan Pasca Imunisasi (KIPI)
Any medical treatment may cause a risk
(whether in a light or severe sign) for the
patient. It is the same as vaccination,
the occurring reaction after the
administration is called as AEFI (Adverse
Following Immunization).
AEFI Reaction can be categorized as
program failure, injection reaction
and vaccine reaction.

RECOMMENDED VACCINES
-

BCG

MMR (measles, mumps, rubella)

Hepatitis B

Haemophilus influenzae type B

DPT (Diphtheria, Tetanus, Pertussis)

Typhoid fever

Poliomyelitis

Varicella

Measles

Hepatitis A

Influenza

Pneumococcal

Rotavirus

Yellow fever

Japanese encephalitis

Meningococcal

BCG

Decrease the risk


of heavy tbc
Immune effect : 6-12 weeks . 50-80 %
provides protection for Tuberculosis
Location : Right Deltoid ( Intradermal )
Dose
: infants : 0.05 ml
child : 0.10 ml
Immunization schedule : from birth - 3 months
KIPI local :
Local superficial ulcers

HEP B
Protective response : raise antibody
titer > 10 mIU / ml
Administration : IM ( anterolateral
thigh , the deltoid )
Immunization schedule :
1. < 12 hours
2. 1-2 months
3. 6 months

KIPI
Local : redness, itching
Systemic : mild fever 1-2 days .

DPT
Schedule :
The primary immunization 3 times since the age of
2 months with intervals of 4-8 weeks ( 2,4,6
months )
Booster DPT 4 one year after the DTP - 3 are age
18-24 months
DPT - 5 at the time of school entry age of 5 years .
For children over 7 years old DPT vaccine should
be given Td
Dose : 0.5 ml IM
Can be given DTwP or DTaP
Giving can be combined with hepatitis B , Hib , and
IPV schedule

KIPI
LOCAL : redness , swelling , itching
Systemic : fever
CONTRA INDICATION
1. encephalopathy
2. History anaphylaxis

POLIO

OPV
Type

Oral : 2 drops

IPV

Subkutan 0,5 ml

SCHEDULE IMMUNIZATION :
1. POLIO I: 0 months
2. POLIO II : 2 months
3. POLIO III : 4 months
4. POLIO IV : 6 months
BOOSTER: 5-6 years ( school )

KIPI
Systemic : headache , muscle pain ,
mild diaare
Contraindication:
1. Fever
2. Vomiting / diarrhea
3. Consumption of immunosuppressive
drugs
4. Radiation general
5. Malignancy
6. People with hiv

Measles

Type

monovale
n

MR

Combinati
on

MMR
MMRV

The vaccine is given one dose of 0.5 ml

subcutaneously
Given 3 times : the age of 9 months , 2
years and 5-6 years of age when entering
grade 1 in the BIAS program
When you've got the age of 15-18 months
MMR immunization is not required measles
immunization at 24 months
The vaccine is stable after dissolved only 68 hours
Kipi : Fever , redness , joint pain

(Measles, Mumps, Rubella =


MMR)

Dose: 0,5 ml IM atau deep subkutan


Still be given even if there is a history
of infectious measles , mumps and
rubella or measles immunization
Should be given to children with a
family history of seizures or seizure
ever
Immunization schedule : 12-15 months ( if not
received immunization against measles )

Influenza

Derived from inactivated virus


Dose : age < 3 years of 0.25 ml and > 3 years 0.5 ml
Mode of administration : intramuscular
Adults and older children in the deltoid muscle
Babies in the anterolateral thigh
The influenza vaccine given at least 6 months , is
repeated every year .
For the first immunization (primary immunization ) in
children aged less than 9 years were given twice at
intervals of at least 4 weeks

Pneumokus ( PCV )

Purpose: to prevent invasive infections


pneumonia , meningitis , bacteremia , and
invasive pneumococcal disease ( IPD )
Giving 3 times the age of 2, 4, 6 months, and
repeated intervals of 4-8 weeks of age 12-15
months
Minimum starting age of 6 weeks
When given at the age of 7-12 months ,
given 2 times at intervals of 2 months, at
more than 1 year of age are given one time .
Both need a repeat dose first time at the age
of more than 12 months or a minimum of 2
months after the last dose .
In children over 2 years of age is given just
once

TIFOID

Type
Oral

Derived from
attenuated
Salmonella bacteria
ttyphii .
Schedule : > 6 years
Given 4 capsules
with a distance of 1
day

Parente
ral
Derived
from
Vi
polysaccharide
capsule that is turned
off salmonella typhii
Schedule : > 2 years
Given every 2-3 years

ROTAVIRUS

Type

ROTARIX
4,8 mgg

ROTATEG
4,8,12
mgg

Administration : Oral
Target : Infants aged 4
weeks
Contraindications :
should not be given
together with polio
vaccine , in intestinal
pathogenic bacteria
infection
Kipi : diarrhea, vomiting,
fever

VARICELLA

Live attenuated virus vaccine


Kept at a temperature of 20-80C
After reconstitution 30 minutes should be
discarded
Dose : 0.5 ml subcutaneously
Varicella vaccine may be given after the
age of 12 months , but the best on the age
before entering elementary school
Immunocompromised individuals ,
adolescents and adults 12 years require
two doses , intervals of 1-2 months
Contra indications : high fever , immune
deficiency , in the treatment of high-dose
steroids

HEPATITIS A

Vaccines derived from killed virus


Age immunization : 2 years
Vaccine two times , the second
injection is given 6-18 months
after the first
Good immunogenicity

HUMAN PAPILOMA VIRUS (HPV)

Immunizations given age > 10 years


Dose : 0.5 ml IM in the deltoid region
Bivalent HPV vaccine is given three
times
o Bivalent vaccine ( Cervarix ) 0, 1
and 6 months
o Tetravalent vaccine ( Gardasil ) 0, 2
and 6 months

Thank You