Indonesia PCV Demonstration

Program

Sri Rezeki Hadinegoro

•  Departemen Ilmu Kes Anak FKUI-RSCM Jakarta
•  Satgas Imunisasi IDAI
•  Ketua ITAGI
Topik yang akan dibahas

—  Rekomendasi Imunisasi

Pneumokokus
—  Pemberian dan manfaat dari PCV
—  Imunisasi PCV di Indonesia
 Kematian Global bayi dan anak akibat
PD3I
In children younger than 5
Pneumococcus 393,000 years
Rotavirus 146,500 •  S pneumoniae is a
leading cause of severe
Hib 58,700 pneumonia, especially in
the developing world2
Pertussis 54,500
•  According to the 2015
Measles 62,600
estimates, Hib and S
pneumoniae were
Neonatal tetanus 19,900
responsible for close to
65% of deaths due to
Estimated deaths in 20151
0 250,000 500,000 lower respiratory
infections1

1. Wang H, et al. Lancet. 2016;388(10053):1459-1544. 2. UNICEF/World Health Organization. Pneumonia: the forgotten killer
of children. http://www.childinfo.org/files/Pneumonia_The_Forgotten_Killer_of_Children.pdf. Accessed October 25, 2018.

3
 WHO Estimates of Global Immunization
Coverage in Children 2017
100%
Pediatric vaccine completion (%)

85% 85% 85% 84%

75%

50% 44%

28%
25%

0%
DTP3 Polio Measles Hepatitis B Pneumococcal Rotavirus

WHO-recommended childhood vaccines

DTP3=diphtheria-tetanus-pertussis; WHO=World Health Organization.

World Health Organization. Immunization coverage. http://www.who.int/news-room/fact-sheets/detail/immunization-coverage. Accessed
October 25, 2018. 4
 Rekomendasi Global
—  WHO recommends the inclusion of PCVs in
childhood immunization programs worldwide
—  Use of pneumococcal vaccine should be
complementary to other disease prevention
and control measures, such as appropriate case
management, promotion of exclusive
breastfeeding for the first 6 months of life and
reducing known risk factors such as indoor air
pollution and tobacco smoke

WHO. WHO position paper 2019. Weekly epidemiological record 2019;94(8):85-104

 Penyediaan  air  bersih  

Nutrisi  seimbang   Air  susu  ibu  eksklusif  

Upaya Pencegahan

Menghindari     Keluarga  berencana  

indoor  polu7on  

Imunisasi  
 Pengendalian Pneumonia
Mengurangi risiko Mencegah penyakit Mencegah kematian

Protect Prevent Treat

(Lindungi) (Cegah) (Obati)
•  ASI eksklusif •  Manajemen pasien
•  Nutrisi seimbang
•  Imunisasi
•  Di RS
•  Menghindari polusi dalam ruang
•  Di komunitas

Program Imunisasi Nasional

(target)
Supardi J. Comprehensive Multi Year Plan Ministry of Health Indonesia for Pneumococcal Disease Prevention.
Presented in Indonesia Pneumococcal Disease Summit, Legian, 21 January 2017
 Perlu cakupan imunisasi
yang tinggi ≥80% target
(Program Imunisasi Nasional)

Intervention
Burden of
(protect- Impact
disease
prevent-treat)

Pneumococcal disease Pemberian PCV Penurunan

jumlah kasus
8/22/19 Slide Sri Rezeki
PCV13 Is Included in Over 120 NIPs, With Exclusivity
in 117 Countries Worldwide1,2

PCV13 Only* = 117

PCV13 / PCV10† Shared = 6

(PCV13 covers >50% of total BC)

PCV13 / PCV10† Shared = 2

(PCV13 covers <50% of total BC)

PCV10 Only = 32 As of January 2019

*Canadian province of Quebec and Italian region of Piemonte have initiated PCV vaccination programs with PCV10.
†Both PCVs are available/reimbursed in the NIP or the NIP consists of different PCVs by region.
BC=birth cohort.
1. Gavi Alliance Annual Progress Report 2017. http://www.gavialliance.org/results/gavi-progress-reports/. Accessed November 27, 2018.
2. Data on file. Pfizer Inc, New York, NY. 2019.
Manfaat Pemberian PCV
 Indikasi PCV13
Anak usia 6 minggu - 5 tahun Dewasa usia ≥ 50 tahun

Anak mulai usia 6 minggu sampai 5 Dewasa usia ≥ 50 tahun guna

tahun untuk membantu mencegah pencegahan penyakit pneumokokus
infeksi pneumokokus invasif, (termasuk pneumonia dan infeksi
pneumonia, dan OMA pneumokokus invasif)

Latest BPOM approved Prevenar 13 local product document. 2018 8/22/19 Slide Sri Rezeki
 Jadwal Imunisasi
Rekomendasi IDAI 2017

Gunardi H, Kartasasmita C, Hadinegoro SRS, et al. Immunization schedule for children aged 0-18 years old Indonesian Pediatrics Society Recommendation 2017.
Sari Pediatri 2017;18:417-22.
 Jadwal Imunisasi PCV 
Rekomendasi IDAI 2017
Dosis 1 Dosis 2 Dosis 3 Dosis 4
2 bulan 4 bulan 6 bulan 12-15 bulan

Usia Dosis
7-11 bulan 3 kali, interval 4-8 minggu. Dosis ketiga diberikan
setelah usia 1 tahun atau minimal 2 bulan setelah
dosis kedua
12-23 bulan 2 kali, minimal diberikan 2 bulan setelah dosis
pertama
> 24 bulan 1 kali, dapat diberikan hingga usia 5 tahun
Satgas Imunisasi IDAI. Pedoman Imunisasi Di Indonesia. Badan Penerbit IDAI. 2017: 297-308.
8/22/19 Slide Sri Rezeki
 “Impact” yang diharapkan dari
Pemberian PCV
Meningitis Karier nasofarings

Resistensi Antibiotik

Bakteriemi

Otitis Media
Akut (OMA)

Herd immunity
Pneumonia

•  World Health Organization. Pneumococcal conjugate vaccine for childhood immunization – WHO position paper. Weekly Epidemiology Rec.
2007; 82:93-104.
•  Pilishvili T, Noggle B, Moore MR. Pneumococcal. Dalam: Centers for Disease Control and Prevention, penyunting, Manual for the Surveillance of
Vaccine Preventable Disease. Edisi 4. Atlanta : CDC; 2008. h. 1-14.
 PCV13 2+1

Kasus CAP pada usia 1 bulan–15 tahun

dan usia <2 Tahun di delapan rumah sakit anak di
Perancis (PCV13, jadwal 2+1)

2400 CAP 1 bulan –15 tahun

CAP <2 tahun
Reduksi 16%
2000
Number of Cases

vs pre-PCV13
1600

1200

800 Reduksi 32%

vs pre-PCV13
400

0
Pre-PCV13 Transition Post-PCV13
(June 2009–May 2010) (June 2010–May 2011) (June 2011–May 2012)

Angoulvant F, et al. Clin Infect Dis. 2014;58(7):918-924. 15

 PCV13 3+1

Kasus IPD Serotype 3 pada Anak Balita

Di USA, PCV13 dengan jadwal 3+1

60 PCV7 PCV13
2000 2010 Reduksi 31%
50 (vs 2007–2010)
Number of Cases

40

30

20

10

0
2004–2007 2007–2010 2010–2013

16
Moore MR, et al. Lancet Infect Dis. 2015;15(3):301-309.
 Taiwan, PCV13 2+1

Distribusi serotipe pneumokokus dari infeksi

paru dan OMP 2012–2015*
Di Taiwan, PCV 13 jadwal 2+1 (N=174)
50 June 2012–May 2013 June 2013–May 2014 June 2014–May 2015
Number of cases

40
Antara 2012 dan 2015, persentase isolat
30 PCV13-serotype menurun 47% dan
proporsi serotype non-PCV13
20 meningkat dari 17% menjadi 55.9%

10

0
19F 6B 23F 14 19A 6A 15A 15B 23A 35B 6C 34

PCV7 serotypes

PCV13 serotypes Non-vaccine serotypes

*Isolates collected from blood, pleural effusion, pus/otorrhea, and sputum from June 2012 to May 2015..
Janapatla RP, et al. J Med Microbiol. 2017;66:729-736. 17
Mencegah Penyebaran Serotipe dari
Karier Nasofarings

Bayi lain

Saudara
kandung

Dewasa

Nenek/kakek
Davis SM, et al. Vaccine. 2013;32:133-145.
 Keamanan Vaksin PCV
 Decreased appetite
 Erythema
 Drowsiness
 Swelling Reaksi
Lokal  Diarrhoea
 Induration
 Chills
 Tenderness
Reaksi  Irritability
 Injection-site pain
Systemik  Rash
 Limitation of arm
movement  Pyrexia

1.  Latest BPOM approved Prevenar 13 local product document

19
Imunisasi PCV di Indonesia
 Program  PCV  2017  
Dilakukan  di  kabupaten    Lombok  Barat  dan  
Lombok  Timur  

Kabupaten Target

Lombok Barat 25.894

Lombok Timur 14.392

Total 40.286

Syamsu Alam. Learning and Sharing Experience on PCV Demonstration Program in Indonesia. Presented in 16th Asia Pasific Congress of Pediatrics, Bali
Nusa Dua Convention Center, 27 August 2018
 Program  PCV  2017  
u  Vaksin yang diberikan PCV13
u  Jadwal    2,  3,  dan  12  bulan  (2+1)  
§  Umur  2  bulan:  Pentavalen  1  +  PCV  1  
§  Umur  3  bulan:  Pentavalen  2  +  PCV  2  
§  Umur  4  bulan:  Pentavalen  3  +  IPV  
§  Umur  12  bulan:  PCV  3    
u  Mulai sejak Oktober 2017
u  Dilakukan di Puskesmas, RS Pemerintah dan Swasta,
Praktek Swasta

Syamsu Alam. Learning and Sharing Experience on PCV Demonstration Program in Indonesia. Presented in 16th Asia Pasific Congress of Pediatrics, Bali
Nusa Dua Convention Center, 27 August 2018
Pencanangan Program Imunisasi PCV

Mataram, Oktober 2017

 Perluasan Imunisasi PCV 2018

Lombok Tengah dan Pangkalpinang, Bangka, Bangka Tengah -

Mataram November 2018 November 2018
 PCV dosis pertama dan kedua diberikan
bersamaan dengan Pentavalen

Posisi bayi saat penyuntikan

Langkah-langkah penyuntikan

Kemkes RI. Petunjuk Teknis Pelaksanaan Program Demonstrasi Imunisasi Pneumokokus Konyugasi (PCV). Dirjen P2P Kemkes Ri. 2017
 Penggunaan Safety Box

Kemkes RI. Petunjuk Teknis Pelaksanaan Program Demonstrasi Imunisasi Pneumokokus Konyugasi (PCV). Dirjen P2P Kemkes Ri. 2017
Kesimpulan
Penyakit Pneumokokus merupakan
penyakit yang dapat dicegah dengan
imunisasi
Imunisasi PCV untuk individu diberikan 3
dosis dasar (usia 2, 4 ,6 bulan) dan 1 dosis
penguat (12 bulan)
Program demonstrasi PCV telah dimulai
di Propinsi NTB dan Bangka-Belitung