Vaksin Saat Pandemi

Prof. Dr. dr.
Soedjatmiko, SpA(K), MSi
• Medical Staff of The Growth, Development and Social Pediatrics Division,

Department of Child Health, Medical Faculty Universitas Indonesia
• Consultant in Growth, Development and Social Pediatrics
• Magister of Science in Developmental Psychology
• Secretary of Immunization Task Force, Indonesia Pediatric Society
• Member of Indonesia Technical Advisory Group for Immunization (ITAGI)
• Member of The Working Group in Growth, Development and Social
Pediatrics, Indonesia Pediatric Society
SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020

Continuing Medical Education
Department of Child Health
FKUI - RSCM
Optimizing Vaccination Coverage

from Primary, Booster to School Age
during and after Covid-19 Pandemic
Soedjatmiko
Division of Growth, Development and Social Pediatrics
Departement of Child Health
Medical Faculty University of Indonesia
Topics
• Rapid assessment MOH & Unicef impact of Covid-19 pandemic on :
immunization service, perception of parents and caregivers
• VPDs cases and immunization coverage in 2019 – July 2020
• The role of health workers in optimizing immunization coverage
during and after pandemic
• Advocation / education during and after pandemic
• on vaccine hesitancy
• call for action using social media
SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

• Indonesia : MOH & Unicef, 20-29 April 2020,
• online survey : 34 provinces.
• 388 of 540 districts and cities
• Subjects : 5,329 of 9,993 puskesmas
Puskesmas
• Stopped completely : 32.04%
• Stopped partially : 67,96 %
Posyandu
• Stopped completely : 35,92 %

Health personnel :
• afraid of being infected
o limited availability of personal protection equipment
o community members returned from high prevalence of COVID-19
o do not follow the national guideline of 14 days of self-isolation
o caregivers and parents reluctant to use masks properly
• understand the risks of VPD outbreaks

o suggesting reorganizing immunization services
• worried about adverse events (AEFI), blamed or threatened
o community may distrust or avoid the vaccination services,

Distribution of Respondents Profile of Respondents
• 34 provinces • 78% of parents and caregivers
• 2,641 parents and caregivers • 3/4 of 20-40 years,
• had children under the age of two years), • 71% women
• 2/3 from Java island, • 8 % Uncle / Aunt
• 4 % grandmother / father

In pandemic
• 51% attend immunization
• 43% in private clinics and hospitals
• 29 % in puskesmas
• 21 % in posyandu
Before COVID-19, in Indonesia,

o 90% vaccinated in public facilities:
• 75% in health posts (posyandu),
• 10% in health centers (puskesmas),
• 5% in village birth facilities (polindes).
o 10% in private clinics and hospitals.

Vaccine hesitancy during COVID-19.
❑ 2/3 of parents and caregivers
‘active acceptance.’
• 23% as ‘active refusal.’
• 13% of parents and caregivers
categorized as ‘hesitant.
Vaccine Demand and Hesitancy

• haram-halal issues,
• mistrust,
• fear of multiple injections,

Vaccine Preventable Diseases (VPDs)
and Immunization Coverage
2019 – July 2020

Immunization Coverage 2019 – July 2020
Chart Title
120
100
80
60
40
20
0
HPV kls 5 HPV kls 6
PCV1 PCV2 Campak DT kls 1 Td kls 2 Td kls 5
HB0 BCG Penta 3 OPV3 IPV OPV4 JE (Bali) (DKI, DIY, (DKI, DIY,
(NTB+BB) (NTB+BB) Rubella BIAS BIAS BIAS
Bali ) Bali )
2019 94.5 96 96.5 95.9 77 94.2 68.2 61.4 94.7 75.8 90.4 91.02 92.5 16 12
sd Juli 2020 46.9 46 41.1 42.3 7.8 40.7 9.4 8.7 42.6 41.4
2019 sd Juli 2020
Source : Immunization Subdit. MOH

Courtessy : Sri R Hadinegoro

Diphtheria : cases & immunization 2019 – July 2020

Diphtheria Cases By Province
Indonesia, 2019 - 2020
Diphtheria Classification
Diphtheria
12% Clinical
Compatible
2019
944 cases
Diphtheria
Confirm Lab 5 High Provinces Diphtheria Cases Diphtheria Classification
December 2019 – July 2020 Diphtheria
16% Clinical
88% Jawa Barat, Jawa Timur, Jakarta, Compatible
Kalimantan Timur, Sumatera Barat 2020

179 cases
Diphtheria
Confirm Lab
84%
Source: DIF-3 Monthly Report

Surveillance Dit, MOH
*Dots are randomly placed within provinces
: 1 Diphtheria case
Suspect of Diphtheria Cases by Age Group and Year
Indonesia, 2011-2020
1800
Source : Surveillance Dit. MOH 1%
1600
1400
12%
1200 0% 0%
1000 18% 13%

0%
12%
800 0% 11%
16% 18% 0%
13%
15%
600 16%
0% 0% 26% 11%
30% 15% 12% 10%
400 0% 31%
37% 13% 12% 10% 34%
28% 13%
40% 39%
200 33% 5%
28% 22% 19% 16% 13%
23% 26% 19% 13%
25% 22% 29%
0 3% 28% 37% 16% 16% 0% 20%
2011 = 807 2012 = 1192 2013 = 767 2014 = 430 2015 = 529 2016 = 542 2017 = 1210 2018 = 1755 2019 = 944 2020 = 179
cases cases cases cases cases cases cases cases cases cases
<1 yr 1 - 4 yr 5 - 9 yr 10 - 14 yr >14 yr Unknown
* Source: Measles Data Validation and Integrated
VPD Surveillance Data (routine report)
Coverage of Routine Immunization DPT-HB-HiB 3rd dose
by Province & District in Indonesia, 2019 - 2020
2020 : 33,6 %
2019 : 96,5 %
Surveillance Dit MOH
Legend (DPT-HB-HiB):
Coverage < 80
Coverage 80 – 95 %
Coverage > 95 %
Not reported
Coverage of Routine Immunization DPT-HB-HiB 4rd dose
by Province & District in Indonesia, 2019 - 2020
2020 : 26,3 %
2019 : 75,9 %
Surveillance Dit
MOH
Data as of 05 August 2020
Legend (DPT-HB-HiB):
Coverage < 80
Coverage > 95 %
Not reported SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020
Polio cases & immunization 2019-2020

POLIO : Global WPV1 & cVDPV Cases
August 2019 – August 2020
cVDPV2
• Afghanistan, July 2020
WPV1, July2020 • Pakistan, June 2020
cVDPV2 • Afghanistan
• Jan – July 2020 • Pakistan
• 17 countries
cVDPV1 cVDPV2
cVDPV1 • Phillipines, Jan 2020
• Yemen • Philippines, Oct 2019 • Sabah, Nov 2019
June 2020 • Malaysia, Jan 2020
1Excludes viruses detected from environmental surveillance

2Onset of paralysis 26 Aug. 2019 – 25 Aug . 2020
Source : Surveillance Dit MOH

Polio cases in 2019 - 2020 Polio in Malaysia
One cVDPV2 and one cVDPV1 positive
environmental samples were reported
from Sabah province.
The samples were collected on 19
November 2019.
UNICEF-WHO
Philippines: Polio Outbreak
Situation Report (15 January 2020)
•11 cases confirmed cVDPV - 2;

cVDPV tipe 1
• 1 case with cVDPV1;
• 1 case with VDPV1;
POLIO : Coverage of Routine Immunization OPV4
by Province & District in Indonesia, 2019 and 2020
2020 : 33,2%
Source : Immunization Subdit

2019 : 94,2% MOH
Legend (OPV4):
Coverage < 80
Coverage > 95 %
Not reported
POLIO : Coverage of Routine Immunization IPV
2020 : 7,4 %
2019 : 77% Source : Surveillance Dit MOH

Data as of 05 Agustus 2020
Legend (OPV4):
Coverage < 80
Coverage > 95 % SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020
Not reported
1x IPV : 4 month, 143 Infants in Bandung
Anti polio 2 : post 1x IPV
• significant lower than anti polio 1 and 3

AFP Surveillance Performance
Indonesia, 2007 - 2020
5 100
89.5 89.6 87.7
4.5 85.6 86.4 87.5 90
83.7 83.3 84.3 82.8
79.5 78.4 80.2 79.4
LAPORKAN 4 80
SEGERA 3.5 70
Specimens Adequate
Non Polio AFP Rate
Ke Dinkes 3 2.75 2.81 2.76 2.77 2.74 60
2.54 2.63
2.4 2.42 2.4
2.5 2.29 50
Semua kasus 2.02 1.98
2 40
lumpuh layuh
1.5 30
akut
(acute flaccid 1 20
paralysis = AFP ) 0.5 0.41 10

Umur < 15 tahun 0 0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Non Polio AFP Rate Specimens Adequate Non Polio AFP Rate Target (2/100000) Specimens Adequate Target (80%)
Indikator Surveilans AFP:

• Non Polio AFP minmal 2 per 100000 penduduk usia <15 tahun Published 31 August 2020
• Persentase Spesimen Adekuat minimal 80%SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020
Measles and Rubella Cases
and MR Immunization Coverage 2019 - 2020

Distribution of Suspect Measles Cases by Province
2020
2699 cases

: 10 suspect measles cases
2019
8828 cases
: 10 suspect measles cases

Source: MR-02 Individual Suspect Measles Cases Form
*Dots are randomly placed within provinces
Map of Measles Positive and Rubella Positive Cases by Province
2019 - 2020
2020 2020
Measles (+) : 175 cases Rubella (+) : 95 cases
14 Provinsi 15 Provinsi
❑ 2019, Prov.Aceh : campak positif tertinggi (318 kasus) rubella positif tertinggi (135 kasus)
❑ 2020, 15 August 2020, Prov. Aceh campak positif tertinggi di Indonesia (52 kasus.)
2019 2019
Measles (+) : 639 cases Rubella (+) : 710 cases
26 Provinsi 31 Provinsi Source : Surveillance Dit MOH
: Measles
: Rubella
: 1 case Dots are randomly placed within districts
Suspect Measles Cases by Age Group and Year
25000
23282
0%
22500
16%
20000 18798
0%
17500 14%
20%
15104
15000 0%
12943
16% 20%
12500 11521 0%
36% 10655
0% 20% 10586
0% 16% 10021
22% 0%
10000 16% 18% 8828
31% 13% 16%
2%
14% 15% 16% 19%
7500 29% 17%
30% 12%
27% 14%
5000 26% 34% 31% 23%
23% 23% 2699
28% 25%
2500 27% 26% 29% 1%
28%
26% 21% 12%
21%
9% 10% 10% 15% 25%
10% 9% 9% 8% 10% 13%
0
2011 = 2012 = 2013 = 2014 = 2015 = 2016 = 2017 = 2018 = 2019 = 8828 2020 = 2699
23282 cases 18798 cases 11521 cases 12943 cases 21576 cases 24970 cases 19617 cases 10021 cases cases cases
<1 yr 1 - 4 yr 5 - 9 yr 10 - 14 yr >14 yr Unknown

* Source: Measles Data Validation and Integrated
VPD Surveillance Data (routine report)
Surveillance of Measles and Rubella 2019-2020
Penemuan Kasus Suspek Campak per Bulan Penemuan Kasus Suspek
2019 - 2020 Campak Kumulatif
▼ 10% ▼ 5% ▼ 28% ▼ 78% ▼ 86% ▼ 79% ▼ 90% 5000
1000 2019 - 2020
▼ 41%
Source : Surveillance Dit MOH 2019 4500
900 928 2020 4476
891
847 858 4000
800 833
762 3500
2019
700
2020
3000
600 631
618
589
Cases
Cases
2500 2640
500
2000
400
406
1500
300
1000
200
165 500
100
90 87
58 0
0
Cumulative (Jan - Mei)
Jan
Source: Feb Mar Apr May Jun Jul
•Routine report (MR-02 report) SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020 Periode
•Measles Lab Information System (MLIS)
Periode
Coverage of Routine Immunization MRCV-1
2020 : 34,9%
2019 : 95,1%
Legend (MCV-1):
Coverage < 80
Coverage > 95 %
Not reported SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020
Coverage of Routine Immunization MRCV-2
2020 : 24,8%
2019 : 72,7%
Legend (MCV-2):
Coverage < 80
Coverage > 95 %
Not reported SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020
70%
Measles and Rubella Positive Rate by Region Indonesia, 2017 – 2020
and the Year62.7%
of Elimination Target
60% Lab+ M Lab+ R
55.3%
51.4% 51.0%
49.6% 50.2%
50%
46.0%
Positivity Rate
40% 36.9%
36.2%
35.0% 33.9%
30%
26.0% 25.5%25.9%
21.6%
20% 17.5%
15.0%
13.58%
10.84%
8.5% 9.48%
10% 7.76% 7.9% 7.19% 6.8%
4.7% 5.50%
3.60% 2.81% 3.6%
2.4% 2.5%
0%
Region 1 Region 2 Region 3 National

(Jawa & Bali) (Sumatera Island) (Kalimantan, Sulawesi, Nusa
Tenggara, Maluku Islands, Elimination
Elimination in Ellimination in Papua Island) In 2023
2021 2022
Elimination in 2023 Source : Surveillance Dit MOH

* Percent of specimens testing IgM positive or equivocal
The Role of Health Workers
(Paediatrician, GP, Midwife, Health Staff in Province & District)
to Optimalizing Immunization Coverage in
• Government Health Services
• Private Health Services

In pandemic


Cakupan Imunisasi Rendah karena Kurang Advokasi / Edukasi
di TV, Radio, Majalah, Media Sosial
❑ Bahaya penyakit-penyakit
sebelum dan selama pandemi Covid-19
yang dapat dicegah
dengan imunisasi (PD3I)
❑ Manfaat imunisasi
untuk mencegah PD3I Berisiko
terbukti di banyak negara terjadi KLB / wabah
Cakupan imunisasi
selama pandemi
Rendah
❑ Ajakan kepada orangtua dan sesudah pandemi
agar melengkapi Imunisasi Covid-19
untuk mencegah wabah,
sakit berat, cacat dan kematian
❑Takut tertular Covid

Negativity of health workers
interactions
A systematic review of 202 peer-reviewer
articles :.2 the combination of :
• Poor access to services,
• Health workers attitudes :
• limited knowledge,
• inaccurate information
• unfriendly, disrespectful health worker : a physician (for example, a
• abusive, humiliated, pediatrician or general practitioner), nurse,
midwife, a vaccinator, or a trained health
→ discourages to return
worker, who is involved in vaccination.
2Rainey JJ, Watkins M, Ryman TK, Sandhu P, Bo A, Banerjee K. Reasons related to non-vaccination and under-vaccination of children
in low and middle-income countries: findings from a systematic review of the published literature, 1999–2009. Vaccine 2011;29:8215–21
Soedjatmiko, IDAI AAP, 7-9 November 2019
Dukungan Dokter Spesialis Anak (IDAI Cabang) dan Tenaga Kesehatan lain
untuk meningkatkan cakupan Imunisasi di faskes pemerintah dan swasta
Advokasi /
5 Pesan utama imunisasi Orangtua /
• Bahaya PD3I selama & sesudah pandemi
komunikasi • Manfaat imunisasi : mencegah PD3I
keluarga
terus menerus • Semua negara melakukan imunisasi
• Isu negatif tidak benar
• Segera lengkapi imunisasi sesuai jadwal Orangtua lain /
Key Opinion Leader
• Bupati / walikota keluarga lain
• MUI / Dewan Mesjid Strategi (zooming, webinar dll)
• Dinkes, RS, Puskes • Rapat koordinasi Pemda / Dinas
• PKK / Dharma Wanita Lengkapi imunisasi
• HKN, Hari Ibu, PID, Kartini, HAN
• Organisasi wanita lain • Pertemuan Ortu / Komite sekolah • 0- 2 thn
• Dinas Pendidikan • Kelompok pengajian, arisan, • 2–6 thn
• Dinas Agama kesenian, olahraga dll • 7–11 thn (Kls 1–5, BIAS)
• Tokoh masyarakat • WAG, IG, tweeter, blogger,
• Kader Kesehatan dll
• 11–18 thn (Remaja)
• Radio, TV, koran, majalah lokal, dll

Pandemi : Tingkatkan Layanan Imunisasi di Zona Hijau (+ Kuning ?)
di Posyandu, Puskesmas, Rumah Sakit dengan protokol ketat
• Lokasi : terpisah dari poli anak sakit → drive through ?
Posyandu di ZONA HIJAU
• Sirkulasi udara dan cahaya cukup
→ sebaiknya diaktifkan, dengan
• Petugas: masker /faceshield, baju, cuci tangan tiap kali masker, jaga jarak, cuci tangan
• Orangtua dan anak tidak demam, batuk, pilek
• Orangtua & anak > 2 tahun : masker, cuci tangan, jarak Sebelum imunisasi
• Atur perjanjian supaya tidak antri lama • Timbang berat BB, Ukur : TB,
• Jaga jarak , jangan ngobrol, jangan mondar-mandir LK : kurva BB/TB, BB/U, LK/U
• Imunisasi ganda : 2 - 3 suntikan di 2 – 3 tempat • Nasihat GIZI

• Tunggu 30 menit, pulang jangan mampir-mampir, • SKRINING dengan buku KIA
• Sampai di rumah: sepatu, helm, tas, desinfektan diluar • CONTOH STIMULASI dgn buku KIA
• cuci tangan, mandi, cuci kerudung, pakaian, jaket
Layanan Imunisasi pada Pandemi Covid 19
Tidak ada Klinis sehat Tidak demam

kontak selama > 2 minggu batuk pilek IMUNISASI
/ tidak tahu
Rapid test reaktif
/ PCR (+)
Klinis
SEHAT Tunda
Ada kontak Rapid test reaktif imunisasi
dgn 2 minggu Klinis
Suspek PCR positif
/Konfirm / karantina sehat
mandiri
PCR negatif
2 minggu ?
Klinis ringan Klinis sedang / berat
Demam Batuk Pilek PCR 2 x negatif
PCR , Positif Klinis sedang / berat Diobati/
Dirawat di RS
Free download di Google

Lengkapi Imunisasi Anak
umur 0–2 thn dan 2–6 thn,
Umur 0 -2 tahun
• Segera setelah lahir : Hepatitis B + OPV Umur 0 -2 tahun
• 1 bulan : BCG • 2 bulan : + PCV1 + Rota 1
• 2 bulan : Penta 1 (DPT-HepB-Hib1)+ OPV • 4 bulan : + PCV2 + Rota 2
• 3 bulan : Penta 2 (DPT-HepB-Hib2)+ OPV • 6 bulan : + PCV3 + Rota 3 + Influenza 1
• 4 bulan : Hexa 1 (DPT-HepB-Hib3)+ OPV + IPV • 7 bulan : + Influenza 2
• 9 bulan : CR (Campak Rubella) 1 • 9 bulan : Jap.Ensefalitis
• 12 bulan : Varicella
• 18 bulan : Penta 3 DPT-HepB-Hib 4 + Polio • 15 – 18 bln : MMR + PCV4
• 24 bulan : Campak Rubela 2
Umur 2 – 6 tahun
Umur 2 – 6 thn tahun • 2 tahun : Typhoid + Hepatitis A
• Lengkapi umur < 2 tahun • 5 tahun : Tetra (DPT-Hib-IPV)
POLIO : Global WPV1 & cVDPV Cases
August 2019 – August 2020
cVDPV2
• Afghanistan, July 2020
WPV1, July2020 • Pakistan, June 2020
cVDPV2 • Afghanistan
• Jan – July 2020 • Pakistan
• 17 countries
cVDPV1 cVDPV2
cVDPV1 • Phillipines, Jan 2020
• Yemen • Philippines, Oct 2019 • Sabah, Nov 2019
June 2020 • Malaysia, Jan 2020
1Excludes viruses detected from environmental surveillance

2Onset of paralysis 26 Aug. 2019 – 25 Aug . 2020

POLIO : Coverage of Routine Immunization OPV4
2020 : 33,2%
2019 : 94,2% Source : Immunization subdit MOH
Legend (OPV4):
Coverage < 80
Coverage > 95 %
Not reported
POLIO
In polio-endemic countries and

in countries at high risk for importation
and subsequent spread,
• bOPV birth dose (a zero dose)

• followed by a primary series of 3 bOPV doses
and
• at least 1 IPV dose.

Coverage of Routine Immunization IPV
2020 : 7,4 %
2019 : 77% Source : Immunization subdit MOH
Legend (OPV4):
Coverage < 80
Coverage > 95 %
Not reported
The immunogenicity of IPV schedules depends on
• the age at administration
• number of doses,
• due to interference by maternal antibodies.
<7 days , single dose IPV shortly after birth (Bhaskaram P et al. J
Trop Paediatrics. 1997)
a systematic review seroconversion rate at 4 – 6 weeks of age.
o type 1 : 8%–100%
o type 2 : 15%–100%
o type 3 : 15%–94%
35 Bhaskaram P et al. Systemic and mucosal immune response to polio vaccination with
additional dose in newborn period. J Trop Paediatrics. 1997; 43(4): 232–234.
1 x IPV : 4 month, 143 Infants in Bandung
Anti polio 2 : post 1x IPV

• significant lower than anti polio 1 and 3

IPV : 1 vs 2 vs 3 doses ; 6 week vs 2 month vs 4 month
o Single dose of IPV (e.g. at 6–8 weeks) lower type 2 seroconversion rates of 32%–39%. (Simasathien, et al
1994, Hird TR et al, 2012);
o single dose : 4 months 63 % seroconverted type 2 (Robertson SE et al, 1988: Resik S et al, 2013)
❑ USA : 2-dose at 2 and 4 months seroconversion 95% all 3 serotypes.
❑ Cuba (Cuba IPV study collaborative griup. New Eng Med J. 2007, Resik S et al : New Eng J Med. 2013 )
o 2 doses : at 4 and 8 months induced type 1, 2 and 3 in 100%, 100%, and 99.4% of vaccinees
o 3 doses : at 6, 10, and 14 weeks induced antibodies to type 1, 2, and 3 in 94%, 83% and 100%
❑ Puerto Rico : 3 doses ( Dayan GH et al , 2007)
o 3 doses : 6, 10, 14 week, seroconversion rates of 85.8%, 86.2% and 96.9% for serotypes 1, 2 and 3
o 3 doses : 2, 4, 6 month, seroconversion rate 99.6%, 100% and 99.1% for serotypes 1, 2, 3
Simasathien S et al. Comparison of enhanced potency inactivated poliovirus vaccine (EIPV) versus standard oral poliovirus vaccine (OPV) in Thai infants. Scand J Inf Dis. 1994; 26:731–738.
Hird TR,et al. Systematic review of mucosal immunity induced by oral and inactivated poliovirus vaccines against virus shedding following oral poliovirus vaccine challenge. PLoS Pathogens. 2012; 8(4)e1002599
❑
Robertson SE et al. Clinical efficacy of a new, enhanced-potency, inactivated poliovirus vaccine. Lancet. 1988; Apr 23; 1(8591):897–899.
Resik S et al. Priming after a fractional dose of inactivated poliovirus vaccine. New Eng J Med. 2013; 368:416–424.
Dayan GH et al. Serologic response to inactivated polio vaccine: a randomized clinical trial comparing 2 vaccination schedules in Puerto Rico. J Inf Dis. 2007; 195:12– 20. Cuba IPV Study collaborative group.
Randomized, placebo- controlled trial of inactivated polio virus in Cuba. New Eng Med J. 2007; 356:1536–1544.
Faden H et al. Comparative evaluation of immunization with live attenuated and enhanced-potency inactivated trivalent poliovirus vaccines in childhood: systemic and local immune responses. JInf Dis. 1990; 162:1291–1297.
Umur 0 -2 tahun
Umur 2 – 6 tahun
IMUNISASI GANDA : AMAN (Lombok, Bangka Belitung, DKI, DIY, Surabaya, Manado, Bali)
(Sumber : Sri R Hadinegoro)

Bulan Imunisasi Anak Sekolah (BIAS) :
Agustus 2020 : kelas 1 CR & kelas 5 HPV))
November 2020 : kelas 1 DT & kelas 2 Td )
❑ Di Sekolah : di jadwal (misal 1 hari 1-2 kelas)

• tidak ada orang sakit, murid dan orang tua sudah familiar,
• ruang tunggu di teras depan kelas, lebih luas, cahaya dan ventilasi cukup
• guru / orangtua mudah awasi antrian, pakai masker, jaga jarak, cuci tangan,
❑ Di Puskesmas : banyak orang sakit, orangtua takut , cakupan rendah ?

• ruang tunggu terbatas, mengganggu kegiatan puskesmas ?
• guru kurang bebas menggunakan tempat / mengatur murid ?
❑Dengan Puskesmas Keliling : bila di sekolah dan puskesmas cakupan kurang

Lengkapi Imunisasi Anak umur 7 – 18 thn
BIAS (umur 7 – 11 thn) Usia sekolah sd Remaja

• Kelas 1 SD : Campak Rubela 3 + DT • 7 tahun : CR 3 + Tetra (TdaP)
• Kelas 2 SD : Td • 8 tahun : TdaP
• 9 tahun : Dengue
• Kelas 5 SD : Td + HPV1 • 10 tahun : Td / TdaP + HPV1
• Kelas 6 SD : HPV2 • 11 tahun : HPV2
• 18 tahun : Td / Tdap
DIPHTHERIA
3 booster doses of diphtheria toxoid-

containing vaccine
during childhood and adolescence

should be given in combination
with tetanus toxoid,
using the same schedule:

• 12-23 months of age,
• 4-7 years
• 9-15 years
DTaP in School-Entry Booster
Immune responses 2 month after SP DTaP-IPV (n=123) as a school-entry booster at 4-6 years in children
primed with DTaP-IPV-PRP~T at 2-4-6 & 18-19 months (n=161) (3+1 Primary Series) (Thailand, 2009-10)[1,2]
Seroprotection rate GMC
100 100 99.2 100 96.3 97.6

100 95.0 10 100 15 100 500 100 93.1 92.6 500
7.81
% Seroconversion (≥4-fold rise)
% Seroconversion (≥4-fold rise)

% Seroprotection (≥0.1 IU/mL)
% Seroprotection (≥0.1 IU/mL)

80 8 80 400 80 400
Anti-FHA GMC (EU/mL)

Anti-PT GMC (IU/mL)
Anti-D GMC (IU/mL)
Anti-T GMC (IU/mL)

60.2 356
9.99 10
60 6 60 307 300 60 300
7.72 272
40 4 40 190 200 40 200

5
2.67
20 2 20 100 20 100
0.15 0.65 10.9 24.3

0 0 80 0 0 0 0 0
Post Pre Post Post Pre Post Post Pre Post Post Pre Post
Toddler Booster SP DTaP-IPV Toddler Booster SP DTaP-IPV Toddler Booster SP DTaP-IPV Toddler Booster SP DTaP-IPV
(DTaP-IPV-PRPT) Booster (DTaP-IPV-PRPT) Booster (DTaP-IPV-PRPT) Booster (DTaP-IPV-PRPT) Booster
Diphtheria Tetanus PT FHA
Sharp decrease in antibody titers for most Ag prior to school-entry booster as observed in previous
studies (wP- or aP-primed)[3,4]
SP DTaP-IPV as a school-entry booster is associated with strong anamnestic responses to all antigens [2]
[1] Chotpitayasunondh. S Asian J Trop Med Health, 2012;43(2) [2] Pancharoen. S Asian J Trop Med Pub Health, 2012;43(3) [3] Langue. Vaccine, 2004;22(11-12) [4] Mallet. Vaccine, 2004;22(11-12)
Hib immunization schedules
may be used:
• 3 primary doses without a booster (3p );

• 2 primary doses plus a booster (2p+1);
• 3 primary doses with a booster (3p+1).


Pertussis Is Significantly Underreported
Only 1%–36% of
pertussis cases are Reported
reported1* cases1-4
Unreported
Atypical forms3,4 Underdiagnosis2,4
Wide disease variability5 Under-reporting2,5
Low physician awareness5 Underconsultation5
Inconsistent case definitions2,5
1. Forsyth KD, et al. Clin Infect Dis. 2004;39(12):1802-1809. 2. Forsyth KD, et al. Vaccine. 2007;25(14):2634-2642.
3. Riffelmann M, et al. J Clin Microbiol. 2005;43(10):4925-4929. 4. Crowcroft NS, et al. Lancet.
2006;367(9526):1926-1936. 5. Tan T. Pediatr Infect Dis J. 2005;24(5 suppl):S35-S38.
• A prospective study was conducted among children aged 0–18 years with persistent cough for more
than 7 days with at least one of the following: paroxysm, inspiratory whooping, or post-tussive
emesis. Nasopharyngeal swabs for PCR of B. pertussis
• 19.6% of children (28 out of 143) had pertussis confirmed by RT-PCR,
• 75% of cases occurred in children , younger than series of vaccine.
• 96% had paroxysm , 93% had post-tussive emesis
• 18%. had whooping among pertussis cases were more likely to have household cough contact
(64% versus 30%, p<0.001)

(International Journal of Infectious Diseases 81 (2019) 43–45.)
PERTUSSIS
• Changing between wP and aP vaccine groups
is unlikely to interfere with the safety or
immunogenicity
• Only aP containing vaccines should be used
for vaccination of persons aged over 7 years
• A shift in distribution towards older age
groups has been reported in some high
income countries, particularly where aP
vaccines have replaced wP vaccines for
primary series.
• a booster dose in adolescence has been
shown to decrease disease in adolescents

IPV in School-Entry Booster
Is highly Immunogenic in children primed with aP-only vaccines
Immune responses 2 month after SP DTaP-IPV (n=123) as a school-entry booster at 4-6 years in children
primed with DTaP-IPV-PRP~T at 2-4-6 & 18-19 months (n=161) (3+1 Primary Series) (Thailand, 2009-10)[1,2]
Seroprotection rate GMC
100
100 100 100 100 100 100 100 100 100
100 100
7000 7000 7000
6087
% Seroprotection (1/dil 5)

80 6000 80 6000 80 6000
5597
Anti-PV1 GMT (1/dil)

4621 5000 5000 3837 5000
60 60 3430 60
3013 4000 4000 4000
40 3000 40 3000 40 3000
2000 2000 2000

20 20 20
583 1000 714 1000 1000
481
0 0 0 0 0 0
Post Pre Post Post Pre Post Post Pre Post
SP DTaP-IPV Toddler Booster SP DTaP-IPV Toddler Booster SP DTaP-IPV
Toddler Booster
Booster (DTaP-IPV-PRPT) Booster (DTaP-IPV-PRPT) Booster
(DTaP-IPV-PRPT)
Polivirus 1 Polivirus 2 Polivirus 3
Sharp decrease in antibody titers for most Ag prior to school-entry booster as observed in
previous studies (wP- or aP-primed)[3,4]
SP DTaP-IPV as a school-entry booster is associated with strong anamnestic responses to all antigens [2]
[1] Chotpitayasunondh. S Asian J Trop Med Health, 2012;43(2) [2] Pancharoen. S Asian J Trop Med Pub Health, 2012;43(3) [3] Langue. Vaccine, 2004;22(11-12) [4] Mallet. Vaccine, 2004;22(11-12)
Pemilihan Kombinasi Vaksin DPT
DTaP formulation TdaP formulation
INFANTS TOOLDER SCHOOL ENTRY SCHOOL AGE & ADOLESCENT

PRIMARY SERIES BOOSTER BOOSTERS
3x DTaP- 1x DTaP- 2x TdaP

1x DTaP-IPV
HB – Hib Hib- (HB)
OPV/IPV
/TdaP-IPV
OPV/IPV
Hexavalent Penta / Hexavalent Tetravalent Tetra / Trivalent
[1] Sanofi Pasteur. Tetraxim CCDS. V.13.0. 2019 [2] Sanofi Pasteur. Pentaxim CCDS. V.11.0. 2011 [3] Sanofi Pasteur. Hexaxim
CCDS. V.8.0. 2018 [4] Sanofi Pasteur. Adacel CCDS. V.17.0. 2018 [5] Sanofi Pasteur. Adacel Polio CCDS. V.12.0. 2018
Cakupan rendah karena Kurang Advokasi / Edukasi
❑ Bahaya penyakit-penyakit sebelum dan selama pandemi Covid-19
yang dapat dicegah
❑ Manfaat imunisasi Berisiko

untuk mencegah PD3I terjadi KLB / wabah
Cakupan imunisasi
terbukti di banyak negara selama pandemi
Rendah
dan sesudah pandemi
❑ Ajakan kepada orangtua
Covid-19
agar melengkapi Imunisasi

Sumber : Sri R Hadinegoro
Foto-foto Penderitaan Anak Sakit Berat ?
Effektif ? Etika ?

Sebarkan Ayo segera lihat catatan imunisasi
Ke Media Sosial • 0 – 2 thn, 2 – 6 thn , 7 – 18 thn
Imunisasi belum lengkap

/ tertunda ? Segera lengkapi
Imunisasi
Sesudah pandemi Covid 19 ?
• Jarang cuci tangan, tanpa masker, jarak Jangan tunggu pandemi
• Berbaur di PAUD,TK,SD, SMP, SMA selesai !
• Ke pasar, naik angkot, bis, KA, MRT Masih lama ?
WABAH (KLB) akan mengancam

bayi, anak-anak kita
sakit berat, cacat & kematian
Kalau catatan hilang ? Terselip ? Sudah pernah? Lupa? → Double?
Pilih imunisasi yang belum (individual) Tidak berbahaya
Supaya tidak bolak balik : 2 suntikan kanan-kiri ? Aman !
Di Lombok, Bangka B, DKI, DI Yogya, Surabaya, Manado, Bali, Bandung,

Negara-negara lain : terbukti aman, kekebalan sama

 Preferred Communication Channels
60% health workers and cadres sources of information
about MOH’s protocol for safe immunization services.
Social media (58%). WhatsApp (WA 42%),
Instagram (IG 22%), Facebook/Messenger (14%)

Contoh ajakan utk orgtua bayi umur 6 bln Contoh ajakan utk orgtua umur 6 bln
yang biasa imunisasi di RS Pemerintah yang biasa imunisasi di RS Swasta
/Puskesmas/ Posyandu /Dokter Spesialis Anak
Yth. Bapak Ibu yang punya bayi umur 6 bulan. Yth. Bapak Ibu yang punya bayi umur 6 bulan.
Untuk melindungi dari penyakit berbahaya, Untuk melindungi dari penyakit berbahaya,
seharusnya bayinya sudah di imunisasi : seharusnya bayinya sudah di imunisasi :
• Hep B 1x, BCG 1x • Hep B 1x, BCG 1x
• Polio tetes (OPV) 4x • Polio tetes (OPV) 4x
• Polio suntik (IPV) 1x • DPT-HepB-Hib 3x IPV 1- 3x
• Pentabio 3x • Rotavirus 2 – 3x
• PCV 3x
Bila belum lengkap atau ragu, • Influenza 1x
Ayo segera ke RS, Puskesmas
/ Posyandu terdekat Bila belum lengkap atau ragu, ayo segera ke RS / Dr.
Covid SpA
Jangan lupa : pakai masker, jaga jarak, cuci tangan
Salam sehat Jangan lupa : pakai masker, jaga jarak, cuci tangan
Dr. Masker Salam sehat
Dr. M. Covid, SpA

Contoh ajakan utk orgtua bayi 9 – 12 bln Contoh ajakan utk orgtua bayi 9 – 12 bln
Yth. Bapak Ibu yang punya bayi umur 9 - 12 bln Yth. Bapak Ibu yang punya bayi umur 9 - 12 bulan.
seharusnya bayinya sudah di imunisasi : seharusnya bayinya sudah di imunisasi :
• Hep B 1x, BCG 1x • Hep B 1x, BCG 1x
• Polio tetes (OPV) 4 x • Polio tetes (OPV) 4x
• Polio suntik (IPV) 1x • DPT-HepB-Hib IPV 3x
• Pentabio 3 x • PCV 3x
• MR 1 x • MR 1 x
• Influenza 2x, JE 1x, Varicella 1x
Bila belum lengkap atau ragu,
Ayo segera ke RS, Puskesmas Bila belum lengkap atau ragu, ayo segera ke RS / Dr. C.
/ Posyandu terdekat Tangan SpA
Jangan lupa : pakai masker, jaga jarak, cuci tangan Jangan lupa : pakai masker, jaga jarak, cuci tangan
Salam sehat Salam sehat
Dr. J. Jarak Dr. C. Tangan, SpA

Contoh WA untuk orangtua anak 2 – 6 thn Contoh WA untuk orangtua anak 2 – 6 thn
Yth. Bapak Ibu yang punya anak umur 2 – 6 tahun Yth. Bapak Ibu yang punya anak umur 2 – 6 tahun .
seharusnya anaknya sudah di imunisasi : seharusnya anaknya sudah di imunisasi :
• Polio tetes (OPV) 4 x • DPT- IPV : 4 – 5 x

• Polio suntik (IPV) 1x • PCV 4x
• Pentabio 4 x • Influenza > 2x,
• MR 2x • MR + MMR (MMR2x)
• JE 1x, Varicella 1x
Bila belum lengkap atau ragu, • Typhoid 1x , Hepatitis A 2x
Ayo segera ke RS, Puskesmas
/ Posyandu terdekat Bila belum lengkap atau ragu, ayo segera ke RS / Dr. C.
Tangan SpA
Jangan lupa : pakai masker, jaga jarak, cuci tangan
Salam sehat Jangan lupa : pakai masker, jaga jarak, cuci tangan
Dr. J. Jarak Salam sehat
Dr. C. Tangan, SpA
Ajakan utk orgtua murid kls 1, 2, 5 SD Ajakan utk orgtua murid kls 1, 2, 5 SD
Yth. Bapak Ibu yang punya anak murid kelas 1, 2, 5 SD
Yth. Bapak Ibu yang punya anak murid kelas 1, 2, 5 SD.
Untuk melindungi dari penyakit berbahaya,
seharusnya anaknya sudah di imunisasi : Untuk melindungi dari penyakit berbahaya,
seharusnya anaknya sudah di imunisasi :
• Kelas 1 : DT 1x dan MR 1x
• Kelas 1 : DT + MMR + Typhoid + Hep A
• Kelas 2 : Td
• Kelas 2 : Td
• Kelas 5 : Td, (+HPV : di DKI, DIY)
• Kelas 5 ; Td + Dengue + HPV
• Kelas 6 : HPV
• Kelas 6 : HPV
Bila belum lengkap atau ragu, Bila belum lengkap atau ragu, ayo segera ke RS / Dr. C.
Ayo segera ke RS, Puskesmas Tangan SpA
/ Posyandu terdekat Jangan lupa : pakai masker, jaga jarak, cuci tangan
Jangan lupa : pakai masker, jaga jarak, cuci tangan Salam sehat
Salam sehat Dr. Swap, SpA
Dr. Rapid

• mistrust,

Menghadapi Keraguan Masyarakat pada Vaksin (Vaccine Hesitancy)
Dengarkan, empati, dialog Tidak mengerti ? Tetap menolak ?

• Jangan dipojokkan • dijelaskan • Jangan dipaksa
Jangan berdebat • 5 pesan utama
Mengajak orang lain ?
di media sosial • (Google info)
Menyerang imunisasi ?
• Semakin berisik Ujaran kebencian ?
• Mempengaruhi awam Semua negara
• laporkan Dinkes/Pemda
melakukan imunisasi
Isu negatif imunisasi : Karena terbukti bermanfaat

pendapat pribadi, bukan hasil penelitian mencegah penyakit berbahaya
Ayo lihat catatan imunisasi : Kalau imunisasi tidak lengkap

Segera lengkapi mudah terserang penyakit berbahaya
Sanksi
Hukum ?

Menolak Tenaga Kesehatan
Imunisasi
• Semua negara : Imunisasi

• Penelitian tim ahli imunisasi
terbukti aman dan bermanfaat
• Cegah sakit berat, cacat, kematian
• Isu negatif : bukan kesimpulan ahli
Vaksin PENDAPAT PERORANGAN
Edukasi BUKAN TIM AHLI
masyarakat • menyebabkan autis ?
• menyebabkan lumpuh ?
• mengandung racun ?
• tidak bermanfaat ?
Tim AHLI – AHLI
di banyak negara • dll, dll,,
Kok semua negara melakukan Imunisasi rutin ?

Kok banyak penelitian tim ahli negara lain menyimpulkan
imunisasi PENTING, BERMANFAAT dan AMAN ?

Berkoordinasi dengan
• Majelis Ulama Daerah

• Dewan Masjid
• Tokoh Agama lain
• dll

Summary

20 to 29 April 2020, online survey
• 34 provinces.
• 388 of 540 districts and cities
• Subjects : 5,329 of 9,993 puskesmas
Puskesmas
• Stopped completely : 32.04%
Posyandu
• Stopped completely : 35,92

In pandemic


Immunization Coverage 2019 – July 2020
Chart Title
120
100
80
60
40
20
0
HPV kls 5 HPV kls 6
PCV1 PCV2 Campak DT kls 1 Td kls 2 Td kls 5
HB0 BCG Penta 3 OPV3 IPV OPV4 JE (Bali) (DKI, DIY, (DKI, DIY,
(NTB+BB) (NTB+BB) Rubella BIAS BIAS BIAS
Bali ) Bali )
2019 94.5 96 96.5 95.9 77 94.2 68.2 61.4 94.7 75.8 90.4 91.02 92.5 16 12
sd Juli 2020 46.9 46 41.1 42.3 7.8 40.7 9.4 8.7 42.6 41.4
2019 sd Juli 2020
Source : Immunization Subdit. MOH

Kurang Advokasi / Edukasi
❑ Bahaya penyakit-penyakit
sebelum dan selama pandemi Covid-19
yang dapat dicegah
❑ Manfaat imunisasi
untuk mencegah PD3I Berisiko
terbukti di banyak negara terjadi KLB / wabah
Cakupan imunisasi
selama pandemi
Rendah
❑ Ajakan kepada orangtua dan sesudah pandemi
agar melengkapi Imunisasi Covid-19


Ayo kita Advokasi Orangtua dan Tokoh Masayarakat
untuk meningkatkan cakupan Imunisasi di faskes pemerintah dan swasta
Advokasi /
5 Pesan utama imunisasi Orangtua /
• Bahaya PD3I selama & sesudah pandemi
komunikasi • Manfaat imunisasi : mencegah PD3I
keluarga
terus menerus • Semua negara melakukan imunisasi
• Isu negatif tidak benar
• Segera lengkapi imunisasi sesuai jadwal Orangtua lain /
Key Opinion Leader
• Bupati / walikota keluarga lain
• MUI / Dewan Mesjid Strategi (zooming, webinar dll)
• Dinkes, RS, Puskes • Rapat koordinasi Pemda / Dinas
• PKK / Dharma Wanita Lengkapi imunisasi
• HKN, Hari Ibu, PID, Kartini, HAN
• Organisasi wanita lain • Pertemuan Ortu / Komite sekolah • 0- 2 thn
• Dinas Pendidikan • Kelompok pengajian, arisan, • 2–6 thn
• Dinas Agama kesenian, olahraga dll • 7–11 thn (Kls 1–5, BIAS)
• Tokoh masyarakat • WAG, IG, tweeter, blogger,
• Kader Kesehatan dll
• 11–18 thn (Remaja)
• Radio, TV, koran, majalah lokal, dll

Pandemi : Tingkatkan Layanan Imunisasi di Zona Hijau (+ Kuning ?)
di Posyandu, Puskesmas, Rumah Sakit dengan protokol ketat
• Lokasi : terpisah dari poli anak sakit → drive through ?
Posyandu di ZONA HIJAU
• Sirkulasi udara dan cahaya cukup
→ sebaiknya diaktifkan, dengan
• Petugas: masker /faceshield, baju, cuci tangan tiap kali masker, jaga jarak, cuci tangan
• Orangtua dan anak tidak demam, batuk, pilek
• Orangtua & anak > 2 tahun : masker, cuci tangan, jarak Sebelum imunisasi
• Atur perjanjian supaya tidak antri lama • Timbang berat BB, Ukur : TB,
• Jaga jarak , jangan ngobrol, jangan mondar-mandir LK : kurva BB/TB, BB/U, LK/U
• Imunisasi ganda : 2 - 3 suntikan di 2 – 3 tempat • Nasihat GIZI

• Tunggu 30 menit, pulang jangan mampir-mampir, • SKRINING dengan buku KIA
• Sampai di rumah: sepatu, helm, tas, desinfektan diluar • CONTOH STIMULASI dgn buku KIA
• cuci tangan, mandi, cuci kerudung, pakaian, jaket
Layanan Imunisasi pada Pandemi Covid 19
Tidak ada Klinis sehat Tidak demam

kontak selama > 2 minggu batuk pilek IMUNISASI
/ tidak tahu
Rapid test reaktif
/ PCR (+)
Klinis
SEHAT Tunda
Ada kontak Rapid test reaktif imunisasi
dgn 2 minggu Klinis
Suspek PCR positif
/Konfirm / karantina sehat
mandiri
PCR negatif
2 minggu ?
Klinis ringan Klinis sedang / berat
Demam Batuk Pilek PCR 2 x negatif
PCR , Positif Klinis sedang / berat Diobati/
Dirawat di RS
Free download di Google

Bulan Imunisasi Anak Sekolah (BIAS) :
Agustus 2020 : kelas 1 CR & kelas 5 HPV))
November 2020 : kelas 1 DT & kelas 2 Td )
❑ Di Sekolah : di jadwal (misal 1 hari 1-2 kelas)

• tidak ada orang sakit, murid dan orang tua sudah familiar,
• ruang tunggu di teras depan kelas, lebih luas, cahaya dan ventilasi cukup
• guru / orangtua mudah awasi antrian, pakai masker, jaga jarak, cuci tangan,
❑ Di Puskesmas : banyak orang sakit, orangtua takut , cakupan rendah ?

• ruang tunggu terbatas, mengganggu kegiatan puskesmas ?
• guru kurang bebas menggunakan tempat / mengatur murid ?
❑Dengan Puskesmas Keliling : bila di sekolah dan puskesmas cakupan kurang

Umur 0 -2 tahun
Umur 2 – 6 tahun
Lengkapi Imunisasi Anak umur 7 – 18 thn
BIAS (umur 7 – 11 thn) Usia sekolah sd Remaja

• Kelas 1 SD : Campak Rubela 3 + DT • 7 tahun : CR 3 + Tetra (TdaP)
• Kelas 2 SD : Td • 8 tahun : TdaP
• 9 tahun : Dengue
• Kelas 5 SD : Td + HPV1 • 10 tahun : Td / TdaP + HPV1
• Kelas 6 SD : HPV2 • 11 tahun : HPV2
• 18 tahun : Td / Tdap
Pemilihan Kombinasi Vaksin DPT
DTaP formulation TdaP formulation
INFANTS TOOLDER SCHOOL ENTRY SCHOOL AGE & ADOLESCENT

PRIMARY SERIES BOOSTER BOOSTERS
3x DTaP- 1x DTaP- 2x TdaP

1x DTaP-IPV
HB – Hib Hib- (HB)
OPV/IPV
/TdaP-IPV
OPV/IPV
Hexavalent Penta / Hexavalent Tetravalent Tetra / Trivalent
[1] Sanofi Pasteur. Tetraxim CCDS. V.13.0. 2019 [2] Sanofi Pasteur. Pentaxim CCDS. V.11.0. 2011 [3] Sanofi Pasteur. Hexaxim
CCDS. V.8.0. 2018 [4] Sanofi Pasteur. Adacel CCDS. V.17.0. 2018 [5] Sanofi Pasteur. Adacel Polio CCDS. V.12.0. 2018
The immunogenicity of IPV schedules depends on
• the age at administration
• number of doses,
• due to interference by maternal antibodies.
<7 days , single dose IPV shortly after birth (Bhaskaram P et al. J
Trop Paediatrics. 1997)
a systematic review seroconversion rate at 4 – 6 weeks of age.
o type 1 : 8%–100%
o type 2 : 15%–100%
o type 3 : 15%–94%
35 Bhaskaram P et al. Systemic and mucosal immune response to polio vaccination with
additional dose in newborn period. J Trop Paediatrics. 1997; 43(4): 232–234.
IPV : 1 vs 2 vs 3 doses ; 6 week vs 2 month vs 4 month
o Single dose of IPV (e.g. at 6–8 weeks) lower type 2 seroconversion rates of 32%–39%. (Simasathien, et al
1994, Hird TR et al, 2012);
o single dose : 4 months 63 % seroconverted type 2 (Robertson SE et al, 1988: Resik S et al, 2013)
❑ USA : 2-dose at 2 and 4 months seroconversion 95% all 3 serotypes.
❑ Cuba (Cuba IPV study collaborative griup. New Eng Med J. 2007, Resik S et al : New Eng J Med. 2013 )
o 2 doses : at 4 and 8 months induced type 1, 2 and 3 in 100%, 100%, and 99.4% of vaccinees
o 3 doses : at 6, 10, and 14 weeks induced antibodies to type 1, 2, and 3 in 94%, 83% and 100%
❑ Puerto Rico : 3 doses ( Dayan GH et al , 2007)
o 3 doses : 6, 10, 14 week, seroconversion rates of 85.8%, 86.2% and 96.9% for serotypes 1, 2 and 3
o 3 doses : 2, 4, 6 month, seroconversion rate 99.6%, 100% and 99.1% for serotypes 1, 2, 3
Simasathien S et al. Comparison of enhanced potency inactivated poliovirus vaccine (EIPV) versus standard oral poliovirus vaccine (OPV) in Thai infants. Scand J Inf Dis. 1994; 26:731–738.
Hird TR,et al. Systematic review of mucosal immunity induced by oral and inactivated poliovirus vaccines against virus shedding following oral poliovirus vaccine challenge. PLoS Pathogens. 2012; 8(4)e1002599
❑
Robertson SE et al. Clinical efficacy of a new, enhanced-potency, inactivated poliovirus vaccine. Lancet. 1988; Apr 23; 1(8591):897–899.
Resik S et al. Priming after a fractional dose of inactivated poliovirus vaccine. New Eng J Med. 2013; 368:416–424.
Dayan GH et al. Serologic response to inactivated polio vaccine: a randomized clinical trial comparing 2 vaccination schedules in Puerto Rico. J Inf Dis. 2007; 195:12– 20. Cuba IPV Study collaborative group.
Randomized, placebo- controlled trial of inactivated polio virus in Cuba. New Eng Med J. 2007; 356:1536–1544.
Faden H et al. Comparative evaluation of immunization with live attenuated and enhanced-potency inactivated trivalent poliovirus vaccines in childhood: systemic and local immune responses. JInf Dis. 1990; 162:1291–1297.
Kalau catatan hilang ? Terselip ? Sudah pernah? Lupa? → Double?
Pilih imunisasi yang belum (individual) Tidak berbahaya
Supaya tidak bolak balik : 2 suntikan kanan-kiri ? Aman !
Di Lombok, Bangka B, DKI, DI Yogya, Surabaya, Manado, Bali, Bandung,

Negara-negara lain : terbukti aman, kekebalan sama


• mistrust,

Menghadapi Keraguan Masyarakat pada Vaksin (Vaccine Hesitancy)
Dengarkan, empati, dialog Tidak mengerti ? Tetap menolak ?

• Jangan dipojokkan • dijelaskan • Jangan dipaksa
Jangan berdebat • 5 pesan utama
Mengajak orang lain ?
di media sosial • (Google info)
Menyerang imunisasi ?
• Semakin berisik Ujaran kebencian ?
• Mempengaruhi awam Semua negara
• laporkan Dinkes/Pemda
melakukan imunisasi
Isu negatif imunisasi : Karena terbukti bermanfaat

pendapat pribadi, bukan hasil penelitian mencegah penyakit berbahaya
Ayo lihat catatan imunisasi : Kalau imunisasi tidak lengkap

Segera lengkapi mudah terserang penyakit berbahaya
Ayo sebarkan Ayo lihat catatan imunisasi
ke Media Sosial • 0 – 2 thn, 2 – 6 thn , 7 – 18 thn
Imunisasi belum lengkap

/ tertunda ? Segera lengkapi
Imunisasi
Sesudah pandemi Covid 19 ?

Jangan tunggu pandemi
• Jarang cuci tangan, tanpa masker, jarak
selesai !
• Berbaur di PAUD,TK,SD, SMP, SMA
Masih lama ?
• Ke pasar, naik angkot, bis, KA, MRT
WABAH (KLB) akan mengancam

bayi, anak-anak kita
sakit berat, cacat & kematian

Vaksin Saat Pandemi

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Prof. Dr. dr.

Soedjatmiko, SpA(K), MSi

• Medical Staff of The Growth, Development and Social Pediatrics Division,

SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020

Optimizing Vaccination Coverage

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

• understand the risks of VPD outbreaks

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

Before COVID-19, in Indonesia,

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

Vaccine Demand and Hesitancy

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020

SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020

Kalimantan Timur, Sumatera Barat 2020

Source: DIF-3 Monthly Report

1000 18% 13%

Surveillance Dit MOH

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

1Excludes viruses detected from environmental surveillance

Source : Surveillance Dit MOH

•11 cases confirmed cVDPV - 2;

Source : Immunization Subdit

2019 : 77% Source : Surveillance Dit MOH

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

paralysis = AFP ) 0.5 0.41 10

Indikator Surveilans AFP:

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

Source : Surveillance Dit MOH

: 10 suspect measles cases

<1 yr 1 - 4 yr 5 - 9 yr 10 - 14 yr >14 yr Unknown

Source : Surveillance Dit MOH

Source : Surveillance Dit MOH

Region 1 Region 2 Region 3 National

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

Before COVID-19, in Indonesia,

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

❑Takut tertular Covid

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

• Imunisasi ganda : 2 - 3 suntikan di 2 – 3 tempat • Nasihat GIZI

Tidak ada Klinis sehat Tidak demam

SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020

1Excludes viruses detected from environmental surveillance

Source : Surveillance Dit MOH

2019 : 94,2% Source : Immunization subdit MOH

In polio-endemic countries and

• bOPV birth dose (a zero dose)

SOEDJATMIKO, PKB Dep IKA, 13 Sept 2020

2019 : 77% Source : Immunization subdit MOH

Anti polio 2 : post 1x IPV

SOEDJATMIKO, PKB DEP IKA, 13 SEPT 2020

(Sumber : Sri R Hadinegoro)

❑ Di Sekolah : di jadwal (misal 1 hari 1-2 kelas)

❑ Di Puskesmas : banyak orang sakit, orangtua takut , cakupan rendah ?

❑Dengan Puskesmas Keliling : bila di sekolah dan puskesmas cakupan kurang

BIAS (umur 7 – 11 thn) Usia sekolah sd Remaja