IMMUNIZATION IN CHILD

Dr. Md Gde Dwi Lingga Utama, Sp.A(K)

Dr. I Wayan Gustawan, MSc., SpA(K)
Department of Child Health
Management of Infection
Disease
 Prevention better than treatment
 Easier
 More comfortable
 Cheaper
 More effective to controlling the disease

 Controlling better than treatment

 Host
•Nutrition
• vaccination
• protection
• washing hands

Agent Environment
• Aseptic • Environment
• Antibiotic Controlling management
• Eradication (Biological/non
infection biological)
• Waste
 Agent
Vaccination role in the
pathophysiology of disease
Vaccination

Sick Immunity

Disability Recover Die

Not Resistance
IMMUNITY SHEMATIC DIAGRAM
Antigen

Immune System

Humoral Celluler

Immunity
 VACCINE
Vaccine

SAFE!

Laboratory

Animal Lab.

Clinical test

Community
KIND OF
Bacteria Viral
VACCINE Vaccine Vaccine

MEASLES
PAROTITIS
Life RUBELLA
Vaccine VARISELLA
BCG OPV
YELLOW FEVER
JE
DENGUE

Diphtheria
Influenza
Tetanus
Inactive Pertusis IPV
Vaccine Pneumoniae Rabies
Cholera
Hepatitis A
Meningo
Thypoid fever Hepatitis B
Factors Affect Vaccine Effectively
 Maternal Antibody (Mother)
 Vaccine Antigenecity
 Dose
 Way of giving
 Way of transport and storage
 Use of Adjuvant
 Host
 Genetic
 Nutrition status
 Health status
Ideal Vaccine
 High antigenesity
 Giving only once
 There is no post-immunization effect
 Giving 100% immunity
 Aimed to overcome more than one kind of
disease (combination)

Far away!
 IMMUNIZATION

ACTIVE PASSIVE
IMMUNIZATION IMMUNIZATION
 PASSIVE IMMUNIZATION

PLACENTA TRANSFER
COLOSTRUM
GLOBULIN-γ HOMOLOGOUS
ANTISERA HETEROLOGOUS
RECOMBINANT DNA SPECIFIC ANTIBODY
 ACTIVE IMMUNIZATION

- FORMED ANTIBODIES, IMMUNE CELLS AND

MEMORY CELLS
- PROTECTIVE IMMUNE
- SPECIFIC, FOR EACH DISEASE AND INFECTION
SITE
- DECREASE IMMUNITY AFTER SEVERAL TIME
- STRENGHTENED BY RE-IMMUNIZATION
Vaccine v/s Antibody
Vaccine Antibody
 Active immunization  Passive immunization
 Immunity from body  Immunity from outer
of body
 As a prophylactic As a treatment (after
(before suffer) suffer)
 Onset: 2 weeks  Onset : Fast (hour)
 Long effect (years)  Short effect (weeks)
Vaccination
• non curable disease
• dangerous disease
• (high incidence of morbidity
and mortality)
• contagious disease
Why Vaccination must be
scheduled?
- Got regularly
response immune
- Similarity

- Age - Vaccine Chain

- Way of giving - Safety injection
- Interval - Post-immunization
- Re-immunization effect
(booster)
PPI (Program Pengembangan
Imunisasi) VACCINE
• BCG
• Hepatitis B
• Diphtheria, Pertusis, Tetanus, (DPT)
• HiB
• Poliomyelitis
• Measles

MR, JE, Pneumokokus

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JADWAL IMUNISASI KEMENKES
No Jadwal Imunisasi Jenis Imunisasi
IMUNISASI DASAR
1 Kurang dari 7 hari Hepatitis B (HB 0)
2 1 bulan BCG, Polio 1
3 2 bulan DPT-HB-HiB 1 dan Polio 2
4 3 bulan DPT-HB-Hib 2 dan Polio 3
5 4 bulan DPT-HB-HiB 3 dan Polio 4
6 9 bulan Campak
IMUNISASI LANJUTAN
7 18 bulan (1,5 tahun) DPT –HB-HIB
8 24 bulan (2 tahun) Campak
BCG VACCINES
 Weakened live Mycobacterium bovis
 Infant less than 2 months old.
 One time, no revaccination
 For baby more than 3 months old
Mantouxt test before vaccination
 Dose : 0,05 ml intracutaneous, deltoid
dextra
 DPT
 2 kinds of vaccines : DTaP (DPT acelluler
pertussis component) and DTwP (DPT with whole
cell pertussis component)
 Pentabio (DPT, Hib, HB)
 Dose: 0,5 ml, IM
 Immunization schedule:

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Vaccine DPT Whole cell, HIB, HB
Vaccine DPT acellular (DPaT)
 Hib
 Hib infection usually cause meningitis, pneumonia,
cellulites, arthritis, and epiglottis
 Hib vaccine made from poliribosiribitol phosphate (PPR)
capsule

 Vaccines available in Indonesia : Pentabio (Combined

vaccine : DTP,HiB,HB)
 Schedule and Dose :
Given since 2 months y.o, given 3 times with time
interval 2 months. Re-immunization given 1 year after
the last injection (at 18-24 months y.o)

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Poliomyelitis Pathogenesis
• Polio viral entry the body via the mouth and
then replicate in the pharynx or
gastrointestinal tract of the host
• The response to poliovirus infection is highly
variable and is classified according to the
severity of the clinical presentation
• Majority of cases produces only mild illness
characterised by fever, sore throat and nausea,
which resolves within a few days (1-3 days)
• Up to 2% of patients, the virus enters the brain
and spinal cord and there is an abrupt onset of a
major neurological illness.
– 0.1-2% cases caused polio paralytic
ORAL POLIO VACCINE
 Polio
Schedule and dose:
 OPV given after birth before leaving the hospital,
because it contains life polio viral and aimed to not
infect the other baby whereas polio viral can excreted
by feces

 Base Immunization (II,III,IV) given three (3) times with

interval 4 weeks. In the endemic area will be given extra
dose recently after birth (Polio I)

 Re-immunization polio : 1 year after polio IV, then when

starting entry the school (5-6 years old)

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 Hepatitis B
Transfusion,
Transplant recipient Baby (vertical)

Sexual
Intravenous Drug
Harassment

househealth TPA/Asrama
 Pathogenesis chronic HBV
infection
Resolution Compensated
Stable Cirrhosis

Acute Chronic Hepatocellular

Infection Hepatitis Cirrhosis carcinoma Die

Chronic Progression Compensated

Carrier Cirrhosis (Die)

Adapted from Feitelson, Lab Invest 1994

 Active Immunization
• Intramuscular injection at the deltoid area or anterior thigh
• Schedule : initial vaccination given three times. Injection
interval between the 1st and 2nd is 1-2 months, the 3rd
injection doing 6 months after 1st injection.
• Contraindication : there is no absolute contraindication
except pregnant woman
Immunization in infants by mother infected with
Hepatitis B
 Give Hepatitis B vaccine with initial dose 0,5 ml recently after birth,
normally in 12 hours after birth, followed by 2nd and 3rd dose based on
hepatitis immunization schedule
 If available, at the same time, give Hepatitis B immunoglobulin 200 IU IM
(0,5 ml) injected on the other thigh on 48 hours after birth (better if 24
hours after birth)
 Give recommendation to mother and make her sure to still breast feeding,
if vaccine has been given

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MEASLES
 Prodormal sign: fever, conjunctivitis,
cold, cough and Koplik‘s spot
 The 3rd – 7th : maculopapular rash,
begin in the face area
 Complication : diarrhea, otitis media and
pneumonia (5%-10%); encefalitis (1 per
1000 case), nefritis, myocarditis
 It‘s usually more severe on baby and
children
Measles Vaccine
 Measles
 Schedule and dose : recommended on 9 month y.o, on
outbreaks can be given at 6 months y.o

 storage : temperature 2-8oC, avoid sun light

 Contraindication : acute infection with fever,

immunodeficiency, immunosupresif treatment, egg
protein alergy, kanamycin, erytromycin and pregnant
woman

 On children who have given blood transfusion or

Immunoglobulin, immunization could be pending
minimum until 3 months

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NON PPI VACCINE
• MR
• Pneumococcus
• JE
• Varicella
• Rotavirus
• Hepatits A
• Thyphoid
• Influenza
•
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Human Papilloma Virus 42
 MR
 To prevent Measles, Rubella
 Dose : 0,5 ml subcutaneous, given at 12-
18 months y.o
 Seroconversion of this viral > 95%
 Recomendation : still given even though
measles infection history, and rubella or
measles immunization

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 Varicella
 Purpose : to prevent chicken pox disease
 Giving :
 initially at 1 y.o
 Dose : 0,5 ml, SC
 Seroconversion 97%, protect 70%

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Typhoid
 In Indonesia there are 2 kinds of vaccine:
injection (polysaccharide) and oral

 Capsular Vi polysaccharide vaccine given

when their age more than 2 y.o, re-
vaccination doing every 3 years.

 Oral Typhoid vaccine given to children above

6 y.o, package on 3 doses with interval 24
hours (the 1st day, 3rd and 5th day).

 Re-immunization done every 3-5 years.

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Hepatitis A
 Active Immunization
 Given to children above 2 y.o, especially those who hasn’t
antibody
 In high risk area are given selectively
 in patients with liver chronic disease (B or C)

 Vaccine :
 In Indonesia available
 Havrix : given IM, 720 U, in deltoid or lateral thigh, single
dose, booster 6 months later
 Avaxim : given IM 720 U, in deltoid or lateral thigh, single
dose, booster 6 months later

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 Influenza
 Purpose : prevent influenza disease caused by virus
infection
 Influenza vaccine contain inactive virus.

 Kinds of vaccine
 Whole virus
 Split virus vaccine
 Storage :
 refrigerator with temperature 2-8oC (should not
be frozen)
 : given to children above 9 y.o, 1 dose vaccine
regularly each year

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 Pneumococcal Vaccines
 Pneumococcal polysacharide vaccine recommended to:
adult > 65 y.o, children > 2 y.o with chronic disease,
asplenia, immunocompromized (disease, chemotherapy,
steroid), HIV infection, environment with high risk
 Schedule : given 4 doses when aged of children 2, 4, 6 and
12 months y.o
 Dose: 0,5 ml, IM, anterolateral/deltoid

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IMMUNIZATION PROCEDURE
Injection and Drops Technique
 Injeksi intradermal

Injeksi Subkutan

Injeksi
intramuskular
Child Position when Vaccination
Child Position when vaccination
Drops Polio vaccination
 Keyword in The Vaccination
Program Management
 Prevention for disease which is not curable,
cause serious complication and include
more people
 Global strategy
 Safe
 Legal
 Aimed to health community
Misconception Immunization Program
1. Immunization isn’t important
2. Most of sick children got vaccination
3. Vaccine is dangerous
4. There is no need to vaccination if the
disease disappear
5. If there is no fever, it means vaccine didn’t
worked.
6. Thiomersal destroy neuron
7. Combo vaccine pushed bad immune
response
8. MMR caused autism
Conclusion and Recomendation
 Actually all of disease could be prevented (non-
specific!)
 Specific prevention with vaccination can’t given to all of
the disease.
 Vaccination prioritize to mortality disease, disability,
and non curable diseases.
 Immunity affected by numerous factors
 Vaccination is a global policy.
THANK YOU