Cacth - Up Immunization in Childhood

CATCH – UP
IMMUNIZATION IN Eka yunita Amna
CHILDHOOD
OUTLINE
What
How Why
Catch –Up
Where Immunization
In Childhood
Who
When
CURRENT SITUATION
 Kemkes RI
 Vaccine coverage in 2019 93,7% In Aceh 2019 < 60 %
 ↑ vaccine coverage in Indonesia (January- February 2020)
 Since pandemic : ↓ 26,2% , some cities < 60 %
 Double pandemic in 2021 ??
 Covid-19 & Vaccine preventable diseases
in Indonesia
 Need Catch Up Immunization
WHAT
Catch-up
Immunization
• Vaccinating an individual
• Missed or has not received
doses of vaccines
• Eligible per national
immunization schedule
World health immunization WORKING DRAFT –Leave No One Behind: Guidance for Planning and Implementing
Catch-up Vaccination August 2020
Covid 19 Pandemic  Significant
immunization services interruption
WH Services delivery disruption
Y Mass campaign suspend
Concern covid 19 exposure
Access & transportation reduction
Supply chain interruption
Economy turndown
WHO will get benefit from
CATCH-UP IMMUNIZATION
Dise
ase
Individual Community Eradi
catio
n
WHO MOV Strategy
www.who.int/immunization/programmes_systems/policies_strategies/MOV/en/
WHERE
• School settings
 Implementing school vaccination checks
 facilitate catch-up vaccination
 Strong collaboration between ministries of
health & ministries of education
• Alternative location (pharmacies, day care, drive-
thru, door to door)
E N As soon as possible
WH
HOW
Prioritize immunization as a core health service
Maintain on going routine immunization delivery

(with covid -19 protection measure in place)
Plan catch-up immunization as early as possible
Every health contact as an opportunity to check vaccination

history  catch up on vaccinations as appropriate
 Trace and follow up, including newborns born during COVID-
19
Determine eligibility including permissible age ranges
 Correct recording and reporting of delayed doses
HOW
Able to comfortably communicate the safety &
benefits of giving multiple injections
Protect as soon as possible
Reduce number of visits needed
Minimize risk of defaulting
Follow recommended techniques to reduce pain at time
of vaccination
If concerns remain, caregiver should not be pressured to

receive all catch-up doses in one visit
Work with caregiver to agree on when to return to

receive remaining doses at earliest opportunity
WHO MOV Strategy
HOW
o PPE (masks, gloves, goggles)
o Handwashing stations, hand sanitizer
o Crowd controllers
o Thermometers and temperature screening
o Modify service hours (specific service hours) to
allow for increases in patient flow, schedule
appointment
o Physically separate immunization services from
other treatment area
HOW TO COMMUNICATE TO
CAREGIVER & BUILD
COMMUNITY ENGAGEMENT
 Develop tailored messages
 Emphasize value of vaccines
 Importance of timely completion of schedule
 Inform that those who missed vaccination  are still eligible
 Inform delayed vaccination still safely & effectively
Provide info on when immunization services resuming

 Timing, location of services, service delivery changes
 Assure that protection measures in place
 Identify communication channels eg whatsapp group
Seek community support by working with community

leaders, NGOs,community health workers
WHO MOV Strategy
SCHEDULE
HEPATITIS B CONTAINING VACCINE
Hepatitis B virus (HBV) infection mostly through perinatal or early childhood

esposure
In 2015: 257 million people with chronic HBV infection & 887.220 death from
HCC, cirrhocis & acute hepatitis  low birth-dose HBV vaccine coverage (39%)
HBV vaccine : 60,1% ↓ HCC, 76,3% ↓ fulminant hepatic failure, 92% ↓ mortality
from chronic liver disease
Should receive 1st dose (monovalent) within 24 hours after birth,

BW < 2000 g  postpone untill age ≥ 1 month
Administration after 24 hours age, effectiveness decline progresively
SAGE guidelines. WHO position paper 2017. Hepatitis B vaccine

Sweitzer et al. Estimtion of worldwide prevalence of chronic Hepatitis B virus infection. Lancet 2015
HBV VACCINE SCHEDULE
Recommended schedule
• 4 primary doses + 1 booster

• 3 primary doses + 1 booster
• BW < 2000 g : 1st dose not count as part of primary
catch-up dose
Start immunization
≤12 months > 12 months Booster
Dose 3 doses 3 dose s 1 dose
Jadwal imunisasi Anak umur 0-18 tahun rekomendasi IDAI 2020

POLIO CONTAINING
VACCINE
SAGE guidelines. WHO position paper 2016. Polio vaccine

POLIO VACCINE SCHEDULE
• Birth dose bOPV + 3 primary doses bOVP (+2 IVP )+ 1

t c h - up
Ca dose bOVP booster
• 3 doses primaryStart
doseimmunization
IVP + 1 IVP booster
Dose ≤12 months > 12 months Booster
bOVP + 4 doses 4 doses Not recommended

IVP (IPV to be given with 1st (IPV to be given with 1st
dose of bOPV) dose of bOPV)
IVP 3 doses 3 doses If started < 2 months old 
booster at least 6 from the last
dose
SAGE guidelines. WHO position paper 2016. Polio vaccine

BCG VACCINE
In 2006, 1,7 billion are estimated
BCG the only vaccine for TB
to be infected with
infection,
M.tuberculosis  1,7 million
significant efectiveness,
died (in children mostly < 5
protection level not consistent
years)
SR of 12 cohort studies:
protection against PTB ranged Protection varies by age,
44 - 99% (11 studies) & no better in younger
protection (1 study)
SAGE guidelines. WHO position paper 2018. BCG vaccine

BCG VACCINE SCHEDULE
• 1 dose before 2 months
Catch-up Start immunization
Dose 1 dose 1 dose (0,2 ml) Not recommended
SAGE guidelines. WHO position paper 2018. BCG vaccine

DPT -CONTAINING
VACCINE
• 3Recommended
primary doses schedule
• 3 doses booster
Start immunization
Dose 3 dose 3 dose 3 booster
DPT - CONTAINING
VACCINE
INTERVAL
HIB CONTAINING
VACCINE
Local & invasive Greatest burden
disease,
↑ antibiotic
In 4-18 months
resistance Hib children
Before introduction of Hib

conjugate vaccine in low
Hib vaccine
resource countries (in 2000)
↓↓ local disease &
Hib caused 8,13 million cases
90% invasive Hib disease
of serious disease in < 5 years
children  371,000 deaths
Watt JP et al, Burden of disease caused by H.Influenza type b in uchildren nder 5 yeers: global estimate.The lancet 2009
HIB VACCINE
SCHEDULE
• 3 primary doses
• 2 primary + 1 booster
catch-up • 3 primary + 1 booster
Start immunization
Dose 3 doses 1 dose .Vaccine not recommended

for > 5 years, if healthy
WHO position paper 2013. Haemophilus influenza vaccine

PNEUMOCOCCAL –
CONJUGATE VACCINE
 Before the introductiion PCVs in the different WHO regions
serotypes accounted for ≥ 70% of all invasive pneumococcal
disease
The reported mean annual incidence and CFR of IPD in

children aged < 2 years higher in developing countries
• PCV10& PCV13: safe and effective and to have both

direct (in vaccinated individuals) and indirect (in
unvaccinated individuals living in communities with
vaccinated children) when used in a 3-dose schedule (either
2p+1 or 3p+0) or in a 4-dose schedule (3p+1)
. SAGE guidelinesWHO position paper 2012. Haemophilus influenza vaccine

PNEUMOCOCCAL –
CONJUGATE VACCINE
• 3 primary doses
• 2 primary + 1 booster
catch-up • 3 primary + 1 Start
booster
immunization
Dose 2-3 dose 1-5 yrs at high-risk: 2 Booster at 9-18 months if

doses following a 2-dose
schedule.
Another booster if HIV+ or
preterm neonate.
ROTAVIRUS VACCINE
 Nearly every child has been RV infected by age 3-5 tahun
 In 2008 about 453.000 RV gastroenteritis asscociated child death
occured
 Human RV : 12 different VP7 Antigens (G-types) & 15 different
VP4 antigens (P-types)  binomial typing system : 5 G-P
combinations
 RV1 (human G1P[8] strain), RV5 (human & bovine G1,G2,G3,G4,
P1A [8})
 RV1 and RV5 show 80%--‐90% efficacy against severe RVGE
Low risk intussuseption (1-2/100.000 vaccinated)
Vesikari T, et al. Vaccine 2004

ROTAVIRUS VACCINE
SCHEDULE
• Rv1 : 2 doses (max 24 weeks)

• RV5: 3 doses (max32 weeks)
catch-up
Start immunization
Dose 2 or 3 Limites benefit Not recommended

MEASLES
CONTAINING VACCINE
 In absence of vaccination: 95 % human would be infected by
age 15 years
 In 2015, there were an estimated 134 200 measles deaths

globally,representing a 79% decline since 2000
The median vaccine effectiveness of a single dose of MCV

administered at 9–11 months and greater than 12 months of
age is 84% (interquartile range (IQR), 72–95%) and 92.5%
(IQR, 84.8–97%), respectively
 Among children that do not respond to their first dose of MCV

approximately 95% develop protective immunity after the
second dose.
MEASLES
CONTAINING VACCINE
• 2 primary doses + 1 boster

catch-up
Start immunization
Dose 2 dose 2 dose 1 doses

HPV VACCINE
 Types
- Bivalent (protein Antigen for HPV 16,18)
- Quadrivalent (protein Antigen for HPV 6,11,16,18)
- Nonavalent (protein Antigen for HPV 6,11,16,18, 31,33,45,52,58)
 comparable immunogenicity, efficacy, effectiveness for

prevent cervical cancer
 Most efficacious in naive individuals  primary target girl 9-

14 years

HPV VACCINE
SCHEDULE
• 2 primary doses (9-14 years)

• No booster
Start immunization
9-14 years : 2 dose Not

Dose Not recommended recommended
> 14 years : 3 doses
SAGE.guidelines. WHO position paper 2017. Haemophilus influenza vaccine

TAKE HOME MESSAGE
Everyone should fully benefit from vaccination:

 Receiving recommended vaccines as soon as
eligible
 who arrive “late” should not be denied vaccination
 Most vaccines are safe & effective
 Most vaccine have no upper age limit and
 Almost always better to vaccinate late than
never
THANK YOU

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CATCH – UP

IMMUNIZATION IN Eka yunita Amna

WH Services delivery disruption

Y Mass campaign suspend

Concern covid 19 exposure

Access & transportation reduction

Supply chain interruption

Maintain on going routine immunization delivery

Plan catch-up immunization as early as possible

Every health contact as an opportunity to check vaccination

If concerns remain, caregiver should not be pressured to

Work with caregiver to agree on when to return to

Provide info on when immunization services resuming

Seek community support by working with community

Hepatitis B virus (HBV) infection mostly through perinatal or early childhood

Should receive 1st dose (monovalent) within 24 hours after birth,

Administration after 24 hours age, effectiveness decline progresively

SAGE guidelines. WHO position paper 2017. Hepatitis B vaccine

• 4 primary doses + 1 booster

≤12 months > 12 months Booster

Dose 3 doses 3 dose s 1 dose

Jadwal imunisasi Anak umur 0-18 tahun rekomendasi IDAI 2020

SAGE guidelines. WHO position paper 2016. Polio vaccine

• Birth dose bOPV + 3 primary doses bOVP (+2 IVP )+ 1

bOVP + 4 doses 4 doses Not recommended

SAGE guidelines. WHO position paper 2016. Polio vaccine

SAGE guidelines. WHO position paper 2018. BCG vaccine

• 1 dose before 2 months

Catch-up Start immunization

≤12 months > 12 months Booster

Dose 1 dose 1 dose (0,2 ml) Not recommended

SAGE guidelines. WHO position paper 2018. BCG vaccine

≤12 months > 12 months Booster

Dose 3 dose 3 dose 3 booster

Before introduction of Hib

≤12 months > 12 months Booster

Dose 3 doses 1 dose .Vaccine not recommended

WHO position paper 2013. Haemophilus influenza vaccine

The reported mean annual incidence and CFR of IPD in

• PCV10& PCV13: safe and effective and to have both

. SAGE guidelinesWHO position paper 2012. Haemophilus influenza vaccine

≤12 months > 12 months Booster

Dose 2-3 dose 1-5 yrs at high-risk: 2 Booster at 9-18 months if

Vesikari T, et al. Vaccine 2004

• Rv1 : 2 doses (max 24 weeks)

≤12 months > 12 months Booster

Dose 2 or 3 Limites benefit Not recommended

. SAGE guidelinesWHO position paper 2012. Haemophilus influenza vaccine

 In 2015, there were an estimated 134 200 measles deaths

The median vaccine effectiveness of a single dose of MCV

 Among children that do not respond to their first dose of MCV

• 2 primary doses + 1 boster

. SAGE guidelinesWHO position paper 2017. Haemophilus influenza vaccine

 comparable immunogenicity, efficacy, effectiveness for

 Most efficacious in naive individuals  primary target girl 9-

. SAGE guidelinesWHO position paper 2017. Haemophilus influenza vaccine

• 2 primary doses (9-14 years)

≤12 months > 12 months Booster

9-14 years : 2 dose Not

SAGE.guidelines. WHO position paper 2017. Haemophilus influenza vaccine

Everyone should fully benefit from vaccination:

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