12. DR. Dr. Iris Rengganis SpPD KAI, FINASIM Vaccinology Workshop Sept 2017

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Cur ric ulum V it a e

Nama : Dr. dr. Iris Rengganis, SpPD, K-AI, FINASIM TTL : Jakarta, 29 June 1958

Pendidikan:

• DU/S1 : FKUI 1983DU/S1 : FKUI 1983

• Internis/S2: FKUI 1994

• Konsultan Alergi Imunologi: FKUI 2000

• Doctor/S3: IPB 2009 Riwayat Pekerjaan:

Riwayat Pekerjaan:

• Puskesmas Kel. Cikoko, Kec.Mampang Prapatan, DKI,1984-1988

• Jakarta Hajj Hospital, Pondok Gede, DKI, 1995-1997

• FKUI/RSCM, DKI, 1998-sekarang

• Ketua Divisi Alergi dan Imunologi Klinik, Dept. Ilmu Penyakit Dalam, g g , p y , FKUI/RSCM, September 2014-sekarang

Organisasi:

• Pengurus Besar IDI (Ikatan Dokter Indonesia)

• Pengurus Besar PAPDI (Perhimpunan Spesialis Penyakit Dalam Indonesia)g ( p p y )

• Ketua Pengurus Besar PERALMUNI (Perhimpunan Alergi Imunologi Indonesia)

• Anggota PERALMUNI JAYA

• Pengurus IIF (Indonesian Influenza Foundation)

• Anggota WAO (World Allergy Organization)gg ( gy g )

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Vaccinology

Vaccinology Workshop

Workshop

Wh Ad lt V

i

Wh Ad lt V

i

Why Adult Vaccines are

Important

Iris Rengganis

Division of Allergy and Clinical Immunology Department of Internal Medicine

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V ksi

si

V ksi

si

d

d D

D

s

Vaksinasi

Vaksinasi pada

pada Dewasa

Dewasa

Pierce G dan Schaffner

Kurangnya perhatian imunisasi usia dewasa karena: Kurangnya perhatian imunisasi usia dewasa karena:

Keraguan keamanan vaksin

G ti i tid k d i / i

Ganti rugi yang tidak memadai /asuransi

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Vaksinasi

Adalah suatu cara untuk meningkatkan

kekebalan seseorang secara aktif

terhadap suatu antigen, sehingga bila kelak terpajan

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Tujuan Vaksinasi

Untuk mencegah terjadinya

penyakit tertentu pada seseorang,

masyarakat/populasi atau bahkan

melenyapkan penyakit tertentu dari y p p y

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B-cell

T-Helper 2-cell Memory

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Antigen

T-Helper 2-cell Memory

B-cell

T-cell Activated _{Virus-infected}

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Antigen Adjuvant Preservative _{St bili}

Bahan ACTIVE Bahan INACTIVE

Antigen Adjuvant _pengawet _Stabilizer

• Mikroorganisme yang dilemahkan atau dimatikan

vaksin selama • Komponen

antigen dari mikroorganisme

terinduksi

bakteri atau

fungi penyimpanan

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Imunisasi

Imunisasi pasif

pasif dan

p

dan ak

ak

tif

Imunitas alami _{Imunitas artifisial}

Aktif Pasif _Pasif _Aktif

Setelah Transfer _Injeksi _Pemaparan

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Imunisasi

Imunisasi pasif

pasif

Imunisasi

Imunisasi pasif

pasif

Kerugian :

o

di

Proteksi jangka pendek, tidak ada sel memori Harga mahal

Efek samping

trasi antib

o Efek samping

Konsen

Minggu

4 8 12 16 20

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Imunisasi

Imunisasi Aktif

Aktif /

/ Vaksinasi

Vaksinasi

Keuntungan :

Proteksi jangka panjang Murah dan efektif

Aman

antibodi _Aman

o

nsentrasi

K

o

Minggu

4 8 12 16 20

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Sif t

dib t hk

k i

Sifat

Sifat yang

yang dibutuhkan

dibutuhkan vaksin

vaksin

Vaksin yang ideal :

I ik i i f k i l i

Imunogenik → meniru infeksi yang alami

Memberikan proteksi jangka panjang

Tidak memberikan efek samping yang tinggi

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Various

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Type of Vaccines

yp

Vaksin virus

• Hidup yang dilemahkan

• Inaktif / dimatikan

• Sub unit

Vaksin bakteri

• Sel utuh

• Toxoid

• Sub-unit

• Polisakarida

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Klasifikasi

Klasifikasi Vaksin

Vaksin

Vaksin Bakteri

Vaksin Bakteri Vaksin VirusVaksin Virus

Vaksin Bakteri Vaksin Virus

BCG

BCG Campak

Parotitis Campak

Parotitis OPVOPV

BCG Campak

Difteria MeningoMeningo

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Adjuvants

S b t dd d t i t

Substance added to many vaccines to

increase their immunogenicity and efficacy

Aluminium salts (alum) have been widely used as adjuvants Aluminium salts (alum) have been widely used as adjuvants and are generally considered safe

Aluminium salts have limitations in terms of adjuvant effect Aluminium salts have limitations in terms of adjuvant effect

Wide range of novel adjuvants now being evaluated for use in

new or improved vaccines: immunostimulators, p ,

microparticulate carriers and emulsions as well as various combinations of these.

WHO website. Global Advisory Committee on Vaccine Safety; Adjuvants.

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Ajuvan

jj

Respon Ajuvan

ibodi

e

ntasi ant

Kons

e

Respon Prim

er

Minggu

2 4 6 8 10

V k i i

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Why Vaccinate ?

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i

Vaccine Preventable Disease

Hepatitis A

Hepatitis

A

Hepatitis

B

Typhoid

Fever

Varicella

Influenza

Meningococcal

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GENERAL

RECOMMENDATION

IN VACCINATION

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Principles of Vaccination

General Rule

General

Rule

All

vaccines

can

be

administered

at

the

same visit as all other vaccines

same

visit

as

all

other

vaccines

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Nonsimultaneous

Nonsimultaneous Administration of

Administration of

Two Live

Two Live Parenteral

Parenteral Vaccines

Vaccines

Administration of live vaccine should be given on same time.

Interference can occur between two live vaccines given less

than 28 days apart.

If two live parenteral vaccines (MMR, MMRV, varicella, zooster, p ( yellow fever), or live intranasal influenza vaccine, are given less than 28 days apart the vaccine given second should be repeated.

Exception is yellow fever vaccine given less than 4 weeks after measles vaccine.

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Principles of Vaccination

Increasing the interval between doses of a multidose

vaccine does not diminish the effectiveness of the vaccine*

Ex: Hepatitis B vaccine 0,1,6 Æ 0, 2, 6?

Decreasing the interval between doses of a multidose vaccine may interfere with antibody response and protection

protection

Ex: Hepatitis B vaccine 0,1,6 Æ 0,1,2?

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VACCINES

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Prefilled Syringes Samples

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NEEDLES

Hub Glue Canula

Disposable Needle

Softpack needle

Sole needle conditioned into a hard plastic packaging They

Hardpack needle

Needles conditioned by 5 into a soft plastic packaging. They are used for syringe by 10 packs.

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NEEDLES

Needle size 23G1.

Diameter : 0.6 mm ; length : 25 mm_g .

Usually for adults and adolescents.

Needle size 25G5/8.

Diameter : 0.5 mm ; length : 16 mm. Usually for pediatric vaccines.y p

Needle size 25G1.

Diameter : 0.5 mm ; length : 25 mm. Usually for paediatric vaccines.

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Vials Samples

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Screening Questions Example

Is the child (or are you) sick today?

Does the child (or are you) have an allergy to any medications, food, or any vaccine?

Has the child (or are you) had a serious reaction to a vaccine in the past?

Is the child/teen (or are you) pregnant or is there a chance she could become pregnant during the next month?

Does the child (or are you) have cancer, leukemia, AIDS, or any other immune system problem?

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B b

i

B b

i

b i

k i

Berbagai

Berbagai cara

cara pemberian

pemberian vaksin

vaksin

- Intramuskular

S bk t

- Subkutan

- Intradermal

- Intranasal

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Subcutaneous injection

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Intramuscular injection

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VACCINE STORAGE &

HANDLING

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Storing the Vaccines

CDC: Vaccine Storage and Handling Toolkit. Accessed 14th_Oct _2009:

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Managing Vaccine Storage

CDC: Vaccine Storage and Handling Toolkit. Accessed 14th _Oct _2009:

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Expiration Date (1)

Vaccine may be used

Vaccine may be used up to and including the expiration dateup to and including the expiration date

Vaccine storage and handling toolkit. National Centre for Immunization and Respiratory Diseases. Vaccine Inventory Management. Centers for Disease Control and Prevention. Downloaded at:

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Expiration Date (2)

Expiry would be

31/10/2010 31/10/2010

Expiry would be Expiry would be

30/9/2010 30/9/2010

Expiry would be

30/9/2010

Use through 31/10/2010

DO NOT

Use through 30/9/2010

DO NOT ft 1/10/2010 DO NOT use on or

after 1/11/2010

DO NOT use on or after 1/10/2010

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Vaccine Transport

p

y Be sure to place an insulating barrier between the refrigerated/ frozen packs and the vaccines to prevent accidental freezing.

Th l h ld b f ll

y The layer should be as follows refrigerated/frozen packs-barrier-

vaccine-thermometer-barrier-additional refrigerated/frozen packs additional refrigerated/frozen packs.

y Pack vaccines in their original packing on top of the barrier

on top of the barrier.

y Do not remove vaccine vials from boxes.

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Disposal

y

y _{Dispose of sharps immediately}_{Dispose of sharps immediately}

after use at the point of care. after use at the point of care.

y

y _{Needles and syringes must be}_{Needles and syringes must be}

disposed of as a single unit. disposed of as a single unit. disposed of as a single unit. disposed of as a single unit.

y

y _{Do not over fill the sharps bin or}_{Do not over fill the sharps bin or}

fill beyond the fill line. fill beyond the fill line.

L k d h bi id if L k d h bi id if

y

y _{Lock and tag the bin to identify}_{Lock and tag the bin to identify}

the clinic source when full for the clinic source when full for disposal.

disposal.pp

y

y _{Full sharps bins must be stored in}_{Full sharps bins must be stored in}

a secure locked area away from a secure locked area away from the public

the public the public the public

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Unsafe Immunization Practices

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Vaccine Adverse Reactions

Ad

• extraneous effect caused by vaccine • side effect

• reactogenicity

Adverse

reaction

g y

reaction

• any event following vaccination • may be true adverse reaction

b l i id l

Adverse

• may be only coincidental • KIPI

event

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Vaccine Adverse Reactions

Allergic

◦

Due to vaccine or vaccine component

◦

Rare

◦

Risk minimized by screening

y

g

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Vaccine Adverse Events

pain, swelling, redness at site of injection

Local

fever, malaise, headache

Systemic Systemic

of injection

common with

nonspecific inactivated

vaccines

nonspecific

usually mild and self-limited

may be

unrelated to vaccine

Epidemiology and Prevention of Vaccine

Epidemiology and Prevention of Vaccine‐‐PreventablePreventable Diseases.Diseases. ChapterChapter 22 GeneralGeneral Recommendation.Recommendation. NationalNational CenterCenter forfor ImmunizationImmunization and Respiratory Diseases. CDC. Revised April 2009.

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Keuntungan

Keuntungan Vaksinasi

Vaksinasi

Keuntungan

Keuntungan Vaksinasi

Vaksinasi

Melindungi individu

Melindungi komunitas – herd immunity (80% yang divaksinasi dari populasi)

yang divaksinasi dari populasi)

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Vaccines don't just protect

Vaccines don't just protect yourself.yourself. Most

Most vaccinevaccine--preventable diseases are spread from person to person. If one preventable diseases are spread from person to person. If one

person in a community gets an infectious disease, he can spread it to others who person in a community gets an infectious disease, he can spread it to others who person in a community gets an infectious disease, he can spread it to others who person in a community gets an infectious disease, he can spread it to others who are not immune.

are not immune.

But a person who is immune to a disease because she has been vaccinated can’t get that disease and can’t spread it to others. The more people who are

vaccinated the fewer opportunities a disease has to spread vaccinated, the fewer opportunities a disease has to spread.

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During a sneeze, millions of tiny droplets of During a sneeze, millions of tiny droplets of gg ,, yy pp water and mucus are expelled at about 200 water and mucus are expelled at about 200 miles per hour (100

miles per hour (100 metresmetres per second). The per second). The droplets initially are about 10

droplets initially are about 10--100 100 micrometresmicrometres diameter but they dry rapidly to droplet nuclei of diameter but they dry rapidly to droplet nuclei of diameter, but they dry rapidly to droplet nuclei of diameter, but they dry rapidly to droplet nuclei of 1

1--4 4 micrometresmicrometres, containing virus particles or , containing virus particles or bacteria. This is a major means of transmission bacteria. This is a major means of transmission of several diseases of humans

of several diseases of humans

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Influenza IS NOT

Common cold

!!!

Presentation Influenza1 _{Common cold}2

Clinical spectrump Systemicy Local (only on the ( y

respiratory tract)

Onset Sudden Gradual

Fever Usually high Usually mild

Clinical manifestation t ti

Fever, chill, myalgia, l i h th t

Sneezing, nose

bl k i iti

or presentation malaise, cough, sore throat blockage, sinusitis

Course of disease May be continuous Usually rapid and mild

Complications May be severe e g Usually no or mild

Severity of illness Tends to be more severe Usually mild

Complications May be severe, e.g.

pneumonia, exacerbation of chronic disease

Usually no or mild complications

Adapted from:

1. Dolin R. Influenza. In: Kasper L et al, eds. Harrison Principles of Internal Medicine 16th Ed. McGraw-Hill 2000; 137: 1066-71

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Kongres PAPDI di Manado 2003: Konsensus Imunisasi Dewasa

Establishment of Adult Immunization Task Force

Vaccinology Training untuk dokter umum dan spesialis

spesialis

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Upaya

Upaya meningkatkan

meningkatkan vaksinasi

vaksinasi

Meningkatkan kepedulian petugas

Meningkatkan kemampuan dan penyediaan vaksin

Vaksin murah, mudah dijangkau

P d i t h i

Pendanaan pemerintah - asuransi

Acara khusus

Memantau Program Imunisasi Nasional (PIN)

Penelitian dalam bidang pelaksanaan vaksin

asi

Agar dampak imunisasi besar → pemutusan

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Klinik Imunisasi Dewasa

Varisela

Gedung IRM, Ruang Prosedur Alergi Imunologi, RSCM Jl. Diponegoro No. 71, Jakarta Pusat

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