CURRICULUM VITAE

Nama : Prof. DR. Dr. Samsuridjal Djauzi, SpPD-KAI, FACP

Pendidikan : - Fakultas Kedokteran UI, 1969

- Spesialis Ilmu Penyakit Dalam FKUI, 1976
- Konsultan Alergi-Imunologi, 1986
- Doktor dibidang Alergi-Imunologi FKUI, 1999
- Honorary Fellow of American College of
Physician, 2001
- Guru Besar FKUI
Jabatan : - Pengajar Dept. Ilmu Penyakit Dalam FKUI
- Chairman Indonesian Association of Physician
in AIDS Care
- Chairman Adult Immunization Working Group PAPDI
Samsuridjal Djauzi, Sukamto Koesnoe
Division of Allergy-Clinical Immunology
Department of Internal Medicine
Faculty of Medicine University Indonesia
Dr. Cipto Mangunkusumo Hospital
Satgas Imunisasi Dewasa PAPDI (Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia)

VACCINATION
PROCEDURES
Current Update Adult
Immunization 2017
History of Adult Imunization in
Indonesia
• 2003 : Consensus of Indonesia Health
Immunization
• 2003 : Adult Immunization Task Force (
Indonesian Society of Internal Medicine)
• 2003-2017 : collaboration with Obgy,
Dermatologist , Neurologist, Pulmunologist ,
Geriatrician, Public Health etc
• 2005 –now : Vaccinology training
• 2003,2009,2012,2017 Publish book on Adult
Immunization
ALV/PRN/22/16/07/11
“Every year, tens of thousands of adults
and hundreds of thousands more are
hospitalized due to diseases that could
be prevented by vaccination.”

Clin Infect Diseases 2007;44:1529-31

 Why Vaccinate Adults?

• High risk group:

- elderly (>60 y.o.)- waning immunity1 : important in
tetanus, pertussis, flu
- chronic diseases (diabetes, asthma, heart disease)—
prone to complications in flu and pneumococcal
diseases1-3
- occupational hazards- health workers, laboratory
workers, soldiers, college students-transmission of
flu,meningococcal diseases,hepatitis A and B, varicella1-3
-pregnant women-increased risk for complications of
influenza2,3

1.Zimmerman RK, et. al. ed.Vaccines Across the Life Span. 4th ed. 2007
2. AAP. Pickering LK, ed. Red Book:2003 Report og the Committee on Infectious
Diseases. 26th ed. Elk Grove Village,IL: AAP;2003:68
3. CDC. Pink Book, 10th ed, 2008
 Key Vaccines: Adults
• Influenza
• Pneumococcal
• Tetanus/Diphtheria
• Human Papillomavirus
• Hepatitis B (high risk groups)
• Hepatitis A (travel to endemic areas)
• Meningococcal (high risk groups)
• Typhoid (travel to endemic areas)
• MMR (catch-up)
• Varicella (catch-up)
• Herpes Zoster 1.Zimmerman RK, et. al. ed.Vaccines Across the Life Span. 4th ed. 2007
2. AAP. Pickering LK, ed. Red Book:2003 Report og the Committee on Infectious
• Dengue Diseases. 26th ed. Elk Grove Village,IL: AAP;2003:68
3. CDC, Pink Book, 10 ed. 2008th
VACCINATION
PROCEDURES
Outline
• Persiapan Imunisasi
• Cara melakukan imunisasi
• Penyimpanan vaksin
Persiapan
• Imunisasi dilakukan pada orang sehat/
dalam keadaan tidak sakit berat
• Harus jelas indikasi & kontraindikasi
• Harus jelas Vaksin yang akan diberikan
• Informasikan manfaat vaksinasi
• Informasikan efek samping yang
mungkin timbul
• Gunakan kartu imunisasi
Pemeriksaan vaksin yang akan
diberikan
• Periksa nama vaksin, dosis, cara
pemberian, masa kadaluwarsa
• Perhatikan nomor batch vaksin dan
tuliskan di kartu vaksinasi
REKOMENDASI UMUM PADA
IMUNISASI
Prinsip imunisasi

Beberapa vaksin dapat diberikan secara

bersamaan dalam satu kali kunjungan:
1. Beberapa vaksin sudah dicampur menjadi
satu pada waktu proses produksi, contoh:
DPT, vaksin pentavalen
2. Vaksin yang terpisah dapat disuntikan di
beberapa tempat (lengan kanan-kiri, satu
lengan dengan jarak 5 cm)
Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Pemberian dua vaksin hidup

• Jika akan memberikan 2 vaksin hidup maka harus

diberikan secara bersamaan
• Jika diberikan tidak bersamaan (<28 hari) maka
vaksin hidup yang disuntikkan belakangan respon
antibodinya akan rendah.
• Jika 2 vaksin hidup akan diberikan tidka
bersamaan perlu waktu sedikitnya 28 hari
• Pengecualian: pemberian vaksin yellow fever dan
morbili dapat diberikan kurang dari 28 hari secara
bersamaan

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Prinsip Imunisasi

•Vaksin Hepatitis B diberikan 3 kali dengan

jadwal: 0, 1, 6 bulan

•Apabila pemberian vaksin ke-2 lebih cepat dari

jadwal, tidak mengurangi efektivitas vaksin

•Apabila pemberian vaksin ke-2 lebih lama dari

jadwal kemungkinan dapat terjadi penurunan
respon antibodi & proteksi

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Jarak & usia minimal pemberian vaksin

Pemberian vaksin pada anak sekolah

berdasarkan umur, bukan kelas
(toleransi 4 hari sebelum ulang tahun)

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Kelebihan jarak antar pemberian vaksin
• Vaksin Hepatitis B diberikan 3 kali dengan
jadwal: 0, 1, 6 bulan

• Apabila pemberian vaksin ke-3 lebih lama dari 6

bulan, tidak perlu diulang dari semula

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
PEMBERIAN VAKSIN
 Persiapan
• Screening
• Pemberitahuan keamanan & resiko vaksin
• Pelayanan Atraumatik:
- Posisi yang nyaman
- Kontrol nyeri
• Kontrol infeksi
• Persiapan vaksin
- Pemilihan alat
- Pemeriksaan vaksin
- Reconstitution
- Spuit sudah terisi
- Labelling
Epidemiology and Prevention of Vaccine-Preventable Diseases. Appendix D Vaccine Administration. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
General Recommendation
in vaccination
Contoh spuit yang sudah terisi
 NEEDLES

Hub Glue Canula

Disposable Needle

Softpack needle

Needles conditioned by 5 into a

soft plastic packaging. They
Hardpack needle are used for syringe by 10
packs.
Sole needle conditioned into a hard plastic
packaging. They are only used for syringe
by one packs.
 Contoh Vial

Need to be reconstituted
 Pertanyaan screening
 Apakah anaknya (atau apakah kamu) sedang sakit hari
ini?
 Apakah anak ini (atau apakah kamu) punya alergi
obat, makanan ataupun vaksin apapun?
 Apakah anak ini (atau apakah kamu) pernah
memiliki reaksi hebat pada pemberian vaksin
sebelumnya?
 Apakah perempuan ini (atau apakah kamu) sedang
hamil atau ada kemungkinan akan hamil sebulan
kedepan?

 Apakah anak ini(atau apakah kamu) memiliki kanker,

leukemia, AIDS atau gangguan imun lainnya?
Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Injeksi subkutan

Epidemiology and Prevention of Vaccine-Preventable Diseases. Appendix D Vaccine Administration. National Center for Immunization and Respiratory
Diseases. CDC. Revised April 2009.
 Injeksi Intramuskuler

Epidemiology and Prevention of Vaccine-Preventable Diseases. Appendix D Vaccine Administration. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
Keamanan Vaksin
 Kontraindikasi
• Kondisi pada resipien imunisasi yang dapat
meningkatkan kemungkinan efek samping
yang serius

 Kondisi pada resipien yang dapat

meningkatkan kemungkinan ataupun
keparahan efek samping yang terjadi
 Dapat menghalangi kemampuan vaksin
untuk membentuk imunitas
Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory
Diseases. CDC. Revised April 2009.
 Kontraindikasi & peringatan
Kontraindikasi permanen:

• Reaksi alergi yang parah pada komponen

vaksin dengan dosis yang tepat
• Kejadian Ensefalopati yang terbukti tidak
disebabkan oleh penyebab lain yang dapat
diidentifikasi, muncul dalam 7 hari setelah
pemberian vaksin pertusis

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Efek Samping Vaksin
• Alergi
– karena vaksin atau komponen vaksin
– jarang terjadi
– Resiko diminimalisasi dengan screening

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Kontraindikasi dan Peringatan
Condition Live Inactivated
Allergy to component C C
Encephalopathy --- C
Pregnancy C V*
Immunosuppression C V
Severe illness P P
Recent blood product P** V

C=contraindication P=precaution V=vaccinate if indicated

*except HPV and Tdap. **MMR and varicella-containing (except zoster vaccine)
only
Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory
Diseases. CDC. Revised April 2009.
 Expiration Date (2)

EXP: EXP BY: EXP BEFORE:

10/2010 10/2010 10/2010

Expiry would be Expiry would be Expiry would be

31/10/2010 30/9/2010 30/9/2010
Use through 31/10/2010.
DO NOT use on or after Use through 30/9/2010.
1/11/2010 DO NOT use on or after 1/10/2010

NHS. Vaccine Handling Recommendations for Clinics, Hospitals, Community Pharmacies and GP Practices July 2007.
 Disposal

• Dispose of sharps immediately

after use at the point of care.
• Needles and syringes must be
disposed of as a single unit.
• Do not over fill the sharps bin or
fill beyond the fill line.
• Lock and tag the bin to identify
the clinic source when full for
disposal.
• Full sharps bins must be stored in
a secure locked area away from
the public

Storage, Distribution and Disposal of Vaccines Policy. North East London NHS. June 2007
 Vaccine Adverse Reactions

Adverse • extraneous effect caused by vaccine

• side effect
reaction • reactogenicity

• any event following vaccination

Adverse • may be true adverse reaction
• may be only coincidental
event • KIPI

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Vaccine Adverse Reactions
• Allergic
– due to vaccine or vaccine component
– rare
– risk minimized by screening

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
 Vaccination During Acute Illness

• No evidence that acute illness reduces vaccine

efficacy or increases vaccine adverse reactions
• Vaccines should be delayed until the illness has
improved
• Mild illness, such as otitis media or an upper
respiratory infection, is NOT a contraindication
to vaccination

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for
Immunization and Respiratory Diseases. CDC. Revised April 2009.
 Invalid Contraindications
to Vaccination
 Mild illness
 Antimicrobial therapy
 Disease exposure or convalescence
 Pregnant or immunosuppressed person in the
household
 Breastfeeding
 Preterm birth
 Allergy to products not present in vaccine or
allergy that is not anaphylactic
 Family history of adverse events
 Tuberculin skin testing
 Multiple vaccines
Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
Thank you