IMUNISASI SETELAH

PENYAKIT INFEKSI BERAT

Hindra Irawan Satari
AGENDA

Pendahuluan
Imunisasi pada penyakit infeksi berat
Kesimpulan
PENDAHULUAN

 The ultimate goal of immunization is control of infection transmission,

elimination of disease, and eventually eradication of the pathogen that
causes infection and disease, the immediate goal is prevention of disease in
people or groups.
 Timely immunization : high priority
 Immunization in Special Clinical Circumstances
 After severe infectious disease
 Models for fulfilling the promise of disease control through immunization:
 Global eradication of smallpox in 1977
 Polio-myelitis elimination in America 1991
 Measles elimination in USA 2000
 Congenital rubella syndrome from USA in 2004
Tuberculosis Vaccine Types and Timings
 POSTEXPOSURE VACCINES

 Postexposure or therapeutic vaccines are those that could be given to individuals after they have been actively infected or exposed. The

most advanced candidate is the RUTI vaccine, which contains detoxified bacterial fragments administered in liposomes. Positive results

have been obtained in animal models, and an early phase I safety trial has been completed.

 A different approach to vaccine design more recently focused on potential antigen availability occurring in animals after they have been

infected. We had previously made the observation that as primary lesions in infected guinea pigs progressed, areas within these structures

were stained brightly with Prussian blue, indicating iron accumulation—potentially by the surviving bacilli. Second, it is well established

that the bacterium upregulates multiple proteins that are encoded within the important DosR regulon, and we identified four DosR-encoded

proteins recognized by lung T cells as the infection was first contained. These two pools, Rv1909, Rv2359, and Rv2711 and Rv1738, Rv2032,

Rv3130, and Rv3841, respectively, were given to infected guinea pigs in GLA/CpG-based adjuvant 10 days (or as a boost) 25 days after

aerosol exposure to high-virulence clinical Beijing isolates. While these vaccines had no influence on the lung bacterial load, they appeared

to significantly prevent infection dissemination and formation of secondary lesions, thus significantly prolonging animal survival. In long-

term survivors (>200 days), there was evidence of bacterial clearance and lung damage healing (necrosis being replaced with fibrosis).

 What type of immunity postexposure vaccines must target obviously depends on the length of time between exposure and vaccine

administration. In a biodefense scenario, the purpose of the vaccine would be to boost or facilitate emerging primary effector immunity,

with the main objective being to control the infection while it is being specifically identified, especially in terms of its drug profile.

Whether such types of vaccines could be applied to chronic TB is far less clear and has not yet been addressed. Moreover, with these types

of approaches, there are potential safety issues.

Ian M. Orme, Clinical vaccine and microbiology, 2017

 Should Typhoid Vaccine be given to a child who has
recently recovered from enteric fever?
If so, when it should be given and which vaccine is most beneficial
 In olden days, only the killed whole cell vaccine was available. Some
physicians treated typhoid fever with chloramphenicol and concurrent
typhoid vaccination. This is no longer considered necessary or appropriate.
But vaccination after recovery is often taught as a good practice.
 No data as to how often this is followed in actual practice in different
places. Not come across any specific study investigating the benefits from
giving vaccine after recovery from typhoid fever. The whole issue is on
theoretical basis.
 Since the disseminated infection with Salmonella typhi would have induced
immune responses to the 0 and H antigens, one dose of whole cell killed
vaccine should be sufficient to raise the immunity levels.

T. Jacob John,
Chairman, Immunization Committee and President, Indian Academy of Pediatrics,
DIPHTHERIA

 Diphtheria patients should be immunized in the convalescent phase of

illness because clinical infection does not always induce adequate levels
of diphtheria antitoxin

CHARLES R.VITEK AND MELINDA WHARTON, DIPHTHERIA TOXOID, VACCINES , 2004

Do a patient need a tetanus jab (vaccine)
after an accident or injury

 They may need a tetanus jab if the injury has broken the skin and the
tetanus vaccinations aren't up-to-date.

NHS, UK
Duration of immunity against pertussis
after natural infection or vaccination.
 Despite decades of high vaccination coverage, pertussis has remained
endemic and re-emerged as a public health problem in many countries in the
past 2 decades. Waning of vaccine-induced immunity has been cited as one of
the reasons for the observed epidemiologic trend.
 Data on duration of immunity reveals estimates that infection-acquired
immunity against pertussis disease wanes after 4-20 years and protective
immunity after vaccination wanes after 4-12 years.
 Further research into the rate of waning of vaccine-acquired immunity will
help determine the optimal timing and frequency of booster immunizations
and their role in pertussis control.

Pediatr Infect Dis J. 2005 May;24(5 Suppl):S58-61.

Wendelboe AM1, Van Rie A, Salmaso S, Englund JA.
IMUNISASI HIV

 Children with HIV infection should be immunized as soon as

appropriate age with inactivated vaccine
 Additionally, live-virus vaccines can be given to asymptomatic HIV-
infected children

Red Book, 2015

Recipients of chemotherapy, radiation
therapy, or hematopoietic stem cell
transplants
 Because of potential suboptimal antibody response, Hib vaccination
during chemotherapy or radiation therapy may not effective; children
younger than 60 months who are vaccinated within 14 days before
starting immune suppressive therapy or while receiving
immunosuppressive therapy should be considered unimmunized, an
doses should be repeated beginning at least 3 months after
completion of chemotherapy.

Red Book, 2015

PCV

When elective splenectomy is performed for any reason, immunization

with PCV13 should be completed at least 2 weeks before splenectomy

Red book, 2015

 Updated SAGE recommendations on the use
of CYD-TDV (Dengvaxia®)

 For countries considering vaccination as part of

their dengue control program, a “pre-
vaccination screening strategy” would be the
preferred option, in which only dengue-
seropositive persons are vaccinated.

Revised SAGE recommendation on use of dengue vaccine

19 April 2018
KESIMPULAN

 Imunisasi dapat dilakukan pada masa konvalesen setelah penyakit

berat
THANK YOU