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Immunization HILYATUS SHALIHAT 1102010125 Faculty of Medicine Yarsi Pediatric Department Bhayangkara Hospital tk.I R.S. Sukanto-Jakarta Periode: 16 March – 23 May 2015


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  • ImmunizationHILYATUS SHALIHAT 1102010125 Faculty of Medicine Yarsi Pediatric DepartmentBhayangkara Hospital tk.I R.S. Sukanto-JakartaPeriode: 16 March 23 May 2015

  • The Purpose of the Referat:

    Knowing and understanding the importance of immunization as a primary action to prevent a certain disease.Knowing when immunization should be done and how importance immunization isUnderstanding and being able to practice how to administer immunization

  • DefinitionImmunization or immunisation, is an active way to improve a persons immunity from a certain antigen, so that if in the future she/he is exposed with the same antigen, she/he will not be ill because of the antigen.3

  • Definition...The Immunization word came from the Immune word which means resistant. Immunization can give immunity or resistance to one disease only, which it is determined by the kind of immunization. That is why to prevent from another disease, another immunization is needed to be done.3

  • Epidemiology

    Based on WHO Report in 2002, 2.5 million children under five died every year, which was caused by diseases that were actually could be prevented through vaccination. From all those deaths, 76% of the deaths happened in developing countries, especially Africa and Southeast Asia (Including Indonesia).1


    It depends on some factors; the host immune status, host genetic factors, as well as the quality and the quantity of vaccine


    Basically, the vaccine is divided into two:Live attenuated (The living bacteria or virus is weakened)Inactivated (the bacteria, virus or its component is made inactive)


    2 immune system, namely:1

    1. Non Specific Resistance

    2. Specific Resistance

  • In order to stimulate specific immune system of the body, the vaccine can be made from2:

    Live attenuated (weakened living vaccines)Inactivated (bacteria, virus or its component is made inactiveRecombinant vaccineVirus-like particle vaccines.


    Before giving vaccine, it is advised to follow these instructions:

    Informing in details about the risks of immunization and the risks if not doing immunization.Check again the preparation of service in case the unexpected reaction happensRead carefully the information of product (vaccine) that will be administered and do not forget to ask parents permission. Questioning and answering with parents before giving immunization.

  • Review whether there are contradictions to the vaccine givenCheck the identity of the recipients and give antipyretics when neededCheck the type of vaccine and be sure that the vaccine has been stored properlyCheck the vaccine that will be given if there are signs of change. Check the expiry date and note the special things, such as a change color that indicates the presence of damageBe sure that the vaccine that will be given is as scheduled and also offered other vaccines for catch-up vaccination (if needed)

  • Administer the vaccine with the correct techniques. See the description of the syringe selection, syringe angle, the location of injection and the position of the vaccine recipientsAfter vaccination, do the following things:

    Give instructions (preferably in written) to the parents or caregivers about what to do in the event of unusual reaction or heavier follow up reactionRecord the immunization in the personal medical record and the clinical record.Immunization record must be submitted to the Health Department of Communicable Disease Control.Check the immunization status of other family members and offer the catch-up vaccination (if needed)

  • StorageThe general rule for most of the vaccine; the vaccine shall be cooled at a temperature of 2-8 C and not frozen. A number of vaccines (DPT, Hib, hepatitis B and A) would be inactive when frozen.

  • The Syringe Angle on Intramuscular Injections

    The syringe should be injected at an angle of 45-60 into vastus lateralis muscle or deltoid muscle.

  • The Recommended Injection Location

    The anterolateral thigh is a part of body that is recommended for vaccination of babies and children under the age of 12 months.. Regio deltoid is an alternative for vaccination in older children (those who can walk) and adults.


    SubcutaneousCaution:It is for MMR, Varicella, Meningitis ImmunizationsNote the recommendation for children age

    AgeLocationSyringe SizeSyringe InsertionBabies (0 12 months)Anterolateral ThighSyringe 5/8-3/4 no 23-25Syringe Direction: 45 to the skin1 3 Years OldAnterolateral thigh / Lateral Upper ArmSyringe 5/8-3/4 no 23-25Pinch tightly for subcutaneous injectionAspirate syringe before injectedFor multiple injections, they are given at different extremities

  • HOW TO GIVE A VACCINE INJECTIONIntramuscularCaution:It is for DPT, DT, TT, Hib, Hepatitis A & B and Influenza ImmunizationNote the recommendation for children age

    AgeLocationSyringe SizeBabies (0 12 months)Vastus lateralis muscle on the anterolateral thigh areaSyringe 7/8-1 no 22-25

  • 1 3 YearsVastus lateralis muscle in the anterolateral thigh area until the deltoid muscle mass is big enough (Usually in the age of three)Syringe 5/8-1 (5/8 for deltoid injection in the age of 12-15 months) no 22-25Children > 3 Years OldDeltoid muscle, below the acromionSyringe 1-1 no 22-25

  • The condition of babies or children before immunization

    The baby experienced a severe Adverse Following Immunization (requiring special treatment or being hospitalized)Allergic to materials contained in vaccines (e.g. neomycin).The baby is now receiving a long-term steroid treatment, radiotherapy, or chemotherapy.

  • The condition of babies or children before immunization...Staying with people with medical treatments that decreases immunity (Radiotherapy, Chemotherapy or steroid therapy)Receiving immunization containing a living virus vaccine (measles, poliomyelitis, rubella vaccines) in the previous monthReceiving immunoglobin or blood transfusion in the last three monthsThe baby has central nervous system diseases

  • Recording Immunization and Immunization card

    The data that must be recorded on immunization card are as follows:

    Kinds of vaccines given, including batch numbers and trademarksThe date of vaccinationSide effects (if any)The date of the next vaccinationThe officers name (who administered the vaccine)

  • Adverse Following Immunization (AEFI)

    Any medical treatment may cause a risk (whether in a light or severe sign) for the patient. It is the same as vaccination, the occurring reaction after the administration is called as AEFI (Adverse Following Immunization).AEFI Reaction can be categorized as program failure, injection reaction and vaccine reaction.


    TuberculosisHepatitis BDPT (Diphtheria, Tetanus, Pertussis)PoliomyelitisMeaslesMMR (measles, mumps, rubella)Haemophilus influenzae type BTyphoid feverVaricellaHepatitis AInfluenzaPneumococcalRotavirusYellow feverJapanese encephalitisMeningococcal Table 1. Recommended vaccinations (Immunization Unit-Indonesian Pediatric Association 2010)1

  • Recommended Immunization Schedule for Persons Aged 0-6years1. Hepatitis B2. Rotavirus3. DTaP4. Hib5. Pneumococcal6. Inactivated Poliovirus7. Influenza8. MMR9. Varicella10. Hep A11. Meningococcal

  • Recommended Immunization Schedule for Persons Aged 7-18 YearsTdapHPVMeningococcal vaccinePneumococcal polysaccharide vaccineInfluenza vaccineHep AHep BInactivated poliovirus vaccine (IPV)MMRVaricella vaccine

  • Hepatitis B vaccine (HepB)Minimum age : birthThe 1st dose at birth, 2nd dose 1-2months, and the final dose no earlier than age 24weeksIf mother is HBsAg (+), administer HepB and 0,5 ml of HBIG within 12 hours of birthIf mothers HBsAg status is unknown, administer HepB within 12hours of birthIf mother is HBsAg (-), the birth dose can be delayed

  • Rotavirus vaccineMinimum age : 6weeksAdminister the 1st dose at age 6-12weeksAdminister the final dose in the series by age 32 weeks. Do not administer any dose later than age 32 weeksCI : should not given to infants with a severe hypersensitivityVaccines available : RV1(rotarix) & RV5(rotateq)

  • Diphtheria and Tetanus toxoids and Acellular Pertussis vaccine (DTaP)Minimum age : 6 weeksThe fourth dose of DTaP may be administered as early as age 12months, provided 6 months have elapsed since the third doseAdminister the final dose in the series at age 4-6 years

  • Haemophilus influenza type b conjugate vaccine (Hib)Minimum age : 6 weeksVaccine is not recommended for children aged 5 years or olderIf 1st dose was administered at age 7-11months, administer 2 doses separated by 4 weeks plus a booster at age 12-15months

  • Pneumococcal vaccineMinimum age : 6 week for pneumococcal conjugate vaccine (PCV); 2 years for pneumococcal polysaccharide vaccine (PPV)Administer one dose of PCV to all healthy children aged 24-59 months having any incomplete scheduleAdminister PPV to children aged 2 years and older with underlying medical conditions

  • Influenza vaccineMinimum age : 6 months for trivalent inactivated influenza vaccine (TIV); 2 years for live, attenuated influenza vaccine (LAIV)For healthy persons ages 2-49 years, either LAIV or TIV may be used

  • Measles, mumps, and rubella vaccine (MMR)Minimum age : 12 monthsAdminister the 2nd dose of MMR at age 4-6 yearsMMR may be administered before age 4-6 years, provided 4 weeks or more have elapsed since the first dose

  • Varicella vaccineMinimum age : 12 monthsAdminister 2nd dose at age 4-6 years; may be administered 3 months or more after 1st doseDo not repeat 2nd dose if administered 28 days or more after 1st dose

  • Hepatitis A vaccine (HepA)Minimum age : 12 monthsAdminister to all children aged 1 yearAdminister the 2 doses in the series at least 6 months apartHepA is recommended for certain other groups of children, including in areas where vaccination programs target older children

  • Meningococcal vaccine

    Minimum age : 2 years for meningococcal conjugate vaccine (MCV4) and for meningococcal polysaccharide vaccine (MPSV4)Administer MCV4 to children aged 2-10 years with terminal deficiencies and certain other high risk groups

  • Human Papillomavirus Vaccine (HPV)Minimum age : 9 yearsAdminister the 1st dose of the HPV vaccine series to females at age 11-12 yearsAdminister the 2nd dose 2 months after the 1st dose and the 3rd dose 6 months after the 1st dose