Immunization

HILYATUS SHALIHAT 1102010125

Faculty of Medicine Yarsi
Pediatric Department
Bhayangkara Hospital tk.I R.S.
Sukanto-Jakarta
Periode: 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 is
Understanding and being able to practice
how to administer immunization

Definition

Immunization 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

THE EFFICCACY OF IMMUNIZATION

It depends on some factors; the host

immune status, host genetic factors, as well
as the quality and the quantity of vaccine

KINDS 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)

VACCINE AND IMMUNE SYSTEM

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 inactive
Recombinant vaccine
Virus-like particle vaccines.

THE ADMINISTRATION OF
IMMUNIZATION
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 happens
Read 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

given
Check the identity of the recipients and give antipyretics
when needed
Check the type of vaccine and be sure that the vaccine has
been stored properly
Check 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
damage
Be 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 recipients
After 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 reaction
Record 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)

Storage

The 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.

HOW TO GIVE A VACCINE INJECTION

Subcutaneous

Caution:
It is for MMR, Varicella, Meningitis Immunizations
Note the recommendation for children age

Age

Location

Syringe Size

Babies (0 12 months)

Anterolateral Thigh

Syringe 5/8-3/4 no 23- Syringe Direction: 45 to

25

1 3 Years Old

Syringe Insertion

the skin

Anterolateral thigh /

Syringe 5/8-3/4 no 23- Pinch tightly for

Lateral Upper Arm

25

subcutaneous injection

Aspirate syringe before

injected

For multiple injections,

they are given at different
extremities

HOW TO GIVE A VACCINE INJECTION

Intramuscular

Caution:
It is for DPT, DT, TT, Hib, Hepatitis A & B and Influenza
Immunization
Note the recommendation for children age

Age

Location

Syringe Size

Babies (0 12 months)

Vastus lateralis

Syringe 7/8-1 no 22-25

muscle on the
anterolateral thigh
area

1 3 Years

Vastus lateralis muscle in

Syringe 5/8-1 (5/8 for

the anterolateral thigh

deltoid injection in the age

area until the deltoid

of 12-15 months) no 22-25

muscle mass is big

enough (Usually in the age
of three)

Children > 3 Years Old

Deltoid muscle, below

the acromion

Syringe 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 month
Receiving immunoglobin or blood transfusion in
the last three months
The 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 trademarks
The date of vaccination
Side effects (if any)
The date of the next vaccination
The 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.

RECOMMENDED VACCINES
-

Tuberculosis

MMR (measles, mumps, rubella)

Hepatitis B

Haemophilus influenzae type B

DPT (Diphtheria, Tetanus,

Typhoid fever

Pertussis)

Varicella

Poliomyelitis

Hepatitis A

Measles

Influenza

Pneumococcal

Rotavirus

Yellow fever

Japanese encephalitis

Meningococcal

Table 1. Recommended vaccinations (Immunization Unit-Indonesian

Pediatric Association 2010)1

Recommended Immunization Schedule for

Persons Aged 0-6years
1. Hepatitis B
2. Rotavirus
3. DTaP
4. Hib
5. Pneumococcal
6. Inactivated Poliovirus
7. Influenza
8. MMR
9. Varicella
10. Hep A
11. Meningococcal

Recommended Immunization Schedule for

Persons Aged 7-18 Years
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Tdap
HPV
Meningococcal vaccine
Pneumococcal polysaccharide vaccine
Influenza vaccine
Hep A
Hep B
Inactivated poliovirus vaccine (IPV)
MMR
Varicella vaccine

Hepatitis B vaccine (HepB)

Minimum age : birth

The 1st dose at birth, 2nd dose 1-2months, and the
final dose no earlier than age 24weeks
If mother is HBsAg (+), administer HepB and 0,5 ml
of HBIG within 12 hours of birth
If mothers HBsAg status is unknown, administer
HepB within 12hours of birth
If mother is HBsAg (-), the birth dose can be delayed

Rotavirus vaccine

Minimum age : 6weeks

Administer the 1st dose at age 6-12weeks
Administer the final dose in the series by age
32 weeks. Do not administer any dose later
than age 32 weeks
CI : should not given to infants with a severe
hypersensitivity
Vaccines available : RV1(rotarix) &
RV5(rotateq)

Diphtheria and Tetanus toxoids and Acellular

Pertussis vaccine (DTaP)

Minimum age : 6 weeks

The fourth dose of DTaP may be
administered as early as age 12months,
provided 6 months have elapsed since the
third dose
Administer the final dose in the series at age
4-6 years

Haemophilus influenza type b conjugate

vaccine (Hib)

Minimum age : 6 weeks

Vaccine is not recommended for children
aged 5 years or older
If 1st dose was administered at age 711months, administer 2 doses separated by 4
weeks plus a booster at age 12-15months

Pneumococcal vaccine

Minimum 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 schedule
Administer PPV to children aged 2 years and
older with underlying medical conditions

Influenza vaccine

Minimum 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 months

Administer the 2nd dose of MMR at age
4-6 years
MMR may be administered before age
4-6 years, provided 4 weeks or more
have elapsed since the first dose

Varicella vaccine

Minimum age : 12 months

Administer 2nd dose at age 4-6 years;
may be administered 3 months or more
after 1st dose
Do not repeat 2nd dose if administered
28 days or more after 1st dose

Hepatitis A vaccine (HepA)

Minimum age : 12 months

Administer to all children aged 1 year
Administer the 2 doses in the series at
least 6 months apart
HepA 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 years

Administer the 1st dose of the HPV vaccine
series to females at age 11-12 years
Administer the 2nd dose 2 months after the
1st dose and the 3rd dose 6 months after the
1st dose

IMMUNIZATION SCHEDULE

THANK YOU