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Prof. Cissy B. Kartasasmita,dr., MSc.

, SpA(K), PhD

Pekerjaan:
Pekerjaan:
Staf
Staf Departemen
Departemen Ilmu
Ilmu Kesehatan
Kesehatan Anak
Anak FKUP/RSHS,
FKUP/RSHS, Bandung
Bandung
Pendidikan/Courses:
Pendidikan/Courses:
•• Dokter Dokter Umum
Umum -- FKFK Unpad
Unpad 1973
1973
•• Spesialis Anak FK Unpad
• Spesialis
Master
Anak FKSciences
Medical Unpad 1990, KUL Leuven, Belgium
•• Master SpesialisMedical SciencesPulmonologi
anak Konsultan 1990, KUL Leuven,
1992 Belgium
•• Spesialis
Doctor inanak Konsultan
Medical Pulmonologi
Sciences 1993, KUL1992
Leuven, Belgium
•• Doctor in Medical Sciences 1993, KUL
Pediatric Pulmonology Course ,1988 , Keio Leuven, BelgiumTokyo – Japan
University
• Pediatric Pulmonology Course ,1988 , Keio University Tokyo – Japan
•• Tropical
Tropical Epidemiology
Epidemiology Course,
Course, Mahidol
Mahidol University,
University, 1988,
1988, Bangkok,Thailand
Bangkok,Thailand
Organisasi:
Organisasi:
• Anggota IDI dan IDAI Jabar
• Anggota IDI dan IDAI Jabar
•• Ketua
Ketua Satgas
Satgas Imunisasi
Imunisasi PP-IDAI
PP-IDAI
•• Anggota ITAGI
Anggota ITAGI
• Ketua Indonesia Influenza Foundation (IIF)
• Ketua Indonesia Influenza Foundation (IIF)
• Board Member of Asia Pacific Alliance for Control of Influenza (APACI)
• Board Member of Asia Pacific Alliance for Control of Influenza (APACI)
• Member of Asian Strategic Alliance for Pneumococcal Disease ( ASAP )
• Member of Asian Strategic Alliance for Pneumococcal Disease ( ASAP )
•• Board Member
Advisory Board ofof CIPP
NESI (Congress
(Network for Education and
of International Support on
Paediatric Immunization)
Pulmonology)
•• Advisory Board of
Board Member CIPP (Global
of GAN (Congress of International
Asthma Network) Paediatric Pulmonology)
• Board Member of GAN (Global Asthma Network)
IMUNISASI
DAN
PENCEGAHAN PNEUMONIA
Cissy B. Kartasasmita
Departemen Ilmu Kesehatan Anak FKUP,
Universitas Padjadjaran,Bandung

WPD Online Simposium IDAI, 4 Desember 2019


GARIS BESAR PRESENTASI
- Mortalitas dan Morbiditas Pneumonia
- Etiologi
- Imunisasi Untuk Mencegah Pneumonia
- Faktor Risiko dan Pencegahan
Incidence of childhood clinical
pneumonia at the country level
What is the most common cause of bacterial
pneumonia in children?
Severe Pneumonia cases1

Others
(Fungi, Virus)
30%

S.Pneumonia
(Pneumococcus)
50%

H.Influenza tipe B
20%

Streptococcus pneumoniae, the most common cause of


bacterial pneumonia in children2

1. UNICEF; WHO. Pneumonia: The Forgotten Killer of Children. 2006.


2. Pneumonia. Fact Sheet No. 331. Updated November 2014. WHO.
GLOBAL ACTION PLAN FOR
PREVENTING AND CONTROL OF
PNEUMONIA (GAPP), 2009

• Diharapkan akan terjadi peningkatan kesadaran tentang


pneumonia sebagai penyebab kematian utama, serta akan
terjadi percepatan penurunan kematian akibat pneumonia
dengan tindakan ini.
• Tiga pendekatan yang dianjurkan untuk menurunkan
mortalitas dan morbiditas pneumonia:
• Protect
• Prevent.
• Treat
Framework for Pneumonia Control
Protect, Prevent and Treat
framework
GAPPD Target
2019 Pneumonia & Diarrhea Progress Report Card
High number of under-5 pneumonia/diarrhea deaths:
Bangladesh India
China Indonesia
DRC Pakistan
Ethiopia Tanzania

John Hopkins - IVAC. 2019 Pneumonia & Diarrhea Progress Report Card. https://www.jhsph.edu/ivac/resources/pdpr/ Accessed 30 November 2019
GAPPD Scores
2019 Pneumonia & Diarrhea Progress Report Card
GAPPD scores for the 15 countries with the highest number of under-5
pneumonia and diarrhea deaths

• Indonesia has 3 points increase in Pneumonia GAPPD Score: This was


driven by increases in pneumonia care-seeking, and PCV3 coverage.
Indonesia did, however, see its coverage for antibiotics decreased

John Hopkins - IVAC. 2019 Pneumonia & Diarrhea Progress Report Card. https://www.jhsph.edu/ivac/resources/pdpr/ Accessed 30 November 2019
Risk factors for pneumonia
or death from ARI
Malnutrition, poor
breast feeding
practices
Lack of immunization Vitamin A deficiency

Young age Low birth weight


Increased
risk of
ARI
Crowding Cold weather
or chilling

High prevalence Exposure to air pollution


of nasopharyngeal • Tobacco smoke
carriage of • Biomass smoke
pathogenic bacteria • Environmental air pollution
IMUNISASI
IMUNISASI UNTUK MENCEGAH
PNEUMONIA
• Pertusis (Batuk Rejan) → DTP
• Campak → MR
• Hib → Pentavalen
• Pneumokokus → PCV
• Influenza
Penyakit yang dapat dicegah dengan
imunisasi- 2000
Difteria
Diphtheria

Tetanus (18%)
Pneumokokus
Pneumococcus Pertussis(12%)
(28%)
Polio

Meningokokus
Meningococcus Campak
Measles
(21%)

Rotavirus
(16%) Yellow Fever

Hepatitis B (16%)
Hib(15%)

4 juta anak dapat dicegah dari 10.5juta kematian balita


Source: Zuber P, 2004, WHO
Deaths From Vaccine-Preventable Diseases
in Children Worldwide
Pneumococcus 393,000 In children younger than 5 years

Rotavirus 146,500 • S pneumoniae is a leading cause of


severe pneumonia, especially in the
developing world2
Hib 58,700
• According to the 2015 estimates,
Pertussis 54,500 Hib and S pneumoniae were
responsible for close to 65% of
Measles
deaths due to lower respiratory
62,600
infections1
Neonatal tetanus 19,900

0 250.000 500.000

Estimated deaths in 20151

Pneumococcal disease continues to be a serious health problem


in children worldwide

Hib=Haemophilus influenzae type b.


1. Wang H, et al. Lancet. 2016;388(10053):1459-1544. 2. UNICEF/World Health Organization. Pneumonia: the forgotten killer of children.
http://www.childinfo.org/files/Pneumonia_The_Forgotten_Killer_of_Children.pdf. Accessed May 16, 2019. 20
Pertusis
(batuk rejan, batuk 100 hari)
• Sangat menular
• Etiologi: Bordetella pertussis
• Penularan melalui kontak dengan
pasien saat batuk1,2
• Insidensi meningkat pada bayi muda
(usia pra-vaksinasi)
• Beban penyakit global:
• 136,372 kasus vs estimasi 17.6 juta
(2003)3
Bordetella pertussis
• 152,535 kasus (2007)4
1. CDC Pink Book. 2008:81–100
2. Linnemann Jr 2003, In: Oxford Textbook of Medicine (Ch 7.11.14)
3. WHO 2005; 4. WHO 2008 Satgas Imunisasi-IDAI
Manifestasi klinis
Batuk >2minggu diakhiri dengan
muntah. Bila terjadi pada
bayi kecil, nafas dapat berhenti
dan
terjadi kematian mendadak (86%)

Batuk menyebabkan pembuluh


darah mata pecah
terjadi perdarahan pada
konyungtiva dan jaringan lunak di
sekitar mata
Satgas Imunisasi-IDAI
Penularan
Komplikasi Pertusis
Pertusis
• Infeksi saluran nafas sekunder
(contoh: pneumonia)1,2
• Konsekuensi batuk parah:
– Konjungtivitis, epistaksis, hernia,
atelektasis paru
• Susunan Saraf Pusat: kejang
koma/kerusakanotak permanen
• 87% kematian terjadi pada bayi <1
th3

1. CDC Pink Book. 2008:81–100


2. Mortimer Adv Pediatr Infect Dis 1990;5:1–33
3. Wortis et al. Pediatrics 1996;97:607–12
CNS, central nervous system
Satgas Imunisasi-IDAI
Campak (morbilli, measles)
• Masa inkubasi10-12 hari
• Stadium prodromal
• demam makin tinggi dapat
mencapai >38,50C
• batuk, pilek, konjungtivitis
dan Koplik spots
• Stadium ruam (rash)
• 2-4 hari setelah prodromal
• Ruam makulopapular, dimulai dari muka dan kepala,
berlangsung 5-6 hari
• Stadium penyembuhan: hiperpigmentasi (bercak
kehitaman)

Satgas Imunisasi-IDAI
Komplikasi Campak

Komplikasi campak
(terutama pada gizi buruk)
• Diare 8%
• Otitis media 7%
• Pneumonia 6%
• Ensefalitis 0,1%
• Kejang 0,6-0,7%
• Kematian 0,2%
Ruam makulo – papular
pada campak
Satgas Imunisasi-IDAI
Haemophyllus influenzae b

Satgas Imunisasi-IDAI
Transmisi
Transmisi lewat Droplet (Udara) pada waktu

Bersin Batuk Bicara


Manifestasi klinis Hib
• Manifestasi klinis, terbanyak pada umur 6-12 bulan
• Epiglotitis (17%)
• Pneumonia (15%)
• Meningitis (50%): gejala sisa kelainan syaraf dan ketulian
(15-30%), kematian 2-5%
• Bakteriemi, osteomielitis, artritis, selulitis (2-6%)

Satgas Imunisasi-IDAI
Streptococcus pneumoniae
Agen Kausatif Penyakit Pneumokokus

• Bakteri Gram-positif 1
• Kapsul polisakarida1,2
• Faktor virulensi
• Menetapkan serotipe
• Target vaksin
• Lebih dari 90 serotipe1,2
• 11 serotipe menyumbang 70% - Bar=100 nm
93% kasus pneumokokus invasif
di dunia3
1. CDC. Epidemiology and prevention of vaccine-preventable diseases. 11th ed. 2009;217-230.
2. WHO. Acute respiratory infections (update September 2009).
http://www.who.int/vaccine_research/diseases/ari/en/print.html. Accessed March 16, 2010.
3. Hausdorff WP et al. Clin Infect Dis. 2000;30(1):100-121. Satgas Imunisasi-IDAI
Kolonisasi Pneumokokus
• S. pneumoniae dapat tinggal di nasofaring apatogen1
• Kolonisasi global nasopharyngeal (NP):
• 10 - 85% pada anak usia <5 th2,
• 4 - 45% pada dewasa2-4
AOM
Sinusitis Menyebar ke individu lain

Pneumonia
Bakteremia

Meningitis

Penyakit pneumokokus invasif atau pneumokokus mukosa umumnya didahului


adanya kolonisasi di NP2,4
Satgas Imunisasi-IDAI
Pneumococcus: Pathogenesis1-4

Otitis media

Transmission of Meningitis
pneumococcus from
host Bacteremia

Pneumococcal strain
establishes itself in
nasopharynx of host

Pneumonia

1. Centers for Disease Control and Prevention. Pneumococcal disease. In: Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and Prevention of Vaccine-
Preventable Diseases. 13th ed. Washington, DC: Public Health Foundation; 2015:279-296. 2. Dagan R, et al. J Infect Dis. 2002;185(7):927-936. 3. Simell B, et
al. Expert Rev Vaccines. 2012;11(7):841-855. 4. Henriques-Normark B, et al. Cold Spring Harb Perspect Med. 2013;3(7):a010215. 31
Beban Penyakit S. pneumoniae pada
Anak-anak

* Perkiraan sementara

Adapted from: American Academy of Pediatrics. Pediatrics. 2000;106:367-376 & MMWR. 1997;46:1-24
Satgas Imunisasi-IDAI
SIMPULAN
• Angka kejadian dan kematian akibat Penyakit yang
Dapat Dicegah Dengan Imunisasi (PD3I) masih tinggi
• Pneumonia penyebab kematian bayi dan balita No 1
• Imunisasi merupakan cara yang sangat efektif
mencegah pneumonia
• Ada 4 penyebab pneumonia yang dapat dicegah
dengan imunisasi yaitu: Batuk Rejan (Pertusis),
Campak, Hib dan Pneumokokus
• Vaksin sudah tersedia: Pentavalen (DTP/HB/Hib), MR
dan PCV
Gunardi H, Kartasasmita C, Hadinegoro SRS, et al. Immunization schedule for children aged 0-18 years old Indonesian Pediatrics Society Recommendation 2017. Sari Pediatri 34
2017;18:417-22.