A. Abstract Vaccination is a passive immunization occurs when preformed antibodies are passed to a recipient.

It is a process of stimulating protective adaptive immune system against microbes by exposure to non pathogenic forms or components of the microbes. Function of vaccination is to immunize body immune system. Basically there are two major types of vaccination which is basic vaccination and recommended vaccination. The main purpose of basic vaccination is for children and recommended vaccination is for adults. There are four basic types of vaccine in use today which are killed vaccine, attenuated vaccine, sub-unit vaccine and DNA vaccine. Expended Program on Immunization (EPI) is created for children in Indonesia. It depends on disease pattern of Indonesia and funds that allocated by government to health sector. EPI contains five types of vaccination which is BCG, hepatitis B, DPT, polio and German measles. Recommended vaccination program is a program for adults as a health promotion to get a better living. This vaccination program could be the initial vaccination or vaccine boosters for the recipient. There are eight types of vaccines which are recommended to Indonesian adults, toxoid tetanus, influenza, hepatitis A, hepatitis B, meningococcal, MMR, pneumococcal and varicella. For tourists or adults who plan to go holidays, they are recommended to have additional vaccinations for yellow fever, Japanese B encephalitis and typhoid fever.

B.

Introduction

Indonesia is known with high prevalency of TBC and hepatitis B in world. Besides Indonesia also got a few of diseases such as polio, dyphteria and German measles. As respons to the high pravelency of these diseases, government has obligate all children in Indonesia to have immunization as a prevention to the diseases. Basic immunization program is a must to all children. With this immunization spreading of diseases can be controlled. So the growth and development of children is not interrupted and they can grow happily. Unlike adults, they have no basic or compulsory vaccination. For adults they are suggested to have some of recommended vaccination such as toxoid tetanus, influenza, hepatitis A, hepatitis B, meningococcal, MMR, pneumococcal and varicella. Adults recommended vaccination nowadays is less concern compare to children immunization even there are lots of disease and death that can be prevent by vaccination. In 2003, Perhimpunan Dokter Speasialis Penyakit Dalam Indonesia (PAPDI) has created a consensus Immunization for Adults, and hoping that adults will concern the benefits of immunization. With this vaccination program either basic or recommended vaccination, we hope that health promotion in primary care will make people more concern about their health. Besides spreading of the contagious virus can be stop from transmitting from one to another.

C. Contents 2

Vaccination is a passive immunization occurs when preformed antibodies are passed to a recipient. It is a process of stimulating protective adaptive immune system against microbes by exposure to non pathogenic forms or components of the microbes. (1) Vaccines induce a primary adative immune response in the host, thereby establishing immunological memory. When the host re-exposed, a secondary response develops. The secondary response is rapid and includes high levels of affinity of high-affinity antibody. This active immunity is very different from passive immunity, where immunity is transferred from one person to another. Antibodies induced by vaccines can prevent infection taking place in the first place. Antibodies elicited by vaccines prevent infectious disease in a number of ways such as: 1) antibodies can prevent microorganisms binding to receptor on cells e.g. influenza virus 2) antibodies activate compliment and opsonize pathogens for phagocytosis 3) antibodies can neutralize exotoxins produced by pathogens e.g. tetanus toxin. In vaccination vaccines aim to produce memory B cell and Th2 cells, which together produce high-titer antibody on exposure to the pathogens or its toxin. (2) There are four basic types of vaccine in use today: (3) 1. Killed vaccines: these are preparations of the normal infectious, pathogenic virus that has been rendered non-pathogenic. E.g. influenza vaccine and pertussis. 2. Attenuated vaccines: these are live virus particles that grow in the vaccine recipient but do not cause disease because the vaccine has been altered to a non-pathogenic form, e.g. polio, BCG and MMR. 3. Sub-unit vaccines: these are purified components of the virus such as surface antigens. 4. DNA vaccines: these are usually harmless viruses into which a gene for a protective antigen has been spliced. The protective antigen is then made in the vaccine recipient to elicit an immune system.

Basically there are two types of vaccination programs in Indonesia, basic compulsory vaccination which is Expended Program on Immunization (EPI) and recommended vaccination program. EPI is created for children in Indonesia. It depends on disease pattern of Indonesia and funds that allocated by government to health sector. EPI contains five types of vaccination which is BCG, hepatitis B, DPT, polio and German measles.

Recommended vaccination program is a program for adults as a health promotion to get a better living. This vaccination program could be the initial vaccination or vaccine boosters for the recipient. There are eight types of vaccines which are recommended to Indonesian adults, toxoid tetanus, influenza, hepatitis A, hepatitis B, meningococcal, MMR, pneumococcal and varicella. For tourists or adults who plan to go holidays, they are recommended to have additional vaccinations for yellow fever, Japanese B encephalitis and typhoid fever.

a.

Basic vaccination (Expanded Program on Immunization for children)

Childhood immunization including immunity by applying a vaccine almost guarantees protection from many major diseases. Childhood vaccination prevents 2 millions deaths per year worldwide and is widely considered to be overwhelmingly good by the scientific community. (4)

Vaccines

Protection to

Contents

Age

Normal reaction

Side effects Lymphadenitis

BCG

TBC

Attenuated vaccines

0-3months

Scar

Osteomyelitis Systemic

Diphtheria DTP Tetanus Pertussis

Toxoid Toxoid Killed vaccines Attenuated vaccines Attenuated virus Neonates None Fever >6-9 months Light rash encephalopathy Diarrhea 6 weeks Fever in 24 hours Encephalopathy seizure

Polio German measles Hepatitis B

poliomyelitis

Morbilli Hepatitis B

Tab 1: basic vaccination for children and the schedule

These vaccinations are recommended to children because: 1. BCG According to WHO in year 2004, incident rate of TBC in 2002 is 555 000 cases (256 cases/100 000 citizens) and 46% of them are new cases. Besides that, Indonesia is the third country with high TBC cases after India and China. Every year, in Indonesia the number of new TB cases is increasing about million and approximately 140 000 patients died because of TBC. Because prevalence of TBC in Indonesia is very high it is compulsory to vaccinate children with BCG vaccination to prevent spreading of TBC among them. (5) 2. DTP Diphtheria, tetanus and pertussis (whooping cough) vaccination are important because complication of these disease can cause death. Children fatality rate is high before this vaccination is given to people. 3. Polio Polio virus is very dangerous because it can cause paralysis even death to children. It is very contagious and always infects children under five years old. Early March 2005, there is polo case in Indonesia after 10 years Indonesia free from it. After that it spread to a few places in Indonesia especially with poor hygiene and immunization programs. Besides, Indonesia is the 16th country which is re-infected with polio. So it is very important to have polio vaccination among childhood to prevent Indonesia from becoming the virus exporter to other countries especially East Asia.(6) 4. German measles In Indonesia, German measles immunization program has been started since 1984 by giving one dosage of vaccine for 9 months old babies. This vaccination is given because German measles can spread easily via airborne and so on. So by giving this vaccination we can stop the transmission and spreading of this virus easily. 5. Hepatitis B According to Indonesian Minister of Health, Achmad Sajudi, in Pekan Peduli Hepatitis B, epidemiogically Indonesia is among the medium to high prevalence of hepatitis B in the world. Hepatitis B has a lot of complication. Infection of hepatitis B virus is the world health problems. Approximately 350 millions people in the world are the carrier of the virus and 78% among them are Asians. So with the vaccination to children, hopefully the number of carriers can be decrease. (7)

b. Recommended Vaccination (adults) Adults recommended vaccination nowadays is less concern compare to children immunization even there are lots of disease and death that can be prevent by vaccination. In 2003, Perhimpunan 5

Dokter Speasialis Penyakit Dalam Indonesia (PAPDI) has created a consensus Immunization for Adults, and hoping that adults will concern the benefits of immunization.

Vaccine

Age (years old) 19 - 44 45 - 59 50 64 65

Tetanus MMR Influenza Pneumococcal Hepatitis A Hepatitis B Meningococcal Vericela

MMR
High risk group 1-2 dosages for risk gruop 2 dosages for high risk individu Every year 1-2 dosages Booster vaccination every 10 years

Tab 2: recommended vaccination and its schedule for adults Explanations of recommended vaccination in adults are as follow: (8) 1. Tetanus Every adult got full vaccination of 3 primer dosage from diphtheria and toxoid tetanus. If
1 so primer dosage of tetanus vaccination will be given with booster they have not been vaccine yet,or more for risk people 3 dosages for high risk individu

vaccination every 10 years.

2 series for certain grop

2. Measles, mumps and rubella (MMR) Adults who are born before 1957 get nature immunization. For adults who born after 1957 has to take 1 dosage of MMR vaccine. High risk adults have to take 2 dosage of vaccination. 3. Influenza Influenza vaccination is been given every year to adults who is above fifties, chronic lungs disease, old folks home residents, metabolic disease, medical workers, kidney failure and so on. This vaccine is highly recommended to adults who want to go for Hajj where the exposure to influenza is very high. 4. Pneumococcal This vaccination is given to adult who has chronic disease (heart failure, kidney failure, diabetes mellitus, and alcoholic). 6

5. Hepatitis A This vaccination is given to adult who is high risk to the exposure to the virus e.g. caterer, and who wants the vaccination e.g. drugs abuser, homosexual person, liver disease. Person who always travels is highly recommended to take this vaccination. 6. Hepatitis B Aim of this vaccination is want to prevent the spreading of the virus. Besides it also want to decrease the number of hepatitis B carrier in the world. High risk group to this virus are medical workers, blood transfusion, HIV patients and so on. 7. Meningococcal It is compulsory to adults who want to go for Hajj. It is also recommended to adult who is asplenic either anatomic or functional. 8. Varisela It is recommended to medical workers, immunocompromised person, schools, military and travelers. it has 2 dosages of vaccination. For travelers or people who love to go holidays overseas, they are much recommended to have these vaccinations: 1. Typhoid fever It is recommended to food caterer or the one who sell foods. Besides it also recommended to travelers who travel to endemic place of typhoid fever. It has to re-vaccination every 3 years. 2. Yellow fever WHO has make this vaccination as a must to travelers who travels to endemic place in Asia and stay more than 30 days or live there especially in rural area. Booster vaccination is every 10 years. 3. Japanese encephalitis - WHO has make this vaccination as a must to travelers who travels to endemic place in Asia and stay more than 30 days or live there especially in rural area. Booster vaccination is every 10 years.

D. Conclusion As a conclusion, with high prevalence and high risk of contagious diseases in Indonesia, children and adults are highly recommended to go for vaccination. For children they have to receive basic vaccination via Expended Program on Vaccination. This program tries to make Indonesia free from contagious diseases and almost guarantees protection from many major diseases. As a result children in Indonesia can growth well besides have a better future. For adults they are recommended to go for recommended vaccination as a health promotion to get a better living. As we know nowadays adults recommended vaccination can prevent lots of disease and death. So as a summary, we can conclude that:

VACCINATION

BASIC

RECOMMENDED

CHILDREN

ADULTS

BCG

POLIO

INFLUENZA

TETANUS

DPT

HEPATITIS B

PNEUMOCOCCAL

MMR

GERMAN MEASLES

MENIGOCOCCAL

HEPATITIS A

HEPATITIS B

VARICELLA

E. References 8

1. Abbas AK, Lichtman AH. Basic Immunology Functions and Disorders of the Immune System. Second edition updated edition 2006-2007. Saunders Elsevier, Philadelphia 2006. Effector Mechanisms of Humoral Immunity: vaccination pg 158. 2. Helbert M. Flesh and Bone of Immunology. Molsby Elsevier, 2006. Vaccines pg 98-101. 3. Vaccines. Available at pathmicro.med.sc.edu/lecture/vaccines.htm. Accessed on June 6th, 2010. 4. Bulletin World Health Organisation vol.86 no.6 Genebra June 2008. Childhood immunization. Available at www.who.int/bulletin/volumes/86/6/07-047159/en/index.html. accessed on June 6th, 2010. 5. Epidemiologi of TBC in Indonesia. Available at www.tbindonesia.or.id. Accessed on June 6th, 2010. 6. Polio. Available at www.unicef.org/indonesia/id/health_nutrition_3136.html. accesses on 6th June, 2010. 7. Indonesia Endemic Tinggi Hep B. available at www.gizi.net/cgi-bin/berita/fullnews.cgi?90922. Accessed on june 6th, 2010. 8. Sudoyo AW, Setiyohadi B, Alwi I, et all. Buku Ajar Ilmu Penyakit Dalam jilid I 4 th edition. Pusat penerbitan departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia, 2006. Imunisasi dewasa pg 279-81.