IMMUNIZATION

In 2002, WHO estimed that 1.4 million of deaths among children under 5 years were due to diseases that could have been prevented by routine vaccination. This represents 14% of global total mortality in children under 5 years of age.

Definition

Immunization is the process whereby a person acquires immunity (resistance) to an infectious disease, typically by the administration of a vaccine/antigen. vaccine stimulate the body's own immune system (antibody) to protect the person against subsequent infection or disease (WHO definition)
The number of doses in the immunization scedudule corresponds to the number of doses required to fully protect a child against the corresponding disease.

Immunization Scedules by antigen in Indonesia

1. BCG : Bacille Calmette Guering Vaccine, Number of dosis; 1, scedule ; 1 mounth
2. DT : Tetanus and Diphtheria toxoid children's dose, Number of dosis; 1, scedule 6 years
3. DTwp : Diphtheria and tetanus toxoid with whole cell pertussis vaccine, Number of dosis; 3, scedule ; 2,3,4 months
4. DTwPHep : Diphtheria and tetanus toxoid with whole cell pertussis and HepB vaccine, Number of Dosis ; 3, scedule ; 2,3,4 months; part of country
5. HepB ; Hepatitis B vaccine, Number of Dosis; 3, scedule ; birth 2 months; 3,2 months
6. Measles : Measles Vaccine, Number of dosis; 2, scedule; 9 months; 6 years
7. OPV : Oral Polio Vaccine, Number of dosis; 4, secudule; birth 1, 2, 3, 4 months
8. TT : Tetanus toxoid, Number of dosis; 2, scedule; 7,8 years
9. Vitamin A : Vitamin A supplementation, number of dosis; 2, scedule 6 - 11, 12 - 59 months

Immunization Contraindications
Each vaccine has specific contraindications, so it is in dispensable to always read the notice carefully before practicing immunization. nevertheless, some contraindications are common to all vaccines;

• In case of immunodeficiency and immunosuppressive treatment, except in special conditions.
• Using a long term corticosteroid treatment and healthy children treated with corticosteroid in common dose for more than 2 weeks, or in high dose (dose>2mg/kgBB or 20mg/day).

Immunizations in Specific Situations

• HIV patients a giving vaccine of OPV (oral polio vaccine), measles, MMR and BCG are contraindicated. Giving vaccine of DPT, infuenza, H. Influenzae, IPV (inactivated polio vaccin), and pneumonia may be allowed.
• In High incidence TB areas, WHO recomend to give BCG for asymtomatic HIV cases.
• The patients of Clinic HIV always in contact with their family is not allowed to receive OPV, but IPV.
• The child without HIV manifestation can receive imunization routinely. Premature baby; The immunization is according to age chronology. under weight baby at birth can receive the same immunization schedule but following points should be taken into consider:

• Passive immunity their titer through maternal trnsmission is lower than on non premature baby. if the baby's weight is under <1000>
• If the baby is still hospitalized after 2 months age, the polio vaccine to be given is IPV injection.

What is AEFI?
In addition to the desired reaction, all vaccines produce some degree of unwanted reaction. The vast majority of these are trivial and harmless. some are more noticeable and annoying. A very small number are serious and potentially life threatening.
AEFI (Adverse Events Following Immunization) can happen within one month after the immunizaiton. In specific situations, the duration of AEFI observation might take 42 days.

Some symptoms of AEFI are :

• Local reaction a abscess on injecton space of lymphadenitis, cellulite, and BCG itis
• SSP a acute parlyze, encephalopthy, encephalitis, meningitis, stiffness.
• Other a allergy reaction (nettle rash, dermatitis, edema), anaphylaxis reaction, anaphylaxis shock, arthralgia, high fever > 38,5oC, septic shock, continuing shout crying (>3 hours) osteomyelitis.

Causes Of AEFI?
Etiology factors based on WHO field clasification of Western Pacific (1999) :

1. Programmic Errors: high doses, wrong injection area, not sterile needle and syringe, vaccine and diluents has been contaminated, vaccine is not stored in the right place or in opotimal conditions (temperature/cold chain and light), Ignorance of the CI, Using an expired vaccine, ignored procedure's instructions
2. Injection Reacion : All clinical symptoms occurring because of needle stick trauma directly (feeling pain, swollen, and reddish on the injection space) or indirectly (feeling fear, dizzy, nausea, and syncope)
3. Vaccine Reaction : When the vaccine is no properly administered (obsolete or non appropriate vaccine toolls)
4. Coincident Factor : An illness or death occurring after immunization, but not linked with the vaccine itself or the orther factors cited above.

WHO recomendations on minimizing AEFIs

• Measles, BCG and yellow fever vaccines should be reconstituted only with the diluents supplied by the manufacturer.
• Reconstitured vaccines should be discarded no longer than six hours after reconstitution or at the end of each immunization session.
• In the refrigeraor , no other drugs and substances shourl be stored beside vaccines.
• Labels should be carefully read before a vaccine is prepared for administration. if the leable cannot be clearly read and there is doubt about the contents of a vial or ampoule it should not be used
• Immunization workers should be trained and closely supervised to ensure that proper proceures are being follwed.

Sources : Melisa Lilisari, Medical Editor, Health Messenger