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Teks asli Inggris

Hepatitis
Teks A may
represent a substantial medical and
asli Inggris
POLICY
economicSTATEMENT
burden.
Sarankan
Sarankan terjemahan
terjemahan yang
yang lebih
lebih baik
baik
Imunisasi Hepatitis A
Hepatitis A adalah penyakit hati bera yang ditimbulkan oleh virus hepatitis A (HAV). HAV dapat
ditemukan pada tinja penderita hepatitis A dan biasana menular jika diminum atau makan sesuatu yang
tercemar dengan virus ini. Penyakit ini ditandai dengan gejala seperti flu, kuning pada mata dan kulit,
mencret dan sakit perut.
Imunisasi Hepatitis A dapat mencegah penyakit ini, dan sangat dianjurkan bagi anak berusia 12 bulan
atau lebih terutama didaerah endemis. Diperlukan 2 dosis untuk dapat memberikan kekebalanseumur
hidup. Dosis ini diberikan dengan jarak waktu minimal 6 bulan.
Seperti vaksin lainnya dan juga obat-obatan lain, imunisasi hepatitis A dapat menimbulkan reaksi alergi
serius pada orang yang alergi pada satu atau lebih komponen vaksin ini. Anak yang menderita alergi
berat setelah pemberian dosis pertama tidak bolah diberikan dosis selanjutnya. Kadang dapat timbul
nyeri pada lokasi suntikan, sakit kepala, kurang nafsu makan dan kelelahan. Namun biasanya akan
membaik dalam 1-2 hari. Jika terdapat kejadian serius atau tidak biasa setelah pemberian imunisasi ini
harap segera hubungi dokter.
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Page 1 Page 1
POLICY STATEMENT PERNYATAAN KEBIJAKAN
Hepatitis A Vaccine Vaksin Hepatitis A
Recommendations Rekomendasi
Committee on Infectious Diseases Komite Infectious Diseases
ABSTRACT ABSTRAK
Since licensure in 1995 of a hepatitis A vaccine, the Centers for Disease Control Sejak lisensi pada
tahun 1995 hepatitis A vaksin, Centers for Disease Control
and Prevention and the American Academy of Pediatrics have been implementing dan Pencegahan dan
American Academy of Pediatrics telah melaksanakan
an incremental hepatitis A immunization strategy for children. suatu hepatitis tambahan Sebuah strategi
imunisasi untuk anak-anak. In 1996, children Pada tahun 1996, anak-anak
living in populations with the highest rates of disease were targeted for immuni- tinggal di populasi
dengan tingkat tertinggi penyakit yang ditargetkan untuk imunisasi-
zation, and in 1999 the program was expanded to immunization of children 2 lisasi, dan pada tahun
1999 program ini diperluas untuk imunisasi anak-anak 2
years and older living in states and counties with rates of hepatitis A that histor- tahun dan hidup lebih
tua di negara dan kabupaten dengan tingkat hepatitis A bahwa sejarah-
ically have been higher than the national average. turun tajam telah lebih tinggi dari rata-rata nasional.
The 1999 program has been Program 1999 telah
successful; the current rate of hepatitis A is the lowest ever reported in the United berhasil; tingkat saat
ini hepatitis A adalah yang terendah yang pernah dilaporkan di Amerika
States. Negara. Regional, ethnic, and racial differences in the incidence of hepatitis A have Regional,
etnis, dan perbedaan rasial di kejadian hepatitis A memiliki
been eliminated. telah dieliminasi. The incidence of hepatitis A in adults in immunizing states has
Kejadian hepatitis A pada orang dewasa di negara-negara imunisasi telah
decreased significantly, suggesting a strong herd-immunity effect associated with penurunan yang
signifikan, menunjukkan efek kawanan-imunitas yang kuat terkait dengan
immunization. imunisasi. In 2005, the US Food and Drug Administration changed the Pada tahun 2005,
US Food and Drug Administration mengubah
youngest approved age of administration of hepatitis A vaccine from 24 to 12 disetujui termuda usia
administrasi vaksin hepatitis A 24-12
months of age, which facilitated incorporation of the vaccine into the recom- bulan usia, yang
memfasilitasi penggabungan vaksin ke direkomendasikan the-
mended childhood immunization schedule. jadwal imunisasi anak diperbaiki. As the next step in the
implementa- Sebagai langkah berikutnya dalam implementasi the-
tion of the incremental vaccine immunization strategy, the American Academy of tion dari strategi
imunisasi vaksin tambahan, American Academy of
Pediatrics now recommends routine administration of a Food and Drug Adminis- Pediatri sekarang
merekomendasikan administrasi rutin dan Obat Administrasi Makanan-
tration–licensed hepatitis A vaccine to all children 12 to 23 months of age in all trasi sipil-lisensi vaksin
hepatitis A untuk semua anak 12-23 bulan usia di semua
states according to a Centers for Disease Control and Prevention–approved immu- negara menurut
Pusat Pengendalian dan Pencegahan Penyakit yang disetujui immu-
nization schedule. nization jadwal. Available data suggest that hepatitis A vaccine can be coadmin-
Data yang tersedia menunjukkan bahwa vaksin hepatitis A dapat coadmin-
istered with other childhood vaccines without decreasing immunogenicity. istered dengan vaksin anak
lainnya tanpa mengurangi imunogenisitas. Hep- Hep-
atitis A vaccines have proven to be extremely safe. atitis Sebuah vaksin telah terbukti sangat aman. In
prelicensure clinical trials of Dalam uji klinis prelicensure dari
both Havrix (GlaxoSmithKline, Rixensart, Belgium) and Vaqta (Merck & Co Inc, baik Havrix
(GlaxoSmithKline, Rixensart, Belgia) dan Vaqta (Merck & Co Inc,
Whitehouse Station, NJ), adverse events were uncommon and mild when they Whitehouse Station,
NJ), efek samping yang jarang dan ringan ketika mereka
occurred, with resolution typically in less than 1 day. terjadi, dengan resolusi biasanya dalam waktu
kurang dari 1 hari. Hepatitis A vaccine is Vaksin hepatitis A
contraindicated in people with a history of severe allergic reaction to a previous kontraindikasi pada
orang dengan sejarah reaksi alergi parah terhadap sebelumnya
dose of hepatitis A vaccine or to a vaccine component. dosis vaksin hepatitis A atau komponen vaksin.
Because the hepatitis A Karena hepatitis A
vaccine is an inactivated product, no special precautions are needed for adminis- vaksin merupakan
produk tidak aktif, tidak ada tindakan pencegahan khusus yang diperlukan untuk administrasi-
tration to people who are immunocompromised. trasi sipil untuk orang-orang yang
immunocompromised. No data exist about administra- Tidak ada data yang ada tentang administrasi-
tion of the hepatitis A vaccine to pregnant women, but because it is not a live tion hepatitis A vaksin
untuk wanita hamil, tetapi karena itu bukan hidup
vaccine, the risk to mother and fetus should be extremely low to nonexistent. vaksin, risiko untuk ibu
dan janin harus sangat rendah untuk tidak ada.
BACKGROUND AND RATIONALE FOR RECOMMENDATIONS LATAR BELAKANG DAN
DASAR PEMIKIRAN REKOMENDASI UNTUK
The purpose of this statement is to provide the rationale and recommendations for Tujuan dari
pernyataan ini adalah untuk memberikan pemikiran dan rekomendasi untuk
universal administration of hepatitis A vaccine to children living in the United universal pemberian
vaksin hepatitis A untuk anak-anak yang tinggal di Amerika
States. Negara. The rationale for implementation of universal immunization is based on Alasan untuk
pelaksanaan imunisasi universal didasarkan pada
several considerations. pertimbangan beberapa. For the 15 years before availability of hepatitis A
vaccines Untuk 15 tahun sebelum ketersediaan vaksin hepatitis A
www.pediatrics.org/cgi/doi/10.1542/ www.pediatrics.org/cgi/doi/10.1542/
peds.2007-1088 peds.2007-1088
doi:10.1542/peds.2007-1088 DOI: 10.1542/peds.2007-1088
All policy statements from the American Semua pernyataan kebijakan dari Amerika
Academy of Pediatrics automatically Academy of Pediatrics secara otomatis
expire 5 years after publication unless berakhir 5 tahun setelah publikasi kecuali
reaffirmed, revised, or retired at or ditegaskan kembali, direvisi, atau pensiun pada atau
before that time. sebelum waktu itu.
Key Words Kata Kunci
hepatitis A, immunization, prevention, hepatitis A, imunisasi, pencegahan,
epidemiology, child epidemiologi, anak
Abbreviations Singkatan
FDA—Food and Drug Administration FDA Food and Drug Administration
CDC—Centers for Disease Control and CDC-Pusat Pengendalian Penyakit dan
Prevention Pencegahan
ELU—enzyme-linked immunosorbent ELU-enzim-linked immunosorbent
assay units uji unit
VAERS—Vaccine Adverse Event Reporting VAERS-vaksin Pelaporan Adverse Event
System Sistem
QALY—quality-adjusted life-year QALY-kualitas-hidup-tahun disesuaikan
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Pediatrics (ISSN Bilangan: Cetak, 0031-4005;
Online, 1098-4275). Online, 1098-4275). Copyright © 2007 by the Hak Cipta © 2007 oleh
American Academy of Pediatrics American Academy of Pediatrics
PEDIATRICS Volume 120, Number 1, July 2007 Pediatrics Volume 120, Nomor 1, Juli 2007
189 189
Organizational Principles to Guide and Prinsip Organisasi untuk Panduan dan
Define the Child Health Care System and/or Tentukan Sistem Kesehatan Anak dan / atau
Improve the Health of All Children Meningkatkan Kesehatan Semua Anak

Page 2 Page 2
(1980–1995), approximately 30 000 cases of symptom- (1980-1995), sekitar 30 000 kasus gejala-
atic hepatitis A infections (disease) were reported annu- ATIC hepatitis A infeksi (penyakit) dilaporkan
Annu-
ally in the United States. sekutu di Amerika Serikat.
11
Because of underreporting and Karena tidak dilaporkan dan
the large number of asymptomatic infections in young jumlah besar infeksi asimtomatik pada muda
children, the actual number of cases was projected to be anak-anak, jumlah kasus yang diproyeksikan
akan
nearly 300 000 per year in the United States. hampir 300 000 per tahun di Amerika Serikat.
11
The US Amerika Serikat
Food and Drug Administration (FDA) licensed the first Food and Drug Administration (FDA) lisensi
yang pertama
inactivated hepatitis A vaccine (Havrix [GlaxoSmith- tidak aktif vaksin hepatitis A (Havrix
[GlaxoSmith-
Kline, Rixensart, Belgium]) in 1995 and a second prod- Kline, Rixensart, Belgia]) pada tahun 1995 dan
yang kedua prod-
uct (Vaqta [Merck & Co Inc, Whitehouse Station, NJ]) in SLT (Vaqta [Merck & Co Inc, Whitehouse
Station, NJ]) dalam
1996. 1996. Initial licensure limited use to people 2 years and Awal lisensi penggunaan yang terbatas
untuk orang 2 tahun dan
older. lebih tua. With the availability of a hepatitis A vaccine, the Dengan ketersediaan vaksin hepatitis
A,
infection became one of the most common vaccine- infeksi menjadi salah satu vaksin yang paling
umum
preventable infections in the United States. dicegah infeksi di Amerika Serikat.
In 1996, the Centers for Disease Control and Preven- Pada tahun 1996, Pusat Pengendalian Penyakit
dan pencegahan-
tion (CDC) and American Academy of Pediatrics pro- tion (CDC) dan American Academy of Pediatrics
pro-
vided guidance for the use of hepatitis A vaccine. vided panduan untuk penggunaan vaksin hepatitis A.
2,3 2,3
As Seperti
part of an incremental strategy, the vaccine was recom- bagian dari strategi tambahan, vaksin ini
direkomendasikan
mended for use in people in specific high-risk groups, diperbaiki untuk digunakan pada orang dalam
kelompok berisiko tinggi tertentu,
including children 2 years and older who live in defined termasuk anak-anak 2 tahun dan lebih tua yang
tinggal di didefinisikan
and circumscribed communities with high endemic rates dan terbatas masyarakat dengan tingkat
endemik tinggi
or periodic outbreaks, people with chronic liver disease, atau periodik wabah, orang dengan penyakit
hati kronis,
men who have sex with men, illicit drug abusers, and laki-laki yang berhubungan seks dengan laki-laki,
pencandu obat terlarang, dan
people with occupational hazards that put them at orang dengan bahaya kerja yang menempatkan
mereka di
increased risk of acquiring hepatitis A. meningkatkan risiko tertular hepatitis A.
22
Despite imple- Meskipun implementasi
mentation of the initial part of the strategy, hepatitis A implementasi PPTA dari bagian awal dari
strategi, hepatitis A
remained one of the most frequently reported vaccine- tetap salah satu vaksin yang paling sering
dilaporkan-
preventable diseases, with more than 23 000 cases re- dicegah penyakit, dengan lebih dari 23 000 kasus
kembali
ported in 1996 (Fig 1). porting pada tahun 1996 (Gambar 1). In 1999, the CDC expanded the Pada
tahun 1999, CDC memperluas
hepatitis A immunization program to include immuni- hepatitis A program imunisasi untuk
menyertakan imunisasi-
zation of children who live in states, counties, and com- lisasi anak-anak yang tinggal di negara bagian,
kabupaten, dan com-
munities with rates of hepatitis A consistently above the komunitas perikanan dengan tingkat hepatitis
A konsisten di atas
national average between 1987 and 1997. nasional rata-rata antara tahun 1987 dan 1997.
44
Eleven states Sebelas negara
with rates at least twice the national average ( 20 cases dengan tingkat minimal dua kali rata-rata
nasional di (20 kasus
per 100 000) were advised to “recommend” immuniza- per 100 000) yang disarankan untuk
"merekomendasikan" imunisasi
tion of children at 2 years of age, and an additional 6 tion anak-anak pada usia 2 tahun, dan tambahan 6
states (with 10–20 cases per 100 000) were advised to negara (dengan 10-20 kasus per 100 000) yang
disarankan untuk
“consider” immunization of children. "Mempertimbangkan" imunisasi anak-anak.
44
Coincident with implementation of the 1999 recom- Bertepatan dengan pelaksanaan direkomendasikan
1999-
mendation, hepatitis A rates dropped to the lowest rates paikan rekomendasi, hepatitis A tarif jatuh ke
tingkat terendah
ever recorded in the United States and in 2003 were pernah tercatat di Amerika Serikat dan pada tahun
2003 adalah
76% lower than the rates before immunization was 76% lebih rendah dibandingkan tingkat sebelum
imunisasi
initiated in 1996 (Fig 1). dimulai pada tahun 1996 (Gambar 1).
55
Before hepatitis A immuniza- Sebelum imunisasi hepatitis A-
tion, incidence was highest in younger children and in tion, kejadian tertinggi pada anak-anak muda
dan
the American Indian/Alaska Native and Hispanic com- Indian Amerika / Alaska Native and Hispanik
com-
munities (Figs 2 and 3). komunitas perikanan (Gambar 2 dan 3).
55
However, since 1999, these age, Namun, sejak tahun 1999, usia ini,
ethnic, and regional differences in incidence have nearly , Perbedaan etnis dan regional dalam insiden
telah hampir
been eliminated (Figs 2 and 3). dieliminasi (Gambar 2 dan 3). By 2003–2004, rates of Dengan 2003-
2004, tingkat
hepatitis A were highest among men 18 to 39 years of hepatitis A yang tertinggi antara laki-laki 18-39
tahun
age who were residing in the states that were not ad- usia yang tinggal di negara-negara yang tidak ad-
vised in 1999 to immunize against hepatitis A virus vised pada tahun 1999 untuk imunisasi terhadap
virus hepatitis A
(nonimmunizing states). (Nonimmunizing negara bagian).
An additional finding associated with the implemen- Sebuah temuan tambahan yang terkait dengan
implemen-
tation of immunization of children against hepatitis A tasi imunisasi anak-anak terhadap hepatitis A
was a significant decrease in the incidence of disease in penurunan signifikan dalam hal insiden
penyakit dalam
adults, suggesting a strong herd-immunity effect of the orang dewasa, menunjukkan efek kawanan-
imunitas yang kuat dari
immunization program. program imunisasi.
66
Similar findings have been re- Temuan serupa telah kembali
ported from Israel, where within 2 years of initiation of porting dari Israel, di mana dalam waktu 2
tahun dimulainya
routine immunization of children 18 to 24 months of age imunisasi rutin anak-anak 18 sampai 24 bulan
usia
against hepatitis A, there was a 90% reduction in hep- terhadap hepatitis A, ada pengurangan 90%
dalam hep-
atitis A disease in adults throughout the country. atitis Sebuah penyakit pada orang dewasa di seluruh
negeri.
77
These Ini
data suggest that focusing on routine administration of Data menunjukkan bahwa fokus pada
administrasi rutin
hepatitis A vaccine in young children will have a signif- vaksin hepatitis A pada anak-anak akan
memiliki signif a-
icant effect on disease incidence in the rest of the pop- icant dampak kejadian penyakit di seluruh pop-
ulation. modulasi.
The success of the interim 1999 strategy has created Keberhasilan dari strategi 1999 interim telah
menciptakan
an opportunity to consider universal immunization of kesempatan untuk mempertimbangkan imunisasi
universal
infants in the United States against hepatitis A virus. bayi di Amerika Serikat terhadap virus hepatitis A.
As Seperti
of 2005, the FDA approved use of the hepatitis A vaccine tahun 2005, FDA menyetujui penggunaan
vaksin hepatitis A
in children as young as 12 months of age, allowing for its pada anak-anak semuda usia 12 bulan,
sehingga memungkinkan untuk nya
incorporation into the recommended early childhood penggabungan ke dalam anak usia dini yang
direkomendasikan
immunization schedule. jadwal imunisasi. This approval was followed by Persetujuan ini diikuti oleh
the recent CDC recommendation for routine use of hep- rekomendasi baru-baru ini CDC untuk
penggunaan rutin hep-
atitis A vaccine in all children 12 months of age and atitis Sebuah vaksin di semua bulan anak-anak usia
12 dan
older regardless of their state of residence. tua terlepas dari negara mereka tinggal.
88
Incorpora- Incorpora-
tion of the vaccine into the routine childhood immuni- tion vaksin ke dalam imunisasi rutin masa
kanak-kanak
FIGURE 1 GAMBAR 1
Incidence of hepatitis A: United States, 1980–2004. Insiden hepatitis A: Amerika Serikat, 1980-2004.
ACIP indicates ACIP menunjukkan
Advisory Committee on Immunization Practices (of the CDC). Komite Penasehat Praktek Imunisasi
(CDC itu).
190 190
AMERICAN ACADEMY OF PEDIATRICS American Academy of Pediatrics

Page 3 Page 3
zation schedule also is aided by the finding that coad- Jadwal lisasi juga dibantu oleh temuan bahwa
coad-
ministration of hepatitis A vaccines with other routinely pertolongan hepatitis A vaksin dengan lainnya
secara rutin
administered immunizations has not been associated imunisasi diberikan tidak terkait
with impairment of vaccine-induced immunity. dengan penurunan nilai vaksin-kekebalan diinduksi. In
addi- Dalam Addi-
tion, the equalization of disease rates among regions as tion, pemerataan tingkat penyakit antar daerah
sebagai
well as among ethnic and age groups across the United serta di antara dan usia kelompok etnis di
Amerika
States precludes sustainability of a vaccine program Amerika menghalangi keberlanjutan program
vaksin
based on the rationale used to implement the interim didasarkan pada pemikiran yang digunakan untuk
melaksanakan interim
strategy. strategi. Extending the program to routine immuniza- Memperluas program untuk imunisasi
rutin
tion of infants nationwide should result in further low- tion bayi nasional harus menghasilkan lebih
lanjut-rendah
ering of disease incidence in the country and possibly erintah kejadian penyakit di negara ini dan
mungkin
could lead to an environment for the eventual elimina- dapat menyebabkan lingkungan untuk elimina
akhirnya-
tion of indigenous hepatitis A infection in the United tion hepatitis adat Infeksi di Amerika
States. Negara.
EPIDEMIOLOGY Epidemiologi
Incidence and Prevalence Insiden dan Prevalensi
Hepatitis A virus has a worldwide distribution, although Virus Hepatitis memiliki distribusi di seluruh
dunia, meskipun
prevalence of infection varies considerably on the basis prevalensi infeksi bervariasi atas dasar
of hygiene and sanitation conditions. dan sanitasi kondisi kebersihan. In areas with over- Di daerah
dengan over-
crowding, limited access to clean water, and inadequate crowding, keterbatasan akses air bersih, dan
tidak memadai
sewage systems, hepatitis A infection occurs almost uni- sistem pembuangan, infeksi hepatitis A terjadi
hampir uni-
versally in people early in life. awal dalam hidup versally pada manusia. Because most young Karena
paling muda
children who acquire hepatitis A are asymptomatic, dis- anak-anak yang mendapatkan hepatitis A tanpa
gejala, dis-
ease rates in highly endemic areas of the world are low. menurunkan suku di daerah endemik tinggi di
dunia rendah.
Although seronegative adults in such areas of the world Meskipun orang dewasa seronegatif di daerah
seperti di dunia
are at high risk of infection and disease, outbreaks are berada pada resiko tinggi infeksi dan penyakit,
wabah ini
unusual because of the high prevalence of antibody to yang tidak biasa karena tingginya prevalensi
antibodi terhadap
FIGURE 2 GAMBAR 2
Incidence of hepatitis A according to age: United States, Insiden hepatitis A sesuai dengan umur:
Amerika Serikat,
1990–2004. 1990-2004.
FIGURE 3 GAMBAR 3
Incidence of hepatitis A according to race/ethnicity: United States, 1990–2004. Insiden hepatitis A
menurut ras / etnis: Amerika Serikat, 1990-2004.
PEDIATRICS Volume 120, Number 1, July 2007 Pediatrics Volume 120, Nomor 1, Juli 2007
191 191

Page 4 Page 4
hepatitis A virus in the population. hepatitis A virus dalam populasi.
99
High endemicity Endemisitas tinggi
patterns also can be seen in geographic regions or ethnic pola juga dapat dilihat di daerah-daerah
geografis atau etnis
groups within developed countries, including the United kelompok dalam negara-negara maju,
termasuk Amerika
States before this decade. Amerika sebelum dekade ini.
10–12 10-12
Historically, hepatitis A disease incidence has been Secara historis, hepatitis A insiden penyakit telah
cyclic in nature. siklik di alam. In developed countries with temperate Di negara maju dengan beriklim
climates, incidence has commonly peaked every 10 to 15 iklim, kejadian yang biasanya memuncak
setiap 10 sampai 15
years. tahun. Dramatic decreases in hepatitis A virus infection Drama penurunan infeksi virus hepatitis
A
rates during the decade before and after licensure of the Tingkat selama dekade sebelum dan sesudah
lisensi dari
first hepatitis A vaccine have dampened this epidemic Vaksin hepatitis pertama telah dibasahi epidemi
ini
pattern significantly in the United States. pola signifikan di Amerika Serikat.
5,13 5,13
In the pre- Dalam pra-
vaccine era, hepatitis A infection rates were highest era vaksin, hepatitis A angka infeksi yang tertinggi
among young children and American Indian/Alaska Na- antara anak muda dan American Indian /
Alaska Na-
tive and Hispanic individuals; these differences virtually efektif dan Hispanik individu, perbedaan-
perbedaan ini hampir
have disappeared as of 2006. telah menghilang sejak 2006.
55
Success of the hepatitis A Keberhasilan hepatitis A
immunization program has resulted in the virtual elim- program imunisasi telah mengakibatkan elim
virtual
ination of age, ethnic, racial, and regional differences in ination usia, suku, ras, dan perbedaan regional
dalam
the incidence of hepatitis A infection in the past de- kejadian hepatitis A infeksi pada masa lalu de-
cade. tong kecil.
5,14 5,14
Mode of Transmission Mode Transmisi
Humans, great apes, and some species of monkeys can Manusia, kera besar, dan beberapa jenis monyet
bisa
be infected with hepatitis A virus. terinfeksi dengan virus hepatitis A. The primary source of Sumber
utama
hepatitis A for human transmission is person-to-person hepatitis A untuk transmisi manusia adalah
orang-ke-orang
spread through the fecal-oral route. menyebar melalui rute fecal-oral. On rare occasions, Pada
kesempatan langka,
hepatitis A infection has been transmitted by transfusion infeksi hepatitis A telah ditularkan oleh
transfusi
of blood or blood products collected from donors during atau produk darah dari donor darah yang
dikumpulkan selama
the viremic phase of infection. viremic tahap infeksi.
15,16 15,16
Since 2002, nucleic Sejak tahun 2002, nukleat
acid amplification tests, such as the polymerase chain uji amplifikasi asam, seperti rantai polimerase
reaction (PCR) assay, have been applied to the screening reaksi (PCR) assay, telah diterapkan untuk
penyaringan
of source plasma used for the manufacture of plasma- sumber plasma yang digunakan untuk pembuatan
plasma
derived products. produk turunan.
17 17
Transmission generally is limited to close contacts, Transmisi umumnya terbatas untuk menutup
kontak,
and hepatitis A rarely is spread by casual interactions. dan hepatitis A jarang menyebar melalui interaksi
kasual.
Spread of hepatitis A within families is common, with Penyebaran hepatitis A dalam keluarga adalah
umum, dengan
disease occurring more commonly in older family mem- penyakit terjadi lebih umum pada anggota
keluarga tua-
bers after being introduced into the household by an gota setelah diperkenalkan ke dalam rumah tangga
oleh
asymptomatically infected young child. asymptomatically terinfeksi anak kecil.
12 12
In child care Dalam penitipan anak
center outbreaks, contact with feces and subsequent per- pusat wabah, kontak dengan kotoran dan
selanjutnya per-
sonal contact are important means by which transmis- menghubungi musiman adalah sarana yang
penting dimana penularan
sion occurs, and cases have occurred in child care center sion terjadi, dan kasus telah terjadi di pusat
penitipan anak
workers and household members of children who attend pekerja dan anggota rumah tangga anak-anak
yang menghadiri
the center. pusat.
18,19 18,19
Foodborne hepatitis A transmission can Bawaan makanan penularan hepatitis A dapat
occur from food that is contaminated during preparation terjadi dari makanan yang terkontaminasi
selama persiapan
by an infected food handler (foods not cooked after oleh penjamah makanan yang terinfeksi (makanan
yang tidak dimasak setelah
handling, such as salads and sandwiches) or during penanganan, seperti salad dan sandwich) atau
selama
growing or processing (eg, produce), but this mode of tumbuh atau pengolahan (misalnya, produksi),
tapi ini adalah cara
transmission accounts for a relatively small proportion of transmisi menyumbang proporsi yang relatif
kecil dari
reported hepatitis A cases in the United States. melaporkan kasus hepatitis A di Amerika Serikat.
20 20
Water- Air-
borne outbreaks are rare in developed countries with wabah ditanggung jarang terjadi di negara maju
dengan
adequate sanitation systems. sistem sanitasi yang memadai. Approximately half of the Sekitar setengah
dari
people with sporadic, community-acquired hepatitis A orang dengan, komunitas-diperoleh hepatitis
sporadis A
infection have no known source of infection. sumber infeksi tidak diketahui infeksi.
12,13,21 12,13,21
Stools from a hepatitis A virus–infected person are Kotoran dari hepatitis A orang yang terinfeksi virus
most infectious from approximately 14 to 21 days before paling menular dari sekitar 14 hingga 21 hari
sebelum
to approximately 8 days after onset of jaundice. sekitar 8 hari setelah onset ikterus.
22 22
Hepa- Hepa-
titis A RNA has been reported to be detectable in stool by Titis A RNA telah dilaporkan terdeteksi
dalam tinja oleh
polymerase chain reaction assay for up to 3 months after polymerase chain reaction assay untuk sampai
dengan 3 bulan setelah
the acute illness, penyakit akut,
23 23
and children can shed hepatitis A for dan anak-anak dapat menumpahkan hepatitis A untuk
up to 10 weeks after onset of clinical illness. sampai 10 minggu setelah onset penyakit klinis.
24 24
Although Meskipun
hepatitis A virus is not excreted chronically, clinical re- virus hepatitis A tidak diekskresikan kronis, re-
klinis
lapses may occur in 10% to 15% of patients and may be penyimpangan dapat terjadi pada 10% sampai
15% dari pasien dan dapat
associated with recurrence of excretion of the virus in terkait dengan kambuhnya ekskresi virus di
stool. tinja.
25,26 25,26
Hepatitis A virus can be detected in the serum Virus hepatitis A dapat dideteksi dalam serum
through the period of jaundice and liver enzyme eleva- melalui periode penyakit kuning dan enzim
Eleva hati-
tion, which is consistent with the possible transmission tion, yang konsisten dengan kemungkinan
penularan
of the infection by the bloodborne route. infeksi dengan rute melalui darah.
15 15
Hepatitis A is the most important vaccine-preventable Hepatitis A adalah yang paling penting dicegah
dengan vaksin
disease for travelers. penyakit untuk wisatawan. The risk of hepatitis A is 4 to 30 Risiko hepatitis A
adalah 4 sampai 30
cases per 100 000 months of stay in an area with en- kasus per 100 000 bulan tinggal di daerah dengan
en-
demic hepatitis A for travelers who are not immunized demic hepatitis A untuk wisatawan yang tidak
diimunisasi
against hepatitis A. terhadap hepatitis A.
27 27
In 2003, international travel was Pada tahun 2003, perjalanan internasional
the source of hepatitis A for more than 25% of cases sumber hepatitis A selama lebih dari 25% kasus
among children younger than 15 years. antara anak muda dari 15 tahun. Although often Meskipun
sering
not perceived as international travel by either the par- tidak dirasakan sebagai perjalanan internasional
dengan baik nominal-
ents or the child's physician, children returning from Ent atau anak dokter, anak-anak kembali dari
visiting family members who live in areas with endemic mengunjungi anggota keluarga yang tinggal di
daerah dengan endemik
hepatitis A is not an uncommon source of infection hepatitis A bukan merupakan sumber infeksi biasa
among cases reported in the United States. antara kasus yang dilaporkan di Amerika Serikat.
28 28
Spread of Penyebaran
hepatitis A virus in child care settings has occurred be- hepatitis A virus dalam pengaturan perawatan
anak telah terjadi be-
cause of exposure to children who acquired hepatitis A menyebabkan pajanan terhadap anak-anak yang
diperoleh hepatitis A
after visiting in the countries of their parent's birth. setelah mengunjungi di negara-negara itu orang tua
kelahiran mereka.
CLINICAL MANIFESTATIONS OF DISEASE Manifestasi klinis dari PENYAKIT
Hepatitis A is an RNA virus in the Picornaviridae family. Hepatitis A adalah virus RNA dalam keluarga
Picornaviridae.
Hepatitis A virus infects the liver; the infection may be Virus hepatitis menginfeksi hati, infeksi
mungkin
either icteric or anicteric. baik icteric atau anicteric. The likelihood of icteric (clin- Kemungkinan
(icteric Clin-
ically apparent) disease is related inversely to the age of turun tajam jelas) penyakit ini berhubungan
terbalik dengan usia
the person acquiring hepatitis A. In children younger orang memperoleh hepatitis A. Pada anak-anak
muda
than 6 years, more than 90% of hepatitis A infections dari 6 tahun, lebih dari 90% dari infeksi hepatitis
A
are asymptomatic. tidak menunjukkan gejala. In contrast, more than two thirds of Sebaliknya, lebih dari
dua pertiga dari
older children and adults will develop jaundice after anak yang lebih tua dan orang dewasa akan
mengembangkan penyakit kuning setelah
hepatitis A infection. infeksi hepatitis A.
29 29
These statistics explain why hep- Statistik ini menjelaskan mengapa hep-
atitis A outbreaks in child care settings frequently are atitis Sebuah wabah dalam pengaturan perawatan
anak seringkali
detected for the first time when adult contacts become terdeteksi untuk pertama kalinya ketika kontak
menjadi dewasa
jaundiced. kuning.
30 30
Hepatitis A virus is resistant to acid, which allows for Virus hepatitis A yang tahan terhadap asam, yang
memungkinkan untuk
passage through the stomach to the lower intestine. bagian melalui perut ke bawah usus.
After an average incubation period of 28 days (range: Setelah masa inkubasi rata-rata 28 hari (rentang:
15–50 days), 15-50 hari),
31 31
infected people often experience vague orang yang terinfeksi sering mengalami samar-samar
and nonspecific symptoms. dan spesifik gejala. One of the first symptoms for Salah satu gejala pertama
untuk
which medical attention frequently is sought is dark perhatian medis yang sering dicari adalah gelap
urine, which usually is preceded by a 1- to 7-day mild urin, yang biasanya didahului oleh 1 - 7 hari
ringan
prodromal illness that can include anorexia, malaise, prodromal penyakit yang dapat mencakup
anoreksia, malaise,
fever, nausea, and vomiting. demam, mual, dan muntah.
32,33 32,33
Within a few days of the Dalam beberapa hari
onset of bilirubinuria, feces become clay colored, and onset bilirubinuria, tinja menjadi berwarna tanah
liat, dan
sclera, skin, and mucous membranes become jaundiced. sklera, kulit, dan selaput lendir menjadi
kuning.
Hepatomegaly can be noted on physical examination. Hepatomegali dapat dicatat pada pemeriksaan
fisik.
Discoloration of the stool resolves within 2 to 3 weeks, Perubahan warna dari bangku memutuskan
dalam waktu 2 sampai 3 minggu,
which frequently indicates resolution of disease. yang sering menunjukkan resolusi penyakit. Pruritus
Pruritus
occurs uncommonly. terjadi luar biasa. Duration of illness is variable, but Durasi penyakit adalah
variabel, tapi
most patients are significantly better within 3 to 4 kebanyakan pasien secara signifikan lebih baik
dalam waktu 3 sampai 4
192 192
AMERICAN ACADEMY OF PEDIATRICS American Academy of Pediatrics

Page 5 Page 5
weeks, including resolution of elevated hepatocellular minggu, termasuk resolusi tinggi hepatoseluler
enzyme concentrations. konsentrasi enzim. Among women in the United Di antara perempuan di
Amerika
States, pregnancy is not a risk factor for more severe Amerika, kehamilan bukan merupakan faktor
risiko yang lebih parah
hepatitis A virus infections. hepatitis A infeksi virus. Although transmission to Meskipun transmisi ke
the fetus is unusual, there have been 2 case reports in janin tidak biasa, ada 2 laporan kasus di
which mothers developed hepatitis A during the first yang dikembangkan ibu hepatitis A selama yang
pertama
trimester of pregnancy and their infants subsequently trimester kehamilan dan bayi mereka kemudian
developed meconium peritonitis. dikembangkan meconium peritonitis.
34,35 34,35
The risk of trans- Risiko trans-
mission from a woman who develops hepatitis A in the misi dari seorang wanita yang mengembangkan
hepatitis A di
third trimester of pregnancy to the infant seems to be trimester ketiga kehamilan untuk bayi tampaknya
low. rendah.
36 36
Infants infected through this means typically are Bayi terinfeksi melalui ini berarti biasanya adalah
asymptomatic, but an outbreak among hospital staff re- tanpa gejala, tetapi wabah antara staf rumah
sakit-ulang
lated to the exposure to such an infant has been report- lated ke paparan seperti bayi telah laporan-
ed. ed.
37 37
The pathologic effects of hepatitis A are limited to the Efek patologis dari hepatitis A adalah terbatas
pada
liver. hati. As hepatitis A replicates in liver cells, virions are Seperti hepatitis A bereplikasi dalam sel
hati, virion
shed from infected hepatocytes into the hepatic sinu- gudang dari hepatosit yang terinfeksi ke sinu hati-
soids and the bile canaliculi, where they pass into the soids dan canaliculi empedu, di mana mereka
masuk ke dalam
intestine and are excreted in feces. usus dan akan dikeluarkan melalui tinja. Peak infectivity oc- Puncak
infektivitas oc-
curs during the 2 weeks before onset of jaundice or curs selama 2 minggu sebelum timbulnya ikterus
atau
serum elevation of liver enzymes. elevasi serum enzim hati.
38 38
Viremia occurs soon Viremia terjadi segera
after infection is acquired and persists through the pe- setelah infeksi diperoleh dan tetap melalui pe-
riod of elevated hepatocellular enzyme concentrations, riod ketinggian konsentrasi enzim hepatoseluler,
but blood viral concentrations are much lower than tetapi darah konsentrasi virus yang jauh lebih
rendah daripada
those that occur in the stool. yang terjadi dalam tinja.
39 39
COMPLICATIONS KOMPLIKASI
Approximately 10% to 15% of patients with illness at- Sekitar 10% sampai 15% dari pasien dengan
penyakit di-
tributable to hepatitis A have relapsing disease lasting up tributable untuk hepatitis A memiliki kambuh
penyakit berlangsung Facebook
to 6 months, and approximately 20% of these people sampai 6 bulan, dan sekitar 20% dari orang-orang
ini
have multiple relapses. memiliki beberapa kambuh.
25,40 25,40
Hepatitis A virus can be de- Virus hepatitis A dapat de-
tected in stool of some patients during the relapse. dilindungi dalam tinja beberapa pasien selama
kambuh.
25,26 25,26
Even with relapsing disease, overall outcomes are very Bahkan dengan kekambuhan penyakit, hasil
keseluruhan sangat
good. baik.
26,41 26,41
The clinical, laboratory, and pathologic find- Laboratorium, klinis, dan patologi menemukan-
ings in people with prolonged jaundice are associated petunjuk untuk keselamatan pada orang dengan
penyakit kuning berkepanjangan terkait
with cholestatic hepatitis. dengan hepatitis kolestasis. A short course of rapidly ta- Sebuah kursus
singkat cepat ta-
pered corticosteroids can reduce symptoms and hasten pered kortikosteroid dapat mengurangi gejala
dan mempercepat
resolution of disease. resolusi penyakit.
42 42
Hepatitis A infection rarely results in fatalities. Infeksi hepatitis A jarang menyebabkan kematian.
Before Sebelum
the recent success with hepatitis A immunization in the keberhasilan baru-baru ini dengan hepatitis A
imunisasi di
United States, there were approximately 100 deaths Amerika Serikat, terdapat sekitar 100 kematian
from hepatitis A viral infections each year in the United dari infeksi virus hepatitis A setiap tahun di
Amerika
States. Negara. Reported case fatality rates for hepatitis A viral Melaporkan angka fatalitas kasus untuk
hepatitis A virus
infections range from 0.01% to 2%. infeksi berkisar dari 0,01% menjadi 2%. Fulminant hepatitis
Fulminan hepatitis
A viral infection is characterized by increasing severity of Infeksi virus ini ditandai dengan
meningkatnya keparahan
jaundice, deterioration in liver function, coagulation penyakit kuning, penurunan fungsi hati, koagulasi
problems, and encephalopathy. masalah, dan ensefalopati. Fulminant disease is penyakit fulminan
adalah
more common among people older than 50 years lebih umum di antara orang yang lebih tua dari 50
tahun
43 43
and dan
patients with chronic liver disease, including chronic pasien dengan penyakit hati kronis, termasuk
kronis
hepatitis B or hepatitis C infections. hepatitis B atau hepatitis C infeksi.
44–46 44-46
Notably, serious Terutama, serius
and even fatal hepatitis A virus infection can occur in dan bahkan fatal hepatitis Infeksi virus dapat
terjadi pada
children, anak-anak,
47,48 47,48
albeit less commonly than in people with meskipun jarang dari pada orang dengan
these other risk factors. faktor-faktor risiko lainnya. Spontaneous recovery occurs in pemulihan spontan
terjadi di
30% to 60% of people with fulminant hepatitis A virus 30% sampai 60% orang dengan hepatitis virus
fulminan
disease, with survivors regaining full liver function. penyakit, dengan korban memperoleh kembali
fungsi hati penuh.
Prognosis is influenced by age, clotting-factor levels, Prognosis dipengaruhi oleh, pembekuan-faktor
tingkat umur,
stage of coma, and presence of renal disease. tahap koma, dan adanya penyakit ginjal.
VACCINE VAKSIN
Description Deskripsi
Hepatitis A vaccines licensed in the United States are Hepatitis A vaksin berlisensi di Amerika Serikat
inactivated, whole-cell virus vaccines that are produced tidak aktif, seluruh-sel virus vaksin yang
diproduksi
from hepatitis A virus grown in human diploid fibroblast dari virus hepatitis A tumbuh di diploid
fibroblast manusia
cells. sel. There are 2 single-antigen vaccines, Vaqta Ada 2 single-antigen vaksin, Vaqta
49 49
and dan
Havrix, Havrix,
50 50
and a combined hepatitis A/hepatitis B vaccine, dan gabungan hepatitis A / vaksin hepatitis B,
Twinrix (GlaxoSmithKline). Twinrix (GlaxoSmithKline). Once hepatitis A virus is Setelah virus
hepatitis A adalah
adapted to growth in cell culture, it becomes attenuated. disesuaikan dengan pertumbuhan kultur sel,
menjadi dilemahkan.
The purified virus is then formalin inactivated and ad- Virus dimurnikan kemudian formalin tidak aktif
dan ad-
sorbed to aluminum hydroxide. diserap untuk aluminium hidroksida.
51 51
Havrix and Twinrix Havrix dan Twinrix
have 2-phenoxyethanol added as a preservative, memiliki 2-phenoxyethanol ditambahkan sebagai
pengawet,
whereas Vaqta is preservative free. sedangkan Vaqta adalah bebas pengawet. All hepatitis A vac- Semua
hepatitis A vaksin
cine preparations are administered intramuscularly. persiapan cine dikelola intramuskular. No Tidak
ada
vaccine containing hepatitis A licensed in the United vaksin yang mengandung hepatitis A berlisensi di
Amerika
States has ever contained thimerosal. Negara-negara yang pernah mengandung thimerosal.
Vaccine activity in Havrix is referenced to a standard Vaksin kegiatan di Havrix direferensikan untuk
standar
by using an enzyme-linked immunosorbent assay and is dengan menggunakan linked immunosorbent
assay-enzim dan
expressed, therefore, in terms of enzyme-linked immu- dinyatakan, oleh karena itu, dalam hal terkait
immu enzim-
nosorbent assay units (ELU). nosorbent uji unit (ELU). Vaqta antigen content is konten antigen Vaqta
adalah
expressed as units (U) of the hepatitis A antigen. dinyatakan sebagai unit (U) hepatitis antigen A. The
The
pediatric/adolescent (12 months to 18 years) dose of anak remaja (12 bulan sampai 18 tahun) dosis /
dari
Havrix is 0.5 mL and contains approximately 720 ELU of Havrix adalah 0,5 ml dan mengandung
sekitar 720 ELU dari
hepatitis A antigen, and the 1-mL adult formulation antigen hepatitis A, dan dewasa mL formulasi-1
contains approximately 1440 ELU of hepatitis A antigen. berisi sekitar 1.440 ELU hepatitis antigen A.
Vaqta also is supplied in 2 formulations, one for use in Vaqta juga tersedia dalam 2 formulasi, satu
untuk digunakan dalam
children 12 months to 18 years of age and another for anak 12 bulan sampai 18 tahun dan satu lagi
untuk
use in individuals 19 years of age and older. digunakan dalam individu 19 tahun dan lebih tua. Twinrix
Twinrix
contains a combination of hepatitis A antigen (720 ELU) berisi kombinasi hepatitis A antigen (720
ELU)
and hepatitis B antigen (20 g) and is administered as a dan hepatitis B antigen (20 g) dan diberikan
sebagai
3-dose series on a 0-, 1-, and 6-month schedule. 3-dosis seri 0 -, 1 -, dan jadwal bulan 6. In the Dalam
United States, Twinrix is only licensed for administration Amerika Serikat, Twinrix hanya berlisensi
untuk administrasi
to people 18 years and older. kepada orang-orang 18 tahun dan lebih tua. After completion of the
Setelah penyelesaian
3-dose Twinrix series, immunogenicity to hepatitis A 3-dosis Twinrix seri, imunogenisitas untuk
hepatitis A
and B is equivalent to immunogenicity of people who dan B adalah setara dengan imunogenisitas orang
yang
received single-antigen vaccines administered separately menerima satu-antigen vaksin diberikan
secara terpisah
according to standard schedules. menurut jadwal standar.
52 52
Immunogenicity Imunogenisitas
Within 1 month of receiving a first dose of hepatitis A Dalam 1 bulan menerima dosis pertama hepatitis
A
vaccine, 97% of children and adolescents and 95% of vaksin, 97% anak-anak dan remaja dan 95% dari
adults developed protective concentrations of antibody, dikembangkan dewasa pelindung konsentrasi
antibodi,
with the second dose resulting in virtually 100% of dengan dosis kedua mengakibatkan hampir 100%
dari
individuals being protected against the infection. individu telah dilindungi terhadap infeksi.
53 53
Al- Al-
though data are limited, the vaccine is less immunogenic Meskipun data terbatas, vaksin kurang
imunogenik
in patients with chronic liver disease, immunocompro- pada pasien dengan penyakit hati kronis,
immunocompro-
mised people, transplant recipients, and elderly individ- malkan orang, penerima transplantasi, dan
orang tua individ-
uals. uals. Because of the high rate of seroconversion in Karena tingginya tingkat serokonversi di
healthy children and the insensitivity of the standardly sehat anak-anak dan ketidakpekaan dari
standardly
available assays, testing for antibodies after immuniza- tersedia tes, tes antibodi setelah imunisasi
tion is not recommended. tion tidak dianjurkan.
Data regarding immunologic response when hepatitis Data tentang imunologi respon ketika hepatitis
A vaccines are administered concomitantly with other Sebuah vaksin yang diberikan bersamaan dengan
lainnya
PEDIATRICS Volume 120, Number 1, July 2007 Pediatrics Volume 120, Nomor 1, Juli 2007
193 193

Page 6 Page 6
routinely administered immunizations of childhood are diberikan imunisasi secara rutin pada masa
kanak-kanak
limited. terbatas. However, available data indicate that simulta- Namun, data yang tersedia
menunjukkan bahwa simulta-
neous administration of hepatitis A vaccine with diph- neous pemberian vaksin hepatitis A dengan diph-
theria and tetanus toxoids and acellular pertussis theria dan tetanus toxoid dan Pertusis
(DTaP), poliovirus (oral and inactivated), Haemophilus (DTaP), poliovirus (lisan dan tidak aktif),
Haemophilus
influenzae type b (Hib), hepatitis B, or measles-mumps- influenzae tipe b (Hib), hepatitis B, atau
campak-gondok-
rubella (MMR) vaccines did not affect immunogenicity rubella (MMR) vaksin tidak mempengaruhi
imunogenisitas
or reactogenicity. atau reactogenicity.
54 54
No data are available regarding si- Tidak ada data yang tersedia mengenai si-
multaneous administration of hepatitis A vaccine and multaneous pemberian vaksin hepatitis A dan
pneumococcal conjugate vaccine (Prevnar [Wyeth Phar- pneumococcal conjugate vaksin (Prevnar
[Wyeth Phar-
maceuticals, Madison, NJ]), but there is no reason to maceuticals, Madison, NJ]), tetapi tidak ada
alasan untuk
assume that there will be an interaction between the mengasumsikan bahwa akan ada interaksi antara
vaccines. vaksin.
Although vaccines containing hepatitis A effectively Meskipun vaksin mengandung hepatitis A efektif
stimulate antibody production, the antibody concentra- merangsang produksi antibodi, maka
konsentrasi antibodi-
tions achieved after immunization are 10 to 100 times tions dicapai setelah imunisasi adalah 10 sampai
100 kali
less than concentrations that occur after natural infec- kurang dari konsentrasi yang terjadi setelah
infeksi alam
tion. tion.
55 55
In addition, many commercially available tests are Selain itu, tes yang tersedia secara komersial banyak
not sufficiently sensitive to detect the presence of anti- tidak cukup sensitif untuk mendeteksi
keberadaan anti-
bodies against hepatitis A virus elicited by the vaccine. tubuh terhadap hepatitis A virus ditimbulkan
oleh vaksin ini.
56 56
Thus, people who are immunized against hepatitis A Dengan demikian, orang-orang yang diimunisasi
terhadap hepatitis A
virus may be protected against the infection but be an- virus mungkin dilindungi terhadap infeksi, tetapi
menjadi-
tibody-negative according to standard assays. tibody-negatif sesuai dengan tes standar.
Efficacy and Effectiveness Efikasi dan Efektivitas
Two large trials have been conducted to evaluate the Dua percobaan besar telah dilakukan untuk
mengevaluasi
efficacy of hepatitis A vaccine in children. kemanjuran vaksin hepatitis A pada anak-anak. One trial,
Satu sidang,
conducted in Thailand, enrolled more than 38 000 chil- dilakukan di Thailand, terdaftar lebih dari 38
000 anak-
dren aged 1 to 16 years who were randomly assigned to anak berusia 1 sampai 16 tahun yang secara
acak ditugaskan untuk
receive 2 doses separated by 1 month of either hepatitis menerima 2 dosis dipisahkan oleh 1 bulan
hepatitis baik
A vaccine (Havrix, 360 ELU per dose) or hepatitis B Sebuah vaksin (Havrix, 360 ELU per dosis) atau
hepatitis B
vaccine. vaksin.
57 57
Efficacy was calculated on development of Khasiat dihitung pada pengembangan
hepatitis A antibodies more than 21 days after receipt of hepatitis A antibodi lebih dari 21 hari setelah
penerimaan
vaccine. vaksin. Ninety-seven percent of children developed a Sembilan puluh tujuh persen dari anak-
anak mengembangkan
protective titer within 1 month of immunization, and pelindung titer dalam 1 bulan imunisasi, dan
the efficacy over a 1-year period of observation after khasiat selama periode 1 tahun pengamatan
setelah
immunization was calculated at 94% (95% confidence imunisasi dihitung sebesar 94% (% kepercayaan
95
interval: 79%–99%). Interval: 79% -99%).
57 57
The other trial was conducted in Percobaan lainnya dilakukan di
1037 children aged 2 to 16 years who were living in an 1037 anak usia 2 sampai 16 tahun yang tinggal
di
area of upstate New York with historically sustained daerah bagian utara New York dengan historis
berkelanjutan
high rates of transmission of hepatitis A. harga tinggi penularan hepatitis A.
58 58
Study partic- Studi tertentu dan memberikan
ipants were immunized with 1 dose of Vaqta, and over ipants diimunisasi dengan 1 dosis Vaqta, dan
lebih dari
the period of observation, vaccine efficacy was calcu- periode observasi, efikasi vaksin adalah calcu-
lated to be 100% (the lower 95% confidence limit was lated menjadi 100% (pada batas kepercayaan
95% lebih rendah
87%). 87%).
58 58
Although long-term measurement of vaccine Meskipun pengukuran jangka panjang vaksin
efficacy is needed, mathematical models predict that kemanjuran yang dibutuhkan, model matematika
memperkirakan bahwa
protective concentrations of antibody will persist more pelindung konsentrasi antibodi akan bertahan
lebih
than 25 years after completion of the recommended dari 25 tahun setelah penyelesaian yang
direkomendasikan
2-dose vaccine series. 2-dosis vaksin seri.
59 59
Postlicensure effectiveness of the hepatitis A vaccine Postlicensure efektivitas vaksin hepatitis A
has been shown to be similar to reported efficacy. telah terbukti untuk menjadi serupa dengan
keberhasilan yang dilaporkan. From Dari
1996–2000, hepatitis A vaccine was provided free of 1996-2000, vaksin hepatitis A diberikan gratis
charge to children who were living in Butte County, biaya untuk anak-anak yang tinggal di Butte
County,
California. California.
60 60
Of the 45 000 children eligible for the pro- Dari 45 000 anak-anak berhak untuk pro-
gram, approximately 30 000 (66%) received 1 dose and gram, kira-kira 30 000 (66%) menerima 1 dosis
dan
17 600 children received 2 doses of hepatitis A vaccine. 17 600 anak menerima 2 dosis vaksin hepatitis
A.
During the 5 years of surveillance, overall hepatitis rates Selama 5 tahun surveilans, tingkat hepatitis
keseluruhan
dropped 94% in the county, and vaccine effectiveness turun 94% di daerah ini, dan efektivitas vaksin
was calculated at 98%. dihitung sebesar 98%.
60 60
Similarly, in Catalonia, Spain, Demikian pula, di Catalonia, Spanyol,
cases of hepatitis A decreased from 10.3 per 100 000 in kasus hepatitis A mengalami penurunan dari
10,3 per 100 000 pada
children 11 to 14 years of age before routine hepatitis A anak-anak 11 sampai 14 tahun sebelum
hepatitis A rutin
immunization to 1.8 cases per 100 000 after implemen- imunisasi menjadi 1,8 kasus per 100 000
setelah mengimplementasikan-
tation of a hepatitis A immunization program, resulting tasi hepatitis A program imunisasi, sehingga
in an effectiveness rate of 97%. dalam tingkat efektivitas 97%.
61 61
Safety Keselamatan
Hepatitis A vaccines have been proven to be extremely Hepatitis A vaksin telah terbukti sangat
safe. aman. In prelicensure clinical trials of both Havrix and Dalam uji klinis prelicensure baik Havrix
dan
Vaqta, adverse events were uncommon and mild when Vaqta, efek samping yang jarang dan ringan saat
they occurred, with resolution typically occurring in less itu terjadi, dengan resolusi biasanya terjadi
dalam waktu kurang
than 1 day. dari 1 hari.
57 57
The most common adverse events, re- Efek-efek samping yang paling umum, ulang
ported in 10% to 15% of subjects, were pain at the site porting dalam 10% sampai 15% dari subyek,
adalah rasa sakit di situs
of injection, redness, and swelling. injeksi, kemerahan, dan bengkak. No serious adverse Tidak serius
merugikan
events have been definitively associated with either acara yang telah pasti terkait dengan baik
Vaqta or Havrix. Vaqta atau Havrix. In a study of more than 38 000 Thai Dalam studi lebih dari 38 000
Thailand
children who received Havrix as part of an efficacy trial, anak-anak yang menerima Havrix sebagai
bagian dari percobaan efikasi,
no serious adverse events were reported. tidak ada efek samping serius yang dilaporkan.
57 57
Since licen- Sejak licen-
sure in 1995, millions of doses of hepatitis A vaccine yakin pada tahun 1995, jutaan dosis vaksin
hepatitis A
have been administered, and no significant adverse telah diberikan, dan tidak merugikan yang
signifikan
events have been associated with either of the hepatitis acara telah dikaitkan dengan salah satu dari
hepatitis
A vaccines (Beth Bell, MD, CDC, personal communication, Sebuah vaksin (Beth Bell, MD, CDC,
komunikasi pribadi,
2006). 2006). A postmarketing study for Vaqta was performed in Sebuah studi pascapemasaran untuk
Vaqta dilakukan di
a large health maintenance organization population in pemeliharaan kesehatan organisasi besar
penduduk di
Northern California. California Utara. During an 18-month period, patients Selama periode 18 bulan,
pasien
were observed for emergency department and clinic use in diamati untuk departemen darurat dan
penggunaan klinik di
the month after receipt of hepatitis A vaccine. bulan setelah menerima vaksin hepatitis A. More than
Lebih dari
49 000 doses of hepatitis A vaccine were administered 49 000 dosis vaksin hepatitis A diberikan
(15 000 to children younger than 18 years), and no serious (15 000 kepada anak-anak berusia di bawah
18 tahun), dan tidak serius
adverse events were noted. kejadian buruk yang dicatat.
62 62
The only vaccine-related ad- Iklan vaksin terkait hanya-
verse event that occurred more commonly after adminis- ayat peristiwa yang terjadi lebih sering setelah
administrasi-
tration of hepatitis A vaccine was mild diarrhea in immu- trasi sipil vaksin hepatitis A diare ringan di
immu-
nized adults. nized orang dewasa. A summary of adverse events reported Sebuah ringkasan kejadian
negatif yang dilaporkan
through the Vaccine Adverse Event Reporting System melalui Buruk Event Vaksin Sistem Pelaporan
(VAERS) showed that 871 adverse events occurred in tem- (VAERS) menunjukkan bahwa 871
kejadian buruk terjadi di tem-
poral relationship to receipt of hepatitis A vaccines. poral hubungan dengan penerimaan hepatitis A
vaksin. How- Bagaimana-
ever, only fever, injection-site reactions, and allergic reac- pernah, hanya demam, reaksi tempat
suntikan, dan reaksi alergi-
tions seemed to be related to the vaccine. tions tampak berhubungan dengan vaksin. Events reported
Acara yang dilaporkan
through the VAERS were similar in type and number for melalui VAERS serupa dalam jenis dan
jumlah untuk
Vaqta and Havrix. Vaqta dan Havrix.
Cost-effectiveness Efektivitas biaya
The cost-effectiveness of nationwide routine hepatitis A Efektivitas biaya rutin nasional hepatitis A
immunization has been evaluated. imunisasi telah dievaluasi. Compared with no Dibandingkan dengan
tidak ada
childhood immunization against hepatitis A, routine im- masa kanak-kanak imunisasi terhadap hepatitis
A, im rutin
munization at 1 year of age would result in 183 806 munization pada usia 1 tahun akan mengakibatkan
183 806
fewer infections and 32 fewer deaths in each cohort. lebih sedikit infeksi dan 32 kematian lebih sedikit
pada kohort masing-masing.
63 63
The cost-effectiveness ratio was estimated at $173 000 The-rasio efektivitas biaya diperkirakan sebesar
$ 173 000
per life-year gained and $24 000 per quality-adjusted per tahun kehidupan diperoleh dan $ 24 000 per
kualitas disesuaikan
life-year (QALY) gained. hidup tahun (QALY) diperoleh. When out-of-cohort herd im- Ketika of-
kohort kawanan im-out-
munity was considered, immunization at 1 year of age komunitas dianggap, imunisasi pada usia 1
tahun
yielded a societal cost of $1000 per QALY gained. menghasilkan biaya sosial dari $ 1000 per QALY
diperoleh. An- An-
other economic analysis that included the estimated re- analisis ekonomi lainnya yang termasuk
perkiraan-ulang
194 194
AMERICAN ACADEMY OF PEDIATRICS American Academy of Pediatrics

Page 7 Page 7
duction in secondary cases among household contacts of produksi dalam kasus sekunder antara kontak
rumah tangga
infected children yielded similar results. anak yang terinfeksi menghasilkan hasil yang sama.
64 64
When these Ketika
values are placed in context, the projected costs of im- nilai ditempatkan dalam konteks, proyeksi biaya
im-
plementation of a universal hepatitis A vaccine program Implementasi dari hepatitis universal Sebuah
program vaksin
is equivalent to an acellular pertussis vaccine program in adalah setara dengan program vaksin Pertusis
di
adolescents and approximately 10% of the cost of the remaja dan sekitar 10% dari biaya
meningococcal vaccine program based on QALYs. program vaksin meningokokus berdasarkan
QALYs.
Vaccine Administration and Storage Vaksin Administrasi dan Penyimpanan
Before administration, vaccine preparations should be Sebelum administrasi, persiapan vaksin harus
shaken and, when well mixed, will be a slightly opaque, terguncang dan, jika tercampur, akan menjadi
sedikit buram,
white-colored suspension. suspensi berwarna putih. The vaccine should be admin- Vaksin harus admin-
istered intramuscularly with needle length based on age istered intramuskular dengan panjang jarum
berdasarkan usia
and size of the patient (see Table 1.5: Site and Needle dan ukuran pasien (lihat Tabel 1.5: Situs dan
Needle
Length by Age for Intramuscular Administration in Red Panjang oleh Usia untuk Administrasi
Intramuscular di Red
Book Buku
65 65
). ). Hepatitis A vaccine in children is administered in Vaksin hepatitis A pada anak-anak diberikan
dalam
a 2-dose series, with the first dose of Vaqta or Havrix sebuah seri 2-dosis, dengan dosis pertama Vaqta
atau Havrix
administered to children as young as 12 months. diberikan kepada anak-anak berumur 12 bulan. The
The
second dose of Havrix should be given 6 to 12 months dosis kedua Havrix harus diberikan 6 sampai 12
bulan
after the first dose, and the second dose of Vaqta can be setelah dosis pertama, dan dosis kedua dapat
Vaqta
administered 6 to 18 months after the first dose. diberikan 6 sampai 18 bulan setelah dosis pertama.
Twinrix Twinrix
is a 3-dose series given on a 0-, 1-, and 6-month sched- adalah seri 3 dosis diberikan pada 0 -, 1 -, dan
6-bulan sched-
ule. ule. If the immunization schedule for vaccines contain- Jika jadwal imunisasi untuk vaksin
mengandung-
ing hepatitis A is interrupted, only the required immu- ing hepatitis A terganggu, hanya dibutuhkan
immu-
nization needs to be administered rather than restarting nization perlu diberikan daripada restart
the series. seri.
66 66
Hepatitis A vaccine is to be stored and shipped be- Vaksin hepatitis A adalah untuk disimpan dan
dikirim menjadi-
tween 2 and 8°C (36 and 46°F). tween 2 dan 8 ° C (36 dan 46 ° F). However, neither the Namun, baik
immunogenicity nor reactogenicity of either Vaqta or imunogenisitas atau reactogenicity baik Vaqta
atau
Havrix was affected by storage at up to 37°C (98°F) for Havrix dipengaruhi oleh penyimpanan hingga
37 ° C (98 ° F) untuk
up to 1 week. hingga 1 minggu.
67 67
The vaccine should not be frozen, be- Vaksin tidak boleh dibekukan, menjadi-
cause it will destroy vaccine potency. menyebabkan itu akan menghancurkan potensi vaksin.
RECOMMENDATIONS REKOMENDASI
As the next step in the incremental immunization strat- Sebagai langkah berikutnya dalam strategi-
strategi imunisasi tambahan-
egy to prevent hepatitis A, the following recommenda- egy untuk mencegah hepatitis A, rekomendasi
berikut-
tions are made. but merupakan dibuat.
Children Anak
1. 1. All children who live in the United States should Semua anak yang tinggal di Amerika Serikat
harus
receive hepatitis A vaccine at 1 year of age (ie, 12–23 menerima vaksin hepatitis A pada usia 1 tahun
(yaitu, 12-23
months of age) as a 2-dose regimen. bulan usia) sebagai dosis rejimen 2. Immunization Imunisasi
should be integrated into the routine childhood im- harus diintegrasikan ke dalam imunisasi rutin masa
kanak-kanak
munization schedule and completed according to the munization jadwal dan diisi sesuai dengan
approved schedules (Table 1) using Havrix or Vaqta jadwal yang disetujui (Tabel 1) menggunakan
Havrix atau Vaqta
hepatitis A vaccines. hepatitis A vaksin. Administration of 2 doses of the Administrasi 2 dosis
same hepatitis A vaccine is preferable. Vaksin hepatitis yang sama adalah lebih baik. However, data
Namun, data
indicate that the vaccines are interchangeable; thus, menunjukkan bahwa vaksin yang dipertukarkan,
dengan demikian,
the 2-dose series may be completed with either of the yang seri 2-dosis dapat diselesaikan dengan salah
satu dari
vaccine preparations approved for children. persiapan vaksin disetujui untuk anak-anak.
68 68
2. 2. States, counties, and communities with existing hep- Negara, kabupaten, dan masyarakat dengan
yang ada hep-
atitis A immunization programs for children 2 to 18 atitis program imunisasi A untuk anak-anak 2
sampai 18
years of age are encouraged to maintain these pro- tahun dianjurkan untuk memelihara pro-
grams and expand to include children who are 12 to gram dan memperluas untuk memasukkan anak-
anak yang 12 untuk
23 months of age. 23 bulan. In these areas, new efforts focused Di wilayah ini, upaya-upaya baru yang
terfokus
on routine immunization of preschool children imunisasi rutin pada anak prasekolah
should enhance, not supplant or replace, ongoing harus meningkatkan, bukan menggantikan atau
mengganti, terus menerus
programs that are directed at a broader population of program yang diarahkan pada populasi yang lebih
luas
children. anak-anak.
3. 3. In areas without existing hepatitis A immunization Di daerah tanpa ada imunisasi hepatitis A
programs, catch-up immunization of unimmunized program, catch-up imunisasi yang tidak diimunisasi
children 2 to 18 years of age can be considered. anak 2 sampai 18 tahun usia dapat dipertimbangkan.
Such Seperti
programs might especially be warranted in the con- khususnya program mungkin diperlukan dalam
konteks-
text of increasing incidence or ongoing outbreaks teks meningkatnya insiden atau wabah yang sedang
berlangsung
among children or adolescents. di kalangan anak-anak atau remaja.
4. 4. Immunocompromising conditions are not a contrain- Immunocompromising kondisi bukan
contrain-
dication to receiving hepatitis A vaccine. dication menerima vaksin hepatitis A. The prepa- prepa The-
ration is an inactivated virus and has not been shown rasio merupakan virus tidak aktif dan belum
menunjukkan
to result in any increased safety risks when adminis- mengakibatkan resiko keamanan meningkat ketika
administrasi-
tered to people with primary or secondary immuno- rapi untuk orang dengan primer atau sekunder
immuno-
deficiencies. kekurangan.
5. 5. The vaccine should not be administered to people with Vaksin tidak boleh diberikan kepada orang-
orang dengan
a hypersensitivity to any of the vaccine components yang hipersensitif terhadap salah satu komponen
vaksin
such as aluminum hydroxide and phenoxyethanol. seperti aluminium hidroksida dan phenoxyethanol.
Persons at Increased Risk of Hepatitis A Virus Infection Orang pada Peningkatan Resiko Infeksi
Virus Hepatitis A
1. 1. Children not previously immunized against hepatitis Anak-anak yang sebelumnya tidak
diimunisasi terhadap hepatitis
A virus who will be traveling to or living in areas with Sebuah virus yang akan bepergian ke atau
tinggal di daerah dengan
intermediate or high endemicity for the infection menengah atau tinggi endemisitas untuk infeksi
should be immunized before departure. harus diimunisasi sebelum keberangkatan. Areas for Bidang-
Bidang
which hepatitis A immunization is recommended be- yang imunisasi hepatitis A dianjurkan menjadi-
fore travel can be found at www.cdc.gov/travel/ perjalanan kedepan dapat ditemukan di
www.cdc.gov/travel/
vaccinat.htm. vaccinat.htm. Protection is reliably present by 4 Perlindungan terpercaya hadir dengan 4
weeks after administration of the first dose of hepa- minggu setelah pemberian dosis pertama HEPA-
titis A vaccine and may afford protection as soon as 2 Titis A vaksin dan mungkin mampu perlindungan
secepat 2
weeks after immunization. minggu setelah imunisasi.
2. 2. Both adolescent and adult males who have sex with Kedua remaja dan dewasa pria yang
berhubungan seks dengan
men should be immunized against hepatitis A virus. laki-laki harus diimunisasi terhadap hepatitis virus.
TABLE 1 Recommended Doses and Schedules for Inactivated Hepatitis A Vaccines TABEL 1
Dosis yang direkomendasikan dan Jadwal untuk Vaksin Hepatitis A Vaksin
Age, y Umur, y
Vaccine (Manufacturer) Vaksin (Manufacturer)
Dose Dosis
Volume per Volume per
Dose, mL Dosis, mL
Route of Rute
Injection Injeksi
No. of Jumlah
Doses Dosis
Schedule, Jadwal,
mo mo
1–18 y 1-18 y
Vaqta (Merck) Vaqta (Merck)
25 U 25 U
0.5 0.5
IM IM
22
0, 6–18 0, 6-18
Havrix (GlaxoSmithKline) Havrix (GlaxoSmithKline)
720 ELU 720 ELU
0.5 0.5
IM IM
22
0, 6–12 0, 6-12
19 y 19 y
Vaqta (Merck) Vaqta (Merck)
50 U 50 U
11
IM IM
22
0, 6–18 0, 6-18
Havrix (GlaxoSmithKline) Havrix (GlaxoSmithKline)
1440 ELU 1440 ELU
11
IM IM
22
0, 6–12 0, 6-12
Twinrix (GlaxoSmithKline) Twinrix (GlaxoSmithKline)
720 ELU (hepatitis A), 20 g (hepatitis B) 720 ELU (hepatitis A), 20 g (hepatitis B)
11
IM IM
33
0, 1, 6 0, 1, 6
IM indicates intramuscular. IM menunjukkan intramuskular.
PEDIATRICS Volume 120, Number 1, July 2007 Pediatrics Volume 120, Nomor 1, Juli 2007
195 195

Page 8 Page 8
Preimmunization serologic testing is not recom- pengujian serologi Preimmunization tidak
direkomendasikan
mended for adolescents or young adults. diperbaiki untuk remaja atau dewasa muda.
3. 3. Immunization is recommended for users of either Imunisasi dianjurkan untuk para pengguna baik
injectable or noninjectable illicit drugs. suntik atau obat-obatan terlarang noninjectable. Again, preim-
Sekali lagi, preim-
munization serologic testing is not recommended for munization pengujian serologi tidak dianjurkan
untuk
adolescents or young adults. remaja atau dewasa muda.
4. 4. Although changes in clotting-factor–preparation Meskipun perubahan dalam faktor pembekuan
persiapan--
practices and donor screening have greatly reduced praktik dan skrining donor telah sangat berkurang
the risk of acquiring hepatitis A for recipients of clot- risiko tertular hepatitis A untuk penerima-bekuan
ting factors, susceptible individuals should be immu- ting faktor, individu yang rentan harus immu-
nized against hepatitis A before administration of the nized terhadap hepatitis A sebelum administrasi
clotting factors. faktor pembekuan.
5. 5. Susceptible persons who work with hepatitis A virus Rentan orang yang bekerja dengan virus
hepatitis A
in a laboratory setting should be immunized against dalam pengaturan laboratorium harus diimunisasi
terhadap
the virus. virus.
REPORTING ADVERSE EVENTS PELAPORAN PERISTIWA MERUGIKAN
The safety of hepatitis A vaccines will continue to be Keamanan vaksin hepatitis A akan terus
assessed through ongoing monitoring of data from the
VAERS and other surveillance systems. Any adverse
event suspected to be associated with hepatitis A immu-
nization should be reported to the VAERS. Information Informasi
on how to report adverse events is available at www.fda.
gov/cber/vaers/vaers.htm. VAERS forms also can be ob-
tained by telephone at 800-822-7967.
FUTURE NEEDS AND RESEARCH
Ongoing Disease Surveillance
The incidence of hepatitis A is at an all-time low in the
United States. Amerika Serikat.
55
The decrease in the rate of disease is
temporally associated with implementation of an immu-
nization program against the infection. Although it is Meskipun
likely that immunization has been a major contributor to
the decrease, other factors, including improved hygiene
or cycling of disease, which have been characteristic of
the epidemiology of hepatitis A virus in the past, could
have contributed to the decreased hepatitis A incidence
during the past decade. selama dekade terakhir. Comprehensive information on
hepatitis A immunization coverage is vital to fully eval-
uate the effect that immunization has had on reduction
of the incidence of the infection. Unfortunately, only
limited data are available, and immunization coverage
among adults is not assessed systematically.
Although data from the Third National Health and
Nutrition Examination Survey
69 69
contributed to the un-
derstanding of hepatitis A, the information gained fo-
cused on prevalence of infection. As vaccine implemen-
tation increases, it will be most important to collect
prospective data on disease incidence by fully investigat-
ing disease outbreaks and encouraging national report-
ing of cases through state and local health departments
to the National Notifiable Diseases Surveillance System.
Only with the availability of these data will it be possible
to determine the full impact and added value of these
mass-immunization programs.
Potential Need for a Catch-up Schedule
Strategies for catch-up immunization are often compo-
nents of universal immunization programs. However, Namun,
currently available data from the United States, Israel,
and some European countries suggest that there is a
significant herd-immunity effect associated with immu-
nization of young children against hepatitis A.
6,7,70
AA
mandate for catch-up immunization should await fur-
ther surveillance to determine if the indirect effect on
older, nonimmunized groups continues.
Observing for Need of a Booster Dose for Adults
Hepatitis A infection in childhood typically is mild, and
in children younger than 6 years, 90% of infections are
asymptomatic. tanpa gejala. However, acquisition of the infection
during adolescence and adulthood typically is associated
with symptomatic infections that can be debilitating for
weeks. minggu. Thus, for a hepatitis A immunization program to
be effective, the vaccine has to confer long-term protec-
tion. tion. Otherwise, an asymptomatic childhood infection
could be replaced by symptomatic disease after exposure
later in life. di kemudian hari. Because the vaccine has been commercially
available for only 10 years, data on the persistence of
antibody is based largely on information collected from
trials that tested the immunogenicity and efficacy of the
vaccine. vaksin. However, the available data are encouraging,
finding that protective antibody concentrations persist
more than 10 years after immunization.
71 71
In addition, Selain itu,
mathematical modeling suggests that protective anti-
body concentrations may persist for more than 25 years
after immunization.
59 59
Finally, studies suggest that im-
munity may be present even beyond the ability to detect
circulating antibodies.
71 71
Thus, although it is not consid-
ered necessary for booster immunization in a fully im-
munized healthy person, observation will be needed to
determine if this evidence-based recommendation will
need to change over time.
Evaluation of Immunogenicity With Coadministration of
Vaccines Vaksin
Limited data are available that indicate that coadminis-
tration of hepatitis A vaccine with other vaccines in the
recommended childhood series does not affect immuno-
genicity of the vaccines.
54 54
Additional studies to assess
hepatitis A vaccine immunogenicity in conjunction with
other vaccines, particularly varicella and pneumococcal
conjugate vaccines, will need to be collected and evalu-
ated. However, unless data become available to the con-
trary, one should assume that concomitant administra-
tion of hepatitis A vaccine with other recommended
vaccines of children is safe and immunogenic.
196 196
AMERICAN ACADEMY OF PEDIATRICS American Academy of Pediatrics

Page 9 Page 9
Evaluating Vaccine Acceptance
The success of a hepatitis A vaccine program will depend
on the enthusiasm that physicians and members of the
health care team display toward implementation of the
program. program. In addition, the attitudes of families to incor-
poration of “another vaccine” into the crowded immu-
nization schedule will critically affect the program. In a Dalam
2003 survey, only 51% of age-eligible children who
lived in the 11 states with recommendation to be immu-
nized with hepatitis A vaccine had received at least 1
dose of vaccine.
72 72
Only 1% of children who lived in
states without a hepatitis A vaccine recommendation
had received 1 dose of vaccine. Despite this moderate
uptake of vaccine in “vaccine” states, there was a signif-
icant decrease in hepatitis A disease, suggesting the vac-
cine is highly effective and, along with the excellent
safety profile of the vaccine, can provide the encourag-
ing information needed to sustain a vaccine program.
ACKNOWLEDGMENTS UCAPAN TERIMA KASIH
This American Academy of Pediatrics statement was pre-
pared in parallel with the recommendations of the CDC
report “Prevention of Hepatitis A Through Active or
Passive Immunization: Recommendations of the Advi-
sory Committee on Immunization Practices (ACIP)”
( MMWR Recomm Rep . 2006;55[RR-7]:1–23). Much of the Sebagian besar
background presented in this statement is based on lit-
erature review, analysis of unpublished data, and delib-
erations of the CDC staff in collaboration with the Ad-
visory Committee on Immunization Practices Hepatitis
Working Group. Kelompok Kerja. We acknowledge the CDC Division of
Viral Hepatitis and especially Drs Beth Bell and Tracy Liu
of the Hepatitis Working Group for outstanding techni-
cal expertise and review.
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“FOR JIMMY AND THE BOYS AND GIRLS OF AMERICA”: PUBLICIZING CHILDHOOD
CANCERS IN TWENTIETH-CENTURY AMERICA
“On the evening of 22 May 1948, Ralph Edwards, host of the popular radio
program Truth or Consequences , introduced his audience to a special guest:
'Tonight we take you to a little fellow named Jimmy. We're not going to give
you his last name, because he's just like thousands of other young fellows and
girls in private homes and hospitals all over the country.' Without further
explanation, the program commenced as Edwards prompted Jimmy to list his
favorite Boston Braves players. Members of the team's starting lineup filed
into his hospital room one by one, and presented the boy with autographed
baseball memorabilia. Jimmy then joined the men in singing 'Take Me Out to
the Ballgame' on air and received special permission to attend a game the
next day—a day designated as 'Jimmy's Day' at the ballpark. After his young
guest signed off, Edwards told listeners that Jimmy was a twelve-year-old
undergoing cancer treatment in Boston. He asked them to contribute money
toward a television set for the boy's room and, more generally, to aid 'Jimmy
and the boys and girls of America.' Members of the show's audience re-
sponded generously, reportedly donating more than $200 000 to the fund
and sending tens of thousands of 'get well' cards to Jimmy. By drawing upon
child-centered fund-raising strategies pioneered by other earlier voluntary
health agencies, the Jimmy Fund and its mission to direct research and
treatment toward childhood cancers were launched with overwhelming pub-
lic support.”
Krueger G. Bulletin of the History of Medicine . Spring 2007 Spring 2007
Noted by James W. Kendig, MD
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