Curiculum vitae

Dr. Anggraini Alam, dr., SpA(K)

Konsultan Infeksi dan Penyakit Tropis

Departemen/KSM Ilmu Kesehatan Anak
FK Universitas Padjadjaran, RSUP Dr. Hasan Sadikin

Pendidikan:
Kelulusan sebagai Dokter tahun 1993, Sp. Anak tahun 2005, Doktor tahun 2017 dari Universitas Padjadjaran.
Fellowship di KK Women & Children Hospital tahun 2010
Konsultan Infeksi dan Penyakit Tropis dari Kolegium Ilmu Kesehatan Anak Indonesia tahun 2011

Organisasi:
Ketua UKK Infeksi & Penyakit Tropis IDAI
Anggota Satgas COVID-19, HIV, dan Farmasi IDAI
Wakil Ketua Tim PINERE RSHS
Wakil Ketua PPRA RSHS
Sekretaris BP2A IDAI Jabar
Anggota Tim Ilmiah IDI Jabar
Anggota Tim HIV/AIDS RSHS
Komite Ahli Difteri, infeksi gastrointestinal, dan HIV Kemenkes RI
Pengurus Harian Kolegium Ilmu Kesehatan Anak Indonesia (KIKAI)
Board Member of Asia Society of Pediatric Infectious Diseases
Anggraini(ASPID)
Alam
 Vaccine-preventable Diseases
dan Update Jadwal Imunisasi IDAI

Upelkes Dinkes Jabar, 2021

Anggraini Alam
Outline
• Vaccine-preventable diseases
• Update of immunization schedule by IDAI 2020
• Explain the importance of vaccination in the control of infectious
diseases

Anggraini Alam
History of Vaccine Development

Vaccination is
one of the
great public
health
achievements
of human
history.
Innoculation against small pox was practice >2000 years ago in China and
India. But, a British physician, Edward Jenner is generally credited with the
modern concept of vaccination. In 1796 used matter from cowpox pustule
to inoculate patients successfully against smallpox

Anggraini Alam
 Cakupan OPV4 bulan Januari-April 2019 dan 2020

Anggraini Alam
Kemenkes RI. Buletin Surveilans PD3I dan Imunisasi Edisi 2 Tahun 2020
 Cakupan penta 1 dan 3 bulan Januari-April 2019 dan 2020
Anggraini Alam

Kemenkes RI. Buletin Surveilans PD3I dan Imunisasi Edisi 2 Tahun 2020
 Faktor Risiko untuk Kasus Wabah PD3I

Penolakan orangtua Informasi yang tidak

karena alasan religius akurat /Menyesatkan
ataupun kepercayaan mengenai keamanan
pribadi vaksin

Cakupan vaksinasi yang Importasi penyakit dari

rendah di segmen Wabah/ daerah yang cakupan
populasi tertentu vaksinasinya suboptimal
Outbreaks

MMR=measles, mumps, rubella.

1. Berger BE et al. Hum Vaccin. 2010;6:1016–1020.
2. Omer SB et al. N Engl J Med 2009;360:1981–1988
Jadwal imunisasi yang disediakan Pemerintah

Anggraini Alam
Anggraini Alam

19 vaccine-preventable diseases
Di Indonesia, secara garis besar, ada dua skema rekomendasi imunisasi

• Pertama, skema imunisasi dari Kemenkes Republik RI, yakni Program

Pengembangan Imunisasi (PPI). Imunisasi PPI ini disebut imunisasi wajib, yang
terdiri dari vaksin BCG, polio, DPT, HiB, hepatitis B, campak dan rubela. Imunisasi
wajib ini disubsidi oleh pemerintah Indonesia.
• Kedua, dalam perkembangannya, bermunculan penyakit lain yang juga potensial
membahayakan manusia. Sebagian di antaranya telah berhasil diproduksi
vaksinnya, seperti MMR (Measles, Mumps, Rubella), tifoid, Hepatitis A, PCV, HPV,
JE, dengue, dll.
• Jadi…. Imunisasi wajib adalah vaksin minimal yang harus didapat anak dengan
fasilitas yang disediakan pemerintah. Sedang tambahannya, bila mampu, baik
sekali jika juga diberikan pada anak.

Anggraini Alam
Hepatitis B

Anggraini Alam
 maksimal dalam 7
hari setelah lahir

Catatan:
bayi bugar <2000g, pemberian dosis ke-1 tidak dihitung sebagai dosis
primer.
Vit. K diberi min. 30’ sebelum hepatitis B
Anggraini Alam
Fokus terhadap pencegahan Hepatitis
B, memiliki arti penting, sbb.:

Anggraini Alam
 Poliomielitis

Anggraini Alam
 Tuberkulosis
Anggraini Alam

Direktorat Jenderal P2P. Subdirektorat Tuberkulosis, 14 Jan 2021

 The cumulative risk (with 95% CIs) of TB by age in a cohort of BCG vaccinated and non-BCG
vaccinated children and young adults in East Greenland.

S W Michelsen et al. Thorax 2014;69:851-856

Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.
Diphtheria
A life-threatening disease mainly affecting preschool & school-aged children [1]

• Toxin-mediated, potentially • 1st epidemiologic stage in • 2nd epidemiologic stage:

systemic disease; transmitted countries relying on shift to adolescents/adults
via respiratory droplets or 3-dose PS only: highest due to recognized waning
skin lesions [1] proportion of cases in children of immunity after PS [1,3]
5-14 years (preschool & school-
• Development of pseudo- è Regular boosters needed to
aged children) [1,3]:
membrane is a medical compensate absence of
emergency [1] • School attendance = high natural boosting (2nd year,
risk of transmission [3] school-entry &
• 5-10% CFR with highest
mortality in young children [2] • Preschool children less able school-leaving prior to
Corynebacterium
to control respiratory adolescence) [3]
diphtheriae
secretions [4]

©
AlainGrillet/Sanofi Pasteur
PS: primary series
©
Fatcamera/GettyImages

[1] WHO. WER, 2017;92(31) [2] WHO. Online [3] Clarke. SAGE Meeting, April 2017 [4] Bertilone. Commun Dis Intell Q Rep, 2014;38(3) 18
Pertussis
An important cause of morbidity in children 1 to 5 years of age [1]

[1]
• Toxin-mediated disease; • Main aim of vaccination = • Highly transmissible, up to
transmitted via reduce death in infants 90% secondary attack rate [1]
respiratory droplets among susceptible household
• Recognized waning of
contacts
• From mild respiratory immunity after primary
(e.g. parents, siblings)
symptoms to distressing vaccination
paroxysmal cough • School-age children
• Disease resurgence in aP-
(whoop) w/ severe increasingly recognized as a
and wP-using countries
complications (apnea, reservoir of transmission for
despite high vaccine
cyanosis, death) [1] infants [2,3]
Bordetella pertussis coverage
• Highest
severity/mortality in 1st
weeks/months of life [1]

©Alain Grillet/Sanofi Pasteur

©Photographee.eu/Shutterstock

[1] WHO. WER, 2015;90(35) [2] Bertilone. Commun Dis Intell Q Rep, 2014;38(3) [3] Skoff. Pediatrics, 2015;136(4) 19
Tetanus
A non-infectious disease with no natural immunity [1]
• Toxin-mediated bacterial
disease (highly potent tetanus
toxin) [1]
• Infection through
contact/reactivation of spores
in tissue lesions [1]
• No naturally-acquired
Clostridium tetani immunity: recovery from
disease does not confer
immunity [1]
©Alain Grillet/Sanofi Pasteur
©Hadynyah/Gettyimages
• Non communicable disease • Immunity only through
[2]
passive or active
• Infection may occur at any immunization [1]
age (high mortality in è In the absence of definite
neonate & >65 yr) [1] correlation of protection,
• Elimination of environmental high anti-body
exposure is impossible (C. concentrations should be
maintained throughout life
tetani spores are ubiquitous)
[2] [1]
[1] WHO. WER, 2016;92(6) [2] Roper. Tetanus Toxoid. In: Vaccines, 2018 20
Anggraini Alam
Anggraini Alam
Influenza
Anggraini Alam
 Wabah Measles

1. https://papuanews.id/2018/02/08/the-measles-outbreak-and-malnutrition-endangering-papuas-children/.
2. https://www.passporthealthusa.com/2018/05/measles-cases-spread-through-multiple-asian-countries/
• Pneumonia/bronchitis1
• Otitis media1
• Infeksi bakteri lainnya1
• Thrombocytopenic
purpura, kadang dengan
manifestasi perdarahan
yang berat 3,4
• Meningitis/Encephalitis2
• Kejang 1. Schneider-Schaulies S, ter Meulen V. In: Encyclopedia of Virology.
2nd ed. New York, NY: Academic Press; 1999:952–960.
2. Gershon AA. In: Mandell, Douglas, and Bennett’s Principles and
Practice of Infectious Diseases. 6th ed. Philadelphia, Pa:
Elsevier Churchill Livingstone; 2005:2031–2038.
3. Hirsch MS. In: Scientific American Medicine. New York, NY:
Scientific American, Inc; 1995.
4. Strebel PM, Papania MJ, Halsey NA. Measles vaccine. In: Plotkin
SA, Orenstein WA, eds. Vaccines. 4th ed. Philadelphia, Pa:
Saunders; 2004:389–440.
COMMON TRANSIENT AND PERMANENT MANIFESTATIONS IN
INFANTS WITH CONGENITAL RUBELLA SYNDROME
Anggraini Alam
Anggraini Alam

Anggraini Alam
 Demam
Tifoid
Anggraini Alam

Anggraini Alam
HPV infection
Anggraini Alam
Dengue infection

Anggraini Alam
WHO, 2009
Bulan
Imunisasi
Anak Sekolah

Anggraini Alam
Pedoman pelaksanaan imunisasi selama masa pandemi

Anggraini Alam
 Skrining
anak
sebelum
imunisasi

Anggraini Alam
*Istilah OTG diganti menjadi
kontak erat, ODP-PDP menjadi
suspek sesuai dengan KMK No
HK.01.07/MENKES/413/2020
Tentang Pedoman Pencegahan
dan Pengendalian COVID-19

Kemenkes RI. Buletin Surveilans PD3I dan Imunisasi Edisi 2 Tahun 2020
Take home messages
• The natural infections and vaccines produce a very similar and result – immunity
– but the peson who receives a vaccine dos not endure the illness and its
potential life-threatening complications
• Vaccine: reduce morbidity and mortality from infectious diseases, saving costs as well as lives
• The very low risk of an adverse event caused by a vaccine greatly outweighs the
risk of illness and complications caused by natural infection
• Jangan sampai pada masa pandemi Covid-19, muncul juga kejadian luar biasa
penyakit-penyakit yang sudah ada vaksinnya, yang bisa dicegah
• Dinkes Jabar perlu berkomitmen untuk meningkatkan cakupan imunisasi rutin di
masa pandemi

Anggraini Alam
 Dinkes Jabar berkomitmen:
tingkatkan cakupan imunisasi rutin di masa pandemi

Terima kasih

Anggraini Alam