Mei Neni Sitaresmi, PhD, SpAK

Position:
• Growth-Development-Social Pediatric division, Child Health Department, FK-KMK UGM
/ RSUP DR. Sardjito
• Secretary Task Force on Immunization, Indonesian Pediatric Society
• Member of Growth Development- Social Pediatric, Indonesian Pediatric Society
• Member of Indonesia Technical Advisory Group on Immunization
• Committee of Adverse Event Following Immunization
• Member of ISSOP (International Society of Social Pediatric and Child Health)
• Member of SIOP (The International Society of Paediatric Oncology)
Education:
• Medical Doctor, FK UGM, 1990
• Pediatrician, FK UGM, 2002
• Consultant on Growth-Development-Social Pediatric, Indonesian Pediatric Collegium, 2008
• Ph.D., VUMC Netherland, 2009
Email: msitaresmi@ugm.ac.id, meisitaresmi@gmail.com
29/05/22 MeiNeni_Webinar _IDAI Banyumas
 Catch up immunization
lesson learn from the pandemic Era
Mei Neni Sitaresmi
FK-KMK UGM/ RSUP DR Sardjito

29/05/22 MeiNeni_Webinar _IDAI Banyumas

outline
• Background
• General Principles for Vaccine Scheduling
• Principle of catch up vaccination
• Immunization schedule catch up
• Case based-discussion
• Take-home messages

29/05/22 MeiNeni_Webinar _IDAI Banyumas

 100
Target dan capaian Imunisasi dasar Lengkap pada Bayi
SUMATERA SELATAN
KALIMANTAN TENGAH
diimunisasi lengkap selama
30.473
29.862
target (%) capaian (%)

80 2018-2021
LATAR
KALIMANTAN TIMU R
periode
BELAKANG (1)2019-2021
27.135
Persentase Capaian
LAMPU NG 26.082
95
60 Secara rata-rata93,7
terjadi penurunan SUL AWESI UTARA
JAWA BAR AT
MALU KU UTARAACEH
25.954
23.624 179.847
332.431

93 92,9 93
cakupan sebesar 11.27% pada 4
SUMATERA UTARA 163.454
90 92,5 92 SUL AWESI BARAT RIAU 22.141 149.060
SUMATERA BARAT 116.832
PAPUA BARAT 19.133
40 antigen sejak 2019 Pandemi SULNU
DKI JAKARTA
SA TENGGARA TIMUR
AWESI TEN GAH
111.967
99.391
18.818
Ø Akumulasi anak yang tidak
JAWA TIMUR 82.057
85 COVID JAMBI PAPUA
15.969 79.725
JAWA TENGAH 70.463
20 84,2 84,2 KEPULKALIMANTAN
Kejadian
AUAN RIAU BARAT
campak
14.594 dan rubella confirmed meningkat
67.966 lebih dari
SUL AWESI SELATAN 55.059
80
mendapat imunisasi rutin
KALIMANTAN UTARA 13.692
KALIMANTAN SELATAN
GOR ON TALBANTEN
O 34.074
11.832 31.886
15x lipat dibandingkan 2021
50.338
0 SUL AWESI TEN GGARA
BANGKA BELITU NG MALU KU
10.021 31.528
75 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019
lengkap mengakibatkan tidak
Terdapat 1,7 juta bayi tidak dan belum
SUMATERA SELATAN 30.473
BENGKULTENGAH
KALIMANTAN U 7.964 29.862
2018 2019 2020 2021 KALIMANTAN TIMU R
NU SA TENGGARA BARAT LAMPU NG 5.406
27.135
diimunisasi lengkap selama tahun
26.082
a.
Campak Bayi Polio 4 DPT-HB-Hib 3 BCG SUL AWESI
BALIUTARA 4.080 25.954

terbentuknya Herd Immunity 2019-2021

MALU KU UTARA 23.624
target (%) capaian (%) DI YOGYAKARTA
SUL AWESI BARAT 3.445 22.141
PAPUA BARAT 19.133
SUL AWESI TEN GAH 18.818

Akumulasi anak yang terjadi tidak mendapat imunisasi

JAMBI 15.969
Jenis Antigen Cakupan 2019 (%) Cakupan 2021 (%) Perubahan
à sangat berpotensi
KEPUL AUAN RIAU
KALIMANTAN UTARA
GOR ON TAL O
14.594
13.692
11.832

rutin lengkap Luarmengakibatkan

Biasa bahkan tidak terbentuknyab.
JAWA BAR AT 332.431
Campak BayiACEH 95.14 87.30 -7.84 BANGKA BELITU NG 10.021

Kejadian
179.847 BENGKUL U 7.964
SUMATERA UTARA 163.454 NU SA TENGGARA BARAT 5.406
RIAU 149.060 BALI 4.080
Polio 4 96.47 80.00 -14.10
Herd Immunity à sangat berpotensi terjadi
SUMATERA BARAT DI YOGYAKARTA 3.445
116.832
DKI JAKARTA 111.967

Wabah
NU SA TENGGARA TIMUR - 50.000 100.000 150.000 200.000 250.000 300.000 350.000
99.391 Sumber: Laporan Rutin s.d 9 Februari 2022
DPT-HB-Hib 3 JAWA TIMUR
94.22
82.057 80.12 -16.47
PAPUA
JAWA TENGAH
KALIMANTAN BARAT
79.725
70.463
67.966
Kejadian Luar Biasa bahkan Wabah 3
BCG* SUL AWESI SELATAN 55.059 96.00 89.35 -6.65
KALIMANTAN SELATAN 50.338
BANTEN 34.074 Sumber: Kementerian Kesehatan, WHO SEARO, 10 Mei 2022
* Data cakupan terakhir31.528
SUL AWESI TEN GGARA
MALU KU
BCG tercatat pada 2020
31.886 c.
SUMATERA SELATAN
KALIMANTAN TENGAH
KALIMANTAN TIMU R
Terdapat 1,7 juta bayi tidak dan belum
30.473
29.862
27.135
LAMPU NG
diimunisasi lengkap selama tahun
26.082
Kejadian campak dan rubella confirmed meningkat lebih dari
LATAR BELAKANG (2)
SUL AWESI UTARA 25.954
MALU KU UTARA 23.624 2019-2021
15x lipat dibandingkan
SUL AWESI BARAT 22.141 2021
PAPUA BARAT 19.133
SUL AWESI TEN GAH 18.818
JAMBI15.969
KEPUL AUAN RIAU 14.594
KALIMANTAN UTARA 13.692
GOR ON TAL O
BANGKA BELITU NG
11.832
10.021
a. Mayoritas wilayah Indonesia berisiko tinggi
BENGKUL U
7.964
NU SA TENGGARA BARAT 5.406
BALI
4.080
terjadi penularan virus campak dan polio dan
DI YOGYAKARTA
3.445
- 50.000 100.000 150.000 200.000 250.000 300.000 350.000 telah terjadi peningkatan kasus yang signifikan di
mber: Laporan Rutin s.d 9 Februari 2022
awal tahun 2022;
b. Kasus difteri yang dilaporkan semakin meningkat
29/05/22 --> Tahun
MeiNeni_Webinar 2022
_IDAI Banyumassudah 20 provinsi yang
Sumber: Laporan Rutin s.d 9 Februari 2022
melaporkan Petunjuk tehnis BIAN, Kemenkes, 2022
 SASARAN:
PEMBERIAN 1 1. 9 BULAN s.d < 12 TAHUN :
DOSIS PROVINSI DI PULAU
IMUNISASI SELURUH SUMATERA, KALIMANTAN,
PROVINSI, SULAWESI, NUSA TENGGARA,
TAMBAHAN
MALUKU DAN PAPUA
CAMPAK RUBELA KECUALI
*KHUSUS ACEH, SUMATERA
TANPA BALI DAN TAHAP 1:
UTARA, SUMATERA BARAT,
MEMANDANG DIY RIAU DAN KEP RIAU SASARAN PROVINSI
STATUS ADALAH 9 BULAN s.d < 15 LUAR PULAU
IMUNISASI TAHUN JAWA, MULAI
SEBELUMNYA 2. 9 s.d 59 BLN: PROVINSI DI MEI 2022
PULAU JAWA
BIAN
TAHAP 2:
PROVINSI
IMUNISASI KEJAR PULAU JAWA,
Leave no one behind: UNTUK MULAI
guidance for planning and MELENGKAPI SASARAN: AGUSTUS
implementing
catch-up vaccination
STATUS
SELURUH ANAK USIA 2022
IMUNISASI ANAK BAWAH LIMA
PROVINSI
(JENIS IMUNISASI
TAHUN (BALITA)
LAIN, SELAIN
CAMPAK
RUBELA)

29/05/22 MeiNeni_Webinar _IDAI Banyumas

 General principle for vaccine scheduling
• response to a vaccine depends on:
• the type of vaccine: live-attenuated, inactivated: whole cell, subunit
• age of the recipient: the older the better
• immune status of the recipient
• Recommendations for the age at which vaccines are administered are
influenced:
• age-specific risks for disease: epidemiology
• age-specific risks for adverse event (Pertussis > 6 weeks, >7 : aP, Td
• age-specific responses to vaccination: (Polysaccharide vaccine à conjugated <2 YoA)
• potential interference with the immune response by passively transferred maternal
antibodies: measles
• Vaccines are generally recommended for members of the youngest age group
at risk for experiencing the disease for which vaccine efficacy and safety have
been demonstrated.

CDC. General Best Practice Guidelines for Immunization: Timing and Spacing of Immunobiologics . https://www.cdc.gov/vaccines/schedules/hcp/index.html
29/05/22 MeiNeni_Webinar _IDAI Banyumas
29/05/22 MeiNeni_Webinar _IDAI Banyumas
Sari Pediatri, Vol. 22, No. 4, Desember 2020
 Spacing of Multiple Doses of the Same Antigen
• Vaccines should be administered at recommended ages and in
accordance with recommended intervals between doses of
multidose antigens to provide optimal protection.
• Vaccine doses should not be administered at intervals less than
these minimum intervals or at an age that is younger than the
minimum age
• “grace period” vaccine doses administered ≤4 days before the
minimum interval or age are considered valid
• Doses of any vaccine administered ≥5 days earlier than the minimum interval
or age should not be counted as valid doses and should be repeated and the
repeat dose should be spaced after the invalid dose by the recommended
minimum interval
CDC. General Best Practice Guidelines for Immunization: Timing and Spacing of Immunobiologics https://www.cdc.gov/vaccines/schedules/hcp/index.html
29/05/22 MeiNeni_Webinar _IDAI Banyumas
 Non-simultaneous Administration of Different Vaccines
TABLE 3-4. Guidelines for spacing of live and non-live antigens

Antigen combination Recommended minimum interval between doses

Two or more non-live (a),(b) May be administered simultaneously or at any interval

between doses

Non-live and live (c) May be administered simultaneously or at any interval

between doses

Two or more live injectable(c) 28 days minimum interval, if not administered

simultaneously
Source: (83).
(a) Certain
experts suggest a 28-day interval between tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis
(Tdap) vaccine and tetravalent meningococcal conjugate vaccine if they are not administered simultaneously.
(b) In
persons with functional or anatomic asplenia, MCV-D and PCV13 should not be administered simultaneously and
should be spaced by 4 weeks. Likewise for persons with immunosuppressive high-risk conditions indicated for PCV13
and PPSV23, PCV13 should be administered first, and PPSV23 should be administered no earlier than 8 weeks later.
For persons 65 years old or older indicated for PCV13 and PPSV23, PCV13 should be administered first and PPSV23
should be administered 6-12 months later.
(c)The live oral vaccines Ty21a typhoid vaccine and rotavirus vaccine may be administered simultaneously with or
at any interval before or after non-live or live injectable vaccines.

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CDC. General Best Practice Guidelines for Immunization: Timing and Spacing of Immunobiologics https://www.cdc.gov/vaccines/schedules/hcp/index.html
Principles of catch up immunization
• assessing vaccination status and vaccinating or referring individuals
for catch-up vaccination if they have missed any doses to prevent
missed opportunities for vaccination.
• if the immunization status is not available, the vaccine should be
considered as not received
• provide optimal protection against disease as quickly as possible by
completing a person’s recommended vaccination schedule in the
shortest but most effective time frame (minimal interval)
• a catch-up schedule based on the previous documented doses the
person has received, do not start the schedule again, regardless of
the interval since the last dose (count previous doses as part of the
schedule)
https://immunisationhandbook.health.gov.au/catch-up-vaccination
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 Principles of catch up immunization

• For most vaccines, it is better to vaccinate late than never

• For some vaccines, catch-up vaccination is not recommended:
rotavirus, HiB, PCV
• As a child gets older, the recommended number of vaccine doses may
change: DPT, PCV, HPV
• Give a combined vaccines or multiple injection

29/05/22 MeiNeni_Webinar _IDAI Banyumas

Table 3: Recommendations* for Interrupted or Delayed Routine Immunization - Summary of WHO Position Papers
read the Footnote Doses for those who start vaccination late
Doses in Primary Interrupted
Antigen Age of 1st Dose Series (min interval primary Booster
between doses)** series***
age
Recommendations for all immunization programmes

BCG 1 As soon as possible after birth 1 dose NA 1 dose 1 dose Not recommended

Resume without
Birth dose <24 hrs plus 2-3
Hepatitis B As soon as possible after birth (<24h) repeating previous 3 doses 3 doses Not recommended
doses with DTPCV (4 weeks)
dose

bOPV 6 weeks Resume 5 doses (if >3 months old

5 5 doses (IPV to be given with 1st
bOPV + IPV without repeating IPV to be given with 1st & Not recommended
(3 bOPV and 2 IPV) dose & 3rd dose of bOPV)
IPV 14 weeks previous dose 3rd dose of bOPV)

Resume without
1-2 doses IPV and 1-2 doses IPV and 2 doses
Polio 3 IPV / bOPV Sequential 8 weeks (IPV 1st) repeating previous 1-2 doses IPV and 2 doses bOPV Not recommended
2 doses bOPV (4 weeks) bOPV
dose

Resume without If the primary series begins < 2 months

IPV 8 weeks 3 doses (4 weeks) repeating previous 3 doses 3 doses of age, booster to be given at least 6
dose months after the last dose

3 doses with interval of at least 4 3 boosters: 12-23 months (DTP-

DTP-containing vaccine (DTPCV) 4
weeks between 1st & 2nd dose, containing vaccine); 4-7 years (Td/DT
and at least 6 mos between 2nd containing vaccine), see footnotes; and
Resume without & 3rd dose 9-15 yrs (Td containing) (if > 7 yrs use
6 weeks (min) 3 doses (4 weeks) repeating previous 3 doses only aP containing vaccine)
dose (if > 7 yrs use only aP containing
vaccine; if > 4 yrs Td containing If tetanus vaccination started during
vaccine is preferred and should adolescence or adulthood only 5 doses
only be used for >7 yrs) required for lifelong protection

29/05/22 Option 1 3 doses (4 weeks) Resume without 3 doses

MeiNeni_Webinar _IDAI Banyumas
1 dose None
Haemophilus
6 weeks (min) repeating previous >5 yrs not recommended if
influenzae type b 5 2-3 doses (8 weeks if 2
Recommendations* for Interrupted or Delayed Routine Immunization - Summary of WHO Position Papers

• Children aged 1 to < 7 years who have not

previously been vaccinated should receive 3 1 sd 5 tahun
doses of vaccine following a 0, 1, 6 month
schedule. Two subsequent booster doses with
an interval of at least 1 year between doses.
• Pertussis:
• <7 years of age DTwP or DTaP combinations
• ≥7 years: Only aP-containing vaccines
• Dipteri:
• 4 -6 years: Td-containing vaccine may be
used and is preferred.
• > 7 years of age only Td combinations
https://cdn.who.int/media/docs/default-
source/immunization/immunization_schedules/immunization-routine-
table3.pdf?sfvrsn=f549aec8_9&download=true

Semua vaksin jarak minimal dengan vaksin COVID 2 minggu

Petunjuk tehnis BIAN, Kemenkes, 2022
29/05/22
MeiNeni_Webinar _IDAI Banyumas
Multiple injection
• Advantages:
• protection during the vulnerable early months
• Fewer vaccination visits, reduce pain experience or discomfort.
• Increasing efficiency, coverage
• Multiple injections given together are generally well tolerated and do not increase
reactogenicity
• Administer at different site, if in the same thigh, separated by 2.5 cm
• Use a separate limb for most reactive vaccines (e.g., tetanus toxoid-containing and
PCV13)
• order of injections (administer most painful vaccine last)
• Health worker should provide reassurance, clear responses to caregiver questions and
Minimize pain during immunization

29/05/22 MeiNeni_Webinar _IDAI Banyumas

 Vaccine 38 (2020) 1962–1967

Contents lists available at ScienceDirect

Vaccine
journal homepage: www.elsevier.com/locate/vaccine

Immunogenicity and safety profile of a primary dose of bivalent oral

polio vaccine given simultaneously with DTwP-Hb-Hib and inactivated
poliovirus vaccine at the 4th visit in Indonesian infants
Eddy Fadlyana a,⇑, Meita Dhamayanti a, Rodman Tarigan a, Rini Mulia Sari b, Novilia Sjafri Bachtiar b,
Cissy B. Kartasasmita a, Kusnandi Rusmil a
a
Department of Child Health, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
b
PT Bio Farma, Bandung, Indonesia

a r t i c l e i n f o a b s t r a c t

Article history: In this study, we aimed to evaluate the immunological protectivity of infants following four doses of biva-
Received 12 August 2019 lent oral polio vaccine (bOPV; Bio Farma), which were given simultaneously with DTwP-Hb-Hib
Received in revised form 24 December 2019 (Pentabio!), along with one dose of inactivated poliovirus vaccine (IPV) at the fourth visit. A total of
Accepted 5 January 2020
143 newborn infants who fulfilled the inclusion criteria were enrolled and completed the study.
Available online 22 January 2020
Subjects received the first dose of bOPV at birth. On days 60, 90 and 120, bOPV was given simultaneously
with Pentabio!. On day 120, one dose of IPV was also administered. Serum samples for serology analysis
Keywords:
were collected before the first dose of bOPV (at day 0), before the second dose of bOPV (at day 60) and
bOPV
IPV
30 days after the last dose of bOPV. In addition, the intensity, duration and relationship of each adverse
Immunogenicity event to the trial vaccines were assessed. Seroprotection rates after the fourth dose of bOPV were 100%,
Pentabio 91.6% and 99.3% for poliovirus P1, P2 and P3, respectively. Seroconversion rates after the fourth dose of
Safety bOPV were 100.0%, 93.3% and 100% for poliovirus P1, P2 and P3, respectively. There were no severe
adverse events, and systemic reactions were generally mild during the 1–28 day post-vaccination period.
Collectively, our findings indicate that bOPV given simultaneously with Pentabio! and one dose of IPV at
the 4th visit was immunogenic and well tolerated.
" 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction is associated with sustained person-to-person transmission. These

Issues have been documented with the oral polio vaccine (OPV),
namely, the occurrence of vaccine-associated paralytic poliomyeli-
tis (VAPP) and circulating vaccine-derived poliovirus (cVDPV). The
incidence of VAPP is approximately 1 in 2.7 million doses of the
OPV. In addition to VAPP, the live poliovirus strains present in
the OPV, currently predominantly Sabin type 2, on rare occasions
can revert to a form that may be able to cause paralysis in humans
and develop the capacity for sustained circulation (cVDPV), which
Abbreviations: GMT, geometric mean titre; GPEI, global polio eradication
initiative; IPV, inactivated poliovirus vaccine; OPV, oral polio vaccine; VAPP,
vaccine-associated paralytic poliomyelitis; cVDPV, circulating vaccine-derived
poliovirus; WHO, World Health Organization.
are considered threats to polio eradication that are not issues with
the use of the inactivated poliovirus vaccine (IPV) [1]. Thus, as long
as the OPV is used, there is a risk of cVDPV causing poliomyelitis
outbreaks in unprotected communities, which would threaten
the global goal of poliovirus eradication [2,3].
With ongoing polio outbreaks in several African and Asian
countries, polio eradication remains a challenge. Since declared
to be free from polio in 2014, Indonesia has confirmed 1 case of
cVPDV1 in 2019 with onset of paralysis in 2018. African countries
such as Angola, Central African Republic, Ethiopia, Ghana, Nigeria,
Democratic Republic of the Congo, Togo and Somalia currently are
facing cVDPV outbreaks. Afghanistan and Pakistan are affected by
both wild polio virus and cVPDPV outbreaks. In 2019, cVDPV cases
also reported from several Asian countries such as Myanmar, China

Conclusion: bOPV given simultaneously with Pentabio and one dose of IPV at the 4th visit was immunogenic
⇑ Corresponding author at: Department of Child Health, Faculty of Medicine and Philippines [4].
Universitas Padjadjaran/Hasan Sadikin Hospital Jl. Pasteur No. 38, Bandung, In May 2013, the World Health Assembly endorsed The Polio
Indonesia. Tel.: +628122022002.
Eradication & Endgame Strategic Plan 2013–2018, developed by
E-mail addresses: edfadlyana@yahoo.com (E. Fadlyana), rini.mulia@biofarma.co.
the Global Polio Eradication Initiative (GPEI) to complete the

and well tolerated

Hasil: DPT-Hb-Hib + IPV menghasilkan imunogenisitas
id (R. Mulia Sari), novilia@biofarma.co.id (N. Sjafri Bachtiar).

Hasil: DPT-Hb-Hib + IPV menghasilkan

https://doi.org/10.1016/j.vaccine.2020.01.007

imunogenisitas
0264-410X/" 2020 The Author(s). Published by Elsevier Ltd.
29/05/22 MeiNeni_Webinar _IDAI Banyumas
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 Procedural Pain Management
prevent vaccine hesitancy
• Breastfeeding , sweet tasting solutions
• Position according the age:
• Infants and young children should be held by caregiver
• Older populations should sit upright
• Patients with history of fainting should be lying down
• No aspiration
• distraction
• Not recommended:
• Topical anaesthetics (effective but costly, availability, additional time)
• warming the vaccine
• manual stimulation of the injection site
• administration of oral analgesics before or at the time of vaccination.
Reducing pain at the time of vaccination: WHO position paper,2015
29/05/22 MeiNeni_Webinar _IDAI Banyumas
Case-based learning
• Ani, 12 bulan, baru mendapat vaksin Hep B lahir, BCG (1 bulan) ,
Pentabio 1, OPV 1 (2 bulan)
• Vaksin apa yang harus dikejar? Jadwal?
• Pentabio, OPV, IPV, MR?
• Rotavirus?
• PCV?
• Varicela?

29/05/22 MeiNeni_Webinar _IDAI Banyumas

11 bulan, baru mendapat vaksin Hep B dan OPV lahir, BCG (1
bulan) , Pentabio 1, OPV 1 (2 bulan)
• catch up segera, beberapa vaksin bersamaan, vaksin kombinasi,
suntikan ganda:
• DPT-Hib-HepB (2), IPV (1) dan OPV (2), MR (1)
• PCV (1)
• Rotavirus tidak boleh
• Tidak perlu mengulang,
Intramuscular dengan interval minimal Mult
• DPT-Hib-HepBSlide&Sriinjection
OPV (3): 4 minggu kemudian, booster DPT-Hib-HepB:
Rezeki
minimal 6 bulan à 18 bulan
• MR, dua dosis: MR/ MMR 18 bulan
• PCV: usia 7-11 bulan (2 dosis primer, interval minimal 4 minggu dan 1 booster,
interval minimal 8 minggu)

29/05/22 MeiNeni_Webinar _IDAI Banyumas

Budi, 7 tahun, baru mendapat vaksin Hep B lahir, BCG ingin
mengejar vaksinasi

• DPT:
• 3 dosis dasar, dan 2 booster: interval 0,1 dan 6 bulan, 1tahun
• 7 tahun: Td, aP
• Polio:
• IPV 3 dosis, interval 4 minggu atau OPV 3 dosis dan 1 (2) IPV
• MR:
• 2 dosis, interval 4 minggu
• MR/ MMR
• PCV? à tidak direkomendasikan kecuali anak dengan risiko tinggi

29/05/22 MeiNeni_Webinar _IDAI Banyumas

Take home messages
• Setiap kesempatan periksa anak lihat dan tentukan status imunisasi
• Bila belum lengkap lakukan kejar vaksin segera, menggunakan vaksin
kombinasi, suntikan ganda, tidak perlu mengulang dari awal,
menggunakan interval minimal yang direkomendasikan
• Suntikan ganda menghasilkan perlindungan dan keamanan yang sama
dengan vaksin terpisah, memberi kesempatan anak terlindungi tepat
waktu, mengurangi trauma anak, dan meningkatkan efisiensi dan
cakupan vaksinasi.

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