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CURRICULUM VITAE

Nama : dr. AGUS JOKO SUSANTO, SpPD, K-AI, FINASIM


Tempat/tanggal lahir : Wonogiri, 6 Desember 1973
Agama : Islam
Istri : dr. Dyah Rohmania Agustiana
Alamat kantor : Divisi Alergi Imunologi Klinik-KSM Ilmu Penyakit Dalam
RSUD dr. Moewardi/FK UNS Surakarta
Alamat rumah : Jl. Garuda 43 RT 1/RW 2 Triyagan, Mojolaban, Sukoharjo
Email : agusjoko.susanto4@gmail.com

RIWAYAT PENDIDIKAN

1. Dokter umum Tahun 1999 FK UNS Surakarta


2. Dokter Spesialis Penyakit Dalam Tahun 2010 FK UNS Surakarta
3. Dokter Spesialis Konsultan Tahun 2017 FK UI Jakarta
Alergi Imunologi Klinik

RIWAYAT PEKERJAAN

Tahun Nama Instansi Jabatan


3. Dokter Spesialis Konsultan Tahun 2017 FK UI Jakarta
Alergi Imunologi Klinik

RIWAYAT PEKERJAAN

Tahun Nama Instansi Jabatan

Tahun 1999-2000 RS Keluarga Ibu, Tangerang Dokter Umum


Tahun 2000-2003 Puskesmas Pagerbarang, Tegal Kepala Puskesmas
Tahun 2003-2005 RSI Muhammadiyah Dokter Umum
Jatibarang, Brebes
Tahun 2003-2005 Bapel JPKM Kabupaten Tegal Kepala Bapel JPKM
Tahun 2010-2012 Bagian IPD RSUP dr. Sardjito/ Staf Bagian
FK UGM Yogyakarta
Tahun 2013-Sekarang Bagian IPD RSUD dr. Moewardi/ Ketua Divisi Alergi
FK UNS Surakarta Imunologi Klinik
Tahun 2013-Sekarang Tim Pelaksana Uji Coba Kurikulum Anggota
Pendidikan Klinis FK UNS
Tahun 2014-2015 Program Studi Profesi Dokter FK Sekretaris
UNS
Tahun 2014-Sekarang Tim Perawatan Paliatif RS Moewardi Anggota
Tahun 2017-Sekarang Tim Verifikator Internal RSDM Anggota

KEANGGOTAAN
Keanggotaan Mulai Tahun
Keanggotaan Tahun
EAACI
PAPDIAlergi Imunologi
Cabang Eropa
Surakarta 2017-sekarang
2010
PERALMUNI Indonesia
PERALMUNI Cabang Surakarta 2015-sekarang
2015
PERALMUNI Cabang Surakarta
IDI Cabang Sukoharjo 2015-sekarang
2008
FINASIM
FINASIM 2014-sekarang
2014
PAPDI Cabang Surakarta
PERALMUNI Indonesia 2010-sekarang
2015
IDI Cabang Sukoharjo 2008-sekarang
ADULT VACCINATION
( DIPHTHERIA : a Current Issue )

dr. Agus Joko Susanto, SpPD,K-AI, FINASIM

Allergy and Clinical Immunology Division


Internal Department-Moewardi Hospital/Sebelas Maret University
“Every year, tens of thousands of adults and hundreds of
thousands more are hospitalized due to diseases that
could be prevented by vaccination.”

Clin Infect Diseases 2007;44:1529-31


Rationale for Adult Vaccination
Why Vaccinate Adults?
Elderly (>60 y.o.)- waning immunity : important in tetanus,
pertussis, flu

Chronic diseases (diabetes, asthma, heart disease)—prone to


complications in flu and pneumococcal diseases

Occupational hazards- health workers, laboratory workers,


soldiers, college students-transmission of flu,meningococcal
diseases,hepatitis A and B, varicella

Pregnant women-increased risk for complications of influenza

1.Zimmerman RK, et. al. ed.Vaccines Across the Life Span. 4th ed. 2007
2. AAP. Pickering LK, ed. Red Book:2003 Report og the Committee on Infectious
Diseases. 26th ed. Elk Grove Village,IL: AAP;2003:68
3. CDC. Pink Book, 10th ed, 2008
Who needs vaccination?
 Every individual, children or adults
 High risk group1,2,3,4,5
 Elderly >65 years old
 Individual with chronic diseases
 Institutionalized people
 Pregnancy on the 2nd and 3rd trimester
 People who are at risk infecting the high risk group1,2,3,4,5
 Mothers/nurses/baby sitters of babies age 0-23 months old
 Healthcare workers
 Currently, there are ±1 billion world population considered to
be high risk group6
 Hajj Pilgimage7
1. MMWR 2002; 51 (RR-3): 1–31
2. Can Commun Dis Rep 2001; 27: 1-24
3. Influenza immunisation programme 2007/2008. Department of Health, UK. Available from:
http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=137431&Rendition=Web [Accessed on December 18th, 2007]
4. Influenza. In: Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Hamborsky J, McIntyre L, Wolfe S,
eds. 10th ed. 2nd printing, Washington DC: Public Health Foundation, 2008. p.235-56. Available at: http://www.cdc.gov/vaccines/Pubs/pinkbook/downloads/flu.pdf
5. Van Essen GA, Palache AM, Forleo E, Fedson DS. Vaccine 2003; 21: 1780–5
6. WHO 56th World Health Assembly. Influenza: Report by Secretariat. WHO 2003; A56/23; 7. Weekly Epidemiological Record (WHO), 3 Nov 2006
Influenza Surveillance
Use of Seasonal Influenza Vaccine in Asia Pacific Region
Invasive Pneumococcal Disease
Incidence by Age Group, 1998 and 2002

1998 2002
250
200
Rate *

150
100
50
0
<1 1 2-4 5-17 18-34 35-49 50-64 65+

Age Group (Yrs)

* Rate per 100,000 population


CDC, Pink Book, 10th ed, 2008
Source: Active Bacterial Core Surveillance/EIP Network
Pneumonia in Elderly

INCIDENCE & MORTALITY


Incidence : 4 to 8 /1 000 per year
Mortality : 40 %

COMORBIDITY
Heart disease, lung, kidney, DM
Poor nutrition, Immunologic disorder
DIFFICULT TREATMENT
Clinical manifestation
Carefull use of antibiotic
Type of Vaccines
Type of Vaccines

Live attenuated vaccines


Killed inactivated vaccines
Recombination
Toksoid
Plasmid DNA Vaccines
Type of Vaccines

Virus Vaccine
• Live attenuated
• Killed inactivated
• Sub unit
Bacteria Vaccine
• Whole cell
• Toxoid
• Sub-unit
• Polysaccharide

Combination Vaccine
Vaccines Administration
Preparation
 Screening
 Vaccine safety and risk communication
 Atraumatic care:
- Positioning & Comforting Restraint
- Pain Control
 Infection control
 Vaccine preparation
- Equipment Selection
- Inspecting Vaccine
- Reconstitution
- Prefilled Syringes
- Labelling

Epidemiology and Prevention of Vaccine-Preventable Diseases. Appendix D Vaccine Administration. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
Screening Questions Example
 Is the child (or are you) sick today?
 Does the child (or are you) have an allergy to any
medications, food, or any vaccine?
 Has the child (or are you) had a serious reaction to a
vaccine in the past?
 Is the child/teen (or are you) pregnant or is there a
chance she could become pregnant during the next
month?

 Does the child (or are you) have cancer, leukemia, AIDS,
or any other immune system problem?

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
Subcutaneous injection

Epidemiology and Prevention of Vaccine-Preventable Diseases. Appendix D Vaccine Administration. National Center for Immunization and Respiratory
Diseases. CDC. Revised April 2009.
Intramuscular injection

Epidemiology and Prevention of Vaccine-Preventable Diseases. Appendix D Vaccine Administration. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
Vaccine Safety
VACCINE SAFETY

CONTRAINDICATION
A condition in a recipient that greatly increases the chance of a
serious adverse reaction

PRECAUTION
A condition in a recipient that might increase the chance or
severity of an adverse reaction, or
Might compromise the ability of the vaccine to produce immunity

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization
and Respiratory Diseases. CDC. Revised April 2009.
Contraindications and Precautions

Permanent contraindications to vaccination:


• Severe allergic reaction to a vaccine component or
following a prior dose

• Encephalopathy not due to another identifiable cause


occurring within 7 days of pertussis vaccination

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization
and Respiratory Diseases. CDC. Revised April 2009.
Vaccine Adverse Reactions

• extraneous effect caused by


Adverse vaccine

reaction • side effect


• reactogenicity

• any event following vaccination


Adverse • may be true adverse reaction

event • may be only coincidental


• KIPI

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and
Respiratory Diseases. CDC. Revised April 2009.
Benefits of Adult Vaccination
Flu Vaccination in Adults Provides Cost-
Effective Benefit

0.215
ILLNESS
0.141

0.086
VISITS TO PHYSICIANS
0.05

PRESCRIBED 0.067
MEDICATIONS 0.045

LOST WORK DAYS DUE 0.121


TO ILLNESS 0.082

LOST WORK DAYS DUE 0.072


TO PHYSICIAN VISITS 0.038

0 0.1 0.2
Placebo (N = 596) Vaccinated (N = 582)

Bridges CB, Thompson WW, Meltzer MI. Effectiveness of and cost-benefits of influenza vaccnation of healthy working adults: a randomized
controlled trial. JAMA 2000; 284: 1655-63
HBV Disease Burden in the United States

 Prevaccine era
 estimated 300,000 persons infected annually, including
24,000 infants and children

 2005
 estimated 51,000 infections

CDC, Pink Book, 2008


Qureshi H, dkk  2070 jemaah haji Pakistan 1999
54% mendapat vaksinasi influenza
selama pengamatan 33 hari:

Vaksinasi Tidak vaksinasi


Influenza Like Illness 34% 64%
Antibiotik 18% 41%
Recommended Immunization
Schedules for Adults
Sejarah Satgas Imunisasi Dewasa

 Kongres PAPDI Manado 2003 : Konsensus Imunisasi Dewasa


 Pembentukan Satgas Imunisasi Dewasa
 Pelatihan Imunisasi Dewasa di beberapa kota untuk tenaga dokter
 Pelatihan Imunisasi Dewasa untuk dokter perusahaan
 Menerbitkan buku Pedoman Imunisasi Dewasa
 Konsensus bersama : influenza, HPV
Actions to Strengthen Implementation of Adult
Immunization

 Increase demand for adult immunization by improving public


and provider (doctor) awareness

 Strengthen health care systems to deliver vaccines to adults


and adolescents

 Surveillance

 Research studies

Clin Infect Diseases 2007;44:1529-31


Factors that Would Influence Unvaccinated High-risk
Individuals to Accept Vaccination
If my doctor suggested it
-
If I knew about its effectiveness -
If I received a reminder letter
-
If I was provided with free vaccine -
If I saw information about vaccination -
If I heard information about vaccination -
If my pharmacist suggested it -
If I knew someone who has it yearly -
-
If I became at risk
-
None
-
Don’t know
Other -
0 10 20 30 40 50 60 70
% respondents
Health Care Workers, Influenza Vaccination
 Variation between Asia Pacific countries
 Hongkong 20-50%
 Korea, Taiwan 80-90%
 New Zealand 35%
 Singapore 39%
 Australia 26-38%
 Indonesia less than 10%
Vaccination in Special Condition
INTRODUCTION
Advanced in medicine, science and technology lead
population with altered host defenses

In US reported :
– 2001 – 40 000 cases HIV infection
– 2002 – 1 284 900 cases cancer
– 23 848 cases solid organ transplant
– 20 000 hematopoetic stem cell transplant
Indonesia data ?
– Mei 2008 270,000 HIV infection
– Selected immunocompromised persons
Vaccination of Hematopoietic
Stem Cell Transplant Recipients
 Antibody titers to VPDs decline during the 1-4
years after allogeneic or autologous HSCT if the
recipient is not revaccinated
 HSCT recipients may be at increased risk of
some VPDs, particularly pneumococcal disease
 Revaccination recommended beginning 6-12
months post-transplant
http://www.cdc.gov/mmwr/PDF/rr/rr4910.pdf
Hepatitis B in
haemodialysis patients
End-stage renal disease (ESRD)
haemodialysis
patients are at high risk due to:
• prolonged vascular access
• frequent hospitalisations and surgical procedures
• immunocompromised status

Majority develop chronic infection

CDC, MMWR Recomm Rep 2001; 50: 1–43


Vaccination of Household Contacts of
Immunosuppressed Persons

 Healthy household contacts of immunosuppressed persons


should receive MMR and varicella vaccines and annual
influenza vaccination

Epidemiology and Prevention of Vaccine-Preventable Diseases. Chapter 2 General Recommendation. National Center for Immunization and Respiratory Diseases. CDC.
Revised April 2009.
DIPHTHERIA
Tetanus, Difteri, Pertusis (Td/Tdap)
Pemberian booster Td/Tdap sangat penting sehubungan dengan
wabah Difteri yang terjadi di beberapa daerah dan waning
immunity pascavaksinasi Pertusis.

Orang dewasa menggunakan Vaksin Td/Tdap, yang merupakan


vaksin DTP dengan reduksi antigen Difteri dan Pertusis. Tdap
menggunakan komponen pertusis aseluler (bukan whole-cell),
sehingga kurang reaktogenik.

Untuk mencegah Tetanus Neonatorum, status imunisasi Tetanus


bagi WUS (Wanita Usia Subur) dan calon pengantin perempuan
juga harus diperhatikan.
Conclusions
– Adults also need protection from vaccine-preventable
diseases

– Adult vaccination contribute to decreasing the burden


of most infectious diseases

– Several bodies recognize the importance of


implementing immunization policies and schedules for
adults
THANK YOU