kuliah imunisasi by rinmion

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  Kuliah Blok VII (Infeksi –Imunologi) FK UNSRI
                Palembang, Juli 2009
At the end of this lecture the student should be able to describe:
• Active and Passive Immunizations
• Types of Vaccines (eg.‘whole-cell’ vaccines and subunit vaccines).
• Use of Adjuvants in Immunization.
• Problems in Immunization
     – Understand the term “Cold-chain monitoring” and storage
       conditions for the different types of vaccines.
     – Mode of Administration
     – Contraindications in Immunizations (side-effects).
• The Extended Program of Immunization (EPI) in Indonesia.
     – Targeted-Immunizable Diseases in Indonesia
     – Immunization schedule
• Immunization
  – remarkably successful
  – very cost-effective

  – Infectious disease
• Immunity and Immunization
• Immunity to contagious disease  protect individu from
   – Types of Immunity:
       • Innate immunity
       • Acquired immunity
           – Active immunity  organism exposure, vaccine
           – Passive immunity  temporary, maternal
             antibody transmission to fetus, immune
             globulins or antitoxin
• High immunization rates  reduced incidence
  of diphtheria, measles, mumps, polio, rubella,
  Tetanus, and Haemophilus influenzae type b
  disease (Table)
Table. Baseline 20th Century Annual Morbidity and 2004 Morbidity From 10 Diseases With Vaccines
Recommended Before 1990 for Universal Use in Children: United States

       Disease            Baseline 20th Century        2004 Morbidity       % Dicrease
                            Annual Morbitiy
      Smallpox                     48 164                      0                 100
      Diphtheria                  175 885                      0                 100
       Pertusis                   147 271                   25 827                82
       Tetanus                      1 314                     34                  97
     Poliomielitis                 16 316                      0                 100
       Measles                    503 282                     37                 >99
        Mumps                     152 209                    258                 >99
       Rubella                     47 745                     10                 >99
 Congenital rubella                  823                       0                 100
         syndr                     20 000                    196                 >99
 H. Influenza type b
  Basic Principle of Immunization

• Produce antibody (immune globulins)
• Activates limphocyte and macrofag
        Defining Aims / Goals
 Prevention of disease in individuals or groups
                (immediate goal)

Reducing prevalence of disease (changed disease

     Eradication of disease (ultimate goal)
            Defining Aims / Goals
Potential goals for reducing vaccine-preventable disease
burden: eradication, elimination, or control
   – reduction of the worldwide incidence of infection by a
     specific agent to zero as a result of deliberate efforts;
   – intervention measures are no longer needed
             Defining Aims / Goals
• Elimination:
   – reduction to zero, or to the level at which it is no longer
     a public health problem, of the incidence of a specified
     disease, or of infec-tion caused by a specific agent, in a
     defined geographic area;
   – continued intervention measures are required to
     prevent reintroduction.
• Control:
   – reduction of disease incidence, prevalence, morbidity,
     or mortality.
   – Continue intervention  maintaining reduction
         Defining Aims / Goals

• Herd immunity:
  – indirect protection observed in the
    unimmunised segment of a population in
    which a large proportion is immunised
Tujuan Imunisasi
    Definition and General Concept
• Vaccination:
   – administration of any vaccine or toxoid (inactivated toxin)
     for prevention of disease.
• Immunization:
   – process of inducing immunity artificially by either
     vaccination (active immunization) or administration of
     antibody (passive immunization).
   – Consist of:
      • Active immunization
      • Passive immunization
 Definition and General Concept
– Active immunization:
   • administration of all or part of a microorganism or a
     modified product of that microorganism (eg, a toxoid,
     a purified antigen, or an antigen produced by genetic
     engineering) to evoke an immunologic response that
     mimics that of natural infection but that usually
     presents little or no risk to the recipient.
   • stimulating the immune system to produce antibodies
     and cellular immune responses that protect against
     the infectious agent.
  Definition and General Concept
– Passive immunization:
   • provides temporary protection through
     administration of exogenously produced
     antibody, such as immune globulin.
   • also occurs naturally through transplacental
     transmission of antibodies to a fetus, which
     provides protection against many infectious
     diseases for the first several months of the
     infant's life.
   Definition and General Concept
• Immunizing agents  protection against disease:
   – Nearly complete lifelong protection
   – Partial protection
• Immunizing agents include vaccines, toxoids,
  antitoxins, and immune globulins derived from
  human or animal donors (Table 1.)
            Definition and General Concept
Table 1. Immunizing Agents
 Agent                                       Definition
Vaccine     A preparation of proteins, polysaccharides, or nucleic acids of pathogens
            that are delivered to the immune system as single entities, as part of
            complex particles, or by live-attenuated agents or vectors, to induce
            specific responses that inactivate, destroy, or suppress the pathogen

Toxoid      A modified bacterial toxin that has been made nontoxic but retains the
            capacity to stimulate the formation of antitoxin
Immune      An antibody-containing solution derived from human blood obtained by
globulin    cold ethanol fractionation of large pools of plasma and used primarily for
            the maintenance of immunity of immunodeficient persons or for passive
            immunization; available in intramuscular and intravenous preparations

Antitoxin   An antibody derived from the serum of humans or animals after
            stimulation with specific antigens; used to provide passive immunity
             Definition and General Concept
• Most immunizing agents contain preservatives, stabilizers,
  antibiotics, adjuvants, and a suspending fluid (Table 2).
  Component                          Use and Examples
 Preservatives, Constituents can inhibit or prevent bacterial growth or
 stabilizers,   stabilize the antigen. Materials such as mercurials or
 antibiotics    antibiotics are used. Allergic reactions to any of the
                additives may occur.
 Adjuvants      An aluminum salt is used in some vaccines to enhance the
                immune response (e.g., toxoids, hepatitis B).
 Suspending     Sterile water, saline, or more complex fluids derived from
 fluid          the growing media or biologic system in which the agent is
                produced (e.g., egg antigens, cell culture ingredients,
                serum proteins).
             Vaccine Preventable Disease
               Type of   Incidence
Disease       Organism     (2000)  Mode of Transmission                      Symptoms                       Complications
Diphtheria    Gram-         1        Person-to-person direct     Sore throat, fever.               Potential respiratory
              positive               contact or contact with     Characterized by formation of     distress.
              bacteria               airborne droplet usually    yellow-white membranes on tonsils
                                     affects children under 15   and pharyngeal walls.
Haemophilus Gram-          1,398     Person-to-person            Bacteria may cause otitis media,       Bacterial meningitis;
influenzae b negative    (invasive   contact or droplet.         sinusitis, epiglottis and upper        most cases of invasive
             bacteria    disease)                                respiratory infections.                disease occur in
                                                                                                        children 3 months to 3
                                                                                                        years of age.
Hepatitis B   Virus       8,036      Exposure to infected        General flu-like symptoms (may be Chronic hepatitis;
                                     blood or body fluids. In    asymptomatic). Liver may be        cirrhosis; liver cancer.
                                     children primarily          enlarged, dark urine, light stool,
                                     prenatally spread.          jaundice. Symptoms last 4-6 weeks.
Measles       Virus         86       Person-to-person            Flu-like symptoms, high fever          Pneumonia and
                                     contact or droplet.         (greater that 101), cough, and         encephalitis. Persons
                                                                 conjunctivitis. Rash usually starts    allergic to eggs may
                                                                 on the face and spreads to the         have severe reactions to
                                                                 body. Koplik’s spots in the mouth      the vaccine.
                                                                 are bluish with very fine red spots.
               Vaccine Preventable Disease
               Type of   Incidence
Disease       Organism     (2000)      Mode of Transmission                   Symptoms                       Complications
Mumps         Virus          338      Person-to person contact     Low-grade fever, headache,            Infrequent complications
                                      or droplet. Communicable     earache, pain and swelling of         are encephalitis and
                                      6 days before to 9 days      parotid glands (may be unilateral     meningitis. Orchitis may
                                      after swelling. Most often   or bilateral). Swelling lasts about   occur in males who
                                      occurs in children.          a week.                               have reached puberty,
                                                                                                         but sterility is rare.
Pertussis     Gram-         7,867     Person-to person contact     Characteristic cough is               Infants younger than 1
              negative                or droplet. Very             nonproductive with quick              year are severely
              bacteria                contagious.                  expiratory phase followed by          affected. Pneumonia,
                                                                   inspiratory "whoop." Small scleral    seizures, and ear
                                                                   and conjunctival hemorrhages          infections may occur.
                                                                   can occur because of severe
Pneumococcus Gram-       Not a        Person-to-person, likely     Causes otitis media, sinusitis,    Pneumonia meningitis
             positive    reportable   by droplet contact; in       and invasive bacterial infections.
             bacteria    disease      many persons are
                                      colonized in the upper
                                      respiratory tract.
Polio         Virus           0       Direct contact of virus with Low-grade fever and sore throat       Muscle weakness
                                      mouth.                       (most cases are asymptomatic).        progressing to paralysis
                                                                                                         in 0.1-2% of cases. May
                                                                                                         affect any muscle group
                                                                                                         including limbs and
                                                                                                         respiratory muscles.
                                                                                                         Adults may develop
                                                                                                         postpolio syndrome 30-
                                                                                                         40 years after the
          Vaccine Preventable Disease
             Type of     Incidence
Disease     Organism       (2000)        Mode of Transmission                    Symptoms                    Complications
Rubella Virus              176       Person-to-person contact or       Mild in adults and young          Severe complications in
                                     droplet. Communicable 4 days      children; macular rash on         early fetal
                                     before to 4 days after rash       scalp, trunk, and limbs lasting   development—may
                                     appears. Highly contagious.       1-3 days.                         result in congenital
                                                                                                         malformations and
                                                                                                         death. Vaccine is live so
                                                                                                         it must NOT be given to
                                                                                                         pregnant women.
Tetanus Neurotoxin          35       Exposure of wound to the          Severe generalized muscle
        produced by an               bacterium. Deep-puncture          spasms.
        anaerobic,                   wounds are at greatest risk.
        Gram-positive                Neonatal tetanus results from
        bacteria                     contamination of the umbilical
Varicella Virus           27,382     Person-to-person contact or       Low-grade fever, listlessness.    Grandparents and older
                                     contact with airborne droplets.   Lesions appear within 2-4         adults should avoid
                                     Very contagious.                  days. Rash has three phases:      caring for children
                                     Communicable 2 days before to     raised spots, fluid-filled        because they may
                                     6 days after vesicles appear.     vesicles, and scabs. Rash         develop herpes zoster
                                     Primarily affects children.       itches and is found over entire   (shingles).
                   Types of Vaccine
                     Bacterial Vaccine                Viral Vaccine

Heat-sensitive   BCG                          OPV
  vaccines                                     Measles

  Freeze-                                      MMR
  sensitive                                    Varicella
                                               Yellow   fever
                 Diphtheria   Meningococ     Influenza
                 Tetanus      Pneumococ      IPV          Rabies
  vaccines       Pertusis     Hib                          Hepatitis B
                 Cholera      Typhoid   Vi                 Hepatitis A
            Types of Vaccine
• Vaccine
  – Live-attenuated or killed microorganisms
  – Inactivated products
  – Specific component
  – Recombinant DNA segmen
           Types of Vaccine
• Live attenuated vaccine:
  – Virus atau bakteri liar yang dilemahkan
    (attenuated) di lab, biasanya dengan
    pembiakan berulang-ulang
  – Mampu replikasi & menimbulkan kekebalan,
    tidak menyebabkan sakit
  – Respons imun pejamu ~ infeksi alamiah
    primer  lifelong immunity
            Types of Vaccine
• Inactivated vaccine:
  – Bakteri / virus dibiak  dibuat tidak aktif
  – Keseluruhan atau fraksi virus / bakteri
  – Basis vaksin fraksi: protein atau polisakarida
  –  lifelong immunity (-)  perlu booster
    secara berkala
          Types of Vaccine
• Inactivated vaccine:
    • Whole organism
    • Purified protein atau antigen polisakarida
      dari whole organism
    • Purified antigen yang dihasilkan dari
      genetically altered organism
    • Chemically modified antigen
    Vaccine Recomendations
• Development of recomendations and
  schedule for vaccine administration:
  – epidemiology of the disease,
  – age-specific morbidity and mortality,
  – vaccine immunogenicity,
  – risks of vaccine-related adverse reactions,
  – cost effectiveness,
  – ages of recommended routine health care
    Vaccine Recomendations
• Priority:
  –delivering the primary childhood
   immunization series and
  –protecting adult women and their
   newborns against tetanus.
      Vaccine Recomendations
• Each country has each own policies
   – Indonesia:
       • PPI (Program Pengembangan Imunisasi):
          – BCG, Polio, Hepatitis B, DPT, Campak
       • IDAI (Ikatan Dokter Anak Indonesia):
          – PPI (diwajibkan)
          – Non PPI (dianjurkan)
            Vaccine Recomendations
• Expanded Program of Immunization (EPI) or Pengembangan Program
  Imunisasi (PPI)
   – Goverements’ program in immunization to achieve international
     commitment: Universal child immunization (UCI):
       • Polio eradication = ERAPO
       • Maternal and neonatal tetanus elimination
       • Measles reduction
       • Improve immunization service quality
       • Establish safe injection practices standard
       • Safe waste disposal management
Vaccine Recomendations

• PPI              • Recommended
   • BCG              • Hib
   • DTP              • MMR
   • Polio            • Hepatitis A
   • Measles          • Typhoid
   • Hepatitis B      • Influenza
                      • IPD
                      • Rotavirus
       Vaccine Recomendations
• Immunization schedule in Indonesia 
  recommended by IDAI (non PPI) and
  government (EPI/PPI) (Table 4 dan Table 5)
Vaccine Recomendations
Vaccine Recomendations
Vaccine Recomendations
Vaccine Recomendations
Vaccine Recomendations
Vaccine Recomendations
                BCG Vaccine
• Live attenuated Mycobacterium bovis
• Administration:
   – < 2 month, repeated BCG not recommended
   – > 3 month, tuberculin test to screen TB infection
• Store:
   – Reconsituted, 2-8oC (not in freezer), only 3 hours
   – Dried: 2-8oC, better in freezer
   – Protected from light
                  BCG Vaccine
• Contraindication:
   – HIV, immunocompromise, steroid th,
     immunosuppresive th, radioth, bonemarrow or lymph
     node, skin infection malignancy, severe malnutrition,
     high fever, skin infection
• Protection
   – 8 – 12 weeks after vaccination
   – Level of protection only 42% (WHO 60-78%)
   – 70% severe TB have BCG scar
   – Adult: positive AFB 25-36% regarding BCG (+)
BCG Vaccine
BCG Vaccine
BCG Vaccine
BCG Vaccine
              Oral Polio Vaccine
• Live attenuated vaccine
   – Poliomyelitis virus type 1,2,3, Sabin Strain
• Store:
   – Before opened: -20oC  2 years;
                       2 – 8oC  6 months
   – After opened: 2 – 8oC  7 days
• Side effect
   – < 1%: headache, diarrhea, or muscle pain
   – VAPP & VDPP
   – 2-4/1 million children immunized: VAPP
       Oral Polio Vaccine
  – routine immunization coverage ↑,
  – NID/PIN 3 yr,
  – AFP surveilans,
  – mopping up,
  – polio certification
• Mopping up:
  – Polio (+)
  –  stop wild polio virus transmision
Oral Polio Vaccine
Oral Polio Vaccine
Oral Polio Vaccine
    Inactivated Polio Vaccine (IPV)
• Imovax, killed polio virus
• Gut mucosal immunity <
• VAPP and VDPP risk (-)
• Store:
   – 2 – 8oC  3 years
• Seroconversion: IPV > OPV (Kenya)
• Already used in developed country since 2002
• When using IPV?
   – Immunization coverage > 90%
   – High AFP coverage (AFP rate ≥ 2)
   – Wild polio virus (-) for 3 years
                    DTP Vaccine
• Diphtheria & tetanus: purified toxoid
• Pertusis: killed bacteria, adsorbed in Al phosphat
• Each 1 ml: 40 Lf Td, 24 OU pertusis, 15 Lf TT, Al phosphat
  3 mg, thimerosal 0,1 mg
• Store & transport vaccine in 2 – 8oC, should never be
• Vaccine has been damaged by freezing?  shake test
• Contraindication:
   – Anaphylaxis history
   – Post DTP encephalopathy
DTP Vaccine
                 DTP Vaccine
• Dose: 3x, 2 month, interval 4-6 week
• Repeat dose:
   – 18-24 month
   – 5-7 year (DTP)
   – 12 year (BIAS)
• Level of protection:
   – Diphtheria:
      • 1st dose: 71-94%  protection level (<0,01
      • 3rd dose: 68-81%  protection level
   – Pertusis:
      • 3rd dose: 65,8-80% protective
   – Tetanus
      • 3rd dose: 65-80% protective
DTP Vaccine
DTP Vaccine
Tetanus Toxoid Vaccine
          Tetanus Toxoid Vaccine
• Goal:
   – Neonatal tetanus elimination
   – Prevent tetanus
• Tetanus immunization target: > 5x
   – 3 doses (infant) + 2 doses (adult)
   – 4th dose (18-24 month)  immunity > 5 yr
   – 5th dose (7 yr)  immunity > 10 yr
   – 6th dose (12 yr; TD or TT)  immunity > 20 yr
Tetanus Toxoid Vaccine
Tetanus Toxoid Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
                  Heat marker /
                  Vaccine Vial
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
Hepatitis B Vaccine
DPT-Hep B Combo Vaccine
DPT-Hep B Combo Vaccine
                 Heat marker /
                 Vaccine Vial
Measles Vaccine
Measles Vaccine
Measles Vaccine
Measles Vaccine
Mumps-Measles-Rubella Vaccine
Vaksin Mumps-Measles-Rubella
MMR Vaccine
Hib Vaccine
              Prosedur Vaksinasi
• Penyimpanan & transportasi vaksin
• Persiapan alat & bahan: untuk vaksinasi & mengatasi
  gawat – darurat
• Persiapan pemberian:
   – Anamnesis, umur, jarak dengan vaksinasi
     sebelumnya, riwayat KIPI, indikasi kontra dan
     perhatian khusus
   – Informed consent: manfaat, risiko KIPI
   – Pemeriksaan fisik
        Prosedur Vaksinasi
• Cara pemberian:
  – Dosis, interval
  – Lokasi, sudut, kedalaman
• Pemantauan KIPI
• Sisa vaksin, pemusnahan alat suntik
• Pencatatan
   Prosedur Vaksinasi

 Vaksin = produk biologis

   Rentan/ mudah rusak

Mengurangi efektifitas vaksin
          Prosedur Vaksinasi

Faktor-faktor yang mengurangi efektivitas
      Jenis Vaksin
      Paparan suhu yang tidak sesuai
      Waktu penyimpanan/ batas
      Paparan sinar matahari langsung
    Penyimpanan dan Distribusi
Vaksin bakteri/ virus inaktif:
 Vaksin yg sangat sensitif thd panas/sinar
  dibuat berupa bubuk ( freeze-dried powders)
 Vaksin (yang bukan cairan) dapat disimpan di
  freezer atau pd +2°C sampai +8°C
 Setelah dicampur segara disuntikkan;
 Vaksin OPV/polio Sabin simpan beku
 Penyimpanan dan Distribusi

Vaksin Ajuvan
Berupa suspensi yg Ag diadsorbsi oleh
garam Al (Al salts)
Simpan pada suhu +2oC to + 8oC

   Penyimpanan dan Distribusi
 Vaksin Sensitif / Labil pada Suhu Ruangan
     BCG (Bacille Calmette-Guérin)
     Measles-mumps-rubella (MMR)
     Oral Polio Vaccine (OPV)
     Varicella
     Yellow fever
     Semua vaksin rekonstitusi
    Penyimpanan dan Distribusi
   Diphtheria-tetanus-pertussis
   Haemophilus influenzae type b
   Hepatitis B
   Hepatitis A
   Vaksin Influenza
   Pneumococcal (polysaccharide and conjugate)
   Meningococcal (polysaccharide and conjugate)
   Semua vaksin kombinasi
   Pelarut vaksin
     Penyimpanan dan Distribusi
 Vaksin yang sensitif pada paparan sinar
   BCG (Bacille Calmette-Guérin)
   Vaksin rekonstitusi measles-Mumps-Rubella
   Oral Polio Vaccine (OPV)

   Semua vaksin akan rusak bila terkena sinar
             matahari langsung
  Penyimpanan dan Distribusi


Amati adakah perbedaan bentuk vaksin
yang terpapar panas atau beku dengan
vaksin yang tersimpan baik, selama kurang
lebih 30-60 menit
       Penyimpanan dan Distribusi

DPT, TT dan hepatitis B dapat
rusak karena beku.

Dengan mengocok 2 vial secara
bersamaan, satu yang
diperkirakan sudah pernah
beku, dan satu lagi belum,
    Penyimpanan dan Distribusi
                       Segiempat lebih terang dari lingkaran
                        Bila belum kadaluarsa: GUNAKAN

Vaccine Vial Monitor   Segiempat berubah gelap tetapi lebih
                       terang dari lingkaran sekitar.
(VVM): Cara menguji     Bila belum kadaluarsa: SEGERA
vaksin yang sudah      GUNAKAN vaksin;

terpapar panas >8°C
                       Segiempat sama warna dengan lingkaran
                        JANGAN GUNAKAN vaksin: Lapor
                       kepada pimpinan;

                       Segiempat lebih gelap dari lingkaran
                        JANGAN GUNAKAN vaksin: Lapor
                       kepada pimpinan.

               Heat marker /
               Vaccine Vial

                   VAKSIN HEPATITIS B
Perubahan warna vaksin polio
    karena perubahan pH

       Boleh diberikan

                   Heat marker /
                   Vaccine Vial

                    VAKSIN DPT-HB

                  Cold Chain
• Vaccines  sensitive to heat & freezing  kept at
  correct temperature from the time they are
  manufactured until used.
• The system used for keeping and distributing
  vaccines in good condition = cold chain.
• The cold chain consists of a series of storage and
  transport links, all designed to keep vaccines
  within an acceptable range until it reaches the
Cold Chain

• Bicara pada bayi dan anak
• Tentukan lokasi penyuntikan : paha, lengan
• Posisi bayi / anak : nyaman dan aman
• Desinfeksi
• Pegang; peregangan kulit, cubitan

• Penyuntikan: dosis, sudut, cara
• Tetesan: dosis, hati-hati dimuntahkan
• Penekanan bekas suntikan
• Membuang alat suntik bekas
• Penulisan tanggal vaksinasi di kolom yang sudah
Tempat Penyuntikan
Tempat Penyuntikan
      Kontraindikasi Imunisasi
• Anafilaksis atau reaksi hipersensitivitas berat
   KI absolut pemberian dosis vaksin
  – Alergi komponen vaksin     Vaksinasi
• Bayi dengan tanda dan gejala AIDS tidak
  boleh diberikan vaksin BCG dan yellow fever
Kontraindikasi Imunisasi
(Kejadian Ikutan Pasca Imunisasi)
               SISA VAKSIN

  – setelah dilarutkan harus segera diberikan
    dalam 3 jam(simpan dalam suhu 2 –8 ◦C)
• Polio
  – Setelah dibuka harus segera diberikan dalam
    7 hari(simpan dlm suhu 2 –8 ◦C)
                  SISA VAKSIN

  – Bila ada penggumpalan atau partikelyang tidak
    hilang setelah dikocok ����jangan dipakai
• Campak
  – Setelah dilarutkan harus diberikan dlm 8
    jam(simpan dlm suhu 2 –8 ◦C)

• Perhatikan keadaan umum
• Tunggu 30 menit di ruang tunggu
                     SAFE INJECTION
• Mengapa perlu?
   – Estimasi WHO : 30 % suntikan imunisasi tidak aman (WHO bull.
     Oktober, 1999)
   – Imunisasi rutin(Soewarta,1999: 4 propinsi): –tidak disterilkan
     : spuit 38%, jarum 23 %–alat suntik pakai ulang :krn tidak ada
     jarum (18%), tidak ada spuit (4%)
• Aman bagi
   – Yang disuntik
   – Penyuntik
   – lingkungan
                 SAFE INJECTION

 Suntikan dapat menularkan : hepatitis B, Hepatitis
  C, HIV, jamur, parasit, bakteri, menyebabkan abses
 Penyebaran melalui suntikan lebih cepat daripada
  melalui udara, mulut atau seks
                    SAFE INJECTION

 Vaksin
   Suhu > 8°C, atau VVM telah terpapar panas
   Botol vaksin bocor, retak, atau terpasang jarum
   Ada partikel dalam larutan
   Telah dilarutkan lebih dari 6 jam
   Beku : DPT, DT, TT, HepB, Hib (tidak boleh beku)
   Uji kocok tetap menggumpal (kecuali HepB atau Hib)
                SAFE INJECTION

 Alat suntik
   – Spuit disposable dipakai ulang
   – Hanya mengganti jarum
   – Tidak dibersihkan dulu langsung disterilkan
   – Hanya dengan desinfektan
   – Membakar jarum di api
   – Merebus dalam panci terbuka
   – Menyentuh ujung jarum
               SAFE INJECTION

 Cara melarutkan / pengambilan vaksin
    Cairan pelarut untuk vaksin lainatau > 8°C
    1 spuit diisi beberapa dosis sekaligus
    jarum ditinggalkan menancap di vial
    Mencampur isi 2 vial
 Lokasi, posisi , kedalaman penyuntikan
 Tidak ada alat / obat gawat -kedaruratan
                 SAFE INJECTION

 Menekan luka berdarah dengan jari (semua cairan
  tubuh dapat menularkan kuman)
 Membawa atau meletakkan alat suntik bekas
  sembarangan (tidak langsung membuang ke kotak
 Menyentuh atau mencabut jarum suntik
               SAFE INJECTION

 Menutup kembali (recapping) jarum suntik
 Mengasah jarum bekas
 Memilah-milah tumpukan jarum bekas
 Tidak ada alat / obat gawat darurat

Tidak aman bagi lingkungan: Meninggalkan alat
         suntik bekas sembarangan
 Dibakar dalam insinerator khusus (suhu 600 -1100°C)
    risiko pencemaran kecil
    Rp. 10 –30 juta, BBM / kayu bakar
 Dibakar dalam lubang atau drum
 Digiling
    Milling atau shreeding
    Serbuk masih infeksius
    375-750 alat suntik / jam
    listrik 750 w

•   Nama dagang dan produsen
•   No. lot / seri vaksin
•   Tgl penyuntikan
•   Bagian tubuh yang disuntik (deltoid kiri,
    paha kanan mis)

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