CHAPTER I

INTRODUCTION
A. Baground
During the process of growth and development, children need strong
nutritional intake, assessment of religious and cultural values, habituation of
consistent discipline and prevention efforts. One effort to prevent disease,
namely giving immunization. An understanding of immunization is needed as
a basis for providing midwifery care especially for healthy children and the
implications of the concept of immunization when treating sick children,
especially in cases of tuberculosis, diphtheria, pertussis, tetanus, polio,
measles, and hepatitis.
The short-term goal of immunization services is to prevent disease
individually or in groups, while the long-term goal is eradication or elimination
of a disease. From infectious diseases that have been found, until now in
Indonesia there are only seven types that have been tried to prevent through
immunization programs, which in turn we call "Immunization-Preventable
Diseases (PD3I)". Since the immunization program began in Indonesia in 1956,
seven types of vaccinations have been developed, namely BCG, Measles,
Polio, DPT, DT, TT, Hepatitis B.
B. Purpose
1. General Purpose
To learn about immunization
2. Special Purpose
a. Learn about immunization in Indonesia
b. Learn about the notion of immunization
c. Learn about immunization goals
d. Learn about the benefits of immunization
e. Learn about the types of diseases that can be prevented by
immunization
f. Learn about the types of immunizations
g. Learn about immunization schedules

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 CHAPTER II
REVIEW THEORY
A. Immunization in Indonesia
In Indonesia, the immunization program is regulated by the Ministry of
Health of the Republic of Indonesia. The government, responsible for setting
targets for immunization recipients, age groups and procedures for giving
vaccines to targets. The implementation of immunization programs is carried
out by government and private health service units. Private institutions can
provide immunization services as long as they fulfill the licensing requirements
set by the Ministry of Health. In Indonesia basic immunization / routine
immunization services can be obtained at:
1. Service centers owned by the government, such as Puskesmas, Posyandu,
auxiliary health centers, hospitals or maternity homes
2. Outside building services, but organized by the government, for example,
during the School Program for Child Immunization Month, National
Immunization Week, or through house-to-house visits.
3. Regular immunization can also be obtained from private practice
midwives, private practice doctors or private hospitals.
B. Understanding of immunization
Immunization is one way to prevent infectious diseases, especially
immunization-preventable diseases (PD3I), which is given not only to children
from infancy to adolescence but also in adults. The way immunization works
is by giving certain bacterial or viral antigens that have been weakened or
turned off in order to stimulate the body's immune system to form antibodies.
Antibodies actively cause or increase a person's immunity so that they can
prevent or reduce the consequences of the transmission of the PD3I. (Ministry
of Health, 2016).
Vaccines are biological products that contain antigens in the form of
weakened or still living microorganisms that have been weakened, intact or
parts thereof, or in the form of microorganism toxins that have been processed
into recombinant toxoids or proteins, which are added to other substances,

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 which give immunity actively specific to certain diseases. (Ministry of Health,
2017).
C. Immunization Goals
1. General Purpose
The decrease in morbidity, disability and infant mortality due to PD3I.
2. Special Purpose
a. Immunization Program
1) Achieving the target of Universal Child Immunization, which is at
least 80% complete immunization coverage for infants in 100% of
villages / kelurahan in 2010
2) Achievement of Maternal and Neonatal Tetanus Elimination
(incidence under 1 per 1,000 live births in one year) in 2005.
3) Eradication of polio in 2008.
4) Achievement of measles reduction (RECAM) in 2005.
b. Meningococcal Meningitis Immunization Program
Providing immunity against certain Meningococcal Meningitis,
according to the vaccine given to prospective pilgrims.
c. Yellow Fever Immunization Program
Providing effective immunity for all people who travel from or to
endemic yellow fever countries so as to prevent the entry of yellow
fever in Indonesia.
d. Rabies Immunization Program
Reducing mortality in rabies transmitting animal cases.
D. Benefits of immunization
1. For children: prevent suffering caused by disease, and possible disability
or death.
2. For families: eliminate anxiety and psychology of treatment if the child is
sick. Encourage the formation of a family if parents are sure that their child
will have a comfortable childhood.
3. For the state: improve the level of health, create a strong and resourceful
nation to continue the country's development.

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E. Types of diseases that can be prevented by immunization
1. TB (Tuberculosis).
Transmission of tuberculosis to a child can occur due to the
inhalation of sparks containing TB germs. These germs can attack various
organs of the body, such as the lungs (most often), lymph nodes, bones,
joints, kidneys, liver, or brain membranes (the heaviest). Provision of BCG
immunization should be performed on newborns up to 12 months of age,
but this immunization should be done before the baby is 2 months old. This
immunization is given only once. If this immunization is "successful," then
after a few weeks at the injection site a small lump will appear. Because
injection wounds leave a mark, then in a baby girl, the injection should be
done in the right upper thigh. Usually after a BCG injection is given, the
baby does not suffer from fever.
2. Diphtheria.
Diphtheria is an infectious disease caused by the bacterium
Corynebacterium Diphteriae. It is easily transmitted and attacks especially
the upper airways with symptoms of high fever, swelling of the tonsils
(tonsils) and visible dirty white membranes that are increasingly enlarged
and can close the airway. Diphtheria poison can damage the heart muscle
which can result in heart failure. Transmission is generally by air (betuk /
sneeze) but it can be through contaminated objects or food. The most
effective prevention is to immunize together with tetanus and pertussis
three times since the two-month-old baby with one-two-month injection
intervals. This immunization will provide active immunity against
diphtheria, pertussis and tetanus at the same time. Side effects that may
arise are fever, pain and swelling on the surface of the skin, how to
overcome it is only given febrifuge.
3. Pertussis
Pertussis or whooping cough, known as "One Hundred Cough", is a
channel infection disease caused by Bordetella Pertussis bacteria. Typical
symptoms are a persistent cough that is difficult to stop, the face becomes
red or bluish and vomiting is sometimes mixed with blood. Coughing ends

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 with a deep breath and in a high-pitched sound. Transmission generally
occurs through the air (coughing / sneezing). The most effective
prevention is to carry out immunizations together with Tetanus and
Diphtheria three times since a two-month-old baby with an injection hose.
4. Tetanus
Tetanus is a dangerous infection because it affects the nervous
system and muscles. Symptoms of tetanus generally begin with spasms of
the jaw muscles (also known as trismus or mouth spasms) together with
the onset of swelling, pain and stiffness in the muscles of the neck,
shoulders or back. Seizures rapidly propagate to the abdominal muscles,
upper arms and thighs.
5. Polio
A common symptom caused by a polio virus attack is that the child
suddenly becomes paralyzed in one of his limbs after a fever of 2-5 days.
There are 2 types of vaccines in circulation, and in Indonesia the most
common is the Sabin (weakened germ) vaccine. How to give it by mouth.
In some countries Tetravaccine is also known, which is a combination of
DPT and polio. Basic immunization is given since a new child is born or
is a few days old and then given every 4-6 weeks. Giving the polio vaccine
can be done in conjunction with BCG, hepatitis B vaccine, and DPT.
Repeat immunization is given together with DPT re-immunization. Polio
immunization will cause active immunity to Poliomyelitis disease. Polio
immunization is given four times with an interval of no less than one
month. Repeat immunization can be given before the child enters school
(5-6 years) and when leaving elementary school (12 years). How to give
polio immunization is by dropping two drops of polio vaccine directly into
the child's mouth or by using a spoon mixed with sweet sugar. This
immunization should not be given to children with severe diarrhea. Side
effects that may occur are very minimal can be in the form of convulsions.
6. Influenza
Influenza is an infectious disease that is easily transmitted and
caused by influenza virus, which attacks the respiratory tract. Virus

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 transmission occurs through the air while talking, coughing and sneezing,
Influenza is very contagious for 1-2 days before symptoms appear, which
is why the spread of the virus is difficult to stop. Contrary to popular
opinion, influenza is not a common cold that is not dangerous. The main
symptoms of infleunza are: Fever, headache, muscle aches throughout the
body, runny nose, sore throat, cough and weak body. Influenza vaccine is
given with a dose depending on the age of the child. At the age of 6-35
months it is enough 0.25 mL. Children aged > 3 years, are given 0.5 mL.
In 8-year-old children, the first dose is only 1 dose.
7. Typhoid fever
Typhoid Fever is an acute infection caused by Salmonella Typhi
which enters through the digestive tract and spreads throughout the body
(systemic), this bacterium will multiply in the intestinal lymph nodes and
then enter the blood so that it causes the spread of germs in the blood and
then spread of germs into the spleen, gallbladder, liver, lungs, brain
membranes and so on.
8. Hepatitis
Hepatitis is caused by the hepatitis B type virus which attacks the
risk groups vertically, namely babies and mothers of sufferers, while
horizontally medical personnel and medical professionals, drug addicts,
patients undergoing hemodialysis, laboratory officers, service users or
acupuncturists.
9. Meningitis
Meningitis caused by the bacterium Haemophyllus influenzae type
B or the so-called Hib B bacteria is the most common cause of meningitis
in children younger than five years. This disease is at high risk, causing
death in infants. Even if healed, not a few that cause disability in children.
Meningitis is not a new type of disease in the world of health. Meningitis
is an infection of the lining of the brain and spinal cord. The causes of
meningitis vary, say viruses and bacteria. Meningitis occurs when the
attacking bacteria become malignant, coupled with the condition of the
child's immune system that is not good, then he goes into the bloodstream,

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 continues to the lining of the brain. Tilapia has attacked the lining of the
brain (meningen) and an infection occurs, so-called meningitis.
10. Pneumococci
Diseases caused by pneumococcal germs are often also referred to
as pneumococcal disease. This disease can affect anyone with the highest
number attacking children aged less than 5 years and above 50 years of
age. There are other groups that have a high risk of pneumococcal disease
(although in terms of age not high risk), namely children with congenital
heart disease, HIV, thalassemia, and children with malignancy who are
getting chemotherapy and other medical conditions that cause reduced
immunity.
11. MMR ((Mumps Measles Rubella)
a. Mumps (parotitis or mumps)
Mumps (parotitis) is caused by a mumps virus that attacks the
salivary glands in the mouth, and affects many children and young
people. The higher the age of mumps sufferers, the more severe the
symptoms. Most people suffering from mumps are only once in a
lifetime.
Prevention of the most effective mumps is by immunization along
with measles and rubella (MMR vaccination) 2 times with a 1-2 month
injection interval. After passing childhood, mumps immunization
continues even though it has grown, along with measles and rubella
(MMR vaccination). Giving MMR immunization will provide active
immunity against mumps, measles and rubella.
b. Measles (measles)
Measles (measles) disease caused by measles virus. Symptoms of
measles are fever, chills, and runny nose and eyes. Skin rashes occur
in the form of red spots and pimples on the skin of the face, neck and
mucous membranes of the mouth. When measles rises, body
temperature can reach 40oC.
The most effective prevention of measles is measles immunization.
Measles immunization is given when the baby is 9 months old.

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 Measles can also be prevented by giving immunization as part of
MMR vaccination. After passing childhood, measles immunization
continues even though it has matured, along with mumps and rubella
(MMR vaccination). MMR immunization is given twice with a 1-2
month injection interval.
c. Rubella (German measles)
Rubella is caused by the rubella virus. Rubella results in a rash on
the skin resembling measles, inflammation of the mucous membranes,
and inflammation of the pharynx. The rubella rash usually goes away
in 2-3 days. The symptoms of rubella are headaches, stiffness in the
joints, and weakness. Rubella is usually suffered after a teenager or
adult. If a newborn or toddler is infected with rubella, it can lead to
blindness. If a pregnant woman is infected with rubella, it can affect
fetal growth. Babies are generally born with physical disabilities (deaf
blind) and mental retardation.
The most effective prevention of rubella is by immunizing together
with measles and mumps (MMR vaccination) 2 times with a 1-2
month injection interval. After passing childhood, rubella
immunization continues even though it has grown, along with measles
and mumps (MMR vaccination).
12. Hepatitis A
Hepatitis A is a disease caused by the type A hepatitis virus and
attacks the cells of the human liver. Every year in Southeast Asia, hepatitis
A cases attack around 400,000 people per year with a mortality rate of up
to 800 people. Most hepatitis A sufferers are children.
F. Types of immunization
1. There are 2 types of immune immunization, namely:
a. Active immunization
Active immunization can arise when a person is in contact with, for
example, microbes. The immune system will form antibodies and other
protection / resistance to microbes. Artificial active immunization is
where microbes, or parts thereof, are injected into someone before they

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 can do it naturally. Examples of live attenuated vaccines include
tampek, mumps, rubella, or a combination of all three in one vaccine as
MMR vaccine, yellow fever (yellow fever), chickenpox (varicella),
rotavirus, and influenza vaccine.
b. Passive immunization
Passive immunization is a pre-synthesis element of the immune
system that is transferred to someone, so that the body does not need to
make it themselves. Recently, antibodies can be used for passive
immunization. This immunization method works very fast, but also
ends quickly, because the antibodies will break apart by themselves,
and if there are no B cells to make more antibodies, they will disappear.
Passive immunization is physiological, when antibodies are transferred
from the mother to the fetus during pregnancy, to protect the fetus
before and after the birth. Artificial passive immunization is generally
given by injection and is used if there is an outbreak of certain diseases
or emergency handling of poisoning, such as in tetanus. These
antibodies can be made using animals, named "serum therapy",
although there is a high probability of anaphylactic shock, because the
immune system is against the serum of the animal. Thus, human
antibodies are produced in vitro through cell culture and are used to
replace antibodies from animals, if available. In big cities in Indonesia,
rabies vaccines are always available for those who want to get rabies
immunity and anti-rabies serum for those who are feared to have
contracted rabies, for example being bitten by dogs or monkeys.
2. Immunization based on the nature of its administration
Based on the nature of its implementation, immunizations are grouped
into:
a. Immunization Program, consisting of:
1) Routine immunization
a) Basic immunization
Basic immunization is given to infants before 1 (one) year of
age and consists of immunization against diseases: hepatitis B,

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 poliomyelitis, tuberculosis, diphtheria, pertussis, tetanus,
pneumonia and meningitis caused by Hemophilus Influenza
type b (Hib), measles.
b) Advanced immunization
Advanced immunization is a test of basic immunization to
maintain the level of immunity and to extend the protection
period of children who have received basic immunization.
Advanced immunization is given at:
i. Children under two years old (Baduta)
Advanced immunization given to Baduta consists of
immunization against diphtheria, pertussis, tetanus,
hepatitis B, pneumonia and meningitis caused by
Hemophilus Influenza type b (Hib), and measles.
ii. Elementary school age children
Advanced immunization given to primary school age
children consists of immunization against measles,
tetanus, and diphtheria given in the month of school
children's immunization (BIAS) which is integrated with
school health efforts.
iii. Women of childbearing age (WUS).
Further immunization given to WUS consists of
immunization against tetanus and diphtheria.
2) Additional immunization
Additional immunization is a certain type of immunization
given to certain age groups most at risk of developing the disease
in accordance with epidemiological studies for a certain period of
time.
Provision of additional Immunization as done to complete
basic and / or advanced Immunization on targets that have not been
achieved.

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 3) Special immunization
Special immunization is carried out to protect a person and
society against certain diseases in certain situations. Certain
situations in the form of preparations for the departure of
prospective pilgrims / pilgrims, preparation for trips to or from
certain disease-endemic countries, and extraordinary conditions /
outbreaks of certain diseases.
Special immunizations include immunization against
meningococcal meningitis, yellow fever (yellow fever), rabies, and
poliomyelitis.
3. 5 Basic Immunization Types:
a. BCG vaccine
The BCG vaccine contains BCG germs that are still alive but have
been weakened. BCG immunization serves to prevent transmission of
tuberculosis Tuberculosis (TBC) caused by a group of bacteria called
Mycobacterium tuberculosis complex.
1) Storage: refrigerator, temperature 2-8º C
2) Dosage: 0.05 ml
3) Packaging: ampoules with 4 ml solvent (NaCl Faali)
4) Expiration period: one year after the issue date (can be seen on
the label)
5) Immunization reactions: usually no fever
6) Method of administration: BCG immunization is injected
intracutaneously in the right upper arm area. Injected into the skin
layer with slow absorption. In giving intracutaneous injections, in
order to be carried out correctly, you must use very fine short
needles (10 mm, size 26).
7) Side effects: rarely found, limited swelling of the local lymph
nodes can occur and usually heal on their own although slow
8) Counter Indications: there are no restrictions, except for children
with TB disease or positive Mantoux tests and the presence of
severe / chronic skin diseases.

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b. DPT Vaccine (Diphtheria, Pertussis, Tetanus)
In Indonesia there are 3 types of packaging: a single package
specifically tetanus, a combination of DT (tetanus diphtheria) and a
combination of DPT. Diphtheria vaccines are made from weakened
diphtheria germ toxin (toxoid), usually processed and packaged
together with tetanus vaccine in the form of DT vaccine, or with
tetanus and pertussis vaccines in the form of DPT vaccine. The tetanus
vaccine used for active immunization is tetanus toxoid, a tetanus germ
toxin that has been weakened and then purified. There are three
packages of tetanus vaccines, namely single, combination with
diphtheria and combination with diphtheria and pertussis. The
pertussis vaccine is made from Bordetella pertussis bacteria which has
been turned off.
1) Storage: refrigerator, temperature 2-8º C
2) Dosage: 0.5 ml, three injections, minimum interval of 4 mg
3) Packaging: Vial 5 ml
4) Expiry period: Two years after the issue date (can be seen on the
label)
5) Immunization reactions: mild fever, swelling and pain at the
injection site for 1-2 days
6) Side effects: Temporary symptoms such as weakness, fever,
redness at the injection site. Sometimes there are more severe side
effects, such as high fever or seizures, which are usually caused
by the pertussis element.
7) Counter indications: Children who are seriously ill, children
suffering from complex febrile seizures, children suspected of
suffering from whooping cough, children suffering from immune
disorders. Cough, runny nose, fever or mild diarrhea are not
absolute indications, adjusted to the doctor's consideration.
c. Poliomyelitis vaccine
There are 2 types of vaccines in circulation, each of which contains
type I, II and III polio viruses; namely (1) vaccines containing polio

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 virus that has been turned off (salk), usually given by injection, (2)
vaccines containing live but attenuated polio virus (sabin), a method
of oral administration in the form of pills or fluids (OPV) more widely
used in Indonesia.
1) Storage: OPV: Freezer, temperature of -20º C
2) Dosage: 2 mouth drops
3) Packaging: vial, accompanied by dropper pipette
4) Expiration: OPV: two years at -20 ° C
5) Immunization reactions: usually nonexistent, maybe in infants
there are mild defecations
6) Side effects: almost none, if there is a form of paralysis of limbs
such as actual polio.
7) Counter Indications: severe diarrhea, severe illness, immune
disorders
d. Measles Vaccine
Contains a weakened live measles vaccine. Packaging for basic
immunization programs is in the form of single dry packaging. But
there is a vaccine with dry packaging in combination with the mumps
vaccine / mumps and rubella (German measles) called MMR.
1) Storage: Freezer, temperature of -20º C
2) Dosage: after being dissolved, given 0.5 ml
3) Packaging: a vial containing 10 doses of dried vaccine, along with
a 5 ml (aquadest) solvent
4) Expiry period: 2 years after the issue date (can be seen on the
label)
5) Immunization reactions: there is usually no reaction. There may
be a mild fever and a slight red spot on the cheek under the ear on
the 7-8 day after injection, or swelling at the injection site.
6) Side effects: very rare, there may be mild and harmless seizures
on the 10th-12th day after injection. Brain inflammation can
occur 30 days after injection but the incidence rate is very low.

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 7) Counter Indications: severe illness, TB patients without
treatment, severe malnutrition, immune disorders, malignancies.
Also avoiding giving to pregnant women.
e. Hepatitis B vaccine
Active immunization is done by injection 3 times with a distance
of one month between 1 and 2 injections, five months between
injections 2 and 3. However, the method of administration of these
immunizations can differ depending on the manufacturer of the
vaccine. Hepatitis B vaccine can be given to pregnant women safely
and does not endanger the fetus, it will even provide the fetus with
immunity until a few months after birth.
1) Immunization reaction: pain at the injection site, which may be
accompanied by a feeling of heat or swelling. Will disappear in 2
days.
2) Dosage: 0.5 ml 3 times
3) Packaging: HB PID
4) Side effects: for 10 years no significant side effects have been
reported
5) Counter indications: children who are seriously ill

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G. Schedule for immunization
Schedule for immunizing children 0-18 years

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To understand the immunization schedule table need to read the table description:
1. Hepatitis B vaccine (HB). The first HB vaccine (monovalent) is best given
within 12 hours after birth and is preceded by injections of vitamin K1 at least
30 minutes before. The schedule for giving monovalent HB vaccines is age 0.1,
and 6 months. Babies born to HBsAg positive mothers, HB vaccines and
hepatitis B immunoglobin (HBIg) are given to different extremities. If HB is
given a combination with DTPw, then the schedule is given at 2.3 and 4
months. If the HB vaccine is a combination with DTPa, then the schedule is
given at 2.4, and 6 months.
2. Polio vaccine. If born at home immediately give OPV-0. If born at a health
facility, OPV-0 is given when the baby is discharged. Furthermore, for polio-
1, polio-2, polio-3, and polio-booster given OPV or IPV. At least one dose of
the IPV vaccine must be taken together with the administration of OPV-3.
3. BCG vaccine. Provision of BCG vaccine is recommended before the age of 3
months, optimal age is 2 months. If given at the age of 3 months or more, a
tuberculin test is needed first.
4. DTP vaccine. The first DTP vaccine is given at the earliest at 6 weeks. Can be
given a DTPw or DTPa vaccine or a combination with other vaccines. If given
the DTPa vaccine, the interval follows the vaccine recommendations, which
are ages 2.4, and 6 months. For ages more than 7 months, Td or Tdap vaccine
is given. DTP 6 can be given Tdap / Tdap at the age of 10-12 years and Td
booster is given every 10 years.
5. Pneumococcal vaccine (PCV). If given at the age of 7-12 months, PCV is given
twice at intervals of 2 months; and at the age of more than 1 year is given 1
time. Both need booster at more than 12 months of age or at least 2 months
after the last dose. In children over 2 years, PCV is given once.
6. Rotavirus vaccine. The monovalent rotavirus vaccine is given twice, the first
dose is given at 6-14 weeks (the first dose is not given at ≥ 15 weeks), the
second dose is given at a minimum interval of 4 weeks. The deadline for
administration at 24 weeks. The pentavalent rotavirus vaccine is given 3 times,
the first dose is given at 6-14 weeks (the first dose is not given at ≥ 15 weeks),

16
 the second and third doses are given at 4-10 weeks intervals. Deadline for
administration at 32 weeks.
7. Influenza vaccine. Influenza vaccine is given at the age of more than 6 months,
repeated every year. For the first immunization (primary immunization) in
children aged less than 9 years are given twice with a minimum interval of 4
weeks. For children 6-36 months, the dose is 0.25 mL. For children aged 36
months or more, the dose is 0.5 mL.
8. Measles vaccine. The second measles vaccine (18 months) does not need to be
given if you have received MMR.
9. MMR / MR vaccine. If you have received a measles vaccine at the age of 9
months, the MMR / MR vaccine is given at the age of 15 months (minimum
interval of 6 months). If at the age of 12 months have not received a measles
vaccine, then the MMR / MR vaccine can be given.
10. Varicella vaccine. Varicella vaccine is given after 12 months of age, best at the
age before entering elementary school. If given at the age of more than 13
years, need 2 doses at a minimum interval of 4 weeks.
11. Human papilloma virus (HPV) vaccine. The HPV vaccine is given starting at
the age of 10 years. Bivalent HPV vaccine is given three times with a schedule
of 0, 1, 6 months; tetravalent HPV vaccine with a schedule of 0.2.6 months. If
given to adolescents aged 10-13 years, giving enough 2 doses at intervals of 6-
12 months; antibody response is equivalent to 3 doses.
12. Japanese encephalitis vaccine (JE). JE vaccine is given from the age of 12
months in endemic areas or tourists who will travel to the endemic area. For
long-term protection, booster 1-2 years can be given.
13. Dengue vaccine. Given at the age of 9-16 years with a schedule of 0.6, and 12
months.

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 CHAPTER III
CASE AND DISCUSSION
A. Case
The diphtheria outbreak has spread to terrorize the people and the
Indonesian government Diphtheria-causing bacteria spread rapidly not only in
areas where health services were considered poor, but also attacked residents
in the capital city, which were considered to have a far better health care
system.
From January to November 2017 there were 593 cases of diphtheria,
spread in 95 districts and cities in 20 provinces, with a mortality rate of 32
cases. Data from the World Health Organization (WHO) on diphtheria shows
that the number of diphtheria cases in Indonesia has been up and down since
the 1980s.
The causes of the diphtheria outbreak, among others, anti-diphtheria
immunization that has not touched all children in this country (around 75%)
and the level of "efficacy" of antibiotics to fight these bacteria began to decline.
The research we conducted in 2015 about the pattern of antibiotic resistance to
diphtheria showed that the sensitivity of penicillin to diphtheria antibiotics was
84% and erythromycin sensitivity was 91.2%. Antibiotic sensitivity shows the
ability to kill antibiotics against bacteria. Currently penicillin and erythromycin
are the antibiotics of choice for treating diphtheria.
The sensitivity of these antibiotics decreased compared to the results of the
study of Robert C. Rockhill at Cipto Mangunkusumo Hospital (RSCM) Jakarta
in 1982 which showed ampicillin antibiotics, which are a class of penicillin,
and erythromycin antibiotics are still 100% sensitive to diphtheria.
Indonesia needs further studies and considers a review of the management of
diphtheria treatment.
What needs to be watched out is the trend of the number of cases of this
disease has increased since 2007 (183 cases) and its peak in 2012 (1,192 cases).
After that it declined but the number is still hundreds of cases.

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 Data from the Ministry of Health also mentions diphtheria cases found
throughout 2017 are not limited to age. Diphtheria is more common in children
under the age of 12 years and is more fatal than when attacking adults.
B. Discussion
From the above case it can be seen that how important immunization is,
especially diphtheria immunization.
Diphtheria treatment requires anti-diphtheria serum and antibiotics. Serum
and antibiotics are given together because the serum cannot be used to
eliminate the causative bacteria. Vice versa, antibiotics cannot replace the role
of serum to neutralize diphtheria toxin. In this case, serum has limitations
because it can only neutralize circulating toxins or not yet bind to cells (tissue).
Therefore, anti-diphtheria serum must be given immediately when the
diagnosis of diphtheria is found. Serum will be effective if given in the first
three days of symptoms. Delaying the administration of serum will increase the
risk of complications and death. Meanwhile, antibiotics are needed to kill the
causative bacteria and prevent disease transmission.
The problem is, when there is a case of diphtheria in an area, the serum
must be available and quickly given because it hunts the time of the fatal
disease. While giving antibiotics to certain patients also does not guarantee
because they may be resistant.
Until now diphtheria is a disease that cannot be completely eliminated.
Giving DPT immunization is one way to prevent diphtheria and does not
eliminate the presence of bacteria if someone is infected.
The government needs to evaluate the treatment of diphtheria with
antibiotics and serum. Indonesia needs to ensure the effectiveness of antibiotics
and also ensure the availability of serum so that it can reach its destination
quickly.

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 CHAPTER IV
COVER
A. Opinion
I think this immunization is very important, especially for complete
immunization to be sent 0-6 months. Immunization through the help of
vaccines will help the child's immune system produce special antibodies to
fight certain types of diseases. Vaccines contain benign or inactive versions of
germs that have been licensed. After entering the body, these benign germs will
not cause disease but change the children's immune system and remember it as
a challenge.
After that, the immune system will make specific antibodies that will work
against these types of germs. Then compile when there are active germs
entering the child's body, the immune system will be ready to kill it with these
special antibodies. This is what helps children to be protected from various
kinds of dangerous diseases.
Acceptable because vaccination does not guarantee 100% effective for
preventing disease. However, the benefits will be greater than the risk. Even if
the child is infected and sick, symptoms that will be much lighter and easily
considered not at all immunized.
If you don't get immunized, your child will be more at risk of contracting
and getting more severe pain. If children are not immunized, they will also have
a higher risk of complex problems that can cause disability, even death.
This is because it is not supported by a special defense system that can protect
certain types of dangerous diseases. Viruses cannot fight the disease that goes
in so they cannot fight it. This will make the germs more easily multiply and
infect the child's body.
If the child is not immunized at all, the child will be at risk of developing
the diseases agreed upon above, the severity of this disease can cause death in
the child. The immune system in children who are not immunized will not be
as strong as immunized children. This is because the child's body is unable to
fight the virus that enters the body so it cannot fight it.

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 Especially if the child is not immunized and then falls ill, he can transmit it to
others so that it endangers the surrounding environment.
B. Conclusion
In Indonesia, the immunization program is regulated by the Ministry of
Health of the Republic of Indonesia. The government, responsible for setting
targets for immunization recipients, age groups and procedures for giving
vaccines to targets. The implementation of immunization programs is carried
out by government and private health service units.
Immunization is one way to prevent infectious diseases, especially
immunization-preventable diseases (PD3I), which is given not only to children
from infancy to adolescence but also in adults. The types of diseases that can
be prevented by immunization are tuberculosis (tuberculosis), diphtheria,
pertussis, tetanus, polio, influenza, typhoid fever, hepatitis, meningitis,
pneumococci, mmr ((rubella measles measles), rotavirus, varicella and
hepatitis A.

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 BIBLIOGRAPHY

Hidayat, A. 2007. Seri Problem Solving Tumbuh Kembang Anak Siapa Bilang
Anak Sehat Pasti Cerdas. Jakarta: PT Elex Media
Suririnah. ____. Buku Pintar Mengasuh Batita. Jakarta: PT Gramedia Pustaka
Utama
Departemen Kesehatan. 2016. Situasi Imunisasi di Indonesia. Depkes.go.id.
Diunduh pada 22 Juni 2019
Dokter Indonesia. 2015. Inilah Perbedaan Imunisasi Aktif Dan Imunisasi Pasif.
Mediaimunisasi.com. Diunduh pada 22 Juni 2019

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