Hepatitis B and Hepatitis

B Vaccine
Epidemiology and Prevention of VaccinePreventable Diseases
National Center for Immunization and
Respiratory Diseases
Centers for Disease Control and Prevention
Revised May 2009

Hepatitis B Virus Infection

More than 350 million chronically

infected worldwide
Established cause of chronic
hepatitis and cirrhosis
Human carcinogencause of up to
80% of hepatocellular carcinomas
More than 600,000 deaths worldwide
in 2002

Hepatitis B Complications

Fulminant hepatitis
Hospitalization
Cirrhosis
Hepatocellular carcinoma
Death

Hepatitis B Perinatal
Transmission*

If mother positive for HBsAg and HBeAg

70%-90% of infants infected

90% of infected infants become chronically
infected

If positive for HBsAg only

5%-20% of infants infected

90% of infected infants become chronically
infected

*in the absence of postexposure prophylaxis

Global Patterns of
Chronic HBV Infection

High (>8%): 45% of global population

lifetime risk of infection >60%

early childhood infections common

Intermediate (2%-7%): 43% of global

population

lifetime risk of infection 20%-60%

infections occur in all age groups

Low (<2%): 12% of global population

lifetime risk of infection <20%

most infections occur in adult risk groups

Risk Factors for Hepatitis B

MMWR 2006;55(RR-16):6-7

Strategy to Eliminate Hepatitis B Virus

TransmissionUnited States

Prevent perinatal HBV transmission

Routine vaccination of all infants
Vaccination of children in high-risk

groups
Vaccination of adolescents
Vaccination of adults in high-risk
groups

Vaksin Hepatitis B

(Engerix-B, Euvax-B,
Hepvac-B)

Hepatitis B Vaccine

Composition

Recombinant HBsAg

Efficacy

95% (Range, 80%-100%)

Duration of
Immunity

20 years or more

Schedule

3 Doses

Booster doses not routinely

recommended

Hepatitis B Vaccine

Routine booster doses are

NOT routinely recommended
for any group

Hepatitis B Vaccine
Routine Infant Schedule
Minimum
Dose+
Usual Age
Interval
Primary 1 Birth
--Primary 2 1- 2 months 4 weeks
Primary 3 6-18 months* 8 weeks**
* infants who mothers are HBsAg+ or whose HBsAg status is
unknown should receive the third dose at 6 months of age
** at least 16 weeks after the first dose
+an additional dose at 4 months is acceptable if the clinician prefers to
use a combination vaccine that contains hepatitis B vaccine

Hepatitis B Vaccine
Adolescent and Adult Schedule
Dose
Primary 1
Primary 2
Primary 3

Usual
Interval
--1 month
5 months

Minimum
Interval
--4 weeks
8 weeks*

*third dose must be separated from

first dose by at least 16 weeks

Prevention of Perinatal Hepatitis B

Virus Infection
Begin treatment within 12 hours of

birth
Hepatitis B vaccine (first dose) and
HBIG at different sites
Complete vaccination series at 6
months of age
Test for response after completion of
at least 3 doses of the HepB series at
9 through 18 months of age
(generally at the next well-child visit)

Hepatitis B Vaccine
Adverse Reactions
Pain at injection site
Mild systemic complaints
(fatigue, headache)

Infants and
Adults
Children
13%-29%
3%-9%
11%-17%

0%-20%

Temperature 99.9F (37.7C)

1%

0.4%-6%

Severe systemic reactions

rare

rare

Hepatitis B Vaccine

Contraindications and Precautions

Severe allergic reaction to a vaccine

component or following a prior dose

Moderate or severe acute illness

Varicella and
Varicella Vaccine
Epidemiology and Prevention of VaccinePreventable Diseases
National Immunization Program
Centers for Disease Control and Prevention
Revised March 2002

Varicella Vaccine Recommendations

Children

Routine vaccination at 12 to 18 months

of age

Recommended for all susceptible

children by the 13th birthday

Varicella Vaccine Adverse Reactions

Injection site complaints - 20%

Rash - 3%-4%
May be maculopapular rather
than vesicular

Average 5 lesions
Systemic reactions uncommon

Zoster Following Vaccination

Most cases in children

Risk from wild virus 4 to 5 times
higher than from vaccine virus

Mild illness without complications

Varicella Vaccine
Contraindications and Precautions

Severe allergy to prior dose or

vaccine component

Pregnancy
Immunosuppression
Moderate or severe acute illness
Recent blood product

Varicella Vaccine

Use in Immunocompromised Persons

Most immunocompromised persons should

not be vaccinated

Vaccinate persons with isolated humoral

immunodeficiency

Consider varicella vaccination for

asymptomatic HIV-infected children with

CD4% >25% (CDC class A1 and N1)

Transmission of Varicella
Vaccine Virus

Transmission of vaccine virus

uncommon

Asymptomatic seroconversion

may occur in susceptible contacts

Risk of transmission increased if

vaccinee develops rash

Vaccine Storage and Handling

Store frozen at -15 C (+5 F) or lower
Generally should not be refrozen
Store diluent at room temperature or
refrigerate

Discard if not used within 30 minutes

of reconstitution

Penyimpanan vaksin
Di Tingkat Propinsi : kmr dingin & kmr beku
Suhu kamar dingin: +2 s/d +8 C
Suhu kamar beku: -15 s/d -25 C
Di Kabupaten dan Pelayanan Primer
Jarak lemari es dengan dinding belakang 15 cm
Lemari es tidak terkena sinar matahari langsung
Sirkulasi ruangan cukup
Penyusunan vaksin
Jarak menyusun dos vaksin 1-2 cm atau
satu jari antar dos vaksin

Plastik penetes (dropper)

Polio JANGAN disimpan di
lemari es
krn jadi rapuh, mudah robek

Masa simpan vaksin

belum
dipakai
Jenis Vaksin
Suhu
Umur Vaksin
Vademicum Bio Farma Jan.2002

Penyimpanan

BCG

+2 s/d +8C
-15s/d -25C
+2 s/d +8C

1 tahun
1 tahun
2 tahun

Hepatitis
B
TT

+2 s/d +8C

26 bulan

+2 s/d +8C

2 tahun

DT

+2 s/d +8C

2 tahun

OPV

+2 s/d +8C
-15 s/d
-25C
+2 s/d +8C

6 bulan
2 tahun

DPT

Campak

2 tahun

Indikasi Kontra Vaksin

Umum (untuk semua vaksin)
Reaksi anafilaksis
Sakit sedang atau berat

Khusus
DTP / DTPa : ensefalopati dalam 7 hari
pasca vaksinasi DPT/DTPa

Pemeriksaan Fisik

Pemeriksaan umum
Pemeriksaan khusus
Mencari indikasi kontra atau halhal yang perlu diperhatikan
bekas vaksinasi terdahulu
Lokasi vaksinasi yang akan
dikerjakan

Persiapan pemberian
vaksin
Cuci tangan dengan antiseptik
Baca nama vaksin, tanggal kadaluwarsa,
Teliti kondisi vaksin apakah masih layak :
warna indikator VVM,

Kocok : penggumpalan, perubahan warna

Alat suntik : sekali pakai
Encerkan dan ambil vaksin sebanyak dosis
Ukuran jarum : ketebalan otot bayi / anak
Pasang dropper polio dengan benar

Uji Kocok (Shake

Test)
Vaksin tidak pernah
beku

Vaksin
pernah
beku
Setelah dikocok
Setelah
15
menit
Setelah 30 menit

Setelah Jangan dig

VVM = Vaccine Vial Monitor

Penempatan alat
untuk memudahkan vaksinasi
Kotak
pembuangan
jarum bekas
Form R&R

Kota
k
pem
baw
a
vaks
Temp
in
Kursi Kursi
at
pasien vaksinat samp

Gambar Alur Kerja Vaksinator

Air & sabun

untuk cuci
tangan

Ukuran jarum
Intramuskular di paha mid-anterolateral
Neonatus
kurang bulan / BBLR : 5/8 inch (15,8 mm)
: 7/8 inch (22,2 mm)
cukup bulan
: 7/8 1 inch
1 24 bulan
(22,2-25,4 mm)
Intramuskular di deltoid
> 2 thn (tergantung ketebalan otot)
7/8 1,25 inch (22,2 -31,75

Usia sekolah dan remaja : 1,5 inch

(38,1mm)

mm)

Teknik dan posisi penyuntikan

Bayi digendong pengasuh,

Jarum disuntikan dengan cepat

Anak dipeluk menghadap pengasuh (chest to chest)

Otot yang akan disuntik : lemas (relaks)
Tungkai : sedikit rotasi ke dalam
Lengan : sedikit fleksi pada sendi siku
Anak dipersilahkan memilih lokasi suntikan
Metode Z tract : sebelum jarum disuntikkan geser kulit dan
subkutis ke samping, setelah disuntik kemudian lepaskan
Bila suntikan lebih dari 1 kali, disuntikan bersamaan

Posisi anak ketika divaksinasi

Lengan yg
satu
dijepit ketiak
ibu

Tungkai anak
dijepit paha ibu

Tangan yg lain
dipegang ibu,
Kemudian
anak dipeluk

Posisi anak ketika di vaksinasi

Tangan
kiri
Dijepit
ketiak su
ibu
nti
k
Suntik

Tangan di

Posisi Anak kurang

aman

Tangan
bebas
Bisa
suntik
meraih
jarum

suntik

Kaki
bebas

Posisi bayi
dalam pelukan
ibu pada
penyuntikan
BCG

Penetesan vaksin polio

Teknik Penyuntikan dan

Penetesan

Intramusc

Subcutaneous

e.g. hepatitis A an
DTP

e.g. measles, mumps,

rubella, varicella

Oral
e.g.
poli

Intradermal
BCG

Pencatatan

Nama dagang, produsen,

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

Pemantauan setelah
vaksinasi

Perhatikan keadaan umum

Tunggu 30 menit di ruang tunggu