imunisasi

PROGRAM IMUNISASI DI INDONESIASubdit Imunisasi, Dit. Epim-Kesma, Dit Jen PPM & PL, Departemen Kesehatan R.I

MENGENAL VAKSINProduk TerapetikFormula antigenSehatSehat dengan kekebalanKekebalan Aktif

Sistem Kekebalan /pertahanan tubuh mammaliaVirus/bakteriKekebalan non spesifik ..menit-jamKekebalan Spesifik..hari-mingguVAKSINASI: dosis, cara pemberian,

Sejarah Imunisasi di IndonesiaTh. 1956Imunisasi Cacar Th. 1973Imunisasi BCG Th. 1974Imunisasi TT pada ibu hamil Th. 1976Imunisasi DPT untuk bayi Th. 1977WHO mulai pelaksana program imunisasi sebagai upaya Global (EPI-Expabded Program on Immunization) Th. 1981Imunisasi Polio Th. 1982Campak Tn. 1990Indonesia mencapai UCI Nasional Th. 1997Imunisasi HB

Kegiatan Imunisasi Rutin(Sasaran, Jenis dan dosis vaksinasi)BAYI 0-11 bulan(dasar)Anak sekolah(lanjutan)BCG 1xDPT 3xPOLIO 4xHep B 3xCampak 1x

DT 1xTT 2xIbu Hamil +Calon Pengantin WanitaTT 5 x(sementara)

Kegiatan Imunisasi RutinFasilitas Pelayanan Imunisasi- utama : puskesmas dan puskesmas pembantu- tambahan : RS Klinik KIA Praktek dokter/bidan swastaJenis Pelayanan Imunisasi:- dalam gedung (static comp).. Pusk, RS- lapangan (outreach comp) .. Posyandu, sekolah

Tehnik Imunisasi Tehnik pemberian dan dosisantigen tehnik dosisBCG injeksi intrakutan 0.05 ml

Hep B injeksi intramusc 0.5 mlDPT injeksi intramusc 0.5 mlDT injeksi intramusc 0.5 mlTT injeksi intramusc 0.5 mlPolio tetes per oral 2 tetes

campak inj subkutan 0.5 ml

Vaksin + alat BCG + ADS 0.05 mlpelarut syr 4ml DPT ADS 0.5 mlDT ADS 0.5 ml TT ADS 0.5 mlCampak + ADS 0.5 mlpelarut syr 5mlHep B uniject 0.5 mlPolio pipetPerlu technical skill: Handling vaccine PenyuntikanMenyiapkan Vaksin :Expiry dateIndikator suhuUji kocokmelarutkan

Karakteristik VaksinProduk biologik. mudah rusak oleh: - suhu tinggi : Polio- suhu rendah: DPT, DT, DT, Hep B- matahari : BCG, campak- pelarutnya : dipakai setelah dilarutkan - dlm 3 jam (BCG), - dlm 8 jam (campak)Steril. multi dose vial:- lebih murah- open vial policy hanya di comp static -> % waste tiap pusk tak samaPerlu technical skills.- management cold chain- management vaccine

VVM

_1081268697.ppt

Segi empat lebih terang dari lingkaran.Gunakan vaksin bila belum kedaluarsa.

Segi empat berubah gelap tapi lebih terang dari lingkaran.Gunakan vaksin lebih dahulu bila belum kedaluarsa.

Batas untuk tidak digunakan lagi: Segi empat berwarna sama dengan lingkaran.JANGAN GUNAKAN VAKSIN

Melewati Batas Buang: Segi empat lebih gelap dari lingkaran.JANGAN GUNAKAN VAKSIN

JADWAL IMUNISASIProgram ImunisasiBayi lahir di RS/RB/Bidan Praktek:Bayi Lahir di Lapangan

Sheet1

UMURVAKSINTEMPAT

0 bulanHB1Rumah

1 bulanBCGPosyandu

2 bulanHB2, DPT1, Polio1Posyandu

3 bulanHB3, DPT2, Polio2Posyandu

4 bulanDPT3, Polio3Posyandu

9 bulanCampak, PolioPosyandu

Sheet1

UMURVAKSIN

0 bulanHB1, Polio1, BCG

2 bulanHB2, DPT1, Polio2

3 bulanHB3, DPT2, Polio3

4 bulanDPT3, Polio4

9 bulanCampak

Komitmen Global

Eradikasi PolioEliminasi Tetanus Maternal dan Neonatal Reduksi CampakReduksi Hep.B

Pengembangan Program :Safe Injection practicesIntroduksi HB birth dose

Wild Poliovirus cases 2003 , North IndiaData as of 29 Sep 2003District infected with cases in week 39Total P1 wild case =124Total P3 wild case =14Total cases = 138Total infected districts =63

CACAR

TERBASMI TH 1974VAKSINASI CACAR STOP TH 1980Saving:1 milyardUSDPer tahun

KASUS LUMPUH POLIO

CACAT MENETAPDapat di eradikasi

Program Eradikasi Polio* 1988: World Health Assembly ke-41 sepakat untuk Eradikasi polio didunia sebelum tahun 2000.

* Empat strategi utk mencapai goal tsb: 1. Imunisasi rutin OPV dg cakupan tinggi 2. Imunisasi Tambahan 3. Surveilans AFP & investigasi Laboratorium 4. Mop-up , utk memutus rantai penularan terakhir

Program Eradikasi Polio Dengan 4 strategi tsb, dunia mengalami banyak kemajuan

Bebas Polio : Region America, 1994. Region European, 2002. Region Western Pacific, 2000.Negara dg VPL (Virus polio liar) a.l India, Pakistan, Afganistan, Nigeria, Egypt, Somalia

DIPHTHERIA50% MENINGGAL DG GAGAL JANTUNG

PERTUSSIS54% KEMATIAN KARENA KOMPLIKASI PNEUMONIA

TETANUS NEONATORUMTanpa fasilitas memadai, CFR >90%ditargetkan untuk di eliminasi

Jane Soepardi

NT elimination, definition:

Scoring system

Supv.deliveryTT2+ coverage 95 % 630 60 + 5 90 95 461 80 + 3 70 89 2>80 % 0 50 69 + 2 < 50 % + 5

Total score

< 3 Low risk

3-5 Medium risk

> 5 High risk

Jane Soepardi

Infant 3 DTP School Children: (1 DT) (2 TT) (3 TT)IMPLEMENTATION STRATEGIES 5 DOSE TTLONG TERMSHORT TERM ACCELERATION Pregn womenBrides- to be1-2 dosesCBAW (15-39 yrs)in High Risk Villages, 5 dosesRR SYSTEM

5 DOSE TT PROTECTION MIN. INTERVALTT-1 0TT-2 3 yearsTT-3 5 yearsTT-4 10 yearsTT-5 25 yearsPROTECTION> 4 weeks> 6 months> 1 year> 1 year

Kebijakan MNTE Akselerasi pencapaian WUS dengan TT 5 dosis melalui :High risk approach dilanjutkan dengan ekspansiTerpadu Lintas programKerja sama org Profesi, LSM dan swasta

Strategi MNTESweeping TT WUS max 3x, interval 1 th mulai di desa risiko tinggi (hasil scoring ) Ekspansi ke WUS di SMU + temp kerja

Screening status TT WUS buku register + kartu TT Sweeping TT kartu TT Rutin (ibu hamil & catin)

Evaluasi cakupan TT 5 WUS th 2007Rencana Stop TT ibu hamil

CampakBalita: Kematian krn komplikasi

Anak besar: Kejadian SSPE(Subacute Sclerosing Pan Encephalitis) 1/25,000 setelah 15 th

Masalah Penyakit Campak di Dunia dan di Asean Laporan th 2000GLOBAL: 831,597 kasusAsean: 61,975 kasusSource: WHO/V&B/02.20

Masalah kematian campak, di Dunia dan Asean, Laporan th 2002GLOBAL: 777,000 kematianASEAN: 202,000 kematianSource: WHO/V&B/02.20

Polio Campak1988EradikasiProgram Jk. PendekKampanye sangat penting, didukung rutinSurveillance: case countPendekatan: Program vertikal

2003Reduksi MortalitasProgram Jk. PanjangKegiatan rutin penting, didukung kampanyeSurveillance: deteksi KLBPendekatan : memperkuat Sistem Pelayanan Kesehatan

Source: de Quadros, C.A., et al. (JAMA-January 17, 1996) 500,000 bayi lahirCakupan campak = 90%450,000 di vaksinasivaccine efficacy = 90%50,000 tak divaksinasi405,000 kebal45,000 divaksinasiTetapi tak kebalplus405,000 kebal95,000 rentanPopulation immunity = 81%

Akumulasi kelompok rentan500,000 newborns, vaccine coverage=90%, vaccine efficacy = 90%Source: de Quadros, C.A., et al. (JAMA-January 17, 1996)

Kebijakan Reduksi CampakMencegah KLB campak pada anak sekolah dan mutuskan rantai penularan dari anak sekolah ke balita

Mencegah KLB campak pada balita

Strategi Reduksi Campakcegah KLB campak anak sekolah + putuskan transmisi dr sekolah ke balita: - Ekspansi Catch up campaign campak anak sekolah ke 26 prov ( th 2003 2004) - BIAS campak pada anak kelas 1 (start 2001, nasional 2005)

cegah KLB campak pd balita: - crash program di desa risti campak (hanya campak) - backlog fighting di desa Non UCI (semua Ag) - sweeping di desa (semua Ag)

MEASLES IMMUNIZATION COVERAGE INDONESIA, 1983-2000

Universal Child Immunization Target AchievementsLEVELTARGETACHIEVEMENTNATIONALPROVINCE ( 27 )DISTRICT (314) SUB.DISTRICT (3.552)VILLAGE (58.803) 1990199219941996 2000 1990 V 1994 100 % 2000 76.2% 2000 63.7% 2002 73.8%

PROPORTION OF VILLAGES ACHIEVED UCI TARGETSINDONESIA 1998-2002

%

Measles High Risk villages, Indonesia 2000

5 thn12-15 thn6 blnMeasles Routine & Supplementary Imm ActivitiesCrash program inHigh risk villages1997, all prov, APBN2000, 5 prov,Polio fund2002, all prov, 15585 vlg(25%) APBNSchool-based Catch upGrade 1- 6 3 prov, 2000, JICA1 prov, 2003, UNICEF3 prov, 2003, Arab Saudi23 prov, 2004, APBN(?)+APBDRoutine 1st doseSince 1984Routine 2nd doseStart 2001-2005 6 thn

Chart1

93.492.196.65

94.591.897.41

94.59197.26

94.891.495.74

94.791.896.99

94.591.496.27

Jakarta

W. Java

Jambi

School-based measles catch up campaign, in West Java and Jakarta (year 2000), Jambi (year 2003)

Vaccine

Sample Field Testing, Indonesia 1999

samplespassed*

Prov storage88 (100%)

District storage1515 (100%)

Health Center storage2827 ( 96.4%)

Measles serologic survey, children 9 - 11 Months, Sukabumi, West Java, 2000

Measles vaccine CAM-70, Bio Farma

Measles neutralization antibody

serum titerpre vaccination(%)post vaccination(%)VE

< 8123 (96.85)4 (3.14)

801 (0.78)

1600

321 (0.78)0

6406 (4.72)

128014 (11.02)

>2563 (2.36)102 (80.31)

TOTAL1271270.9032258065

source : Heriyanto B, NIHRD Jakarta, 2000Rate of Seroconversion, children 9 - 11 Months, Sukabumi, 2000

pre vaccinationpost vaccination% seroconversion

negativepositivenegativepositive

67234130296.04

83.3 % with titer

> 256

source : Heriyanto B, NIHRD Jakarta, 2000

Vaccine titer, Sukabumi, 2000

Health Centreaverage titer/dose

Sukaraja

Cisaat

Cibadak

Parungkuda


Test results of Bio Farma measles vaccine, CAM-70

WHO standard

FDA test

field test


routine cove

Measles Coverage, Report vs WHO/UNICEF estimate, Indonesia 1984 - 2000

% covest

19835.96

198412.713

198536.426

198645.245

198756.848

198864.251

198968.454

199085.458

199188.659

199290.361

199389.263

199492.063

199590.963

199691.771

199792.371

199888.871

199988.371

200094.2

Ref : WHO?

Before Immunization :

AR95%

CFR7%

After Immunization

VE85%

AR80%

CFR2.85%

routine cove

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

% cov

est

COV ESTIMATE

Measles coverage

yearreportedDHS

cardmemorycard or memory

199157.5

199462.5

199770

2000

Incidence

Measles Incidence < 15 years of age per 10,000

pre program (1982)8,000

Sentinel Health Center (1996)9

Measles incidence < 5 years of age per 10,000

pre program (1982)500?

House-hold Health Survey (1986)528

Sentinel Health Center (1996)12

Target year 2000 (90% reduction)50?

House-hold Health Survey (2000)?

Measles deaths

Hospital report (1982)

- cases73

- CFR (%)4.8

Hospital report (1996)

- cases16

- CFR (%)0.6

Measles Incidence, Indonesia, 1992 - 1998

1992199319941995199619971998

< 120.41612.71195.30.9

1 - 4181411.17.57.43.50.8

5 - 146.26.54.93.53.41.20.4

ARI+Measles : 55% measles death

Diarrhoea + measles ; >10% measles death

Vit A suppl + measles cases: 23% reduction of measles death

source : CDC&EH, Indonesia 2000

City of Yogyakarta

1997199819992000

141.70.20.61.8

Sleman

1997199819992000

140.00.00.20.5

Gunung Kidul

1997199819992000

140.31.84.610.6

Kulon Progo

199519961997199819992000

140.00.00.20.11.00.2

West Jakarta

19961997199819992000

140.20.81.72.0

East Jakarta

19961997199819992000

140.31.01.21.71.5

South Jakarta

19961997199819992000

140.20.50.20.70.4

Central Jakarta

19961997199819992000

140.20.10.10.40.9

North Jakarta

19961997199819992000

140.01.70.90.90.6

District of Cirebon

199519961997199819992000

140.50.00.10.81.51.1

City of Cirebon

199519961997199819992000

140.300.50.10.30.7

District of Subang

199519961997199819992000

140.30.20.10.40.20.3

Measles Incidence , district of Banyuwangi

1997199819992000

140.00.10.10.2

District of Ponorogo

199519961997199819992000

140.10.10.00.00.00.2

Kota Surabaya

199519961997199819992000

140.10.100.10.10.5

Probolinggo

199519961997199819992000

140.10.10.00.20.10.3

ASUS L7200:

Incidence

0000

0000

0000

0000

14

Yogyakarta

Hospital data

0000

0000

0000

0000

14

Gunung Kidul

Outbreak

0000

0000

0000

0000

14

Sleman

MultiAg - PIN 97

0000

0000

0000

0000

0000

0000

14

Kulon Progo

sero school

0000

0000

0000

0000

0000

14

West Jakarta

Catch up

0000

0000

0000

0000

0000

14

City of East Jakarta

mapping Bogor

0000

0000

0000

0000

0000

14

City of South Jakarta

mapping Agam

0000

0000

0000

0000

0000

14

City of Central Jakarta

Crash progr

0000

0000

0000

0000

0000

14

City of North Jakarta

2 dose schedule

000

000

000

000

000

000

000

< 1

1 - 4

5 - 14

CEA

0000

0000

0000

0000

0000

0000

14

District of Cirebon

Strategy

0000

0000

0000

0000

0000

0000

14

Cirebon City

0000

0000

0000

0000

0000

0000

14

District of Subang

0000

0000

0000

0000

14

District of Banyuwangi

0000

0000

0000

0000

0000

0000

14

District of Ponorogo

0000

0000

0000

0000

0000

0000

14

Surabaya City

0000

0000

0000

0000

0000

0000

14

City of Probolinggo

0

0

5.9235155055

0

0

0

0

0

13.7856183227

0

0

0

0

0

0

3.825515126

0

3.8659120009

0

0

7.4713946459

8.7601920229

0

8.5681519894

0

0

0

0

0

5.7400766818

0

0

0

0

0

0

0

0

0

4.8983628105

0

0

0

62.8422659126

0

0

34.7981706105

0

0

0

0

0

0

0

0

13.4242284493

0

0

0

0

0

0

0

0

0

0

0

11.1404963043

0

0

0

0

0

0

0

14.115780309

13.0865046615

0

6.2658575935

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

12.7485383141

0

Measles Incidence, 1-4 Years of Age, Region of Kulon Progo-gunung Kidul, 1997 - 1999

per 10000

0

6.0934939017

17.7705465165

0

0

3.8331404693

0

0

13.7856183227

10.8020851598

0

0

4.7179156722

0

113.2233690867

99.4633932748

4.109280607

0

10.1510371651

0

59.7711571675

192.7242245036

4.56006574

0

0

0

272.1678801726

55.1383353425

0

34.4404600908

0

0

120.4872422623

0

0

127.7029172989

0

0

0

0

0

0

0

31.0283687943

0

0

15.013726836

0

0

0

0

0

0

0

13.2361481908

35.2963951756

0

0

0

0

0

5.0254802038

1.9218136644

0

0

0

0

30.4876446192

0

0

0

0

0

0

3.1291874182

0

0

2.4747168471

0

0

0

6.2658575935

0

0

0

5.7496771053

0

0

0

0

0

8.0611320921

2.3535765094

0

0

0

0

5.1538385507

11.1925638446

0

0

0

0

0

1.7723059015

0

0

2.1684086532

0

0

3.2407410451

0

0

0

Measles Incidence, 5 - 14 Years of Age, Region of Kulon Progo-gunung Kidul, 1997 - 1999

per 10000

0

0

0

0

0

7.5533898635

0

27.7193076852

27.0444930787

0

0

0

0

0

0

5.9598578897

0

18.1501036695

0

4.7808425245

0

0

0

0

0

0

10.4458734881

0

0

18.9869360017

2.0475395909

4.3993420685

4.5204753921

0

0

2.6287189507

0

3.4878727981

0

2.6074396034

0

13.9063445515

0

0

7.8427867267

3.4001955112

0

0

0

52.2645355693

11.7826114259

Measles Incidence 1-4 Years of Age, District of Banyuwangi, 1997 - 1999

per 10000

0

0

3.7663859494

0

0

0

0

3.2281463245

3.1495584926

0

0

2.2071709121

0

0

2.1120341283

11.6419442195

0

0

0

0

0

0

0

0

0

0

0

0

0

5.3070919462

3.5980447044

4.6384537334

1.5887236191

0.9145462332

3.3299847106

3.6954590151

0

0

0

1.5164987449

0

0

0

0

4.9308368555

1.0688681158

1.8323453414

0

7.5847750937

7.9097348553

0

Measles Incidence 5-14 Years of Age, District of Banyuwangi, 1997 - 1999

per 10000

0

27.2418108208

0

0

0

10.0308993332

28.3059440559

4.0180229086

0

0

3.1149941061

0

1.5593556414

0

0

12.0987589163

20.2949025441

0

0

0

0

0

0

0

20.4420595375

4.2850721024

68.7296085614

0

26.7598380272

37.0994040908

0

39.2144168474

0

0

21.1063511201

0

0

4.5171368881

0

4.8792980088

7.3082935241

0

0

0

15.7145466388

33.0622776356

19.6188398993

45.0060751641

0

0

0

0

0

4.8927326611

5.1127885798

0

0

0

2.9363901296

0

4.2537975932

16.969327326

0

0

9.1772892682

0

0

16.970178971

0

0

4.6407123723

0

18.6533999746

0

0

0

0

6.1388410571

0

8.8712628927

9.9219297436

0

4.9795626783

5.1785510504

2.744418067

12.501631477

0

0

6.5433415982

20.5937727818

12.3562636691

9.181785791

36.4750117463

3.1739506438

67.4263118999

5.7959692979

5.7702094343

5.7256763957

11.8565947281

62.0452627347

2.4450039976

0

4.8900079952

25.6580459036

10.7076051359

2.0883070409

0

10.2659337071

0

2.2385237674

0

0

0

0

0

12.76553993

6.330323211

12.7023962865

6.5677777901

9.026365961

0

5.0700910482

2.5102650204

13.022318032

11.033302324

4.9815734547

0

2.4621295455

0

0

7.6106501373

0

5.0693852671

0

0

12.2725048207

4.0908349402

8.1988102504

0

2.192064279

0

0

0

0

0

4.9141442789

7.3094032827

4.7052434087

4.9141442789

21.1789543864

1.9581450566

7.7712575342

1.9222916964

1.9953612638

23.4579658575

5.9053366446

0

2.9680668533

0

0

0

0

0

4.5514588256

7.3430202387

0

0

16.563203546

0

0

0

5.1592804611

0

0

5.5877630757

7.6915549777

0

12.8798981178

0

0

8.1704740048

0

0

10.4482366159

4.4417788941

0

2.5399351326

0

36.93735123

28.0413023903

9.7826488972

2.4626459898

9.6742307935

0

0

0

8.0595686937

12.1065498444

0

0

5.9412946182

23.4460180181

11.7230090091

0

0

8.4097216382

12.578088969

0

2.2003168456

4.5911574308

13.6595101021

8.2320506558

0

0

11.7721913461

2.9094838783

11.6194625999

0

0

0

0

3.8000963927

0

0

0

0

7.2249774279

14.5343341541

0

0

7.3530420204

7.3421968257

3.6603010646

0

20.0726187411

19.078846199

8.7236844457

7.5846473061

0

8.2845728126

Measles Incidence of Children 1 - 4 Years of Age, Surabaya, 1995 - 1999

per 10000

0

0

0

0

0

2.2584290151

2.2760729918

0

0

0

3.3815151786

2.5482855403

2.5391627997

0

0

5.7916727883

0

0

0

0

3.6923518179

2.7373808913

0.9154717172

0

1.9568813427

7.9810743128

6.000512874

4.0500974125

0

0

1.5187865297

16.7378792131

0

0

14.7417026543

2.233934046

4.4678680921

4.4738976037

2.3280604806

33.8281441257

7.238336516

14.4137309753

7.160168735

11.1998585281

3.8910306623

4.6062290422

4.555487229

15.675590531

0

0

0

4.9935148472

0

0

0

0

4.2403588341

0

0

3.0866606827

2.1335499179

2.1277991094

0

0

0

3.3461485793

0

0

0

1.8051115039

21.6146037679

0

19.005035752

0

0

0

0.6805178803

0

0

0.7335255787

0

0

1.866917788

5.8245651456

4.1157051235

0

0

0

7.3596106396

2.5736450643

3.4744208369

2.29493235

10.2562994955

2.3799298444

8.8477214204

4.753982652

6.310471787

0

8.1042017812

11.8745436852

5.3478574466

3.9995947946

0

15.4332190442

0

2.0586048658

0

9.1079283842

0

2.2066850465

1.1816765091

0

0

0

0

31.5138277404

0

52.2632455106

10.8090906742

44.5661278063

0

0

0

25.7181812594

81.7125458274

0

24.5956612238

0

12.5411111384

0

2.6152411961

0

0

0

0

4.2171903329

0

5.282531536

0

3.3896572784

0

0.9570279872

1.0993758475

1.1326902672

0

0

0

5.2965880913

2.7658715826

5.9601697429

3.4542016617

0

0

1.1732838978

11.2855244917

5.8831677433

0

0

1.4999743155

11.0555209995

0

0

5.7780635579

0

10.1899360879

4.2774918279

2.1548267103

2.1548267103

2.2173458605

0

0

0

0

0

0

5.7629582335

0

2.8951095761

0

0

0

0

0

9.3941084328

13.728156216

0

4.281899471

0

13.3435937005

12.6061001935

3.3048637932

3.3278142363

0

0

0

3.6563109205

1.8151714016

0

0

1.9842867496

5.3523797559

2.6402493114

0

0

0

0

1.8636674296

0.6303402233

0

1.3605231429

0.5858700674

0

0

0

3.7869080692

0

0

2.1932944097

0

2.3992733629

4.050379173

4.009466252

0

0

0

18.0228104143

4.5057026036

0

0

0

2.2927836735

9.1576079465

0

0

7.5107155497

7.7744413647

1.4811730162

1.9316680349

10.0440566353

12.6595559471

Measles Incidence of Children 5 - 14 Years of Age, Surabaya, 1995 - 1999

per 10000

155.0824133892

24.4696189495

27.6198614304

28.6916014375

5.8977180733

5.6998080708

28.4943301703

14.6565663807

35.42003542

47.8753118352

8.9332694588

21.5773978891

70.206035467

0

0

47.8869208159

9.8362323838

42.8565564237

0

0

0

0

6.9358178054

0

32.1513314725

8.2727046078

16.0251133283

0

16.1330354927

46.7710019788

51.8041948681

13.3568257003

32.2958601214

18.4809987953

0

3.6696083939

5.4327189882

5.5753724409

10.7735526659

16.6547704021

0

0

1.371452357

2.8013544245

2.835779064

0

0

0

8.1427219305

0

0

0

0

0

5.5886296557

0

0

1.9060834957

3.9006323932

4.2472156073

3.2085307799

0

0

0

0

0

22.8115262283

6.687626922

7.0132302872

0

0

0

0

0

0

0

0

0

Measles Incidence Among Children 1-4 Year of Age, Region of Yogyakarta -Sleman, 1996 - 1999

per 10000

35.6757292428

19.8190567854

20.6497674294

17.153447475

8.8149660636

0

23.9673488291

2.7395628611

2.648244099

34.1833558718

5.0116203505

6.4560298254

22.6495235203

0.9307538572

0.9008430527

46.544933763

5.5157198014

32.0427236315

82.4094534786

0

11.6292085919

0

3.8218885834

3.6914829362

81.1440863314

0

23.9670862959

2.9308697037

0

17.4776633709

58.05907173

9.9796924862

7.2390572391

31.8734505962

0

0

4.0609101591

6.2513135601

0

14.0112089672

1.5959165993

0

10.9399136793

4.2234902245

6.4130863184

12.6834635492

6.0297050285

1.2617291801

27.1680464248

17.1707291689

0

42.2303555941

0

0

34.4337045626

0

0

11.8676310179

3.3182116155

0

10.7330177718

2.3240773483

1.813876611

0

1.3495064504

2.6518653858

96.8032103226

21.6962352941

43.6090910118

4.1846242583

0

1.8791696733

0

1.0841557459

0

0

1.0026652452

0

Measles Incidence Among Children 5-14 Years of Age,Region of Yogyakarta -Sleman, 1996 - 1999

per 10000

0

23.0845443861

15.1095197326

0

7.2709933859

5.4412451163

0

3.9415662799

8.2576281683

0

0

2.1271132135

0

7.0124304174

4.9000668132

1.273618037

12.3318702011

9.139295835

0

0

0

0

0

6.8618863088

1.4665229634

0

9.4600141207

0

0

16.0444511109

0

1.2646499707

23.8418629728

0

0

4.8028237365

2.9303430562

5.1617967975

2.7053345715

7.2930931394

0

0

14.3507169154

16.0802388939

9.619505115

11.8930073345

0

1.8267553901

0

1.4068160039

6.016139984

5.1354698226

6.0308383791

9.4702353016

6.3723930863

13.4566002363

7.0422583868

0

0.880719451

1.8464284786

9.9869563499

0

25.3314537788

6.0635960984

0

0

3.8766083904

7.6778217936

11.234997493

0

12.1040708356

51.7024564198

0

0

8.3765306889

52.0979347725

31.9105931006

51.00932121

0

0

87.4818563415

24.2729014281

0

0

0

0

122.7709976967

0

33.6216000228

17.8614750121

0

0

9.3624088826

0

0

190.8779885824

23.5023432855

0

52.8802723925

13.0427034794

7.2680714046

0

0

0

0

0

0

8.7618161411

9.3958949408

0

932.4455078424

11.3347304048

0

99.4090044779

Measles Incidence among Children 1 - 4 Years of Age, Area of Cirebon, 1997 - 1999

per 10000

0

4.5465217805

1.9045334411

0

1.5656458531

0.4100776662

0

0.49802905

6.2602606479

0

0

1.7210579751

0

4.1461840925

0

0.8312272542

1.46334534

2.2367867253

0

0

0

0

0

4.637760553

0.5880765856

0

4.8773202702

0

0.6519563057

3.4159265847

0

0

2.6826332518

0.5276148312

0.4642832116

2.4313724627

0.7101763531

0

1.9669348637

2.9447783482

0

0

2.8283042548

7.4701776502

6.7776838243

2.3751188879

0

1.4592646279

0

0

0.4461456085

0

0

2.0383581732

2.7320918566

3.0048781178

2.5160742244

0

0.3560600352

1.1197198864

8.0806142546

0

1.8632822774

3.8553907761

0.6788658866

1.421579783

3.0561643432

1.3450867262

1.4762044239

0

5.677253408

9.0938810245

0

0

5.9013183139

20.3907340116

29.974950166

29.9469884588

0

11.1842153107

6.8479461663

3.8000913385

1.7978926763

0

0

1.5407635281

30.392387971

0

0

4.1889508421

0

0

2.198891308

0

0

69.9353264945

11.0397012172

0

4.1398879565

0

1.7057188688

0

1.2817352111

0

0

0

1.8936370492

0

4.4101810225

0

88.6409937755

3.9901637823

0

9.3319839735

1997

1998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

Measles Incidence among Children 5 - 14 Years of Age, Area of Cirebon, 1997 - 1999

per 10000

16.3834001596

3.0212522468

0

1.1936756895

2.559693585

6.5405761284

5.9318462369

19.1873367302

3.0765499219

0

0

0

3.4506601454

0

1.4282236689

0

87.982254134

57.5986559563

5.0665762022

26.935512463

1.7133329368

0

0

0

6.167604801

1.3151174774

4.5371718074

0

0

35.0996236727

2.2610451122

8.0597605826

16.1395193389

6.4811295

13.2050612773

4.6877869686

1.866768455

3.3816243724

13.5978489596

3.1789701248

4.1475836963

3.2026749622

6.8098193283

0

1.403223005

0

16.922364992

0

0

0

28.8362243583

48.1593948989

0

0

2.3466983267

3.5084287127

9.079782805

2.2316898979

17.1256555356

3.8615401509

7.7567668144

20.9983521782

0

6.8877360816

9.5536292485

0

3.083773966

5.3802273186

0

0

71.8021814705

13.0415942358

0

206.8205995079

10.5918690471

Measles Incidence among Children 1-4 Years of Age, District of Subang, 1995 - 1999

per 10000

1.8026682378

5.3188621757

0

0.5253613366

1.1265740394

2.878615778

7.8321110412

7.2382837535

8.1242431614

0

0

0.8185828634

3.7976657962

1.418297411

2.5149581579

0

18.2224845861

2.304576376

0

6.9153390523

5.2789369147

0.9058782334

2.1178710236

2.2504186154

6.7867713022

1.1573650423

2.6619492839

0.631007949

0

23.1669859165

0

0

0

0

0

3.4390387794

0.8216955018

1.488489656

6.7335360771

0.6996436663

1.2169769842

0

2.9971884823

0

0

2.3399425344

6.516107631

1.8265002971

0.7838174937

2.863212431

4.8810334209

0

0

0

0

3.0883205581

4.9953416109

0.982230844

11.3062395718

2.5493621527

8.5370296315

9.9045439411

2.5193101323

2.4257862454

5.4075294986

3.5266612136

5.4287380906

4.7357305209

0

1.1503076359

7.9012092947

195.1755982008

0

2.7586447125

186.4869784158

Measles Incidence among Children 5-14 Years of Age, District of Subang, 1995 - 1999

per 10000

46.2360072425

36.446548553

51.1970640642

90.2984812584

0

23.785713883

6.2998016569

70.3452989637

54.2909134911

27.2842828659

43.2807070215

120.9781251776

55.1789396723

45.9944220962

42.4427555908

81.8854503694

40.6600773808

34.6980726294

48.1998860121

83.6590436626

24.211632747

13.4828286619

11.3104335488

42.0881497961

6.5055349073

19.7614847512

15.8229035838

31.5450644468

46.2956810014

23.9164093225

26.610021826

29.4699845781

4.7072726014

0.9707784802

0.5863385623

3.8645135875

6.0859287641

1.6734811825

5.7273926939

0.7836259685

11.6153279991

6.6564774898

9.745832978

13.4562594673

5.3285413799

5.6141583383

1.106375034

3.0871956321

2.5833295065

3.4099016034

3.1470647131

4.6557647963

7.7138864249

2.5451467074

0.8539490484

1.9856856114

4.5669778351

5.3425796994

1.2410701818

8.6580178469

10.4434082129

5.6384949736

1.2613731446

0

7.3235779308

2.4164169895

0.4054502565

2.3572689329

1.9944602832

1.1449213132

2.1125368421

1.7866570968

23.5691567497

12.6382563413

8.8066927522

31.8610139712

27.9575503696

12.9730198353

12.1890526381

26.3238438741

24.3321320525

12.9586845988

20.6102763274

21.1482583377

51.1943559762

11.7516175638

11.0902371337

24.9334644084

5.9308610301

15.097470731

7.5989932574

0

34.4870245927

26.5535104313

26.2516629708

9.990355988

29.8214347456

9.5368301303

10.0567744535

3.1895211602

24.0742884662

6.8090199902

12.3372306975

29.4867562997

10.9069797398

8.225824826

16.0467425987

2.4071670764

13.2601260759

24.8715704514

25.7330111252

19.4088778226

Measles Incidence Among Children 1-4 Years of Age, by Subdistrict, Region of West-South-East of Jakarta, 1996 - 1999

per 10000

14.8126172817

16.0168896183

15.8973131226

12.9409755209

17.193990285

12.5076788465

3.1471034039

18.7095484167

7.4404899814

8.9158054314

7.4144466881

32.444196384

15.2528727274

12.8611899455

17.1688071629

39.6030508794

6.753168737

6.4824440922

13.866258343

26.7921501619

6.690610692

3.5326360722

3.1116191473

14.2151580501

2.1201035468

3.4283480121

5.094229919

19.4930165425

3.4787565031

1.7025443592

4.5703633427

2.9894908699

4.6158485786

2.4923105008

1.0453650413

5.8361698676

5.0582344724

5.3648631699

1.8000916027

0.418692697

11.760026532

9.3772977073

5.207711152

15.8945400794

4.5074806133

6.351720896

0.9457481918

12.3702530663

2.449694022

6.0628267359

2.7468823452

4.9667876495

4.5878196114

2.2705819094

2.7425768889

2.6572113587

1.7764979551

6.5942805229

2.6551853234

10.290689374

7.4481537282

7.0373252563

0.3373503972

1.9611871074

1.3085974082

3.0224050697

1.304045765

4.5489968547

0.9681564227

0.8151306065

1.0254734723

1.9080248565

3.3531557898

10.6222058727

5.0116706516

31.0822519985

4.8758195796

9.0855112254

3.4298310751

17.9481332905

9.0445690214

9.487855222

13.5196005592

21.4393142

21.8542522238

5.3503908939

1.4050145866

19.3340566301

0.8564673829

3.6740487045

0.8535022495

1.3233822429

7.9345043591

7.5405274052

13.2831166016

9.1940112632

6.2294133711

3.7598704192

5.449876323

2.288577934

8.5159495647

3.9808764104

1.6500168714

23.8445808819

2.8597843062

7.493265717

5.0297406575

4.2881312508

2.1799095276

6.2777268921

3.9497591275

11.9410979323

Measles Incidence Among Children 5-14 Years of Age, by Subdistrict, Region of West-South-East of Jakarta, 1996 - 1999

per 10000

0

0

0

1.7132506754

9.0945428558

23.7857274689

13.2920241738

6.2962219771

0

0

0

0

8.9071552969

5.0898030268

8.9071552969

5.0898030268

3.2978558455

7.4201756523

11.5424954592

18.1382071501

16.8880526065

25.3320789098

15.4807148893

23.9247411925

5.2321751395

1.7440583798

0

12.2084086587

7.7361998738

1.2893666456

1.2893666456

9.0255665195

44.693772488

15.9620616029

61.453937171

42.2994632476

31.806460581

17.3489784987

11.5659856658

57.8299283291

25.3921903154

13.0588407336

13.0588407336

21.0392434042

125.6091463056

222.8549369938

303.8930959006

89.1419747975

2.5488982651

7.009470229

0.6372245663

4.4605719639

44.3722098582

44.3722098582

58.53355343

87.800330145

1-4

0

0

0

1.062453479

4.121450973

4.5552879176

0

1.5184293059

1.7412788019

0

0

0

1.5781925584

2.3672888376

2.3672888376

3.1563851168

0.5112822173

1.0225644345

1.2782055432

1.7894877605

4.8000971567

5.2364696255

5.2364696255

10.472939251

0.5407792683

1.6223378048

0.5407792683

3.7854548779

1.1993797213

0

0

2.798552683

5.0284106962

6.6283595541

12.1138984955

5.7141030639

3.3123157033

7.4527103324

2.0701973146

11.1790654986

1.8699229136

3.5320766145

7.064153229

5.6097687407

15.6654333229

40.0338851585

30.7506654116

22.6278481331

0.3649821119

1.0949463358

0.3649821119

2.0074016156

7.3000534227

17.3038303353

19.1964367782

20.2779261741

5-14

Ciptomangunkusumo Hospital

year9totalImmunized

199401061177

199531131186

19961112107409

19975942206

19984541144

Measles Outbreak Investigation Report

Indonesia, 1997

Age groupPacitanTrenggalekPonorogo

>19.819.91.8

1 - 437.638.314.2

5 - 1452.539.578.6

>1402.25.4

Note :age proportion


Indonesia, 1998

Age groupSumenepLampungBengkuluMusirawas

140000

# cases38244732

Not imm84%95.8%77.1%100%

IgM +91.30%69.70%100%

Note : age proportion



Indonesia, 1999

Age groupKendalTegalBimaBimaWonogiri

140000

# cases634410921293

VE100.054.550.5100100

CFR %14.32.32.759.50.68

Age prop (%):

- preschool47.6

- school52.4

Imm cov:

199468.368.42010.7

199571.470.15337.9

199673.29876.948.727.2

199778.010056.192.849.4

199874.895.694.170.6

Transmission:

- siblings15.8

- neighbour82.5

Note : Age specific Attack rate per 1000 population


Measles Outbreaks in Indonesia, 1994 - 1999

199419951996199719981999200020012002

Freg424835193225010060100

Cases5545.6221525.516151515

CFR4.51.60.91.71.82.4


Laboratory test (Elisa) on several outbreaks, 1998/1999

Location# cases# sampleIgM+Notes

Garut'983921100%

Ciawi'983525100%IgM dengue

Parung'984224100%

Sumenep'983823391.3%!9.7% ?

Purbolinggo'98362487.5%12.5% ?

Bengkulu'98483371.4%28.6 %?

Palembang'984915100%13 death

Lampung'9917912100%



Indonesia, 2000

AgegroupBali

Field study

District TTSCases : 20 per 6 months

KLB last 5 yrs : 0

UCI 1999: 54/146 villges

HCs performance :recording in KMS 10/10

recording in register book : 10/10

LAM 7/10

sweeping house to house : 8/10

Logistics/vaccine maintenance :

LE functioning : 10/10

minifreezer functioning : 10/10

thermometer : 10/10

temp monitoring : 8/10

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Freg

Cases

Number of Measles Outbreaks and Average number of cases per outbreak

Multi antigen campaign, NIDs 1997

Indonesia by province

totalmeasles vaccination199720002002

NoProvincepop < 5starget 2 - 3423480.9

>3 - 4473472.3

>4 - 7 - 8562480

(70.0)(30.0)

>8 - 9702494

(74.5)(25.5)

>9 - 10592786

(68.6)(31.4)

>10 - 117830108

(72.2)(27.8)

>11 - 12701686

.(81.4)(18.6)

total430168598

(71.9)(28.1)

source: Heriyanto B, 1998

Measles antibody, primary school children,

Yogyakarta, Ambon, Palu, 1998

Type of areaIgG +Ig G -sample

(%)(%)

urban (u)21683299

(72.2)(27.8)

rural ( r)21485299

(71.6)(28.4)


Measles antibody, primary school children,


LocationIgG +%sample

Yogya (u)7675.899

Yogya ( r)7171.899

Ambon (u)5959.0100

Ambon ( r)7878.0100

Palu (u)8383.0100

Palu ( r)6585.0100

Total43071.9598


Measles antibody by sex, primary school children,


SexIgG +IgG -sample

(%)(%)

boys21889307

(71.0)(29.0)

girls21279291

(72.9)(27.1)


School Catch up Campaign, Jakarta and West Java, 2000

JakartaW. JavaJambi

gr 193.492.196.65

gr 294.591.897.41

gr 394.59197.26

gr 494.891.495.74

gr 594.791.896.99

gr 694.591.496.27

Measles serologic survey, School children, Jakarta and West Java 2000

Measles neutralization antibody

serumJakartaWest Java

titerprepostVEprepostVE

< 440 (12.7)1 (0.3)67 (22.2)1 (0.3)

42 (0.6)000

82 (0.6)01 (0.3)0

1611 (3.59)04 (1.3)9 (2.9)

3248 (15.2)3 (0.9)10 (3.3)1 (0.3)

6462 (19.6)11 (3.5)29 (9.6)7 (2.3)

128150 (47.6)248 (28.7)0.91184 (60.9)229 (75.8)0.84

256037 (11.7)6 (2.0)39 (12.9)

512015 (4.8)1(0.3)16 (5.3)

TOTAL315315302302


Average geometric antibody titer by age group

Agebefore, GMT (log 2)after , GMT log (2)

groupJakartaW JavaJakartaW Java

6 - 76.326.347.346.98

'7 - 86.076.826.076.91

8 - 96.36.76117.19

9 - 106.486.791.17.33

10 - 116.126.527.367.2

11 - 126.267.04

6.456.658.327.12


Seroconversion

AgeJakartaWest Java

groupbefore campaignafter campaignbefore campaignafter campaign

negativepositivenegativepositivenegativepositivenegativepositive

6 - 7736043

'7 - 8938047

8 - 91547062

9 - 10349052

10 - 11447051

11 - 12258159

total402751314672341302

seroconv.97.50%98.50%


provinceSchooltiter/dose

JakartaTrisula

Ursula

W. JavaDarma

SDN 04

note: average virus titer per dose


JakartaWest Java

beforeafterbeforeafter

Positive240 (76.2)308 (97.7)215 (71.2)288 (95.4)

Negative75 (23.8)7 (2.2)87 (28.8)14 (4.6)

total315315302302

note : Protective level of antibody, Elisa


Jakarta

W. Java

Jambi

School-based measles catch up campaign, in West Java and Jakarta (year 2000), Jambi (year 2003)

MAPPING OF MEASLES HIGH RISK VILLAGE

BOGOR, 2000

NOHealth CenterVILLAGE199719981999cumulatedest prop ofest.prop ofproportion% suscCRASH PROGRAM

%PRO%%PRO%%PRO%susc under 5smeaslesmeaslesof suscunder 5wbased onbased on

COV.TECTEDSUSCCOVTECTEDSUSCCOVTECTEDSUSCduring 3 year periodcasesdeathsunder 5sby 2000non UCI% susc

ABCDEFGHIJKLMN

A X 85 %(100% - B)D X 85 %(100% - E)G X 85 %(100% - H)(C+F+I) X BALITAJ X 80%K X 2,85%(J-K-L)M X 100

1JASINGAJASINGA70%0.5950.40538.16%0.3240.67655.91%0.4750.5250.5350.40.0120.0959.5YESYES

KALONG SAWAH87%0.7400.26171.19%0.6050.39547.23%0.4010.5990.4180.30.0100.0747.4YESYES

PANGRADIN75%0.6380.36372.60%0.6170.38373.85%0.6280.3720.3730.30.0080.0666.6YESYES

2CURUGCURUG48.8%0.4150.58521.03%0.1790.821UCI0.6800.3200.5750.50.0130.10210.2YESYES

JUGALA JAYA49.20%0.4180.58240.44%0.3440.656UCI0.6800.3200.5190.40.0120.0929.2YESYES

KOLEANG66.90%0.5690.43151.35%0.4360.564UCI0.6800.3200.4380.40.0100.0787.8YESYES

3CIGUDEGCIGUDEG63.70%0.5410.45949.35%0.4190.58162.98%0.5350.4650.5010.40.0110.0898.9YESYES

SUKARAKSA31.50%0.2680.73228.33%0.2410.75968.98%0.5860.4140.6350.50.0140.11311.3YESYES

BANYURESMI55.80%0.4740.52637.42%0.3180.682UCI0.6800.3200.5090.40.0120.0909.0YESYES

MARGAJAYA26.90%0.2290.77137.43%0.3180.682UCI0.6800.3200.5910.50.0130.10510.5YESYES

4LEBAK WANGIARGA PURA69.20%0.5880.41259.40%0.5050.495UCI0.6800.3200.4090.30.0090.0727.2YESYES

BANGUNJAYA64.10%0.5450.45552.05%0.4420.558UCI0.6800.3200.4440.40.0100.0797.9YESYES

BATU JAJAR73.97%0.6290.37155.05%0.4680.532UCI0.6800.3200.4080.30.0090.0727.2YESYES

5BUNARBUNAR63.80%0.5420.45869.31%0.5890.411UCI0.6800.3200.3960.30.0090.0707.0YESYES

SUKA MAJU68.20%0.5800.42055.12%0.4690.531UCI0.6800.3200.4240.30.0100.0757.5YESYES

6SUKAJAYASUKAJAYA57.10%0.4850.51556%0.4760.524UCI0.6800.3200.4530.40.0100.0808.0YESYES

SIPAYUNG63.90%0.5430.45755%0.4680.532UCI0.6800.3200.4360.30.0100.0777.7YESYES

SUKAMULIH45.50%0.3870.61349.30%0.4190.581UCI0.6800.3200.5050.40.0120.0898.9YESYES

7KIARAPANDAKKIARAPANDAK79.30%0.6740.32665.73%0.5590.441UCI0.6800.3200.3620.30.0080.0646.4YESYES

8TENJOTENJO58.42%0.4970.50357.31%0.4870.51378.85%0.6700.3300.4490.40.0100.0808.0YESYES

9NANGGUNGHAMBARO94%0.7990.20147.65%0.4050.59577.78%0.6610.3390.3780.30.0090.0676.7YESYES

10GOBANGCIBODAS75.80%0.6440.35674.77%0.6360.364UCI0.6800.3200.3470.30.0080.0616.1YESYES

11CICANGKALSUKASARI68.70%0.5840.41651.64%0.4390.56176.33%0.6490.3510.4430.40.0100.0787.8YESYES

TAMAN SARI52.10%0.4430.55764.43%0.5480.452UCI0.6800.3200.4430.40.0100.0797.9YESYES

12GUNUNG SALAKCIBITUNG32.80%0.2790.72159.26%0.5040.496UCI0.6800.3200.5120.40.0120.0919.1YESYES

G. MALANG23.20%0.1970.80343.43%0.3690.631UCI0.6800.3200.5850.50.0130.10410.4YESYES

13SUKARESMISUKARESMI53.81%0.4570.54350.36%0.4280.57273.41%0.6240.3760.4970.40.0110.0888.8YESYES

SUKALUYU31.21%0.2650.73544.67%0.3800.620UCI0.6800.3200.5580.40.0130.0999.9YESYES

14SIRNAGALIHSIRNAGALIH63.30%0.5380.46259.18%0.5030.49771.21%0.6050.3950.4510.40.0100.0808.0YESYES

15SUKAMANAHSUKAKARYA85%0.7230.27842.66%0.3630.63767.12%0.5710.4290.4480.40.0100.0797.9YESYES

SUKAMAHI47%0.4000.60144.55%0.3790.621UCI0.6800.3200.5140.40.0120.0919.1YESYES

SUKAMAJU54%0.4590.54136.51%0.3100.69076.69%0.6520.3480.5260.40.0120.0939.3YESYES

SUKAGALIH47%0.4000.60131.61%0.2690.731UCI0.6800.3200.5510.40.0130.0989.8YESYES

16SUKAHARJASUKAHARJA42%0.3570.64343.01%0.3660.63467.05%0.5700.4300.5690.50.0130.10110.1YESYES

17BANTAR JAYABANTAR JAYA52%0.4420.55830.21%0.2570.743UCI0.6800.3200.5400.40.0120.0969.6YESYES

BOJONG57%0.4850.51660.54%0.5150.485UCI0.6800.3200.4400.40.0100.0787.8YESYES

18JAMPANGP. UDIK68%0.5780.42250.00%0.4250.575UCI0.6800.3200.4390.40.0100.0787.8YESYES

19PUTAT NUTUGCISEENG103%0.8760.12559.01%0.5020.498UCI0.6800.3200.3140.30.0070.0565.6NOYES

CIHOE26%0.2210.77949.65%0.4220.578UCI0.6800.3200.5590.40.0130.0999.9YESYES

KURIPAN37%0.3150.68635.81%0.3040.69648.78%0.4150.5850.6550.50.0150.11611.6YESYES

PUTAT NUTUG45%0.3830.61829.45%0.2500.75051.01%0.4340.5660.6450.50.0150.11411.4YESYES

20GUNUNG SINDURRAWA KALONG50%0.4250.57545.18%0.3840.616UCI0.6800.3200.5040.40.0110.0898.9YESYES

PADURENAN54%0.4590.54136.15%0.3070.693UCI0.6800.3200.5180.40.0120.0929.2YESYES

21SUKARAJANAGRAK54%0.4590.54151.89%0.4410.559UCI0.6800.3200.4730.40.0110.0848.4YESYES

G. GEULIS99%0.8420.15973.47%0.6240.376UCI0.6800.3200.2850.20.0060.0505.0YESYES

22KLAPA NUNGGALBANTAR JATI60%0.5100.49050.28%0.4270.57368.71%0.5840.4160.4930.40.0110.0878.7YESYES

LULUT74%0.6290.37139.93%0.3390.66176.00%0.6460.3540.4620.40.0110.0828.2YESYES

23BOJONGBOJONG23%0.1960.80531.05%0.2640.736UCI0.6800.3200.6200.50.0140.11011.0YESYES

LEUWIKARET14%0.1190.88129.41%0.2500.750UCI0.6800.3200.6500.50.0150.11511.5YESYES

24BALE KAMBANGBALE KAMBANG36%0.3060.694UCI0.6800.32049.52%0.4210.5790.5310.40.0120.0949.4YESYES

BENDUNGAN44%0.3740.626UCI0.6800.32069.28%0.5890.4110.4520.40.0100.0808.0YESYES

25SUKA MAKMURCIBADAK40%0.3400.66043.08%0.3660.63467.37%0.5730.4270.5740.50.0130.10210.2YESYES

26SUKA DAMAISUKA RESMI60%0.5100.49076.24%0.6480.35257.47%0.4880.5120.4510.40.0100.0808.0YESYES

SUKA HARJA65%0.5530.44868.65%0.5840.41658.66%0.4990.5010.4550.40.0100.0818.1YESYES

SUKA WANGI54%0.4590.54161.90%0.5260.47454.37%0.4620.5380.5180.40.0120.0929.2YESYES

27KARYA MEKARMEKAR WANGI37%0.3150.68645.36%0.3860.61471.68%0.6090.3910.5640.50.0130.10010.0YESYES

SELAWANGE47%0.4000.60147.50%0.4040.59661.11%0.5190.4810.5590.40.0130.0999.9YESYES

SUKA RASA47%0.4000.60151.41%0.4370.56372.33%0.6150.3850.5160.40.0120.0919.1YESYES

28SIRNA SARICIBADAK62%0.5270.47349.01%0.4170.583UCI0.6800.3200.4590.40.0100.0818.1YESYES

PASIR TANJUNG58%0.4930.50750.25%0.4270.57374.58%0.6340.3660.4820.40.0110.0858.5YESYES

Dari 60 desa yang melaksanakan cr-program = 25 desa non uci tahun 98 dan 99 (41,7 %)

33 desa non uci tahun '98 (55 %)

2 desa non UCI tahun '99 (3,3 % )

Seharusnya jumlah desa yang seharusnya di cr-program :

non UCI 1998 : 192 desa --> 68 PUSK

Non UCI 1999 : 74 desa --> 38 PUSK

Atau bila digabung 2 tahun ('98 & '99) menjadi --> 77 Puskesmas di 227 desa

dari 423 desa di Bogor = 53,7 % desa kenyataan Cr-Pgrm hanya di 28 Pusk.

atau 60 desa non UCI ('98 & '99) yaitu 60/227 = 26,4 % .

Desa non UCI tahun 97/98: 183



&R&"Times New Roman,Regular"LAMPIRAN - 13

PREDIKSI SASARAN RENTAN (SUSCEPTIBLE) TKT DESA BERDASARKAN CAKUPAN CAMPAK

DARI TAHUN 1997 s/d 1999 DI KABUPATEN AGAM

NOPUSKESMASDESA199819992000Cumest prop ofest prop ofProp of% susccrash prog

%pro%%% pro%%% pro%sus < 5smeasesmeaslessusc < 5sunder 5sbased onbased on

covtectedsusccovtectedsusccovtectedsuscfor 3 yearcasesdeathsby 2000non UCI% susc

ABCDEFGHIJKLMNOP

A X E.V(100% - B)D X E.V(100% - E)G X E.V(100% - H)(C+F+I) X BALITAJ X 80%K X 2,85%(J-K-L)M X 100

(E.V=85 %)(E.V=85 %)(E.V=85 %)

10IV Koto1 Kamobek80.00%68.00%32.00%80.00%68.00%32.00%71.70%60.95%39.06%0.3440.30.0080.0616.1'NOYES

2.Koto Tua Timur80.00%68.00%32.00%80.00%68.00%32.00%56.90%48.37%51.64%0.3850.30.0090.0686.8'NOYES

3. Sungai Jariang57.50%48.88%51.13%80.00%68.00%32.00%67.70%57.55%42.46%0.4190.30.0100.0747.4YESYES

4.Balingka62.90%53.47%46.54%80.00%68.00%32.00%64.00%54.40%45.60%0.4140.30.0090.0737.3YESYES

5.Abah baruah72.10%61.29%38.72%74.30%63.16%36.85%64.10%54.49%45.52%0.4040.30.0090.0727.2YESYES

6.Koto Tinggi57.40%48.79%51.21%80.00%68.00%32.00%80.00%68.00%32.00%0.3840.30.0090.0686.8'NOYES

7.Sutijo78.20%66.47%33.53%70.00%59.50%40.50%45.00%68.00%32.00%0.3530.30.0080.0636.3YESYES

8. Guguak R67.70%57.55%42.46%80.00%68.00%32.00%63.10%53.64%46.37%0.4030.30.0090.0717.1YESYES

9.Ranah80.00%68.00%32.00%74.30%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

10. Koto Tuo selatan50.00%42.50%57.50%75.00%68.00%32.00%80.00%68.00%32.00%0.4050.30.0090.0727.2YESYES

11.jambak48.70%41.40%58.61%77.70%66.05%33.96%58.30%49.56%50.45%0.4770.40.0110.0848.4YESYES

12.Sianok44.20%37.57%62.43%75.00%63.75%36.25%80.00%68.00%32.00%0.4360.30.0100.0777.7YESYES

13. Koto gadang54.70%46.50%53.51%80.00%68.00%32.00%75.00%63.75%36.25%0.4060.30.0090.0727.2YESYES

14. Koto tua barat32.50%27.63%72.38%80.00%68.00%32.00%80.00%68.00%32.00%0.4550.40.0100.0818.1'NOYES

11Matur1.Panbar80.00%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

2. Pauh80.00%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

3.Bukik Apik30.20%25.67%74.33%80.00%68.00%32.00%80.00%68.00%32.00%0.4610.40.0110.0828.2'NOYES

4.Matur80.00%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

5.IV Surau80.00%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

6. Sidang tangah71.40%60.69%39.31%80.00%68.00%32.00%80.00%68.00%32.00%0.3440.30.0080.0616.1'NOYES

7.Padang galanggang80.00%68.00%32.00%80.00%68.00%32.00%75.80%64.43%35.57%0.3320.30.0080.0595.9'NOYES

8.Kuak Tigo Koto72%61.20%38.80%80.00%68.00%32.00%80.00%68.00%32.00%0.3430.30.0080.0616.1'NOYES

9.Tigo baleh80%68.00%32.00%80.00%68.00%32.00%77.70%68.00%32.00%0.3200.30.0070.0575.7'NOYES

10.Puncak Lawang80%67.66%32.34%80.00%68.00%32.00%73.50%68.00%32.00%0.3210.30.0070.0575.7'NOYES

11.Bualan Pabatuangan80%68.00%32.00%44.40%37.74%62.26%66.60%68.00%32.00%0.4210.30.0100.0757.5YESYES

12.Cubadak lilin60%51.00%49.00%80.00%68.00%32.00%78.50%68.00%32.00%0.3770.30.0090.0676.7YESYES

13.saribulan80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

14. Andaleh80.00%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

12Palembayan1. Baringirn Satu48%40.80%59.20%80.00%68.00%32.00%35.00%68.00%32.00%0.4110.30.0090.0737.3YESYES

2. Baringin Duo65.00%55.25%44.75%71.40%60.69%39.31%52.00%44.20%55.80%0.4660.40.0110.0838.3YESYES

3. Baringin Tigo63.00%53.55%46.45%80.00%68.00%32.00%80.00%68.00%32.00%0.3680.30.0080.0656.5'NOYES

4. Baringin Empat59.00%50.15%49.85%70.40%59.84%40.16%57.00%48.45%51.55%0.4720.40.0110.0848.4YESYES

5. Tigo Koto Sipinang53.00%45.05%54.95%51.50%43.78%56.23%69.00%68.00%32.00%0.4770.40.0110.0858.5YESYES

6. III Koto Sel Puar80.00%68.00%32.00%60.50%51.43%48.58%40.00%68.00%32.00%0.3750.30.0090.0666.6YESYES

7. Piladang63.00%53.55%46.45%75.10%63.84%36.17%43.00%68.00%32.00%0.3820.30.0090.0686.8YESYES

8. Pasar Pelambayan80.00%68.00%32.00%64.00%54.40%45.60%56.00%68.00%32.00%0.3650.30.0080.0656.5YESYES

9. Palembayan Tangajh60%51.00%49.00%57.70%68.00%32.00%80.00%68.00%32.00%0.3770.30.0090.0676.7YESYES

10. Bamban Koto Tinggi61%51.85%48.15%80.00%68.00%32.00%80.00%68.00%32.00%0.3740.30.0090.0666.6'NOYES

11. Ladang Makmur80%68.00%32.00%56.30%68.00%32.00%67.00%56.95%43.05%0.3570.30.0080.0636.3YESYES

13Koto Alam1. Tamtaman80.00%68.00%32.00%78.30%66.56%33.45%80.00%68.00%32.00%0.3250.30.0070.0585.8'NOYES

2. Silungkang80.00%68.00%32.00%69.40%58.99%41.01%80.00%68.00%32.00%0.3500.30.0080.0626.2'NOYES

3. Gumarang80%68.00%32.00%55.90%41.93%58.08%80.00%68.00%32.00%0.4070.30.0090.0727.2'NOYES

4. Koto Alam80%68.00%32.00%54.50%46.33%53.68%80.00%68.00%32.00%0.3920.30.0090.0707.0'NOYES

5. Kayu Pasak80%68.00%32.00%65.40%55.59%44.41%63.70%54.15%45.86%0.4080.30.0090.0727.2YESYES

6. Tapian Kandis80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

14Batu Kambing1. Batu Kambing80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

2. Kampung Melayu78%66.56%33.45%73.80%62.73%37.27%80.00%68.00%32.00%0.3420.30.0080.0616.1YESYES

3. Tandika64%54.66%45.35%40.60%34.51%65.49%80.00%68.00%32.00%0.4760.40.0110.0848.4YESYES

4. Sitanang80.00%68.00%32.00%71.90%61.12%38.89%80.00%68.00%32.00%0.3430.30.0080.0616.1'NOYES

5. Malabur71.60%60.86%39.14%80.00%68.00%32.00%80.00%68.00%32.00%0.3440.30.0080.0616.1'NOYES

6. Bawan72%61.46%38.55%80.00%68.00%32.00%66.40%49.80%50.20%0.4020.30.0090.0717.1YESYES

7. Lubuk Alung73%62.14%37.87%80.00%68.00%32.00%46.20%68.00%32.00%0.3400.30.0080.0606.0YESYES

15Tiku1.Durian kapah80%68.00%32.00%58.00%49.30%50.70%48.00%68.00%32.00%0.3820.30.0090.0686.8YESYES

2.Pasar Tiku80%68.00%32.00%43.00%36.55%63.45%42.00%68.00%32.00%0.4250.30.0100.0757.5YESYES

3.pasir Tiku80%68.00%32.00%74.00%62.90%37.10%17.00%68.00%32.00%0.3370.30.0080.0606.0YESYES

4.Gagasan Kecil80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

5.Batang tiku80%68.00%32.00%58.00%49.30%50.70%25.00%21.25%78.75%0.5380.40.0120.0959.5YESYES

6.taratak nantigo80%68.00%32.00%62.00%52.70%47.30%30.00%25.50%74.50%0.5130.40.0120.0919.1YESYES

7.cacang tinggi80%68.00%32.00%63.00%53.55%46.45%80.00%68.00%32.00%0.3680.30.0080.0656.5'NOYES

8.cacang renadah80%68.00%32.00%69.00%58.65%41.35%62.00%68.00%32.00%0.3510.30.0080.0626.2YESYES

9.Banda gadang80%68.00%32.00%68.00%57.80%42.20%80.00%68.00%32.00%0.3540.30.0080.0636.3'NOYES

10.Bukik malintang80%68.00%32.00%66.00%56.10%43.90%68.00%68.00%32.00%0.3600.30.0080.0646.4YESYES

11. Sungai Nibung80%68.00%32.00%55.00%46.75%53.25%80.00%68.00%32.00%0.3910.30.0090.0696.9'NOYES

12.Muara Putus80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

13.ujung labung80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

16palupuh1.batang palupuh80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

2.Sitingkal73%62.31%37.70%75.00%63.75%36.25%7.00%68.00%32.00%0.3530.30.0080.0636.3YESYES

3.Rimbo panjang80%68.00%32.00%80.00%68.00%32.00%55.00%46.75%53.25%0.3910.30.0090.0696.9'NOYES

4.palupuh80%68.00%32.00%80.00%68.00%32.00%29.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

5.angge palimbatan80%68.00%32.00%54.50%46.33%53.68%38.00%68.00%32.00%0.3920.30.0090.0707.0YESYES

6.Pasie laweh43%36.38%63.62%80.00%68.00%32.00%21.00%68.00%32.00%0.4250.30.0100.0757.5YESYES

7.Singai guntung75%63.75%36.25%76.40%64.94%35.06%13.00%68.00%32.00%0.3440.30.0080.0616.1YESYES

8. Nam limo Mudiak80%68.00%32.00%80.00%68.00%32.00%37.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

9.nam Limo Hilir80%68.00%32.00%80.00%68.00%32.00%11.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

10.Sipisang3%2.64%97.37%48.50%68.00%32.00%19.00%16.15%83.85%0.7110.60.0160.12612.6YESYES

11.Simaung54%45.56%54.44%70.40%68.00%32.00%40.00%34.00%66.00%0.5080.40.0120.0909.0YESYES

12. Pagadis43%36.64%63.37%70.30%68.00%32.00%19.00%16.15%83.85%0.5970.50.0140.10610.6YESYES

17Maninjau1.Bayur75%63.33%36.68%52.00%68.00%32.00%23.40%19.89%80.11%0.4960.40.0110.0888.8YESYES

2.Pasar maninjau70%59.33%40.67%51.70%43.95%56.06%67,7%68.00%32.00%0.4290.30.0100.0767.6YESYES

3.II Sidang68%57.38%42.63%50.00%42.50%57.50%60.00%51.00%49.00%0.4970.40.0110.0888.8YESYES

4.sungai batang Utara75%63.75%36.25%45.80%38.93%61.07%48.00%68.00%32.00%0.4310.30.0100.0767.6YESYES

5. Sungai batang selatan80%68.00%32.00%55.80%47.43%52.57%57.50%48.88%51.13%0.4520.40.0100.0808.0YESYES

6.Pantai Panjang80%68.00%32.00%52.30%44.46%55.55%53,4%68.00%32.00%0.3980.30.0090.0717.1YESYES

7.Pantai barat80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

18Pasar Ahad1.koto baru53%45.31%54.70%47.70%40.55%59.46%53,3%68.00%32.00%0.4870.40.0110.0868.6YESYES

2.Pasar rabea76%64.43%35.57%62.50%53.13%46.88%75,8%68.00%32.00%0.3810.30.0090.0686.8YESYES

3.Paninjauan44%37.57%62.43%53.10%45.14%54.87%44,2%68.00%32.00%0.4980.40.0110.0888.8YESYES

4.balai belo54%45.73%54.27%62.50%53.13%46.88%53,8%68.00%32.00%0.4440.40.0100.0797.9YESYES

5.Koto kecil65%55.51%44.50%52.90%44.97%55.04%65,3%68.00%32.00%0.4380.40.0100.0787.8YESYES

6.Koto gadang51%43.18%56.82%67.20%57.12%42.88%50,8%68.00%32.00%0.4390.40.0100.0787.8YESYES

7.Koto malintang78%66.30%33.70%36.60%31.11%68.89%78.00%68.00%32.00%0.4490.40.0100.0797.9YESYES

8.dalko57%48.11%51.89%51.30%43.61%56.40%56,6%68.00%32.00%0.4680.40.0110.0838.3YESYES

19lubuk basung1.Surabayo80%68.00%32.00%69.50%59.08%40.93%66,8%68.00%32.00%0.3500.30.0080.0626.2YESYES

2.balai ahad80%68.00%32.00%41.50%35.28%64.73%77,5%68.00%32.00%0.4290.30.0100.0767.6YESYES

3.Sungai jaring80%67.66%32.34%49.70%68.00%32.00%45.00%38.25%61.75%0.4200.30.0100.0747.4YESYES

4.sangkai48%40.89%59.12%60.00%51.00%49.00%76,8%68.00%32.00%0.4670.40.0110.0838.3YESYES

5.parit panjang80%68.00%32.00%62.90%53.47%46.54%56,9%68.00%32.00%0.3680.30.0080.0656.5YESYES

6.Sigunung80%68.00%32.00%78.60%66.81%33.19%80.00%68.00%32.00%0.3240.30.0070.0575.7YESYES

7.Garangan Timur55%47.09%52.91%54.60%46.41%53.59%65.20%55.42%44.58%0.5040.40.0110.0898.9YESYES

8.garangan tengah63%53.89%46.11%50.00%42.50%57.50%55.50%68.00%32.00%0.4520.40.0100.0808.0YESYES

9.bancah tales69%58.65%41.35%53.10%45.14%54.87%63.60%54.06%45.94%0.4740.40.0110.0848.4YESYES

10.Pasar Lubuk basung80%68.00%32.00%56,6%68.00%32.00%55.50%47.18%52.83%0.3890.30.0090.0696.9YESYES

20manggopohBUANA JAYA80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

1. Balai salu80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

2.batuh nampat80%68.00%32.00%78.00%66.30%33.70%80.00%68.00%32.00%0.3260.30.0070.0585.8'NOYES

3.batu hampar80%68.00%32.00%80.00%68.00%32.00%67.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

4.kampung Tengah80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

5.balai salasa80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

6.batang tarau80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

7.Pasar Duria80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

8.Anak air80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

9.Manggopoh Utara80%68.00%32.00%80.00%68.00%32.00%42.00%35.70%64.30%0.4280.30.0100.0767.6'NOYES

10.Padang Tongga80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

11.sago80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

12.Pasar Durian MGP80%68.00%32.00%80.00%68.00%32.00%71.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

13.Anak Air dadok80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

14.Kubu Anai80%68.00%32.00%80.00%68.00%32.00%80.00%68.00%32.00%0.3200.30.0070.0575.7'NOYES

&R&"Times New Roman,Regular"&9LAMPIRAN - 14.&P

Coverage of Measles Crash Program in Urban Slum Area

4 Cities, Indonesia, 2000

NoCitiesTarget% Vit A% Measles

6-11 Mo12-59 Mo6-59 Mo100,000 IU200,000 IU6-59 Mo

1JAKARTA3,65419,91323,56799.994.693.5

2SEMARANG1,78010,83712,63799.399.593.6

3SURABAYA2,44513,47415,91992.999.696.5

4MAKASSAR4,90128,53133,430104.8107.8104.9

12,78072,75585,553100.4101.498.5

Source : National EPI Office

Note : Vit A 100,000 IU for 6 - 11 Months old children

Vit A 200,000 IU for 12 - 59 Months old children

Coverage of Measles Crash Program in High Risk Villages

Prov. West Nusa Tenggara, Indonesia, 2001

NoDistrict# villages# children% Measles% Vit A coverage

totalHigh Risk6-59 MoCoverage100.000 IU200,000 IU

1Mataram236735591.3101.593.4

2W Lombok7810913695.1100.590.7

3C Lombok11412764891.597.897.1

4E Lombok108141714694.398.895.4

Evaluasi PIN 2002

n=215

Elisa IgGSNT (Netralisasi)

prepostprepost

Sero neg545200

Sero pos85134117137

GMT(log2)NCNC5.66.7

Seroconv ratio90.74%100%

titer>12827.20%66.20%VE=53.5%

2 dose schedule to increase vaccine efficacy

AGE (MONTHS)

Country1 st dose2 nd dose

Saudi Arabia612

Lesotho918

USA1218

North Europe1218

Netherlands158 years

China87 years

Cost effectiveness analysis of school catch up campaign and

crash program, 2000

modellocationCE ratio per case preventedconclusion

Routine + crash program + school catch up campaignhigh risk villagesRp 1,898,790

Routine + school catch up campaignnon high risk villagesRp 1,289,179

Routine + school catch up campaignhigh risk villagesRp 433,086Cost effective

Source : Simbolon, ES, 2001

Catch up Campaign

Crash Program

200120022003200420052006

2 dose Measles-school enters (routine)

BLF < 3 yrsBLF < 3 yrs

MEASLES CONTROL

STATUS :High risk district = % (total district = )

STRATEGY:

1Interrupt measles transmission from school children to younger age group

through school catch up campaign

2Prevent measles outbreak among children under five years of age

by integrating measles vaccination in high risk villages during polio campaign

3Introduce late 2 dose measles schedule through school based immunization

4Prevent accumulation of susceptibles through backlog fighting, targeting

children under 3 years of age in non UCI villages

MONITORING TOOLS:% suceptibles among children under five years of age

EVALUATION PROCEDURES :????

PLAN OF ACTION

NoActivitiestime

20012002200320042006

1Workshopto identify high risk villages

to develop district PoA

2Develop proposal and fund raising

3school catch up campaign and measles&polio campaign

4Introduce routine 2 dose schedule

5Backlog fighting in non UCI villages

MBD001968FB.xls

Chart1

147194

231288

10773

191224

351713

16434

4442

21726

9803

000

JLH KASUS

JLH KEMATIAN

FREK. KLB

NUMBER OF CASE AND DEATH

FREQ

Sheet1

KLB CAMPAK DI KAB. BOGOR TAHUN 1991 - 2000

NoTAHUNPUSKESMASLOKASIWAKTU KEJADIANJUMLAHMENINGGALATTACK RATECFR

DESAMINGGUPENDERITAkasus/jlh pddk x 100%

jlh pddk%abs%

I1991

1CIGUDEGDs Sukamaju7 okt (29/9 s/d 1 okt)1211226.76128.33

dukuh cikaret, Rw 4

2LEBAK WANGIDs Argapura Cigudeg11 okt s/d 20 okt173173

3SUKAJAYADs. Cileuksa9-Oct516516

kp. cileuksa hilir

Jasinga

Ds. madang Rt 13/248 s /d 51679?67.67913.43

Jasinga

II

1

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KLB THN 91-2000

JUMLAH FREK., KASUS & KEMATIAN DALAM KLB CAMPAK

DI KAB. BOGOR TAHUN 1991 S/D TAHUN 2000

NOTAHUNFREKWENSIJUMLAHRANGERATA2JUMLAHCFR(%)RATA-RATA

KLBKLB/THNKASUSJLH KASUSKASUS/KLBMENINGGALKLBMENINGGALCFR (%)

per KLBKLB SETAHUNPER TAHUNKLB PER FREK.KLB PER FREK.

12345678910

11991414712 - 67371912.94.812.8

2199282319 - 82292812.13.512.1

3199331077 - 583676.52.36.5

41994419112 - 103482211.55.511.5

51995133519 - 562772.00.52.0

61996416420 - 934131.80.81.8

7199724411 - 332249.12.09.1

81998621730 - 573620.90.30.9

9199939821 - 443300.00.00.0

102000000000.00.00.0

TAHUN1991199219931994199519961997199819992000

JLH KASUS14723110719135116444217980

JLH KEMATIAN1928722734200

FREK. KLB48341342630

KLB THN 91-2000

000

000

000

000

000

000

000

000

000

000

&A

Page &P

JLH KASUS

JLH KEMATIAN

FREK. KLB

KASUS & KEMATIAN

FREKUENSI

Gbr. 5.9 FREK. KLB, JLH KASUS & KEMATIAN DALAM KLB CAMPAK DI KAB. BOGOR TAHUN 1991 - 2000

KOSONG-2

TAHUN1991199219931994199519961997199819992000

JLH KASUS14723110719135116444217980

KOSONG-1

TAHUN1991199219931994199519961997199819992000

FREK. KLB48341342630

KOSONG

TAHUN1991199219931994199519961997199819992000

FREK. KLB48341342630


JLH KASUS & KEMATIAN

TAHUN1991199219931994199519961997199819992000

FREK. KLB48341342630

JLH KASUS14723110719135116444217980


JLH KASUS & KEMATIAN

14719

23128

1077

19122

3517

1643

444

2172

980

00

JLH KASUS

JLH KEMATIAN

TAHUN

JLH KASUS

JLH KEMATIAN

JUMLAH KASUS & KEMATIAN DLM KLB CAMPAK THN 1991 - 2000 DI KAB. BOGOR

FREK & KEMATIAN KLB

TAHUN1991199219931994199519961997199819992000

FREK. KLB48341342630

JLH KASUS14723110719135116444217980


FREK & KEMATIAN KLB

419

828

37

422

137

43

24

62

30

00

FREK. KLB

JLH KEMATIAN

TAHUN

FRKUENSI KLB

JLH KEMATIAN

FREKUENSI & JUMLAH KEMATIAN DLM KLB CAMPAK DI KAB. BOGOR TAHUN 1991 - 2000

Sheet8

&A

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Sheet9

&A

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Sheet10

&A

Page &P

Sheet11

&A

Page &P

Sheet12

&A

Page &P

Sheet13

&A

Page &P

Sheet14

&A

Page &P

Sheet15

&A

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Sheet16

&A

Page &P

TAHAPAN PROGRAM HB DI INDONESIATh. 1986 The International Task Force on Hepatitis B Immunization mengumumkan misinya untuk mempercepat imunisasi Hep.B di negara endemis sedang sampai tinggi. Th. 1987 Indonesia negara pertama dipilih untuk pengembangan model program imunisasi hepatitis B. Proyek percontohan imunisasi di pulau Lombok, Propinsi Nusa Tenggara Barat Kerjasama antara Pemerintah Indonesia dengan Task Force on Hep.B Immunization, USA dan PATH, USA. Pendekatan Birth Centered HB1 pada bayi sedini mungkin (0-7 hari), dengan melakukan kunjungan rumah.

Th. 1991-19924 Propinsi yaitu: NTB, Bali, Yogyakarta & JatimTh. 1992-1993+ 6 Propinsi yaitu: Jateng, Jabar, Jakarta, Lampung, Sumbar & Kalbar)Th. 1996-1997+ 3 Propinsi yaitu: Irja, NTT & Tim.Tim)14 Propinsi (Hanya 1 Kabupaten)April 1997Semua PropinsiCatatan:Masih menggunakan vial dan jadual pemberian HB1 umur 2 bulan kecuali NTB

Th. 1996 Field trial Uniject HB di NTB dan BaliTh. 2000-2001 Pengembangan Program Uniject HB pada bayi usia dini di Propinsi NTB, DIY dan Jatim.Th. 2000-2002 Operasional Pemberian Uniject HB pada bayi usia dini di Kendari dan Buton Prop.Sultra (HMHB) Th. 2000-2002 Wilayah proyek ICDC di 6 Propinsi & 12 Kabupaten menggunakan uniject HB.Th. 2002 Seluruh Propinsi menggunakan uniject HB pada dosis I (masing-masing 1 Kab. bagi Propinsi yang belum melakukan)Th. 2002-2003 Proyek Asuh di Kab. Cirebon, Cianjur (Jabar), Kab. Kediri & Blitar (Jatim)April 2003 Seluruh wilayah Indonesia menggunakan uniject HBPengenalan Uniject HB

Kebijakan HB Birth doseIntensifikasi hepatitis B birth doseMelalui:* Gunakan prosedur pelayanan th 2002JadualPendistribusian/pengelolaan vaksinPencatatan /pelaporan

* Memanfaatkan System Pelayanan setempat yang paling efektif dan efisien:Terpadu Lintas ProgramKerja sama dengan org Profesi, LSM dan swasta

* Pemantauan cakupanTerhadap target

Strategi hepatitis BHB birth dose dalam paket:persalinan tenaga kesehatanpelayanan neonatalCakupan HB < 7 hr mencapaiSetara cakupan Nakes (min 50% th 2003)Peningkatan min 10% setiap tahun Sosialisasi:Pelatihan awal berjenjang (Juli02-Feb03)Retraining (th 2004)Diss Info (melalui setiap pertemuan Lintas Program, org Profesi, LSM, swasta)

Mengapa imunisasi Hepatitis B harus diberikan saat lahir?Endemisitas Karier kronik Transmisi maternal ?

Epidemiologi infeksi Hepatitis B Yaound declaration Oct 1991350 juta karier kronik1 juta kematian per tahunPenyebab 1st at 2nd kanker hati

Hepatitis BPerjalanan penyakit menurut kelompok umurKelompok umurInfeksi kronik (%)

Infeksi kronis HBVperjalanan penyakit25% mortality rate apabila kronisitas terjadi pada masa anak-anak * 15% mortality rate apabila kronisitas terjadi pada masa dewasa Kariers : mempunyai risiko terjadi KHP 230 kali lipat Infeksi kronis HBV*Hepatitis kronik persistenHepatitis kronik aktif Asimtomatik Karier menular Sirosis hepatis Kanker hati primer

Karier VHB kronikKetidakmampuan untuk membersihkan HBsAg atau ketidakmampuan membentuk anti-HBs dalam waktu 6 bulan setelah infeksi awal Ketidakmampuan mengeliminasi virus HBMenular kepada orang lainInsidens 350juta di seluruh duniaTidak menyadari pernah terinfeksiCenderung progresif : sirosis, kanker hati & meninggal

Penularan Infeksi VHBPerinatal/vertikal: ibu ke bayi saat lahirHorizontal: bayi ke bayi/anak ke dewasaParenteral, perkutan: unsafe injection, transfusi darahSexual transmission

Penularan PerinatalIbu (karier) bayi saat atau segera setelah lahirPenularan terbanyak terjadi di daerah endemisitas tinggi (misal Asia Tenggara)70-90% bayi yang terinfeksi menjadi kariers 25% diantaranya meninggalPenularan vertikal (ibu fetus) jarang terjadi(Chen, 1996; Consensus statements, 2000)

Apakah Infeksi VHB dapat dihindari melalui imunisasi HB?Mencegah gejala klinis akutMencegah penyakit hati & kanker hatiMencegah viral transmission

Vaksin combo DPT-HBIntroduksi bertahap melalui:

Uji lapanganPenyesuaian standar & pedomanSosialisasi

Introduksi Hep B at birth dan Safe Injection

Kebijakan safe injection practices dan safe disposal managementHanya gunakan AD syringes untuk penyuntikan dalam program imunisasiGunakan metode pembuangan limbah standar sesuai hasil pemetaan

Strategi Safe injection practices dan safe disposal managementStandardisasi alat suntikIntroduksi UnijectPeralihan ke vaksin kombinasiTraining PetugasMonitoring & SupervisiPemetaan kabupaten ttg system pembuangan limbahPemilihan metodologi penanganan limbahMembentuk Komisi

Kejadian Ikutan Pasca ImunisasiAdverse events associated with vaccinesAdverse events following immunizationSemua kejadian sakit dan kematian yang terjadi dalam masa satu bulan setelah imunisasiyang diduga disebabkan oleh imunisasi(KIPI)(AEFI)

PenyakitCakupanimunisasiKasus KIPIKLBEradikasipenyakitPravaksinasiCakupanmeningkatKIPI meningkatKepercayaan masyarakat menurun,terjadi KLBKepercayaanmasyarakatmeningkatkembaliEradikasi

ImunisasistopBagan Maturasi Perjalanan Program Imunisasi(Chen RT, 1999)

Faktor Penyebab KIPIKesalahan prosedur/ teknik imunisasi Induksi vaksin Kejadian kebetulan (koinsiden) Tidak/belum diketahui

Kesalahan Prosedur/Teknik ImunisasiKesalahan Program Dosis vaksin (berlebih) Lokasi dan cara penyuntikan Sterilisasi semprit dan jarum suntik Jarum bekas pakai Tindakan a dan antiseptik Penyimpanan vaksin Pemakaian sisa vaksin Jenis dan jumlah pelarut vaksin Mengabaikan petunjuk produsen

Induksi Vaksin Reaksi simpang vaksin Sudah dapat diperkirakan sebelumnya Secara klinis biasanya ringan Dapat terjadi reaksi hebatanafilaksis sistemik risiko kematian

Kejadian Koinsiden (kebetulan)Terjadi secara kebetulan setelah imunisasi Kejadian yang sama terdapat pula pada populasi setempat yang tidak mendapat imunisasi

NASIONALPROPINSIKABUPATENPUSKESMASBIDAN DESABIDAN SWASTABIDAN SWASTADUKUNKADERMASY. Informasi tentang Ibu hamilLaporan PersalinanLaporan CakupanRumah SakitPolindesRumah BersalinALUR PELAPORAN

CAKUPAN IMUNISASI PER KAB/KOTA BULAN . TAHUN 2002Propinsi: ...

00000

Sheet2

No.Kab/KotaSasaranCakupanVaksinStok AwalPenerimaanPengeluaranStokIP

BCGDPT1DPT2DPT3Polio1Polio2Polio3Polio4CampakHB1HB2HB3123456

7 hariBCG

Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%DPT

Polio

Campak

Hepatitis B

Uniject HB

TT

DT

Sheet3

MONITORING VAKSIN TAHUN 2002 Propinsi: Bulan: .

00000

Sheet2

No.Kab/KotaSasaranCakupanVaksinStok AwalPenerimaanPengeluaranStokIP

BCGDPT1DPT2DPT3Polio1Polio2Polio3Polio4CampakHB1HB2HB3123456

7 hariBCG

Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%Abs%DPT

Polio

Campak

Hepatitis B

Uniject HB

TT

DT

Sheet3

Pemantauan Wilayah SetempatMar Feb Jan DecNovOctSept Aug Jul Jun May AprDESA% DPT 1

Chart3

96.8DimoroDimoroDimoro

94.9KatongKatongKatong

82.7BandunchajoBandunchajoBandunchajo

79.4GenengadalGenengadalGenengadal

77.5PulangpuyangPulangpuyangPulangpuyang

77.1SugihanSugihanSugihan

75.5TambirejoTambirejoTambirejo

68.7KranganharjoKranganharjoKranganharjo

68.5DepokDepokDepok

65.4SindurejoSindurejoSindurejo

77.8Health Center TorohHealth Center TorohHealth Center Toroh

Cumulative %

% This month

% Last month

Trnd

00000

Sheet2

DimoroKatongBandunchajoGenengadalPulangpuyangSugihanTambirejoKranganharjoDepokSindurejoHealth Center Toroh

Cumulative %96.894.982.779.477.577.175.568.768.565.477.8

% This month

% Last month

Trnd

Sheet2

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

0000

Cumulative %

% This month

% Last month

Trnd

Sheet3

Sheet1

Cumulative %97.494.982.779.477.577.175.568.768.565.477.4

% This Month9.47.666.410.99.93.712.19.65.78

% Last month7.63.8187.113.37.66.111.18.94.28.7

Trend

INDIKATOR KEBERHASILANOutput:Cakupan Imunisasi tinggi dan marata:Akses: % DPT1 > 90%Perlindungan: % Campak > 80%Manajemen: % drop out DPT1 - CampakImpact:PD3I:Insidens turun (reduksi campak)tak menjadi masalah kes.masy. Lagi (eliminasi tetanus tetanus)terbasmi (eradikasi polio)

In 1991 in Yaound, a declaration was made in order to eliminate Hepatitis B. In 1992, WHO endorsed the recommendation that Hepatitis B should be integrated into the EPI in all countries by 1997 and in carrier prevalence countries > 8%, by 1995.58 countries have already implemented Hepatitis B vaccine in their schedule. Hepatitis B vaccines have been administered in various schedules within EPI : 3 doses at 0, 1 and 6 months together with the other EPI vaccines 4 doses starting at birth when the prevalence is high(From Thompson,S.C. Hepatitis B vaccination : what are the current international recommendations ? , Clin. Immunother. 3(1) : 15-26, 1995)In addition to the primo-immunization in children, other countries have adopted a strategy for at-risk adults, and adolescents.34Chronic HBV infection: Clinical outcome Chronic infection with HBV progresses in either of two ways chronic persistent hepatitis (CPH) or chronic active hepatitis (CAH).CPH seldom progresses to CAH. Healthy carriers insidiously infect other people.CAH may progress to cirrhosis or to primary hepatocellular carcinoma (PHC).The mortality rate from HBV infection is 25% for those chronically infected during childhood, and 15% if chronicity develops during adulthood.

15151517Perinatal transmission Occurs when HBV is transmitted from infected mother to infant.As many as 70-90% infants born to infectious mothers become infected, 40-90% of whom will become chronic carriers. Of these carriers, 25-30% will die from cirrhosis or PHC.In areas with high prevalence of HBV, up to 15% of pregnant women will be HBsAg positive, of which 10-45% will be highly infectious (i.e. HBsAg and HBeAg positive).

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