CURRICULUM VITAE

Nama : Prof. DR. Dr. Samsuridjal Djauzi, SpPD-KAI, FACP

Pendidikan : - Fakultas Kedokteran UI, 1969

- Spesialis Ilmu Penyakit Dalam FKUI, 1976
- Konsultan Alergi-Imunologi, 1986
- Doktor dibidang Alergi-Imunologi FKUI, 1999
- Honorary Fellow of American College of
Physician, 2001
- Guru Besar FKUI
Jabatan : - Pengajar Dept. Ilmu Penyakit Dalam FKUI
- Chairman Indonesian Association of Physician
in AIDS Care
- Chairman Adult Immunization Working Group PAPDI
Rationale and Ethics of
Influenza vaccination of Health
Care Workers

Samsuridjal Djauzi
Satgas Imunisasi Dewasa PB PAPDI
Vaksin yang dianjurkan untuk
petugas kesehatan
 Hepatitis B
 Influenza
 Varisela
History of Adult Imunization in
Indonesia
 2003 : Consensus of Indonesia Health
Immunization
 2003 : Adult Immunization Task Force (
Indonesian Society of Internal Medicine)
 2003-2017 : collaboration with Obgy,
Dermatologist , Neurologist, Pulmunologist ,
Geriatrician, Public Health etc
 2005 –now :Vaccinology training
 2003,2009,2012,2017 Publish book on Adult
Immunization
ALV/PRN/22/16/07/11
Layanan Imunisasi di Masyarakat
 “Every year, tens of thousands of
adults and hundreds of thousands
more are hospitalized due to
diseases that could be prevented by
vaccination.”

Clin Infect Diseases 2007;44:1529-31

Why Vaccinate Adults?
 High risk group:
- elderly (>60 y.o.)- waning immunity1 : important in
tetanus, pertussis, flu
- chronic diseases (diabetes, asthma, heart disease)—
prone to complications in flu and pneumococcal
diseases1-3
- occupational hazards- health workers, laboratory
workers, soldiers, college students-transmission of
flu,meningococcal diseases,hepatitis A and B, varicella1-3
-pregnant women-increased risk for complications of
influenza2,3

[Link] RK, et. al. [Link] Across the Life Span. 4th ed. 2007
2. AAP. Pickering LK, ed. Red Book:2003 Report og the Committee on Infectious
Diseases. 26th ed. Elk Grove Village,IL: AAP;2003:68
3. CDC. Pink Book, 10th ed, 2008
 Key Vaccines: Adults
 Influenza
 Pneumococcal
 Tetanus/Diphtheria
 Human Papillomavirus
 Hepatitis B (high risk groups)
 Hepatitis A (travel to endemic areas)
 Meningococcal (high risk groups)
 Typhoid (travel to endemic areas)
 MMR (catch-up)
 Varicella (catch-up)
 Herpes Zoster [Link] RK, et. al. [Link] Across the Life Span. 4th ed. 2007

Dengue
2. AAP. Pickering LK, ed. Red Book:2003 Report og the Committee on Infectious
 Diseases. 26th ed. Elk Grove Village,IL: AAP;2003:68
3. CDC, Pink Book, 10th ed. 2008
Use of Seasonal Influenza Vaccine
in Asia Pacific Region
 Complications: Influenza
Hospitalization Rates
60
Hospitalisation rate/10,000 population

50

40

30

20

10

0
<5 5–9 10–19 20–34 35–44 45–54 55–64 65
Age (yrs)
Glezen et al. 1987
Angka Komplikasi pada Manula
Lebih Tinggi
80%
Persen dari semua
kasus imfluenza
70%
60%
50%
40%
30%
20%
10%
0%
40-49 50-59 60-69 >70
Kelompok umur

Distribusi komplikasi paru-paru pada pasien influenza

pada lima epidemi berturut-turut
Penduduk Usia Lanjut
 Penduduk Indonesia saat ini 231 juta jiwa.
(perkiraan hasil sensus 2010, BPS)

 7,6 % dari total penduduk berusia lanjut

(WHO, 2002). 9,77 % (2010, BPS)

 Jumlah penduduk usila: 28,8 juta jiwa,

jumlah balitanya: 17,6 juta jiwa
(perkiraan pada tahun 2020, BPS)
Pencegahan influenza di Perusahaan
 Vaksinasi untuk melindungi karyawan masih
dianggap sebagai pemborosan biaya
 Kurang informasi mengenai kerugian yang
disebabkan oleh penularan influenza di
kalangan karyawan
 Kurang informasi mengenai penurunan
produktivitas
Dampak Influenza Pada
Perusahaan
 Sekitar 15 juta hari kerja hilang di Amerika Serikat
 Biaya yang harus dikeluarkan perusahaan
 Biaya berobat, perawatan rumah sakit , dll
 Kehilangan rata-rata hari kerja produktif 0.5-15 hari
 Kehilangan hari kerja produktif 145 dollar per hari
 Hadi bekerja tetapi produktivitas menurun 30-70%
 based on 2003 US$

1. Molinari N 2007; 2. Prosser LA 2008

3. VIscusi WK J Risk Uncert 2003
Influenza pada Petugas
Kesehatan
 Petugas kesehatan berisiko tertular influenza :
 Kontak dengan pasien influenza
 Penularan 11-59% selama hospital outbreaks.1
 Penularan sekitar 23% selama community outbreaks.2
 Sekitar 75% petugas kesehatan yang menderita
influenza tetap bekerja sehingga :
 Dapat menularkan pada pasiennya
 Mempengaruhi perawatan pasien menjadi lebih lama dan
lebih mahal

1. Bellei. Braz J Infect Dis. 2007 Aug;11(4):399-402.

2. Salgado. Lancet Infectious Diseases 2002; 2: 145–55.
Pencegahan Penularan Influenza di
Rumah Sakit
 Petugas kesehatan dapat tertular influenza
dari pasien
 Petugas kesehatan dapat menularkan
influenza kepada pasien dampaknya
berbahaya pada pasien dalam keadaan
defisiensi imun
 Di beberapa negara petugas kesehatan
diwajibkan menjalani vaksinasi influenza (di
Amerika Serikat dan negara-negara maju
lainnya)
Vaksin Influenza
 Seasonal influenza (influenza A, influenza B)
 H1N1 pandemi influenza (Meksiko, Flu babi)
 Avian influenza (H5N1)
Imunisasi Influenza di Indonesia
 Masih amat rendah penggunaannya
terutama untuk calon jemaah haji
 Harga masih dirasakan tinggi
 Layanan belum merata
Seasonal Influenza Vaccine
 North-South Vaccine
 Trivalent vaccine (2 influenza A,1 influenza B)
 Quadrivalent vaccine
Influenza Pada Petugas Kesehatan
 Petugas kesehatan dapat tertular influenza
dan menularkan kepada pasiennya
 Sebagian besar petugas kesehatan tetap
bekerja meski menderita influenza sehingga
berisiko menularkan pada pasiennya
 Pasien yang mengalami defisiensi imun
dapat mengalami komplikasi bila tertular
influenza
Health Care Workers,
Influenza vaccination
 Variation between Asia Pacific countries
 Hongkong 20-50%
 Korea, Taiwan 80-90%
 New Zealand 35%
 Singapore 39%
 Australia 26-38%
 Indonesia less than 10%
Influenza Outbreaks in Healthcare Facilities are Common
and Probably Underreported

| 26
The Consequences of Healthcare-associated
Influenza are Significant
• Nosocomial outbreaks with illness and deaths
in vulnerable patients
• Extended hospital stays and increased costs
• Sick and exposed hospital staff furloughed from
work, creating staff shortages
• Damage to the reputation of the healthcare
facility
Doctors make the worst patients
 Compliance with influenza vaccination among
health care workers (HCWs)1
◦ vary from 2 to 36% around the world

 Survey of HCWs at the Ob-Gyn Department in

RS Hasan Sadikin, Bandung (2007)2
◦ Only 38% fully vaccinated against hepatitis B

petugas kesehatan

1. Couto C, et al. Fighting Misconceptions to Improve Compliance with Influenza Vaccination among Health Care Workers:
An Educational Project. Plos One. February 2012 ;7(2 )
2. Antono SK, Raya RP. Occupational risk for human immunodeficiency virus, hepatitis B, and hepatitis C infection in
health care workers in a teaching hospital in Indonesia. American Journal of Infection Control. November 2010
Influenza vaccine coverage rates are still
insufficient (2010/11)
Korea
UK3 Spain2, 4 Poland 4, 5 USA 1 China4*
(south) 4

Senior adults 73% 57% 8% 75% 3% 70%

General population - 19% 5-6% 41% 3% 24%

35%
Chronic ill 50% - 9% 1% 75%
(18-49 yrs)

HCW 34% 28% 12% 56% 10% 70%

Children (6m-17y) - - 7% 46% 6% 30%

1) From Center of Disease Control and Prevention, Behavioral Risk Factor Surveillance System (BRFSS) and National
Immunization Survey (NIS). Coverage estimates 29by Nov 2010; CDC, USA 2011; 2) Gripometro, 2011; 3) NHS London;4)
Sanofi Pasteur internal data; 5) personal communication; * 3 main cities
30
Influenza Vaccination is an Ethical
Responsibility and Patient Safety Issue
 Influenza vaccination of healthcare workers is a
personal issue, a professional issue and an institutional
concern
 HCW vaccination builds public trust and credibility in
the healthcare facility by putting patient safety first
 Vaccination is consistent with the ethical imperative to
“do no harm” by taking reasonable action to prevent
disease transmission in healthcare settings
 “the welfare of patients is best served by very high
rates of staff immunity that can only be achieved
through mandatory vaccination…under voluntary
standards, institutional outbreaks occur”
(AM Stewart. N Engl J Med 2009; 361:2015-7)
Percent influenza vaccination in persons 65,
Australia, 1997, by state Source: IMS Australia

80

60

40

20

0
Australia NSW Vic Q’ld SA WA Tas
Langkah-langkah yang Harus Dilakukan
 Meningkatkan informasi
 Memperbanyak tempat layanan imunisasi
 Harga vaksin yang lebih terjangkau
 Upaya untuk terjun ke lapangan
Malaysian National Campaign
ONE MILLION INFLUENZA
SHOT IN INDONESIA IN 2014?
Langkah-langkah yang Harus Dilakukan
 Meningkatkan informasi
 Memperbanyak tempat layanan imunisasi
 Harga vaksin yang lebih terjangkau
 Upaya untuk terjun ke lapangan
Pengalaman Thailand
 Jumlah tenaga kesehatan sekitar 400 ribu orang
 Pemerintah menyediakan vaksin sebanyak
3.400.000
 Penggunaan :
- 400 rb untuk petugas kesehatan (cakupan 93%)
- 3 Juta untuk ibu hamil, usia lanjut, penyakit kronik
Pengalaman Filipina
 Telah mulai melaksanakan imunisasi
influenza pada petugas kesehatan (2015)
Kemungkinan imunisasi Influenza
pada petugas kesehatan di Indonesia
 Dokter + Dokter Gigi : 157.393
 Perawat : 237.181
 Bidan : 124.948
 Petugas Kesehatan : 576.634
 Tenaga Penunjang : 195.444

 TOTAL : 772.078
Persiapan
 Kebijakan
 Program
 Anggaran
 Pedoman pelaksanaan
 Dana terutama untuk pengadaan vaksin
(Thailand)
Terima kasih