Imunisasi Bagi Pekerja, Travelers, Jamaah Haji danUmroh)

Imunisasi Bagi Pekerja, Travelers, Jamaah Haji danUmroh)

Dr. Edi Alpino Siregar, MKKKa. Instalasi OHC, RS YARSI

Ketua Komite K3RS

Dr. Edi Alpino Siregar, MKKKa. Instalasi OHC, RS YARSI

Ketua Komite K3RS

Agenda

Tra

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Va

ccin

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1

2

3

4

5

Introduction: Travel Med ServicesIntroduction: Travel Med Services

Adult Immunization in IndonesiaAdult Immunization in Indonesia

Principles of Travel VaccinationPrinciples of Travel Vaccination

Vaccines for Hajj, Umrah, and WorkersVaccines for Hajj, Umrah, and Workers

Setting the PrioritySetting the Priority

INTRODUCTIONSection 1

What is Travel Medicine?

Travel medicine is the field of medicine concerned with the promotion of health and the prevention of disease or other

adverse health outcomes in the international traveler.

The primary goals of travel medicine are:

• to prevent disease and injury in travellers.

• to treat medical problems in travellers when returning home.

Prof. Robert SteffenDepartment of Epidemiology and Prevention of Infectious Diseases, University of Zurich

The Continuum of Travel Medicine

PRE-TRAVEL DURING TRAVEL

POST-TRAVEL

• General advice• Vaccination• Malaria

prophylaxis

• Local treatment• Evacuation

• Late treatment• Diagnosis and

treatment for travel-related disease occurring later

Prof. Peter A. LeggatDeputy Dean, College of Public Health, James Cook University, Australia

Travel Medicine Services

Initial visit and travel consultation with nurse Initial visit and travel consultation with physician Follow-up visits Travel consultation with physician Replacement of international certificate Prescription(s) only Immunizations

ADULT IMMUNIZATION IN INDONESIA

Section 2

Destinations of Indonesian Travelers

-

500.000

1.000.000

1.500.000

2.000.000

2.500.000

3.000.000

3.500.000

2009 2010 2011 2012 2013

Nu

mb

er

of

arr

ivals

Outbound Travelers from Indonesia, 2009-2013

Malaysia

Singapore

China

Thailand

Hong Kong

Saudi Arabia

From various sources

Adult Immunization Recommendation in Indonesia

Vaccine Schedule

Influenza 1 dose annually

Td/Tdap Primary: 3 doses (month-0, 1, 7-13) then 1 booster every 10 years

Varicella 2 doses (month-0, 1-2)

HPV for women 3 doses (month-0, 1 or 2, 6) at 19 to 55 years

HPV for men (quadrivalent) 3 doses (month-0, 2, 6) at 19 to 26 years

Zoster 1 doses after 50 years

MMR 1 or 2 doses (at least 28 days apart)

Pneumococcalconjugate 13-valent (PCV13)

1 dose after 50 years

Pneumococcal polysaccharide(PPSV23)

1 dose after 60 years

Hepatitis A 2 doses (month-0 and 6-12)

Hepatitis B 3 doses (month-0, 1 and 6)

Typhoid fever 1 dose for 3 years

Djauzi S, et al (eds). Pedoman Imunisasi Dewasa 2017. Jakarta: Satgas Imunisasi PAPDI, 2017.

Indonesian adults should receive many vaccines without going anywhere.

Non-routine vaccination

Rabies Japanese encephalitisMeningococcal meningitis Yellow fever

Dengue fever?

Cholera Tick-borne encephalitisQ fever Anthrax

Travel-related vaccines

PRINCIPLES OF TRAVEL VACCINATION

Section 3

Asian vs. Western Travelers

1. Vaccine-preventable diseases that are rare in the West may be endemic in Asia e.g. typhoid fever, hepatitis A, hepatitis B, dengue,

rabies, Japanese encephalitis).2. Some Western “travel vaccines” are included in Asian

country immunization program. e.g. hepatitis B

3. Natural immunity may be present in Asian travelers. e.g. hepatitis A (vaccine-preventable), diarrheal

disease (non-vaccine preventable)4. Different behavior between Asian and Western travelers

Piyaphanee W, et al. J Trav Med. 2012;19:335–7.

Risk Management in Travel Medicine

Advice to Risk Reduction Strategies

Identify Risks for Individual or Groups

Encourage Behavioral Change to Reduce Risks

Steps in Risk Management

Recommendation & Supplies

Risk reduction interventions

Information enabling behaviour modification

Vaccinations Medications (including

antimalarias) Other - travel insurance,

pre existing medical problems, nets, syringes, medical kits

Basic Principle Of Vaccination-1

A vaccine is recommended if the risk of getting an infectious disease is higher in the destination country/ area.

For example: Risk of Japanese encephalitis is higher in Japan than

Singapore

Risk of typhoid fever is higher in India than in Indonesia

Basic Principle of Vaccination-2

A vaccine is recommended for non-immune travellers that is susceptible to certain infectious disease.

For example: Meningococcal meningitis is not a routine

vaccine in Indonesia. It is recommended for traveler to high-risk

areas Hajj pilgrims going to Saudi Arabia

Basic Principle of Vaccination:-3

A vaccine should be given when optimal protection can be expected before the trip. Otherwise, postpone the trip or consider other preventive measures or self-treatment.

For example: Antibody appear at least 2 weeks after

vaccine injection. Hepatitis B needs 3 doses at month 0, 1, and

6. However, there is accelerated schedule of day-1, 7, and 21 + booster dose at 1 year.

SETTING THE PRIORITYSection 4

Setting the Priority of Travel Vaccination: 5R

Route

Record

RiskRecommendation

Realization

ItineraryRencana perjalanan

HistoryRiwayat

RisikoRekomendasi

Realisasi

Pakasi LS. Imunisasi Perjalanan. Jakarta: Satgas Imunisasi PAPDI, 2017.

Risk of vaccine preventable diseases

Influenza remains the most frequent vaccine preventable illness.

Estimated incidence per month in lower income countries among non-immunes

Steffen R. J Trav Med. 2018;25:1–3.

Required (mandatory) vaccine

International certificate of vaccination or prophylaxis (ICVP)

Mandatory vaccines: Yellow Fever Meningococcal disease

(against serogroups A, C, Y and W135), required by Saudi Arabia for pilgrims

Polio

2018: Update on Yellow Fever vaccination

2019: Update on polio vaccination

Why a traveler does not get vaccination?

Low compliance with travel vaccines Unaware of health risks (no consultation) Consult unreliable sources of information (friends, travel

agents, Google, etc.) Last minute traveler (too late for vaccination) Fear of needles or adverse events High cost of vaccines Forget the 2nd or 3rd dose Do not perceived risk as a serious matter

Caillet-Gossot S et al. J Travel Med. 2013; 20:171-6.Muller JM et al. J Travel Med. 2013; 20:78-82.Baggett HC et al. J Travel Med. 2009; 16:112-8.

Laverone E et al. J Travel Med. 2006; 13:338-44.Van Herck K et al. J Travel Med. 2004; 11:3-8.14

HAJJ AND UMRAHSection 5

Hajj and Umrah Pilgrims

Muslim country has a hajj quota of 1,000 pilgrims per million inhabitants.

Every year, >200,000 Indonesians go to Mecca for Hajj the largest contingent.

Plus umrah about 1 million Indonesians go to Saudi Arabia each year

Things to consider before going for Hajj or Umrah

Physical fitness Environment – desert Weather, season, humidity Culture

Food Accident Crowded airborne

Infections

Hajj Pilgrims – Death Rate

323

451522

451

312

410

494428

2009 2010 2011 2012

Total In Saudi Arabia

Heart attack and pneumonia are the main cause of death. Poor physical condition and fitness, low respiratory and

musculoskeletal endurance, old age are risk factors.

Jemaah haji wafat di Arab Saudi – 2018 data

0 50 100 150

Cedera, keracunan dan…

Kanker

Penyakit sistem genitourinari

Penyakit pencernaan

Nutrisi dan penyakit…

Penyakit menular dan parasit

Penyakit peredaran darah

Penyakit kardiovaskular

Penyakit pernapasan

Vaksin untuk Jemaah Haji

Meningococcal meningitis quadrivalent– mandatory vaccine

Influenza PneumococalDPT Hepatitis AHepatitis BMMRTyphoid

Alqahtani AS, et al. J Trav Med. 2018;25(1):1–2

Routine vaccines!

Adult recommendation

in Indonesia

WORKERS Section 6

Types of workers

Indonesian Workers

Business trip

(Corporate, businessmen)

Long-term

(TKI, TKW)

Vaccine recommendation

Similar to requirement for general travelers. Special attention to: Corporate travelers short notice before

going, no sufficient time for antibody to develop

Company standard requirements, issued by HRD/ HSE

Pregnant women/ kids (family) Flexible itinerary for long-term workers, e.g.

go to higher risk area on weekend, local vacations, etc.

CONCLUSION

When considering vaccines

4th Step

3rd Step

2nd Step

1st Step

Required & Routine Vaccines

Risk of Diseases

Complete History

Detailed Itinerary

Follow these steps……

PRIORITY VACCINESPRIORITY VACCINES

TERIMA KASIH