Solid Foods: Frequently Asked Questions

Expert answers to questions about feeding your baby solids.
By Bryan Vartabedian, MD

When it comes to feeding solids, just as soon as you've figured out what foods to start with, you're wondering "What's next on the menu?" and "What should my baby be eating?" Late infancy brings your child from pureed baby feed closer to the table. He'll advance from two feedings a day to three and begin to eat with the rest of the family. Although each new step comes pretty naturally, here are some questions that may arise along the way:

How much cereal should my 6-month-old be eating?

While there's nothing magical about cereal, it does provide a valuable source of iron during the second half of a baby's first year. How much cereal a baby needs depends on the child's intake of formula or breast milk. A 6-month-old needs about 10 milligrams of iron per day, which can be met with 27 ounces of regular infant formula (avoid low-iron varieties). The amount of breast milk is harder to quantify, because the number of daily feedings and the amount of iron that a woman's milk contains will vary. Since your child may not consistently take in adequate formula or breast milk, to round things out, give her at least 4 tablespoons a day of dry cereal mixed with formula. This provides about half of her daily iron requirement. Once your child is 7 or 8 months old, you can introduce meat, which will make cereal less important.

My baby doesn't seem to like meat. Does he really need it?

While babies don't necessarily need meat, it offers a terrific source of iron, especially since cereal intake often decreases late in the first year. In addition, the type of iron found in meat is absorbed more efficiently than the iron in cereals or fortified foods. So give your baby some more time to get used to meat before counting it out.

My baby eats a lot of squash and carrots, and I've noticed that her skin in a slight shade of yellow. Is this jaundice?

This is a condition called carotenemia, which results from the intake of a lot of carotene, a pigment abundant in the orange and yellow vegetables your baby appears to enjoy. The resulting slight skin discoloration is harmless, and it will fade with the addition of other foods to your baby's diet. One of the ways you can distinguish carotenemia from jaundice -- an excess of bilirubin (a liver by-product) in the blood -- is that in children with jaundice the whites of the eyes are also yellow. Carotenemia doesn't affect the eyes.

When is it okay to switch from stage 1 to stage 2 foods?

Some parents place a lot of stock in the label on the baby-food jar. But these stages are created by the baby-food manufacturers and are somewhat arbitrary. The main difference between stage 1 and stage 2 is that stage 2 foods are more diverse, mixing foods such as chicken and rice. The jar may also be bigger to satisfy the larger appetites of older infants. But the texture of stage 2 foods isn't any more advanced, or lumpier, than stage 1 foods -- they're both purees. So if your child is polishing off his stage 1 foods and eating a small variety of four to six baby-food fruits and vegetables, feel free to take the leap. Just be aware of the new fruits, veggies, or other foods introduced in stage 2, in case your baby has an allergic reaction. Chunkier baby food (stage 3) can be offered at around 7 or 8 months.

What foods are most likely to cause an allergic reaction?

Fortunately, the fruits and vegetables that babies start with infrequently cause true allergic reactions, which usually means just a rash or stomach problems. The most common allergies experienced by children are to milk (from exposure to cow's milk protein in formula or breast milk), wheat, eggs, fish, and peanuts. Bread and egg yolks should be withheld until your baby is 8 months old, egg whites and fish until age 2; shellfish should not be given until age 3. Peanut exposure, through nuts, oils, or peanut butter, should certainly be avoided during the first year of life. (Allergic reactions to peanuts are often serious, and the nuts themselves are a choking hazard until a child is 4.) If you have a family history of allergies, you may want to talk to your doctor about holding off on these foods for even longer.

My son was diagnosed with a food allergy at 4 weeks. He's 5 months old now and we'd like to start him on solids, but we're nervous about it. What should we do?

This is a very common concern among parents of children with milk protein sensitivity. The fear is that if he's allergic to milk protein, he'll also be at risk for a number of other allergies. As it turns out, most babies who react to milk in the first weeks of life do just as well advancing on solids as any other baby would. However, if your baby has had a severe milk protein allergy with symptoms that included blood in the stool, rash, or breathing difficulties, you should proceed with caution. He's at risk for reactions to other baby-food components, such as soy. Discuss this with your baby's physician.

My son is 7 months old and we haven't yet offered him solids. Is there any danger in waiting?

While the word "danger" may be a bit strong, it isn't a good idea to keep your child away from solids much longer, because you risk the development of what's known as oral aversion -- a hypersensitivity to solids usually characterized by choking or gagging. It can occur when a child is fearful of certain food textures or tastes because he's never encountered them before. Oral aversion can also occur when swallowing is painful. Babies with recurrent heartburn, or reflux, often learn to avoid solids because of their fear of pain. While I normally don't push parents to start their children on solid food until they feel comfortable, the potential for aversion illustrates the importance of getting things underway by 6 months of age.

When should my child begin eating three solid meals a day?

When you start your infant on solid food, you'll typically offer baby food twice a day. As soon as your child is used to solids -- at around 7 months -- you can transition him to three meals a day, just like the rest of the family.

How much formula should an 8-month-old be taking? My son takes three 6-ounce bottles a day, in addition to three hearty meals of baby and table food. But I'm concerned that this isn't enough.

Most babies between the ages of 6 and 9 months will take anywhere from 25 to 35 ounces of formula a day. This varies depending on how often a bottle (or breast) is offered, what other liquids are being given, and how interested the baby is in solids, among other things. At 1 year of age, formula intake should drop to about 20 to 28 ounces a day. In your case, 18 ounces a day in addition to healthy solid feedings is a little less than what the average 8-month-old consumes. This shouldn't necessarily be a cause of concern, since plenty of healthy, thriving babies get by on this amount of formula. And growth -- monitored by your pediatrician at well-baby visits -- should be the bottom line when judging whether your baby is eating enough. However, be sure that your child isn't filling up on juice or other beverages instead of milk. Breast milk or formula is the preferred beverage during the first year.

How do I know when my baby is ready for table food?

Once your child is 8 months old, if she seems curious about what's on your plate or bored with her same old baby foods, you can try offering some unseasoned mashed potatoes or squash. Some babies will actually begin to refuse their silky-textured baby food as a sign that they're ready for something more advanced. If giving your fickle feeder table food arouses a new attitude, you may be on to something.

How early can I begin giving zwieback toast or teething biscuits to my child?

While most teething biscuits are designed to soften and melt upon chewing, larger pieces can break off and present a choking hazard to young children. Because of this remote but possible risk, teething biscuits should not be introduced until your baby is 10 to 12 months old, and then only under close supervision. And if your child seems more interested in breaking the biscuit into pieces with his teeth than sucking on it, biscuits may not be a good idea, even if he's at the right age. Instead, offer unsalted crackers that have a melt-away consistency and present much less of a choking risk.

I understand that children aren't supposed to drink regular milk until age 1. Can I give my baby cooked table foods prepared with whole milk?

You're right that your baby's digestive system is unable to process the proteins in regular cow's milk until she's a year old. But table foods that a child eats toward the end of the first year can contain whole milk, because the amount in these foods is not enough to cause harm.

What about yogurt?

Yogurt contains cow's milk protein, but the quantities are fairly limited and thus not usually a concern. You can give your baby yogurt after 8 months of age, but limit it to 2 to 4 ounces a day. Stick with plain, unsweetened yogurt and add your own minced fruit to keep things interesting. Yogurt can be a good addition to a baby's diet, as it appears to offer health benefits: Studies have shown that its active cultures may help prevent and treat diarrhea in infants and protect against eczema. However, yogurt should not be given to babies who have a documented milk allergy.

My 9-month-old has started crying in the middle of the night. We offer her a bottle and it seems to help. Does this mean she isn't getting enough to eat during the day?

Most 9-month-olds are able to get enough to eat during the day and don't need to be fed at night. Yet babies at this age will experience nighttime awakenings, perhaps as the result of a dream. Some parents interpret these episodes as a sign of hunger, and the eager acceptance of a bottle reinforces that notion. After several nights of this, though, a baby will come to understand that her wailing leads not only to a midnight social break but also to a warm bottle. Instead of giving your child milk, be sure she has some familiar objects in her crib to reassure her she's in a safe place. Don't reinforce her awakenings with food unless you're prepared to make middle-of-the-night snacks a permanent habit.

Adapted from the book First Foods, Copyright 2001 by Bryan Vartabedian, MD. Reprinted by arrangement with St. Martin's Press, LLC, New York, NY

Too Much Juice

Is juice squeezing important nutrients out of your child's diet?

By Madeleine Greey

There was a time when my son seemed to have only two words in his vocabulary: "No!" and "Juice!" Both words tumbled out of his two-year-old mouth with the same sense of dire urgency. When Nicholas awoke, it was "Juice!" Mid-morning, it was "Juice!" And so on throughout each busy day. I found myself pouring little plastic cups of juice like a mindless robot, until one day I stopped to take stock. My cute little juice-aholic was knocking back more than 24 ounces of the sweet stuff a day. No wonder his other favourite word came my way every time I asked him to sit down and eat.

Juice, like many good things, is best in moderation. Too much of it can lead to a surprising array of problems. The wake-up call for many health-care professionals was a study, published in a 1994 issue of Pediatrics, revealing that excessive juice consumption in toddlers could actually lead to failure to thrive, or growth deficiencies.

Less extreme, but still worrisome to many parents, is the relationship between juice drinking and picky eating. This phenomenon has been witnessed in detail by William Wilkoff, author of Coping with a Picky Eater, who points to a problem he calls "the juice deception."

"Juice is better than soft drinks," writes Wilkoff, "but it is easy to get too much, particularly in a bottle, and it displaces important nutritious components of the child's diet.... In my pediatric nutrition clinic days, more often than not, I would find toddlers were drinking way too much juice - sometimes as much as 24 ounces a day."

That amount far exceeds the Canadian Paediatric Society (CPS) recommendation that children from six to 24 months drink no more than four to six ounces (125 to 200 mL) a day, and children two to 12 years old drink no more than eight to 12 ounces (250 to 375 mL) a day. In other words, parents should limit juice intake to two servings daily.

"Parents have a tendency to offer juice more often than not," says Toronto dietitian Lorry Chen. "Kids love juice and will ask for it, again and again. Most parents aren't even aware that overconsumption is an issue. They think it's nutritious... so why not offer it all the time?"

That's the catch: Juice is nutritious. Most varieties are excellent sources of vitamin C. Depending on the type, juice can also supply folate, potassium - even vitamin A and calcium. It's fat-free, easy to digest, has no additives and is all natural.

Yet despite all of its attributes, juice is high in calories and does fill up tiny tummies quickly. If your little guy is feeling satiated from a juice bottle, chances are he won't want his Pablum. If babies and toddlers are filling up on the sweet liquid, they might routinely refuse solid foods, which may lead to anemia.

There's another concern. Too much juice - especially apple or pear juice - can sometimes lead to watery stools or toddler's diarrhea. Different than infectious diarrhea, toddler's diarrhea occurs when too much sorbitol and fructose enter the digestive tract. "These sugars are not broken down easily in a young child's digestive system," explains Doris Yuen, chairperson of the CPS Nutrition Committee, "and as a result, water actually leaks into the gut, causing diarrhea."

The other type of diarrhea - caused by gastrointestinal infections - can be compounded, warns Yuen, if a child drinks juice. While the old school of medical thought was to prescribe "clear fluids" for gastrointestinal infections and flu-related diarrhea, doctors now recommend that children take electrolyte rehydration solutions, such as Pedialyte, and avoid apple juice.

Another place to avoid juice is in a bottle. When children drink juice from a bottle, teeth are in constant contact with sugary liquids, wreaking havoc with dental health. According to Burton Conrod, a Sydney, N.S. dentist and president-elect of the Canadian Dental Association, children who spend a lot of time with a bottle in their mouth - whether lying down or walking around - are at risk of suffering from severe tooth decay (unless, of course, that bottle is filled with water). Thus it is better to drink juice from a bottle, cup, sippy cup or juice box in a single sitting rather than throughout the day, to limit the contact time between teeth and sweet fluids.

The best place for babies to get their first taste of juice is from a cup. That's what Darlynn Harmison of Bourget, Ontario chose to do with her six-month-old daughter. "Courtney was still nursing exclusively and I figured, `Why introduce a bottle, then take it away?' " she says. "Besides, I had read about the risk of dental caries with a juice bottle."

Harmison started Courtney with diluted apple juice since she didn't want her daughter's palate to become accustomed to the sweetness of full-strength juice. (The CPS says it's fine to offer pure, undiluted fruit juice to babies, but does not recommend introducing diluted or undiluted juice until a baby is six months old.)

Now Courtney is 18 months old, and her mother limits her juice intake to four ounces (125 mL) a day. "I fill her sippy cup every day, and if she doesn't finish it when it's served, she can finish it later," explains Harmison. "But I'll always offer her water or milk first. I know that there's vitamin C in her juice, but I'd rather she got more nutrients from whole fruit."

The only time Harmison will break down and offer extra juice to her daughter is during a heat wave. "When it's really hot out and the temperature is up in the 30s, I do get concerned about dehydration," she says. "If juice is all she'll take, that's what I'll give her."

Since most juice hounds complain loudly when parents try to cut back, it's wise to do so gradually, perhaps over a month. Reduce the actual serving size, too, or consider diluting it. Juice from concentrate is easier to water down (without kids noticing) than juice from a can. When a dedicated juice-drinker witnesses his beverage getting a shot of water from a faucet, the success rate is sure to plummet. But if you dilute canned juice and store it in a pitcher, who's to know? Another trick for children over three is to serve one or two frozen-juice ice cubes in a glass of water. You can jazz up the cubes by adding a slice of strawberry or a few blueberries.

Of course, it makes better sense to serve juice judiciously, right from the get-go. If kids under two get a cup in a high chair, then wandering with bottles is prevented. If you instill some structure, such as, "We only serve it at breakfast" or "Here's your daily juice snack," then the all-day habit never starts.

Donna Green of Toronto remembers when her daughter, Stella, was two and a confirmed juice-aholic. "When she was hungry, Stella would much rather drink something sweet than eat food. So I started a no-juice policy during mealtimes to ensure a balanced meal."

It worked. Stella, now nine, is still an avid drinker. "The difference nowadays is that if she's hungry, she'll take a steamy bowl of soup over a glass of juice, hands down. She's kicked the habit, so to speak."

Month-by-Month Guide to Baby's Emotional Development

What to expect each month of your child's first year.
By Kristen Finello

Your baby's emotional development will grow by leaps and bounds during this remarkable first year. She'll go from quiet observation to active participation. Here's what she's likely to do as she grows.

Month 1
- Makes eye contact
- Cries for help
- Responds to parents' smiles and voices

Month 2
- Begins to develop a social smile
- Enjoys playing with other people and may cry when play stops
- Prefers looking at people rather than objects
- Studies faces
- Gurgles and coos in response to sounds around her
- First begins to express anger

Month 3
- Starts a "conversation" by smiling at you and gurgling to get your attention
- Smiles back when you smile at him. The big smile involves his whole body -- hands open wide, arms lift up, legs move
- Can imitate some movements and facial expressions

Month 4
- Is intrigued by children. Will turn toward children's voices in person or on TV
- Laughs when tickled and when interacting with others
- Cries if play is disrupted

Month 5
- Becomes increasingly assertive
- Can differentiate between family members (parents and siblings) and strangers
- Likes to play during meals

Month 6
- May quickly tire of a toy but will never tire of your attention
- Temperament becomes increasingly apparent. You'll see whether she tends to be easygoing or easily upset; gentle or active
- Recognizes his own name
- Coos for pleasure and cries with displeasure
- Can make noises like grunts and squeals; clicks his tongue

Month 7
- Starts to understand the meaning of "no"
- Enjoys social interaction
- Expresses anger more strongly
- Tries to mimic adult sounds

Month 8
- Can differentiate between familiar and unfamiliar
- May become shy or anxious with strangers
- Cries in frustration when he can't reach a toy or do something he wants to do

Month 9
- Imitates gestures that other people make
- Looks at correct picture when an image is named
- Smiles and kisses own image in the mirror
- Likes to play near parent (i.e., in kitchen while Mom is cooking)
- May be more sensitive to the presence of other children

Month 10
- Separation anxiety may begin
- Self-esteem begins to develop
- Responds to positive recognition such as clapping
- Becomes cautious of heights
- Shows moods such as sad, happy, and angry

Month 11
- Tries to gain approval and avoid disapproval
- Can be uncooperative

Month 12
- May have temper tantrums
- Can fluctuate between being cooperative and uncooperative
- Shows a developing sense of humor
- May cling to parents or one parent in particular

Chickenpox

The reason varicella is called chickenpox has nothing to do with chickens. Chickenpox got its nickname because the blisters look like chick peas.

The Disease
Varicella, or chickenpox, is one of the most common childhood diseases. It is caused by the varicella-zoster virus. Most people in the United States get chickenpox while they are still children. Until the late 1990's there were about 4 million cases a year. But now that people are using varicella vaccine, that number has begun to drop.
The most recognizable feature of chickenpox is an itchy rash all over the body. Children with chickenpox can also be drowsy and have a fever.

Chickenpox can be spread very easily from person to person. It is spread through the air, by coughing or sneezing, or even talking. It can also be spread by contact with fluid from the blisters. It usually takes 2-3 weeks from the time a child is exposed to chickenpox virus until he or she becomes ill. The disease is contagious from 1 or 2 days before the rash appears until all the blisters are dried up, which usually takes 4 to 5 days.
Chickenpox is usually a mild disease, uncomfortable but not dangerous. Still, serious problems do occur. The blisters can become infected, and some children get encephalitis (infection of the brain). Of every 100,000 infants under one year old who get chickenpox, about 4 die. For older children, 1 to 14 years old, about 1 in 100,000 dies. If a woman gets chickenpox just before or after giving birth, her baby can get very sick, and about 1 in 3 of these children die if they are not treated quickly.
Even when chickenpox is not serious, it can create problems for the family because the parents may have to miss work to care for the sick child. About 1 child out of 500 who get chickenpox must be hospitalized. For adults who get chickenpox, 1 in 50 must be hospitalized.
After a person has chickenpox, the virus stays in the body. Years later, it can cause a painful disease called zoster, or shingles.

The Immunization
Varicella vaccine is a live-virus vaccine. It has been used in some parts of the world, such as Japan, for over 20 years. It was licensed in the United States in 1995.
A single dose of varicella vaccine is recommended for children between 12 and 18 months of age. It is usually given at the same time as the MMR shot. Children who miss this shot can still get a single dose of the vaccine up to their 13th birthday. Adolescents or adults who haven't gotten the vaccine by their 13th birthday will need two doses, 4 to 8 weeks apart. A child who has already had chickenpox disease does not need to get the shot.
It appears that the vaccine prevents chickenpox in about 70% to 90% of people who get the shot, and prevents severe chickenpox in over 95%. The vaccine used in Japan is still protecting those people who were vaccinated 20 years ago. In the United States, people who were vaccinated during testing, before the vaccine was licensed, are still immune to chickenpox. The vaccine is expected to give lifelong immunity.
Occasionally even children who respond to the vaccine get a very mild case of chickenpox (about 1-2 children out of a hundred).
There is some concern that a child who gets chickenpox vaccine can actually give chickenpox to other, unprotected, family members. This appears to happen extremely rarely, and only when the child who was vaccinated develops a rash. To be safe, anyone with a suppressed immune system should consider avoiding contact with a child who develops a rash after getting the chickenpox vaccination, just as they should avoid anyone who has a case of chickenpox.
Side Effects from Varicella Immunization
Varicella vaccine is very safe. Some children (about 1 out of 5) get red or sore where the shot was given. Some children also get a mild rash (about 5 spots), about 1 to 3 weeks after the shot. Febrile seizures (seizures caused by fever) have occurred in less than 1 out of a thousand children; and other serious problems, such as inflammation of the brain (encephalitis) or loss of muscle coordination, have been reported very rarely. These problems happen so rarely that experts cannot tell whether or not they are caused by the vaccine, or just happen at the same time by chance.
Like any vaccine, or medicine, varicella vaccine could theoretically trigger a serious reaction in someone who is allergic to one of its components. But severe allergic reactions to childhood vaccines are very rare (estimated at around one per million doses), and no child is ever known to have died from an allergic reaction to a vaccine.

Precautions
There are several reasons a doctor might want to delay giving a child a varicella vaccination or not give it at all:
· A child who is known to have a severe allergy to gelatin or the antibiotic neomycin should not get varicella vaccine.
· A child who had a life-threatening allergic reaction after a dose of varicella vaccine should not get another dose.
· A child with a suppressed immune system (because of a disease such as cancer or HIV
infection, or medication such as steroids) should be evaluated by a doctor before getting varicella vaccine.
· A child who has recently gotten a transfusion or other blood product might have to wait several months before getting varicella vaccine.
· A child who has a moderate or severe illness on the day a varicella (or any) vaccination is scheduled should probably delay the vaccination until he or she has recovered.

After Getting Varicella Vaccine . . .
If the child has any serious or unusual problem after getting this vaccine, call a doctor or get the child to a doctor right away.

Why get vaccinated?
Chickenpox (also called varicella) is a common childhood disease. It is usually mild, but it can be serious, especially in young infants and adults.
· The chickenpox virus can be spread from person to person through the air, or by contact with fluid from chickenpox blisters.
· It causes a rash, itching, fever, and tiredness.
· It can lead to severe skin infection, scars, pneumonia, brain damage, or death.
· A person who has had chickenpox can get a painful rash called shingles years later.
· About 12,000 people are hospitalized for chickenpox each year in the United States.
· About 100 people die each year in the United States as a result of chickenpox.

Chickenpox vaccine can prevent chickenpox.
Most people who get chickenpox vaccine will not get chickenpox. But if someone who has been vaccinated does get chickenpox, it is usually very mild. They will have fewer spots, are less likely to have a fever, and will recover faster.

Who should get chickenpox vaccine and when?
Children should get 1 dose of chickenpox vaccine between 12 and 18 months of age, or at any age after that if they have never had
chickenpox.
People who do not get the vaccine until 13 years of age or older should get 2 doses, 4-8 weeks apart.
Ask your doctor or nurse for details.
Chickenpox vaccine may be given at the same time as other vaccines.

Some people should not get chickenpox vaccine or should wait
· People should not get chickenpox vaccine if they have ever had a life threatening allergic reaction to gelatin, the antibiotic neomycin, or (for those needing a second dose) a previous dose of chickenpox vaccine.
· People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting chickenpox vaccine.
· Pregnant women should wait to get chickenpox vaccine until after they have given birth. Women should not get pregnant for 1 month after getting chickenpox vaccine.
· Some people should check with their doctor about whether they should get chickenpox vaccine, including anyone who:
o Has HIV/AIDS or another disease that affects the immune system
o Is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer
o Has any kind of cancer
o Is taking cancer treatment with x-rays or drugs
· People who recently had a transfusion or were given other blood products should ask their doctor when they may get chickenpox vaccine.
Ask your doctor or nurse for more information

What are the risks from chickenpox vaccine?
A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of chickenpox vaccine causing serious harm, or death, is extremely small.
Getting chickenpox vaccine is much safer than getting chickenpox disease.
Most people who get chickenpox vaccine do not have any problems with it.

Mild Problems
· Soreness or swelling where the shot was given (about 1 out of 5 children and up to 1 out of 3 adolescents and adults)
· Fever (1 person out of 10, or less)
· Mild rash, up to a month after vaccination (1 person out of 20, or less). It is possible for these people to infect other members of their household, but this is extremely rare.

Moderate Problems
· Seizure (jerking or staring) caused by fever (less than 1 person out of 1,000).
Severe Problems
· Pneumonia (very rare)
Other serious problems, including severe brain reactions and low blood count, have been reported after chickenpox vaccination. These happen so rarely experts cannot tell whether they are caused by the vaccine or not. If they are, it is extremely rare.

What if there is a moderate or severe reaction?
What should I look for?
Any unusual condition, such as a serious allergic reaction, high fever or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness within a few minutes to a few hours after the shot. A high fever or seizure, if it occurs, would happen 1 to 6 weeks after the shot.

What should I do?
· Call a doctor, or get the person to a doctor right away.
· Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
. Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Reporting System (VAERS) form, or call VAERS yourself at 1-800-822-7967

source: www.aap.org

Haemophilus Influenzae Type b

Even though the word "influenzae" is part of it's name, Hib is not related to influenza (flu).

The Disease
You may never have heard of Haemophilus influenzae type b, or "Hib" disease. For some reason Hib disease has never become as well known as other childhood diseases, but it is just as dangerous. As recently as the mid-1980's, Hib disease struck one child out of 200 under 5 years old in the United States. Every year about 12,000 children got meningitis (inflammation of the covering of the brain) as a result of Hib. In fact, Hib disease was the leading cause of bacterial meningitis in children under five. About 1 in 4 of these children suffered permanent brain damage, and about 1 in 20 died. In addition, about 8,000 children a year suffered from other serious complications, such as pneumonia.
Hib is a bacterial disease. It is spread through the air by coughing, sneezing, or even breathing. Hib bacteria enter a child's system through the nose or throat, and if they stay in the nose and throat the child will probably not become sick. But sometimes the bacteria spread into the lungs or bloodstream. This is called "invasive" Hib disease, and it can cause serious complications. In addition to meningitis, invasive Hib disease can lead to:
· pneumonia,
· epiglottitis (inflammation and swelling in the throat that can cause the child to choke),
· arthritis, and other problems.
Most invasive Hib disease occurs in children under 5 years old, and up to 60% in children younger than 1 year. The disease is not common in older children or adults. Most Hib disease today strikes infants who are not immunized.
It probably takes about 2-4 days from the time a child is exposed to Hib bacteria until symptoms appear. An infected person can spread the disease to others for as long as the bacteria remain in the body. Antibiotics can stop spread within 2-4 days

The Immunization
Hib vaccine has had a dramatic impact on Haemophilus influenzae type B. As soon the first vaccine came into use in 1985 the disease began to disappear. Several improved vaccines have been licensed since then, and the age for the first shot has been lowered from 24 months to 2 months. There were an estimated 20,000 cases of Hib disease a year in the mid-1980's, but now there are only a few hundred cases a year.
Hib vaccine is an inactivated (killed) vaccine. It is made from only a part of the Hib bacteria.
Several different companies make Hib vaccine. Children should get either 3 or 4 doses, depending on which company's vaccine your doctor or clinic is using. All children should get the vaccine at 2 and 4 months of age, and a booster dose between 12 and 15 months. Some children should get an additional dose at 6 months. Children who have passed their 5th birthday do not need Hib vaccination.
Hib vaccine can be combined (that is, given in the same shot) with DTaP vaccine, or with hepatitis B vaccine. Your doctor or nurse might offer the vaccines in these combination forms. They work just as well, and are just as safe, as if the vaccines were given separately.

Side Effects from Hib Immunization
Hib is a very safe vaccine. It cannot cause Hib disease or meningitis, and is not known to cause any other serious reactions. About 2 children in every 100 who get Hib vaccine get some redness, swelling or warmth where the shot was given, or a fever of over 101°F. These reactions usually begin within 24 hours after the shot and last up to 2 or 3 days. They do not cause any permanent harm.
Like any vaccine, or medicine, Hib vaccine could theoretically trigger a serious reaction in someone who is allergic to one of its components. But severe allergic reactions to childhood vaccines are very rare (estimated at around one per million doses), and no child is ever known to have died from an allergic reaction to a vaccine.

Precautions
There are several reasons a doctor might want to delay giving a child a Hib vaccination or not give it at all:
· A child who has had a life-threatening allergic reaction after a dose of Hib vaccine should not get another dose.
· A child who has a moderate or severe illness on the day a Hib (or any) vaccination is scheduled should probably delay the vaccination until he or she has recovered.
· Children under 4 weeks of age should not get Hib vaccine. This isn't because it is unsafe, but because the vaccine might not protect as well when the first dose is given too early.

After Getting Hib Vaccine . . .
If the child has any serious or unusual problem after getting Hib vaccine, or any other vaccine, call a doctor or get the child to a doctor right away.

What is Hib disease?
Haemophilus influenzae type b (Hib) disease is a serious disease caused by a bacteria. It usually strikes children under 5 years old.
Your child can get Hib disease by being around other children or adults who may have the bacteria and not know it. The germs spread from person to person. If the germs stay in the child’s nose and throat, the child probably will not get sick. But sometimes the germs spread into the lungs or the bloodstream, and then Hib can cause serious problems.
Before Hib vaccine, Hib disease was the leading cause of bacterial meningitis among children under 5 years old in the United States. Meningitis is an infection of the brain and spinal cord coverings, which can lead to lasting brain damage and deafness. Hib disease can also cause:
· pneumonia
· severe swelling in the throat, making it hard to breathe
· infections of the blood, joints, bones, and covering of the heart
· death
Before Hib vaccine, about 20,000 children in the United States under 5 years old got severe Hib disease each year and nearly 1,000 people died.
Hib vaccine can prevent Hib disease.
Many more children would get Hib disease if we stopped vaccinating.

Children should get Hib vaccine at:
· 2 months of age
· 4 months of age
· 6 months of age *
· 12-15 months of age
* Depending on what brand of Hib vaccine is used, your child might not need the dose at 6 months of age. Your doctor or nurse will tell you if this dose is needed.
If you miss a dose or get behind schedule, get the next dose as soon as you can. There is no need to start over.
Hib vaccine may be given at the same time as other vaccines.

Older Children and Adults
Children over 5 years old usually do not need Hib vaccine. But some older children or adults with special health conditions should get it. These conditions include sickle cell disease, HIV/AIDS, removal of the spleen, bone marrow transplant, or cancer treatment with drugs. Ask your doctor or nurse for details.

Some people should not get Hib vaccine or should wait
· People who have ever had a life-threatening allergic reaction to a previous dose of Hib vaccine should not get another dose.
· Children less than 6 weeks of age should not get Hib vaccine.
· People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting Hib vaccine.
Ask your doctor or nurse for more information.

What are the risks from Hib vaccine?
A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of Hib vaccine causing serious harm or death is extremely small.
Most people who get Hib vaccine do not have any problems with it.

Mild Problems
· Redness, warmth, or swelling where the shot was given (up to 1/4 of children)
· Fever over 101°F (up to 1 out of 20 children)
If these problems happen, they usually start within a day of vaccination.
They may last 2-3 days.

What if there is a moderate or severe reaction
What should I look for?
Any unusual condition, such as a serious allergic reaction, high fever or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat, or dizziness within a few minutes to a few hours after the shot.

What should I do?
· Call a doctor, or get the person to a doctor right away.
· Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
· Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Reporting System (VAERS) form, or call VAERS yourself at 1-800-822-796

source: www.aap.org

Imunisasi

Tuhan menciptakan setiap makhluk hidup dengan kemampuan untuk mempertahankan diri terhadap ancaman dari luar dirinya. Salah satu ancaman terhadap manusia adalah penyakit, terutama penyakit infeksi yang dibawa oleh berbagai macam mikroba seperti virus, bakteri, parasit, jamur. Tubuh mempunyai cara dan alat untuk mengatasi penyakit sampai batas tertentu. Beberapa jenis penyakit seperti pilek, batuk, dan cacar air dapat sembuh sendiri tanpa pengobatan. Dalam hal ini dikatakan bahwa sistem pertahanan tubuh (sistem imun) orang tersebut cukup baik untuk mengatasi dan mengalahkan kuman-kuman penyakit itu. Tetapi bila kuman penyakit itu ganas, sistem pertahanan tubuh (terutama pada anak-anak atau pada orang dewasa dengan daya tahan tubuh yang lemah) tidak mampu mencegah kuman itu berkembang biak, sehingga dapat mengakibatkan penyakit berat yang membawa kepada cacat atau kematian.
Apakah yang dimaksudkan dengan sistem imun? Kata imun berasal dari bahasa Latin ‘immunitas’ yang berarti pembebasan (kekebalan) yang diberikan kepada para senator Romawi selama masa jabatan mereka terhadap kewajiban sebagai warganegara biasa dan terhadap dakwaan. Dalam sejarah, istilah ini kemudian berkembang sehingga pengertiannya berubah menjadi perlindungan terhadap penyakit, dan lebih spesifik lagi, terhadap penyakit menular. Sistem imun adalah suatu sistem dalam tubuh yang terdiri dari sel-sel serta produk zat-zat yang dihasilkannya, yang bekerja sama secara kolektif dan terkoordinir untuk melawan benda asing seperti kuman-kuman penyakit atau racunnya, yang masuk ke dalam tubuh.
Kuman disebut antigen. Pada saat pertama kali antigen masuk ke dalam tubuh, maka sebagai reaksinya tubuh akan membuat zat anti yang disebut dengan antibodi. Pada umumnya, reaksi pertama tubuh untuk membentuk antibodi tidak terlalu kuat, karena tubuh belum mempunyai "pengalaman." Tetapi pada reaksi yang ke-2, ke-3 dan seterusnya, tubuh sudah mempunyai memori untuk mengenali antigen tersebut sehingga pembentukan antibodi terjadi dalam waktu yang lebih cepat dan dalam jumlah yang lebih banyak. Itulah sebabnya, pada beberapa jenis penyakit yang dianggap berbahaya, dilakukan tindakan imunisasi atau vaksinasi. Hal ini dimaksudkan sebagai tindakan pencegahan agar tubuh tidak terjangkit penyakit tersebut, atau seandainya terkena pun, tidak akan menimbulkan akibat yang fatal.
Imunisasi ada dua macam, yaitu imunisasi aktif dan pasif. Imunisasi aktif adalah pemberian kuman atau racun kuman yang sudah dilemahkan atau dimatikan dengan tujuan untuk merangsang tubuh memproduksi antibodi sendiri. Contohnya adalah imunisasi polio atau campak. Sedangkan imunisasi pasif adalah penyuntikan sejumlah antibodi, sehingga kadar antibodi dalam tubuh meningkat. Contohnya adalah penyuntikan ATS (Anti Tetanus Serum) pada orang yang mengalami luka kecelakaan. Contoh lain adalah yang terdapat pada bayi yang baru lahir dimana bayi tersebut menerima berbagai jenis antibodi dari ibunya melalui darah placenta selama masa kandungan, misalnya antibodi terhadap campak.

B C G ( BACILLUS CALMETTE-GUERIN )
Penularan penyakit TBC terhadap seorang anak dapat terjadi karena terhirupnya percikan udara yang mengandung kuman TBC. Kuman ini dapat menyerang berbagai organ tubuh, seperti paru-paru (paling sering terjadi), kelenjar getah bening, tulang, sendi, ginjal, hati, atau selaput otak (yang terberat). Pemberian imunisasi BCG sebaiknya dilakukan pada bayi yang baru lahir sampai usia 12 bulan, tetapi imunisasi ini sebaiknya dilakukan sebelum bayi berumur 2 bulan. Imunisasi ini cukup diberikan satu kali saja. Bila pemberian imunisasi ini "berhasil," maka setelah beberapa minggu di tempat suntikan akan timbul benjolan kecil. Karena luka suntikan meninggalkan bekas, maka pada bayi perempuan, suntikan sebaiknya dilakukan di paha kanan atas. Biasanya setelah suntikan BCG diberikan, bayi tidak menderita demam.

Pemberian Imunisasi ini akan memberikan kekebalan aktif terhadap penyakit Tuberkulosis ( TBC ), Imnunisasi ini diberikan hanya sekali sebelum bayi berumur dua bulan. Reaksi yang akan nampak setelah penyuntikan imunisasi ini adalah berupa perubahan warna kulit pada tempat penyuntikan yang akan berubah menjadi pustula kemudian pecah menjadi ulkus, dan akhirnya menyembuh spontan dalam waktu 8 – 12 minggu dengan meninggalkan jaringan parut, reaksi lainnya adalah berupa pembesaran kelenjar ketiak atau daera leher, bial diraba akan terasa padat dan bila ditekan tidak terasa sakit. Komplikasi yang dapat terjadi adalah berupa pembengkakan pada daerah tempat suntikan yang berisi cairan tetapi akan sembuh spontan.

D P T (Difteri Pertusis Tetanus)
Penyakit Difteri adalah penyakit infeksi yang disebabkan oleh bakteri Corynebacterium Diphteriae. Mudah menular dan menyerang terutama saluran napas bagian atas dengan gejala Demam tinggi, pembengkakan pada amandel ( tonsil ) dan terlihat selaput puith kotor yang makin lama makin membesar dan dapat menutup jalan napas. Racun difteri dapat merusak otot jantung yang dapat berakibat gagal jantung. Penularan umumnya melalui udara ( betuk / bersin ) selain itu dapat melalui benda atau makanan yang terkontamiasi.

Pencegahan paling efektif adalah dengan imunisasi bersamaan dengan tetanus dan pertusis sebanyak tiga kali sejak bayi berumur dua bulan dengan selang penyuntikan satu – dua bulan. Pemberian imunisasi ini akan memberikan kekebalan aktif terhadap penyakit difteri, pertusis dan tetanus dalam waktu bersamaan. Efek samping yang mungkin akan timbul adalah demam, nyeri dan bengkak pada permukaan kulit, cara mengatasinya cukup diberikan obat penurun panas .

Penyakit Pertusis atau batuk rejan atau dikenal dengan “ Batuk Seratus Hari “ adalah penyakit infeksi saluran yang disebabkan oleh bakteri Bordetella Pertusis. Gejalanya khas yaitu Batuk yang terus menerus sukar berhenti, muka menjadi merah atau kebiruan dan muntah kadang-kadang bercampur darah. Batuk diakhiri dengan tarikan napas panjang dan dalam berbunyi melengking.
Penularan umumnya terjadi melalui udara ( batuk / bersin ). Pencegahan paling efektif adalah dengan melakukan imunisasi bersamaan dengan Tetanus dan Difteri sebanyak tiga kali sejak bayi berumur dua bulan dengan selang pentuntikan.

Penyakit tetanus merupakan salah satu infeksi yan berbahaya karena mempengaruhi sistim urat syaraf dan otot. Bagaimana gejala dan apa penyebabnya? Gejala tetanus umumnya diawali dengan kejang otot rahang (dikenal juga dengan trismus atau kejang mulut) bersamaan dengan timbulnya pembengkakan, rasa sakit dan kaku di otot leher, bahu atau punggung. Kejang-kejang secara cepat merambat ke otot perut, lengan atas dan paha.
Neonatal tetanus umumnya terjadi pada bayi yang baru lahir. Neonatal tetanus menyerang bayi yang baru lahir karena dilahirkan di tempat yang tidak bersih dan steril, terutama jika tali pusar terinfeksi. Neonatal tetanus dapat menyebabkan kematian pada bayi dan banyak terjadi di negara berkembang. Sedangkan di negara-negara maju, dimana kebersihan dan teknik melahirkan yang sudah maju tingkat kematian akibat infeksi tetanus dapat ditekan. Selain itu antibodi dari ibu kepada jabang bayinya yang berada di dalam kandungan juga dapat mencegah infeksi tersebut.
Apa yang menyebabkan infeksi tetanus? Infeksi tetanus disebabkan oleh bakteri yang disebut dengan Clostridium tetani yang memproduksi toksin yang disebut dengan tetanospasmin. Tetanospasmin menempel pada urat syaraf di sekitar area luka dan dibawa ke sistem syaraf otak serta saraf tulang belakang, sehingga terjadi gangguan pada aktivitas normal urat syaraf. Terutama pada syaraf yang mengirim pesan ke otot. Infeksi tetanus terjadi karena luka. Entah karena terpotong, terbakar, aborsi , narkoba (misalnya memakai silet untuk memasukkan obat ke dalam kulit) maupun frosbite. Walaupun luka kecil bukan berarti bakteri tetanus tidak dapat hidup di sana. Sering kali orang lalai, padahal luka sekecil apapun dapat menjadi tempat berkembang biaknya bakteria tetanus.
Periode inkubasi tetanus terjadi dalam waktu 3-14 hari dengan gejala yang mulai timbul di hari ketujuh. Dalam neonatal tetanus gejala mulai pada dua minggu pertama kehidupan seorang bayi. Walaupun tetanus merupakan penyakit berbahaya, jika cepat didiagnosa dan mendapat perawatan yang benar maka penderita dapat disembuhkan. Penyembuhan umumnya terjadi selama 4-6 minggu. Tetanus dapat dicegah dengan pemberian imunisasi sebagai bagian dari imunisasi DPT. Setelah lewat masa kanak-kanak imunisasi dapat terus dilanjutkan walaupun telah dewasa. Dianjurkan setiap interval 5 tahun : 25, 30, 35 dst. Untuk wanita hamil sebaiknya diimunisasi juga dan melahirkan di tempat yang terjaga kebersihannya.

Polio
Gejala yang umum terjadi akibat serangan virus polio adalah anak mendadak lumpuh pada salah satu anggota geraknya setelah demam selama 2-5 hari. Terdapat 2 jenis vaksin yang beredar, dan di Indonesia yang umum diberikan adalah vaksin Sabin (kuman yang dilemahkan). Cara pemberiannya melalui mulut. Di beberapa negara dikenal pula Tetravaccine, yaitu kombinasi DPT dan polio. Imunisasi dasar diberikan sejak anak baru lahir atau berumur beberapa hari dan selanjutnya diberikan setiap 4-6 minggu. Pemberian vaksin polio dapat dilakukan bersamaan dengan BCG, vaksin hepatitis B, dan DPT. Imunisasi ulangan diberikan bersamaan dengan imunisasi ulang DPT Pemberian imunisasi polio akan menimbulkan kekebalan aktif terhadap penyakit Poliomielitis. Imunisasi polio diberikan sebanyak empat kali dengan selang waktu tidak kurang dari satu bulan.

Imunisasi ulangan dapat diberikan sebelum anak masuk sekolah ( 5 – 6 tahun ) dan saat meninggalkan sekolah dasar ( 12 tahun ).Cara memberikan imunisasi polio adalah dengan meneteskan vaksin polio sebanyak dua tetes langsung kedalam mulut anak atau dengan menggunakan sendok yang dicampur dengan gula manis. Imunisasi ini jangan diberikan pada anak yang lagi diare berat. Efek samping yang mungkin terjadi sangat minimal dapat berupa kejang-kejang.

Rabies
Rabies adalah penyakit zoonotik yang disebarkan oleh Virus Rabies ( Rhabdovirus ). Penyakit zoonotik lainnya adalah Toxoplasmosis, Japanese Encephalitis, Leptospirosis. Kota Jakarta sebenarnya sudah tidak ada rabies, namun terdapat resiko penduduk terkena Rabies melalui gigitan anjing, kucing atau kera dari uar Jakarta dan menunjukan gejala Rabies di Jakarta. Angka kematian ( fatalitas ) masih 100%. Penderita Rabies diisolasi secara ketat dalam ruangan khusus.

Penyakit Rabies disebabkan oleh virus rabies.

Rabies di Jawa Barat pertama kali ditemukan pada hewan tahun 1894, sampai saat ini masih belum dapat diberantas secara tuntas dan menyebabkan Jawa Barat merupakan satu-satunya propinsi di Pulau Jawa yang belum bebas dari penyakit rabies.

Penyakit rabies menular pada manusia melalui gigitan hewan penderita rabies atau dapat pula melalui luka yang terkena air liur hewan penderita rabies.

PENCEGAHAN DAN PEMBERANTASAN
Anjing peliharaan, tidak boleh dibiarkan lepas berkeliaran, harus didaftarkan ke Kantor Kepala Desa / Kelurahan atau Petugas Dinas Peternakan setempat.

Anjing harus diikat dengan rantai yang panjangnya tidak boleh lebih dari 2 meter.

Anjing yang hendak dibawa keluar halaman harus diikat dengan rantai tidak lebih dari 2 meter dan moncongnya harus menggunakan berangus (beronsong).

Pemilik anjing wajib untuk menvaksinasi rabies.

Anjing liar atau anjing yang diliarkan harus segera dilaporkan kepada petugas Dinas Peternakan atau Pos Kesehatan Hewan untuk diberantas / dimusnahkan.

Kurangi sumber makanan di tempat terbuka Untuk mengurangi anjing liar atau anjing yang diliarkan.

Daerah yang terbebas dari penyakit rabies, harus mencegah masuknya anjing, kucing, kera dan hewan sejenisnya dari daerah tertular rabies.

Masyarakat harus waspada terhadap anjing yang diliarkan dan segera melaporkannya kepada Petugas Dinas Peternakan atau Posko Rabies.

PENANGANAN HEWAN RABIES

Hewan yang telah menggigit manusia harus diusahakan tertangkap dan jangan dibunuh, laporkan kepada petugas Dinas Peternakan, Pos Kesehatan Hewan atau diserahkan langsung kepada Dinas Peternakan setempat untuk dilakukan observasi selama 14 hari.

Hewan yang telah menggigit manusia dan tertangkap tetapi terpaksa dibunuh atau mati, kepalanya harus diserahkan kepada Dinas Peternakan setempat sebagai bahan pemeriksaan laboratorium.

GEJALA PENYAKIT RABIES

Hewan yang menjadi garang atau ganas ( furious rabies)

Sikap hewan tenang ( dum rabies )

TINDAKAN PADA ORANG YANG DIGIGIT HEWAN TERSANGKA RABIES

Cuci luka bekas gigitan dengan sabun kemudian keringkan dengan lap yang bersih atau kapas.

Luka yang sudah bersih dan kering diberi alkohol 70% kemudian diberi obat merah , Iodium atau Betadine.

Penderita segera dikirim ke Puskesmas atau Rumah Sakit terdekat

Campak
Campak adalah penyakit yang sangat menular yang dapat disebabkan oleh sebuah virus yang bernama Virus Campak. Penularan melalui udara ataupun kontak langsung dengan penderita.Gejala-gejalanya adalah : Demam, batuk, pilek dan bercak-bercak merah pada permukaan kulit 3 – 5 hari setelah anak menderita demam. Bercak mula-mula timbul dipipi bawah telinga yang kemudian menjalar ke muka, tubuh dan anggota tubuh lainnya.
Komplikasi dari penyakit Campak ini adalah radang Paru-paru, infeksi pada telinga, radang pada saraf, radang pada sendi dan radang pada otak yang dapat menyebabkan kerusakan otak yang permanen ( menetap ). Pencegahan adalah dengan cara menjaga kesehatan kita dengan makanan yang sehat, berolah raga yang teratur dan istirahat yang cukup, dan paling efektif cara pencegahannya adalah dengan melakukan imunisasi. Pemberian Imunisasi akan menimbulkan kekebalan aktif dan bertujuan untuk melindungi terhadap penyakit campak hanya dengan sekali suntikan, dan diberikan pada usia anak sembilan bulan atau lebih.

CAMPAK DI INDONESIA

Program Pencegahan dan pemberantasan Campak di Indonesia pada saat ini berada pada tahap reduksi dengan pengendalian dan pencegahan KLB. Hasil pemeriksaan sample darah dan urine penderita campak pada saat KLB menunjukkan Igm positip sekitar 70% – 100%. Insidens rate semua kelompok umur dari laporan rutin Puskesmas dan Rumah Sakit selama tahun 1992 – 1998 cenderung menurun, terutama terjadi penurunan yang tajam pada kelompok umur = 90%) dan merata disetiap desa masih merupakan strategi ampuh saat ini untuk mencapai reduksi campak di Indonesia pada tahun 2000. CFR campak dari Rumah Sakit maupun dari hasil penyelidikan KLB selama tahun 1997 – 1999 cenderung meningkat, kemungkinan hal ini terjadi berkaitan dengan dampak kiris pangan dan gizi, namun masih perlu dikaji secara mendalam dan komprehensive.
Sidang WHO tahun 1988, menetapkan kesepakatan global untuk membasmi polio atau Eradikasi Polio (Rapo), Eliminasi Tetanus Neonatorum (ETN) dan Reduksi Campak (RECAM) pada tahun 2000. Beberapa negara seperti Amerika, Australia dan beberapa negara lainnya telah memasuki tahap eliminasi campak. Pada sidang CDC/PAHO/WHO tahun 1996 menyimpulkan bahwa campak dimungkinkan untuk dieradikasi, karena satu-satunya pejamu (host) atau reservoir campak hanya pada manusia dan adanya vaksin dengan potensi yang cukup tinggi dengan effikasi vanksin 85%. Diperkirakan eradikasi akan dapat dicapai 10 – 15 tahun setelah eliminasi.
Program imunisasi campak di Indonesia dimulai pada tahun 1982 dan masuk dalam pengembangan program imunisasi. Pada tahun 1991, Indonesia dinyatakan telah mencapai UCI secara nasional. Dengan keberhasilan Indonesia mencapai UCI tersebut memberikan dampak positip terhadap kecenderungan penurunan insidens campak, khususnya pada Balita dari 20.08/10.000 – 3,4/10.000 selama tahun 1992 – 1997 (ajustment data rutin SST). Walaupun imunisasi campak telah mencapai UCI namun dibeberapa daerah masih terjadi KLB campak, terutama di daerah dengan cakupan imunisasi rendah atau daerah kantong.
Tahapan pemberantasan Campak
Pemberantasan campak meliputi beberapa tahapan, dengan kriteria pada tiap tahap yang berbeda-beda.
a. Tahap Reduksi.
Tahap reduksi campak dibagi dalam 2 tahap: Tahap pengendalian campak. Pada tahap ini terjadi penurunan kasus dan kematian, cakupan imunisasi >80%, dan interval terjadinya KLB berkisar antara 4 – 8 tahun.
Tahap pencegahan KLB. Pada tahun ini cakupan imunisasi dapat dipertahankan tinggi dan merata, terjadi penurunan tajam kasus dan kematian, dan interval terjadinya KLB relative lebih panjang.
b. Tahap Eliminasi
Pada tahap eliminasi, cakupan imunisasi sudah sangat tinggi (>95%), dan daerah-daerah dengan cakupan imunisasi rendah sudah sangat kecil jumlahnya. Kasus campak sudah jarang dan KLB hampir tidak pernah ternadi. Anak-anak yang dicurigai tidak terlindung (susceptible) harus diselidiki dan mendapat imunisasi tambahan.
C. Tahap Eradikasi
Cakupan imunisasi tinggi dan merata, dan kasus campak sudah tidak ditemukan. Transmisi virus sudah dapat diputuskan, dan negara-negara di dunia sudah memasuki tahap eliminasi. Pada TCG Meeting, Dakka, 1999, menetapkan Indonesia berada pada tahap reduksi dengan pencegahan terjadinya KLB.
Tujuan Reduksi Campak
Reduksi campak bertujuan menurunkan angka insidens campak sebesar 90% dan angka kematian campak sebesar 95% dari angka sebelum program imunisasi campak dilaksanakan. Di Indonesia, tahap reduksi campak diperkirakan dengan insiden menjadi 50/10.000 balita, dan kematian 2/10.000 (berdasarkan SKRT tahun 1982).
Strategi Reduksi Campak
Reduksi campak mempunyai 5 strategi yaitu:
Imunisasi Rutin 2 kali, pada bayi 9-11 bulan dan anak Sekolah Dasar Kelas I (belum dilaksanakan secara nasional) dan Imunisasi Tambahan atau Suplemen. Surveilans Campak.
Penyelidikan dan Penanggulangan KLB Manajemen Kasus
Pemeriksaan Laboratorium Masalah pokok Surveilans dalam reduksi campak di Indonesia.
Surveilans dalam reduksi campak di Indonesia masih belum sebaik surveilans eradikasi polio. Kendala utama yang dihadapi adalah, kelengkapan data/laporan rutin Rumah Sakit dan Puskesmas yang masih rendah, beberapa KLB campak yang tidak terlaporkan, pemantauan dini (SKD – KLB) campak pada desa-desa berpotensi KLB pada umumnya belum dilakukan dengan baik terutama di Puskesmas, belum semua unit pelayanan kesehatan baik Pemerintah maupun Swasta ikut berkontribusi melaporkan bila menemukan campak. Dukungan dana yang belum memadai, terutama untuk melaksanakan aktif surveilans ke Rumah Sakit dan pengembangan surveilans campak pada umumnya. Surveilans campak sangat penting untuk menilai perkembangan pemberantasan campak dan untuk menentukan strategi pemberantasannya di setiap daerah.
Angka Insidens
Insidens campak di Indonesia selama tahun 1992 – 1998 dari data rutin Rumah sakit dan Puskesmas untuk semua kelompok umur cenderung menurut dengan keleng - kapan laporan rata-rata Puskesmas kurang lebih 60% dan Rumah sakit 40%. Penurunan Insidens paling tajam terjadi pada kelompok umur Kejadian Luar Biasa (KLB).
Dampak keberhasilan cakupan imunisasi campak nasional yang tinggi dapat menekan insidens rate yang cukup tajam selama 5 tahun terakhir, namun di beberapa desa tertentu masih sering terjadi KLB campak. Asumsi terjadinya KLB campak di beberapa desa tersebut, disebabkan karena cakupan imunisasi yang rendah (90%) atau kemungkinan masih rendahnya vaksin effikasi di desa tersebut. Rendahnya vaksin effikasi ini dapat disebabkan beberapa hal, antara lain kurang baiknya pengelolaar: rantai dingin vaksi yang dibawa kelapangan, penyimpanan vaksin di Puskesmas cara pemberian imunisasi yang, kurang baik dan sebagainya.
Dari beberapa hasil penyelidikan lapangan KLB campak dilakukan oleh Subdit Surveilans dan Daerah selama tahun 1998 – 1999, terlihat kasus-kasus campak yang belum mendapat imunisasi masih cukup tinggi, yaitu kurang lebih 40% – 100% (Grafik: 9). Dari sejumlah kasus-kasus yang belum mendapat imunisasi tersebut, pada umumnya (>70%) adalah Balita. Frekuensi KLB campak berdasarkan laporan yang dikirim dari seluruh propinsi Indonesia ke Subdit Surveilans melalui laporan (W 1) selam tahun 1994 – 1999 terlihat ber fluktuasi, dan cenderung meningkat dari tahun 1998 – 1999 yaitu dari 32 kejadian menjadi 56 kejadian (grafik: 2). Angka frekuensi tersebut sangat dipengaruhi oleh intensitas laporan W1 dari Propinsi atau Kabupaten/Kota. Daerah-daerah dengan sistern pencatatan dan pelaporan Wl yang cukup intensive dan mempunyai kepedulian yang cukup tinggi terhadap pelaporan Wl KLB, mempunyai kontribusi yang besar terhadap kecenderungan meningkatnya frekuensi KLB campak di Indonesia (Jawa Barat, NTB, Jambi Bengkulu, Yogyakarta). Dari sejumlah KLB yang dilaporkan ke Subdit Surveilans, diperkirakan KLB campak yang sesungguhnya terjadi jauh lebih baik. Dengan pengertian lain, masih cukup banyak KLB campak yang tidak terlaporkan oleh Daerah dengan berbagai kendala. Walaupun frekuensi KLB campak yang dilaporkan mengalami peningkatan, namun jumlah kasusnya cenderung menurun dengan rata-rata kasus setiap KLB selam tahun 1994 – 1999 sekitar 15 – 55 kasus pada setiap kejadian. Berarti besarnya jumlah kasus setiap episode KLB campak selama periode tahun tersebut rata-rata tidak lebih dari 15 kasus (grafik: 3 dan 4).
Dari 19 lokasi KLB campak yang diselidiki o1eh Subdit Surveilans dan Daerah serta mahasiswa FETP (UGM) selama tahun 1999, terlihat Attack Rate pada KLB campak dominan pada kelompok umur Balita, (Grafik 5 dan 6'). (pie diagram). Angka proporsi penderita pada KLB campak tahun 1998 – 1999 juga menunjukkan proporsi terbesar pada kelompok umur 1 – 4 tahun dan S – 9 tahun dibandingkan pada kelompok umur yang lebih tua (10 – 14 tahun) grafik:7.

Pada kelompok KLB campak telah dilakukan pengambilan spesimen serologis dan urine untuk memastikan diagnosa lapangan dan mengetahui virus campak. Hasil pemeriksaan sampel serologis dan urine penderita campak pada 12 lokasi KLB campak di beberapa Daerah selama tahun 1998 – 1999 yang diperiksa oleh Puslit. Penyakit Menular Badan Litbangkes RI, menunjukkan IgM positif sekitar 70% – 100%, (tabel: l). Angka tersebut mengindikasikan ketajaman diagnosa campak dilapangan pada saat KLB berlangsung.
Angka Fatalitas Kasus (AFP atau CFR) campak di Rumah Sakit maupun pada saat KLB terjadi selama tahun (1997 – 1999) cenderung meningkat, masing-masing dari 0,1% – 1,1% dan 1,7% – 2,4% (grafik 8). Kecenderungan peningkatan CFR ini perlu pengkajian yang mendalam dan koprehensive.
Kesimpulan.
Insidens Rate Campak dari data rutin selama tahun 1992 – 1998 di Indonesia cenderung menurun untuk semua kelompok umur. Penurutan paling tajam pada kelompok umur

Hepatitis
Masalah Hepatitis B makin maningkat. Prevalensi pengidap di Indonesia tahun 1993 bervariasi antar daerah yang berkisar dari 2,8% - 33,2% . Bila rata-rata 5% penduduk Indonesia adalah carier Hepatitis B maka diperkirakan saat ini ada 10 juta orang. Para pengidap ini akan makin menyebar ke masyarakat luas. Negara dengan tingkat HbsAg >8% dihimbau oleh WHA untuk menyertakan Hepatitis B ke dalam program imunisasi nasional. Target di tahun 2007 adalah Indonesia bebas dari Hepatitis B. Sebesar 50% dari Ibu hamil pengidap Hepattis B akan menularkan penyakit tersebut kepada bayinya. Data epidemiologi menyatakan sebagian kasus yang terjadi pada penderita Hepatitis B ( 10 % ) akan menjurus kepada kronis dan dari kasusu yang kronis ini 20%-nya menjadi hepatoma. Dan kemungkinan akan kronisitas kan lebih banyak terjadi pada anak-anak Balita oleh karena respon imun pada mereka belum sepenuhnya berkembang sempurna.

Influenza
Influenza adalah penyakit infeksi yang mudah menular dan disebabkan oleh virus influenza, yang menyerang saluran pernapasan. Penularan virus terjadi melalui udara pada saat berbicara, batuk dan bersin, Influenza sangat menular selama 1 – 2 hari sebelum gejalanya muncul, itulah sebabnya penyebaran virus ini sulit dihentikan.
Berlawanan dengan pendapat umum, influenza bukan batuk – pilek biasa yang tidak berbahaya. Gejala Utama infleunza adalah : Demam, sakit Kepala,sakit otot diseluruh badan, pilek, sakit tenggorok, batuk dan badan lemah. Pada Umumnya penderita influenza tidak dapat bekerja / bersekolah selama beberapa hari.
Dinegara bermusim empat, setiap tahun pada musim dingin terjadi letusan influenza yang banyak menimbulkan konmplikasi dan kematian pada orang-orang beresiko tinggi :
o Usia lanjut ( > 60 tahun )
o Anak – anak penderita Asma
o Penderita penyakit kronis ( Paru , Jantung, Ginjal, Diabetes )
o Penderita gangguan sistem kekebalan tubuh.
Dinegara-negara tropis seperti Indonesia, influenza terjadi sepanjang tahun. Setiap tahun influenza menyebabkan ribuan orang meninggal diseluruh dunia. Biaya pengobatan, biaya penanganan komplikasi, dan kerugian akibat hilangnya hari kerja ( absen dari sekolah dan tempat kerja ) sangat tinggi.
Berbeda dengan batuk pilek biasa influenza dapat mengakibatkan komplikasi yang berat. Virus influenza menyebabkan kerusakan sel-sel selaput lendir saluran pernapasan sehingga penderita sangat mudah terserang kuman lain, seperti pneumokokus, yang menyebabkan radang paru ( Pneumonia ) yang berbahaya. Selain itu, apabila penderita sudah mempunyai penyakit kronis lain sebelumnya ( Penyakit Jantung, Paru-paru, ginjal, diabetes dll ), penyakit-penyakit itu dapat menjadi lebih berat akibat influenza.
Setiap orang dapat terserang influenza tanpa membedakan usia dan tingkat sosial. Cara mencegah agar kita tidak terserang penyakit Influenza adalah dengan memelihara cara hidup sehat, yakni dengan makanan sehat dan berolah raga teratur serta istirahat yang cukup. Cara yang lain adalah dengan melakukan Vaksinasi, cara ini paling efektif dan aman dan dapat memberikan perlindungan selama satu tahun terhadap serangan penyakit Influenza..
Bagi ummat Islam yang akan menunaikan Ibadah haji baik ibadah haji Umroh maupun ibadah haji biasa sebaiknya dilakukan imunisasi influenza ini, karena bila jamaah terjangkit penyakit influenza maka pelaksanaan ibadah hajinya tentu akan terhambat, sementara dengan melakukan Imunisasi ( pencegahan ) kiranya lebih mudah daripada bila jamaah haji sudah terkena penyakit influenza ini.

MENGENAL INFLUENZA PADA JEMAAH INDONESIA Dalam musim haji tahun ini, jamaah haji Indonesia perlu mewaspadai kemungkinan tertular penyakit Influenza selama di Arab Saudi. Hal ini mengingat penyakit Influenza berpotensi sebagai salah satu masalah kesehatan jamaah berbagai bangsa yang sedang berhaji termasuk jamaah haji Indonesia.
WHO melaporkan penyakit ini telah beberapa kali menimbulkan pandemi yang dikenal dengan Spanis Flu ( 1918 ), Asian Flu ( 1968 ), Hongkong Flu( 1968), Russian Flu( 1977 ) dan Flu Burung di Hongkong ( 1997 ). WHO menekankan pula, adanya kecenderungan peningkatan jumlah baik kesakitan dan kematian karena Influenza akhir-akhir ini di Eropah dan Amerika serta penyakit ini diperkirakan akan merebak ke seluruh dunia termasuk Arab Saudi.
Beberapa kondisi yang diidentifikasi dapat berhubungan dengan kejadian Influenza pada jemaah Indonesia. Adapun kondisi tersebut, seperti; besarnya jumlah jemaah yang datang berhaji dari seluruh dunia haji pada setiap tahunnya, peningkatan jumlah kasus Influenza dapat terjadi pada musim hujan atau dingin disuatu negara, kualitas fisik jemaah yang memperihatinkan dan ruas perjalanan haji yang panjang serta berbagai pengaruhnya kepada kesehatan. Disamping itu, lebih kurang dua perlima dari jemaah haji Indonesia termasuk golongan risti. Perdefinisi risti adalah kondisi/ penyakit pada calon jemaah haji/ jemaah haji yang dapat memperburuk kesehatannya selama perjalanan ibadah haji. Kondisi risti ini juga dikenal sebagai kelompok berisiko tinggi bagi penyakit Influenza. Kesemua hal ini dapat berdampak tidak menguntungkan bagi kesehatan jemaah haji Indonesia.
Tulisan ini memuat gambaran ringkas tentang penyakit Influenza, perlunya kewaspadaan serta upaya pencegahan yang dilakukan oleh jemaah haji. Melalui tulisan ini diharapkan dapat meningkatkan pengetahuan jamaah haji tentang Influenza sekaligus mampu berprilaku semestinya selama perjalanan haji.
Apa yang disebut penyakit Influenza?
Penyakit Influenza adalah suatu infeksi saluran pernafasan yang bersifat akut dan menular. Apa penyebab penyakit ini? Penyebab penyakit inluenza adalah Virus Influenza( yang termasuk dalam kelompok virus Orthomyxoviruses ). Ada 3( tiga ) type virus penyebab penyakit Influenza, yaitu; A, B, dan C. Type A dikenal bersifat sangat menular dan dapat tersebar pada kelompok penduduk secara lokal, nasional atau bahkan secara global.
Bagaimana cara penularan dan perjalanannya ditubuh manusia? Penularan penyakit Influenza dapat terjadi secara kontak langsung ataupun tidak langsung. Umumnya, penularan terjadi melalui percikan air ludah /liur yang keluar dari penderita sewaktu bercakap-cakap atau percikan batuk maupun bersin.
Adapun periode masuknya virus penyebab sampai timbulnya gejala dan tanda penyakit Influenza rata-rata 2 hari dengan rentang jarak 1 – 4 hari, sedangkan kemungkinan penularan mulai dapat terjadi 1-2 hari sebelum dan 4-5 hari setelah gejala penyakit.

Apa gejala dan tanda penyakit Influenza?
Gejala berupa;
- Demam mendadak disertai menggigil
- Sakit kepala
- Badan lemah
- Nyeri otot dan sendi
Gejala ini bertahan selama 3 – 7 hari. Bila penyakit bertambah berat, gejala tersebut diatas akan berganti dengan gejala penyakit saluran pernafasan seperti batuk, pilek dan sakit tenggorokan. Kadang-kadang juga disertai gejala sakit perut, mual dan muntah. Pada pemeriksaan fisik : muka kemerahan, mata kemerahan dan berair serta kelenjar getah bening leher dapat teraba.
Apa yang dapat diakibatkan Penyakit Influenza? Akibat penyakit Influenza yang ditakutkan adalah timbulnya infeksi sekunder, seperti; radang paru-paru( Pneumonia ), myositis, sindroma Reye, gangguan syaraf pusat. Disamping itu, penderita/ pengidap penyakit kronis dapat bertambah berat bila terkena penyakit Influenza. Beberapa penyakit kronis tersebut, seperti; Asma, paru–paru kronis, jantung, kencing manis, ginjal kronis, gangguan status imunitas tubuh, kelainan darah dll.
Mengapa Jemaah Haji Indonesia Perlu Mewaspadai Tertular Penyakit Influenza Selama Perjalanan Haji? Jemaah haji Indonesia perlu mewaspadai tertular Penyakit Influenza, karena: penyakit inluenza bersifat menular dan kepadatan manusia dalam musim haji dapat memudahkan penularan penyakit diantara jemaah; jemaah haji terpajan musim dingin dimana penderita penyakit ini biasanya meningkat; status kesehatan jemaah berpenyakit risti dan usia lanjut cukup besar yang dikategorikan sebagai kelompok berisiko tinggi tertular penyakit influenza, kualitas fisik jemaah haji cukup memperhatinkan dan perjalanan haji yang panjang menjadikan jemaah cukup rentan tertular penyakit. Untuk kesemua hal diatas jemaaah haji patut meningkatkan kewaspadaan dari tertular penyakit Influenza.

Bagaimana upaya-upaya yang dilakukan jamaah haji untuk mencegah dari risiko tertular penyakit Influenza?

Upaya-upaya pencegahan yang harus dilakukan jemaah haji, yaitu:
Memelihara kebersihan diri dan lingkungan pondokan secara baik.
Istirahat yang cukup, banyak mengkonsumsi buah-bahan segar dan sayur-sayuran hijau.
Minum air yang cukup dan upayakan membawa air minum serta tempat minum( mangkuk/ gelas ) masing-masing.
Membiasakan diri untuk membersihkan ingus memakai kertas tissu atau sapu tangan yang dapat menyerap cairan hidung dan membuangnya di tempat sampah.
Selalu memakai masker(penutup) hidung dan mulut yang bersih selama berada di Arab Saudi. Pemakaian masker bertujuan untuk mencegah jamaah haji dari terkena percikan air ludah/ liur yang keluar dari penderita sewaktu bercakap-cakap atau terkena percikan dahak, ingus, batuk dan bersin.
Bagi jemaah haji yang terkena penyakit Influenza agar tetap menggunakan masker baik di pemondokan atau diluar pemondokan agar tidak menularkan kepada jemaah haji yang sehat.
Mengurangi keluar dari pondokan bila tidak perlu.
Menghindari diri agar tidak kontak dekat dengan penderita bergejala dan tanda penyakit Influenza.
Sedapat mungkin menghindari kerumunan kepadatan manusia atau tempat - tempat yang dipadati orang terutama pada tempat yang tidak ada kaitannya dengan kegiatan ibadah haji.
Hindari hidup berdesakan dalam satu kamar pondokan di luar jumlah yang sudah ditentukan selama di Arab Saudi.
Bila merasa sakit, segera berobat ke TKHI Kloter atau BPHI setempat.

Demam Tifoid
Penyakit Demam Tifoid adalah infeksi akut yang disebabkan oleh Salmonella Typhi yang masuk melalui saluran pencernaan dan menyebar keseluruh tubuh ( sistemik), Bakteri ini akan berkembang biak di kelenjar getah bening usus dan kemudian masuk kedalam darah sehingga meyebabkan penyebaran kuman dalam darah dan selanjutnya terjadilah peyebaran kuman kedalam limpa, kantung empedu, hati, paru-paru, selaput otak dan sebagainya. Gejala-gejalanya adalah : Demam, dapat berlangsung terus menerus. Minggu Pertama, suhu tubuh berangsur-angsur meningat setiap hari, biasanya menurun pada pagi hari dan meningkat pada sore / malam hari. Minggu Kedua, Penderita terus dalam keadaan demam. Minggu ketiga, suhu tubuh berangsung-angsur turun dan normal kembali diakhir minggu. Gangguan Pada Saluran Pencernaan, Nafas tak sedap, bibir kering dan pecah-pecah, lidah ditutupi selaput lendir kotor, ujung dan tepinya kemerahan. Bisa juga perut kembung, hati dan limpa membesar serta timbul rasa nyeri bila diraba. Biasanya sulit buang air besar, tetapi mungkin pula normal dan bahkan dapat terjadi diare. Gangguan Kesadaran, Umumnya kesadaran penderita menurun walaupun tidak seberapa dalam, yaitu menjadi apatis ( acuh tak acuh) sampai somnolen ( mengantuk )
Bakteri ini disebarkan melalui tinja. Muntahan, dan urin orang yang terinfeksi demam tofoid, yang kemudian secara pasif terbawa oleh lalat melalui perantara kaki-kakinya dari kakus kedapur, dan mengkontaminasi makanan dan minuman, sayuran ataupun buah-buahan segar. Mengkonsumsi makanan / minuman yang tercemar demikian dapat menyebabkan manusia terkena infeksi demam tifoid. Salah satu cara pencegahannya adalah dengan memberikan vaksinasi yang dapat melindungi seseorang selama 3 tahun dari penyakit Demam Tifoid yang disebabkan oleh Salmonella Typhi. Pemberian vaksinasi ini hampir tidak menimbulkan efek samping dan kadang-kadang mengakibatkan sedikit rasa sakit pada bekas suntikan yang akan segera hilang kemudian.


IMUNISASI

Apa yang seharusnya diketahui oleh setiap keluarga dan masyarakat mengenai imunisasi ?. Tanpa Imunisasi, Kira-kira 3 dari 100 kelahiran anak akan meninggal karena penyakit campak. 2 dari 100 kelahiran anak akan meninggal karena batuk rejan. 1 dari 100 kelahiran anak akan meninggal karena penyakit tetanus. Dan dari setiap 200.000 anak, 1 akan menderita penyakit polio. Imunisasi yang dilakukan dengan memberikan vaksin tertentu akan melindungi anak terhadap penyakir-penyakit tertentu. Walaupun pada saat ini fasilitas pelayanan untuk vaksinasi ini telah tersedia di masyarakat, tetapi tidak semua bayi telah dibawa untuk mendapatkan imunisasi yang lengkap. Bilamana fasilitas pelayanan kesehatan tidak dapat memberikan Imunisasi dengan pertimbangan tertentu, orang tua dapat menghubungi seseorang Dokter (Dokter Spesialis Anak) untuk mendapatkannya.

Tujuan Imunisasi:
Untuk memberikan kekebalan kepada bayi agar dapat mencegah penyakit dan kematian bayi serta anak yang disebabkan oleh penyakit yang sering berjangkit.

Manfaat Imunisasi:
(1)Untuk Anak: mencegah penderitaan yang disebabkan oleh penyakit, dan kemungkinan cacat atau kematian.
(2)Untuk Keluarga: menghilangkan kecemasan dan psikologi pengobatan bila anak sakit. Mendorong pembentukan keluarga apabila orang tua yakin bahwa anaknya akan menjalani masa kanak-kanak yang nyaman.
(3)Untuk Negara: memperbaiki tingkat kesehatan, menciptakan bangsa yang kuat dan berakal untuk melanjutkan pembangunan negara.

Perlukah Imunisasi ulang?
Imunisasi perlu diulang untuk mempertahankan agar kekebalan dapat tetap melindungi terhadap paparan bibit penyakit.

Dimana mendapatkan imunisasi?
(1)Di Pos Pelayanan Terpadu (Posyandu).
(2)Di Puskesmas, Rumah Sakit Bersalin, BKIA atau Rumah Sakit Pemerintah.
(3)Di Praktek Dokter/Bidan atau Rumah Sakit Swasta.

Apakah Imunisasi Difteri, Pertusis (Batuk Rejan), Tetanus (DPT) dapat diberikan bersama-sama Imunisasi polio?
Imunisasi DPTdan polio dapat diberikan bersamaan waktunya.

Efek samping Imunisasi:
Imunisasi kadang dapat mengakibatkan efek samping. Ini adalah tanda baik yan membuktikan bahwa vaksin betuk-betul bekerja secara tepat. Efek samping yang biasa terjadi adalah sebaagai berikut:

BCG: Setelah 2 minggu akan terjadi pembengkakan kecil dan merah ditempat suntikan. Setelah 2 – 3 minggu kemudian pembengkakan menjadi abses kecil dan kemudian menjadi luka dengan garis tengah ± 10 mm. Luka akan sembuh sendiri dengan meninggalkan luka parut yang kecil.

DPT: Kebanyakan bayi menderita panas pada waktu sore hari setelah mendapatkan imunisasi DPT, tetapi panas akan turun dan hilang dalam waktu 2 hari. Sebagian besar merasa nyeri, sakit, merah atau bengkak di tempat suntikan. Keadaan ini tidak berbahaya dan tidak perlu mendapatkan pengobatan khusus, akan sembuh sendiri. Bila gejala tersebut tidak timbul tidak perlu diragukan bahwa imunisasi tersebut tidak memberikan perlindungan dan Imunisasi tidak perlu diulang.

POLIO: Jarang timbuk efek samping.

CAMPAK: Anak mungkin panas, kadang disertai dengan kemerahan 4 – 10 hari sesudah penyuntikan.

HEPATITIS: Belum pernah dilaporkan adanya efek samping.
Perlukah pemerikasaan darah sebelum pemberian Imunisasi Hepatitis?
Untuk bayi berumur lebih dari 1 tahun seyogyanya dilakukan pemerikasaan darah.

TETANUS TOXOID: Efek samping TT untuk ibu hamil tidak ada. Perlu diingat efek samping imunisasi jauh lebih ringan dari pada efek penyakit bila bayi tidak diimunisasi.

Untuk apakah Imunisasi ini?
Kelompok yang paling penting untuk mendapatkan Imunisasi Imunisasi adalah bayi dan balita karena meraka yang paling peka terhadap penyakit dan ibu-ibu hamil serta wanita usia subur.


Apakah Imunisasi Dasar dan beberapa kali diberikan?
Imunisasi Dasar diberikan untuk mendapat kekebalan awal secara aktif.
Kekebalan Imunisasi Dasar perlu diulang pada DPT, Polio, Hepatitis agar dapat melindungi dari paparan penyakit.
Pemberian Imunisasi Dasar pada Campak, BCG, tidak perlu diulang karena kekebalan yang diperoleh dapat melindungi dari paparan bibit penyakit dalam waktu cukup lama.

Source : www.infeksi.com

Thimerosal

What Parents Should Know About Thimerosal
From the American Academy of Pediatrics

What is thimerosal?
- Thimerosal is an organic mercury-based preservative used in vaccines.
- Thimerosal has been used as an additive to vaccines since the 1930s because it is very effective in preventing bacterial and fungal contamination, particularly in opened multi-dose containers.
- Thimerosal is also found in other medicines and products including some throat and nose sprays and contact lens solutions
Does thimerosal cause autism?
- There are no valid studies that show a link between thimerosal in vaccines and autistic spectrum disorder. A 2004 report from the Institute of Medicine, Vaccines and Autism, concluded that the available evidence is against the existence of a causal relationship between thimerosal-containing vaccines and autism.
- The CDC examined the incidence of autism in relation to the amount of thimerosal a child receives in vaccines. They found no change in autism rates relative to the amount of thimerosal a child received from vaccines in the first 6 months of life. In other words, a child who received more thimerosal was not more likely to be autistic.

Have any studies shown thimerosal in vaccines causes health problems in children?
An early CDC study suggested a possible weak connection between the amount of thimerosal given and certain neurodevelopmental disorders, such as ADHD, speech and language delays, and tics (but not autism). Further review by independent experts led many to feel this study was flawed in parts of its design that favored a connection when none may have existed. Later studies did not show any connection. Researchers will continue to look at this question.

Which vaccines contain thimerosal?
- Since 2001, all routinely recommended vaccines manufactured for administration to infants in the U.S. have been either thimerosal-free or have contained only extremely small amounts of thimerosal.
- In 2004, the AAP recommended that children 6-23 months of age receive an annual influenza vaccination. Some thimerosal-free influenza vaccine is available. Thimerosal-preserved influenza vaccine contains only small amounts of thimerosal (12.5 micrograms per dose).
- Many routinely recommended childhood vaccines never contained thimerosal: measles/mumps/rubella (MMR), polio (IPV), varicella/chicken pox, pneumococcal conjugate (PCV). Some of the Haemophilus influenzae type b (Hib) and diphtheria/tetanus/pertussis (DTaP) vaccines never used thimerosal as a preservative.
- Some vaccines that are NOT routinely recommended for young children under 6 months of age, such as meningococcal vaccine, are only available with thimerosal.

Why was thimerosal removed from vaccines if there is no danger?
Even though there’s no evidence that thimerosal in vaccines is dangerous, the Public Health Service and the American Academy of Pediatrics believe the effort to remove mercury-based preservatives from vaccines was a good decision. Mercury exists in a different form in our environment (such as in some fish) so children will be exposed to it in other ways. We can’t always remove mercury from the environment. But we can control the mercury used in some vaccines. So, by taking thimerosal out of vaccines, we are lessening the amount of mercury a child will be exposed to early in life.

What risks does mercury pose to an infant's health?
Studies of mercury ingested from fish and other sources have shown that in high doses, mercury can cause brain damage. Mercury can also affect the kidneys and immune system. Mercury in vaccines (ethyl mercury) is in a different form than mercury in food products (methyl mercury). It is difficult to predict adverse effects of ethyl mercury exposure based on studies of exposure to other forms of mercury.Experts have differing opinions.

Have any adverse reactions to thimerosal ever been reported?
When vaccines containing thimerosal have been administered in the recommended doses, allergic type reactions (hives, shock) have been noted on rare occasions. No other harmful effects have been reported.

Should parents have their children who have received vaccinations with thimerosal be tested for mercury?
- No. Infants and children who have received thimerosal-containing vaccines do not need to have blood, urine or hair tested for mercury. The body eliminates a mercury dose completely within 120 days - it doesn’t stay in your child’s body.
- Screening children for mercury exposure will likely result in more questions than answers. Mercury in the urine is a measure of inorganic mercury exposure, not the organic form found in thimerosal. Mercury found in blood, hair or fingernails can come from any mercury source… it is more likely to come from dietary and environmental mercury sources than from thimerosal. Children who are suspected to have had environmental exposures (from broken thermometers or excessive fish consumption) may be appropriately tested.

Who should be concerned about exposure to large amounts of mercury?
Pregnant women, nursing mothers, and young infants should be especially careful about mercury exposure. Some fish contain high levels of organic mercury. State health, environmental and conservation officials have information about which fish to avoid in your state. Pediatricians can also give parents advice about avoiding exposure.

Immunizations have already been successful at nearly wiping out many diseases, so why should children continue to get vaccinated when these diseases barely exist anymore?
Although vaccine-preventable diseases are at record low numbers, the organisms that cause these diseases are still present. Unvaccinated children continue to be at risk of serious, even deadly diseases. We are only one airplane ride away from many parts of the world where these diseases are still rampant and where immunization is not available. We cannot afford to let down our guard.

Copyright © 2002 by the American Academy of Pediatrics; Revised August 2004
source: www.aap.org

Immunization Schedule

The following recommended immunizations and the timing of them will often coincide with your well-baby visits.

Age -> Immunizations
Birth -> 1st Hepatitis B
2 Months -> 2nd Hepatitis B, 1st DTP/DTaP, 1st Hib, 1st polio
4 Months -> 2nd DTP/DTaP, 2nd Hib, 2nd polio
6 Months -> 3rd Hepatitis B, 3rd DTP/DTaP, 3rd Hib
12 Months -> MMR, VAR (recommended between 12 and 18 months), 4th Hib
15 Months -> 4th DTP/DTaP, 3rd polio
4-6 Years -> 5th DTP/DTaP, 4th polio, MMR

Abbreviations Used:
DTP Diphtheria/tetanus/pertussis
DtaP Diphtheria/tetanus/acellular pertussis
Hib Haemophilus influenza type b
MMR Measles/mumps/rubella
TD Tetanus/diphtheria
VAR Varicella (chicken pox)

A note about the Hepatitis B vaccine: The American Academy of Pediatrics recommendations remain unchanged from this schedule for infants born to women who have tested positive for hepatitis B and women not tested for hepatitis B during pregnancy. The timing of hepatitis B vaccination has been a controversial topic because of concerns about the presence of the mercury-based vaccine preservative thimerosol.

For full-term infants born to mothers who have tested negative for hepatitis B, vaccination should be delayed until six months of age if a thimerosal-free vaccine is unavailable. Hepatitis B immunization for premature infants born to hepatitis B negative mothers should be deferred until an infant reaches the size and developmental level of a full-term six-month-old if a thimerosal-free vaccine is unavailable.

Parents should speak to their healthcare provider regarding the benefits and risks of vaccines containing thimerosol. According to the AAP, the larger risks of not vaccinating children far outweigh any known risk of exposure to thimerosol-containing vaccines. Thimerosal-free vaccines will be widely available in the future. Parents should also check with their healthcare provider to find out if hepatitis A immunization is recommended in their state.

Source: http://parenting.ivillage.com

Preambule

Eversince i have a baby, my browsing habit change from a cake-recipe-searcher to become anything-about-baby-searcher. Once i get the interesting article or babyfood recipe, i save them in my pc, print them out, and forget about them.

What a waste.

So from now on, rather than put them in my pc alone, i posted them in this blog as well, so i can read them some other time when i was not in the office.. hehehe...

Enjoy