How does the distribution of vaccines reach the community?
Distribution of the government sector
From the Bio Farma Warehouse, Vaccines are brought with refrigerated vehicles to the Provincial Health Office Warehouse. From the Provincial Health Office warehouse, the vaccine will be distributed to the warehouse of the City and District Health Office. From the warehouse of the City and District Health Office, the vaccine will be distributed to the health center, which is then given to the consumer.
Distribution of the private and exports sector
From the Bio Farma Warehouse, Vaccines are carried by refrigerated vehicles through land / air / sea transportation to the distributor / buyer warehouse, while paying attention to the cold chain system. From the distributor / buyer warehouse, vaccines are carried using refrigerated vehicles to the final destination (hospitals, clinics, doctors' practice sites) which are then given to consumers
How to guarantee that the vaccine received is still in good condition, considering the vaccine is very sensitive to changes in temperature?
We can find out whether the vaccine is in good condition or not by looking at VVM (Vaccine Vial Monitor). By reading the color changes on VVM paper, we can find out whether the vaccine is stored in the appropriate temperature or not, if the color has changed, it means that the vaccine cannot be used anymore because it has been damaged even though the expired period is still long.
How is the vaccine production process?
There are 7 stages in the vaccine production process, namely:
- Media Preparation: The collection of the best vaccine seeds (virus / bacteria), so that the amount meets the need for vaccine production
- Inoculation: To sow viruses / bacteria on a purified medium
- Harvest: The process of harvesting viruses and bacteria grown in a certain amount in a media
- Inactivation: To undermine / inactivate viruses or bacteria
- Purification: To purify the virus / bacteria that has grown, in the purification process, which is a process to remove substances that are not relevant to vaccine products
Formulation: To formulate bulk of vaccines that have been purified with additional substances.
- Final Products (Filling & Packaging): To fill vaccines into packaging. To label on vaccine packaging
What are the stages of vaccine clinical trials at Bio Farma?
Clinical Trial I: Knowing product safety and side effects that can be caused. In this stage, 10-100 people have started to be given.
Clinical Trial II: Finding out and evaluating the immune response by increasing the number of respondents to 100-300 people.
Clinical Trial III: Knowing the level of vaccine efficacy with the number of subjects counted statistically.
How to handle waste at the vaccine factory?
There are 2 types of waste in bio farma, namely solid and liquid waste, for solid waste it will be destroyed by incinerator, burned with high temperature and then the remaining combustion is left to the 3rd party that has been registered according to the law such as companies engaged in waste processing.
Liquid waste consists of liquid waste from viruses and bacteria. Before entering the waste pond,
Where is the raw material for the vaccine?
There are primary and secondary raw materials, for primary ones such as chemical salt it is still imported because Indonesia does not have a pharmaceutical upstream industry. While for secondary materials such as vials, labeling is from domestic.
Where do you get the seeds of viruses and bacteria?
Bio Farma cooperates with the Ministry of Health and the World Health Organization (WHO) so as to get a disease seed to make a vaccine.
The media used to grow viruses & bacteria?
To grow the virus using egg media while to grow bacteria using media such as potatoes & gelatin
Do you make various types of vaccines use the same machine?
Each drug and vaccine product uses different machines, depending on the type and class of the raw material. For certain types and groups, are required to use a dedicated machine to avoid cross contamination.
How is the quality control in biofarma?
Bio Farma implements a comprehensive QMS (Quality Management System), ranging from vendor selection, system of reception - storage - raw material distribution, manufacturing systems including production, in process control, sampling and QC tests to storage, packages and finish product distribution. Each batch produced, tested, storage during quarantine and product release are clearly separated from other batches with segregation thus avoiding mixing between different materials or batches.
The Regulatory Organization periodically conducts inspections, namely the BPOM and the World Health Organization.
How long is the research process needed to find one type of vaccine?
Making a new type of vaccine is not easy. Starting from research on disease burden, to finding good microorganism seeds and their formulation can take 12 years or even more. Every stage of this development must always be in the CPOB order
Can everyone be protected from illness by immunization?
Although all vaccination doses have been given, not everyone is protected from disease. Vaccines for measles, tetanus, polio and HIb provide protection for more than 95% of children who have received a complete dose. Three DPT vaccine doses protect approximately 85% of vaccinated children. The remaining 15% can still suffer from the disease, but with milder and uncomplicated symptoms.
If the vaccine does not provide 100% protection, what is the use of getting immunizations?
Vaccines are not 100% effective, so it is possible that the vaccinated children are still affected by the disease. But vaccinated children are much less likely to get the disease compared to children who are not vaccinated. Even if the vaccinated children are affected by the disease, their immune systems are better prepared to fight the germs and the symptoms will be much lighter. They can also be prevented from getting serious complications from the disease such as disability or even death.
How long does the vaccine protect us?
Different vaccines will provide different periods of protection. There is a vaccine that provides life-long protection. One can last for 30 years. Other one can last less than that. Influenza viruses, for example, since they quickly mutate, influenza vaccines need to be given annually to provide protection against the most recent viruses.
How long does the vaccine take to react in the body?
In general, the normal immune response will start working for about two weeks. This means protection against disease, not immediately occurs after immunization.
What is contained in the vaccine?
- A live virus that is attenuated in very small doses
- Bacteria / viruses that have died or parts of bacteria in very small doses
- Toxins from modified bacteria in small doses
What are the types of vaccines?
- Live vaccine contains weakend live germs
- Inactive vaccines (such as whole cell vaccine) use germs that are killed by chemical substances, heat or radiation
- Vaccine subunits (toxoid, acellular, DNA & recombinant vaccines) only use certain parts of the germs
Is the vaccine really safe? Even though it is produced from viruses / bacteria?
The vaccine only uses certain parts / whole of killed / attenuated germ. It does not have the ability to cause disease.
Do vaccines contain dangerous chemicals?
- Aluminum acts as an adjuvant to improve the vaccine's immune response. Even more aluminum content in breast milk.
- Formalin is used to neutralize tetanus toxin so that it becomes toxoid to stimulate the body's immunity. Formalin content in human blood is even higher.
- Mercury in its organic form, mercury ethyl acts as a preservative to prevent bacterial and fungal contamination into the vaccine
Is there really a vaccine containing mercury?
Most vaccines do not use mercury, except in an organic form known as thimerosal. This organic material comes from ethyl mercury which can be easily disposed of by the body. In addition, there are very few of them. We actually get more mercury from food consumed every day.
How safe is the vaccine?
All vaccines must pass rigorous safety tests before they are authorized by the authorized institution. This test is regulated by law and is usually carried out for several years when the vaccine is developed. Vaccine safety is always monitored after being used in the midst of the community.
Before being marketed, the vaccine was clinically tested on thousands of people in large-scale clinical research. This study security is closely monitored. The process of obtaining passing can take up to 10 years. Because of the rigorous clinical trials, several vaccines that failed clinical trials were never produced for mass use.
Lots of vaccines given to children, does the vaccine overload their immune system?
The vaccine does not burden the children's immune system because the immune system is able to deal with various attacks at once at a time. The fact is that every day children are faced with various kinds of foreign antigens
What is the recommended immunization schedule determined?
The immunization schedule is determined by recommendations from experts and epidemiologists, infectious disease prevention experts and immunologists. The schedule is evaluated annually based on the latest scientific data available and adjustments made if necessary to best protect children against vaccine preventable diseases.
What is the time and gap between injections determined?
Every dose of vaccine scheduled for the children's age which is considered optimal for producing the best immune response that is offset by the need to protect infants and children at the earliest possible age. Some doses of vaccine need to be gapped within a certain amount of time to produce a protective response.
Why are immunization schedules different from private doctors, health centers and hospitals?
Differences in immunization schedules at different time periods in some doctors' practices include different reference sources, modifications to make it easier for parents or special consideration based on the circumstances of the infants and children at that time. If observed more closely, the schedule that seems different is generally still in the range of schedule life recommended by the Immunization Development Program and IDAI Immunization Task Force.
Can ill children be vaccinated?
If the illness is a mild cold and cough without fever they can still be vaccinated, unless the infants are very fussy, vaccination can be delayed 1-2 weeks later.
If they are taking antibiotics can they be immunized?
They can, because antibiotics do not interfere with the potential of the vaccine. Antibiotics that are being consumed work against bacterial infections that are attacking the body, not against the bacteria in the vaccine. It should be considered if the infants / children are suffering from certain diseases or conditions according to general guidelines for vaccination.
Should the immunization schedule for premature babies be delayed?
Polio vaccine should be given after a preterm baby of 2 months / body weight> 2000 grams, as well as DPT, hepatitis B and Hib. Every premature baby needs a specific immunization schedule, consult with a pediatrician.
Why is the vaccine not given once?
One dose of vaccine can only provide low protection. For some vaccines, three or four serial doses are needed to get the optimal protective effect. The first dose will provide a minimal response and subsequent doses will trigger a better immune response and a greater protective effect.
If the children are given several types of vaccines at once is it not dangerous?
It is not harmful. Some bacteria or viruses that are inserted into the body will stimulate each specific memory cell. The important thing is that the immunization is done in different parts of the body (for example, the thigh / left arm / right arm) using different syringes and paying attention to the general provisions regarding vaccine given.
What about children who have delayed their immunization schedule?
For those who missed immunization can be given immediately if the condition of the children are healthy. Discuss with the doctor how to catch up with children immunization because each case is different and must be matched with the children's age at that time. Immunizations that are not timetable, incomplete or never given is not an obstacle to continuing immunization. The immunization that has been given has produced an immunological response even though it is still below the threshold of protection level or has not reached protection for a long period of time, so doctors need to continue and complete immunization (catch up) to achieve maximum protection levels.
Can children with allergies be immunized?
If there are children who are severely allergic to eggs, we must be very careful. If a history of anaphylactic reaction to eggs (swelling of the mouth / throat, difficulty in breathing, decrease in blood pressure / shock) is contraindicated for influenza vaccination.
Is it true that vaccines can cause autism in children?
No, actually this accusation came from Dr. Andrew Wakefield's research in 1998 and has been proven wrong. In fact many other studies have been carried out in various countries to prove whether these charges are true or not. Within 15 years no study has found evidence of a link to this vaccine with autism. Even a study conducted in Japan found that cases of autism among children continued to increase even after the MMR vaccine was stopped. So the MMR vaccine is not the cause of autism.
What are the side effects of immunization?
Many children experience mild side effects from immunization. Most side effects last for a while and the children's condition improves without any problems. The most common side effects are redness, pain and swelling at the injection spot, mild fever and the children becomes fussy
Why is the vaccine given at a very early age, even since newborn babies?
Because diseases that can be prevented from transmission by giving vaccinations usually attack the babies at the beginning of their life, namely when the immune system of the babies has not been able to fight the attack of these pathogenic organisms.
What is the history of immunization?
Immunization is inseparable from the name of Edward Jenner, a doctor in England who introduced variola vaccine. But actually before Jenner, immunization has been carried out in India, China and Muslim countries like Turkey. Lady Montagu, wife of British Ambassador in Turkey told British doctors how the practice of immunization against variola was carried out by Muslim doctors in Turkey. Although Jenner later became known as the Father of Immunization, the historical fact shows that Muslim doctors have started an immunization business before Jenner.
There are 2 versions of the immunization schedule, why is that?
The best immunization schedule is those within the Ministry of Health Immunization Schedule or IDAI Immunization Service recommendations. However, consideration must be given to the condition and history of the baby / child relating to the contradiction / risk of the occurrence of post-immunization follow-up (KIPI) and parental requests.
What is the function of the vaccine given during primary school age?
Immunizations that need to be repeated in primary schools are measles and DT (grade 1, and TT (grades 2.3 and 6). Many children have been vaccinated when they were babies in 5 - 7 years old 28.3% of them are still affected by measles. At the age of> 10 years, there are still cases of diphtheria.
What if the baby vomits the polio vaccine?
If vomiting occurs before 10 minutes, immediately give the polio vaccine again with the same dose. If vomiting is repeated, give it again the next day
How long is the gap between breastfeeding and oral polio vaccine?
Breast milk can be given immediately after oral polio immunization at the age of more than 1 week. Mother's milk produced in the first 1 week (colostrum) contains antibodies with high titer that can bind oral polio vaccine
If the gap between immunizations is longer than the recommended gap, does vaccination need to be repeated?
It doesn't need to be repeated, because the body's immune system can remember previous vaccine stimuli. Continue with vaccinations that have not been given with the recommended gap.
If the previous immunization got occurrence of post-immunization follow-up, what is the next vaccination schedule?
If the occurrence of post-immunization follow-up (KIPI) is only mild, the next vaccination is on schedule, but if it is heavy, the next dose should not be continued. For example if the occurrence of post-immunization follow-up of DPT is quite heavy, the next dose uses DT vaccine
How to deal with children who are fussy due to vaccines ?
Give more drink, do not wear too thick clothes, and if necessary, provide paracetamol to reduce pain and fever. Serious reactions are rare.
After being BCG vaccinated, is there a left thing?
For BCG injection it usually does cause a reaction in the form of inflammation and pus, about 3 weeks after injection, which indicates that there is an immune reaction (immune system) to the immunization given. But it's not straightforward, so 3 weeks later the reaction arises
Do children who have ever received MMR still need measles booster?
Measles immunization is given at school age in the BIAS program (month of student immunization) as a government program. The point is, the booster of measles immunization will do no harm a.k.a not harmful to children who have ever received MMR, it will strengthen the effects of previous immunizations.