Malaysia Vaccination Schedule 2013

Jadual Imunisasi Yang Disarankan oleh Kementerian Kesihatan Malaysia 

• Newborn
• BCG
• Hepatitis B - 1st dose
• 1 month
• Hepatitis B - 2nd dose
• 2 months
• DTaP+IPV+Hib - 1st dose
• 3 months
• DTaP+IPV+Hib - 2nd dose
• 5 months 
• DTaP+IPV+Hib - 3rd dose
• 6 months
• Hepatitis B - 3rd dose
• Measles (Sabah only)
• 10 months
• Japanese Encephalitis  – 1st dose (Sarawak only)
• 12 months
• MMR - 1st dose
• Japanese Encephalitis  – 2nd dose (Sarawak only)
• 18 months
• DTaP+IPV+Hib - 4th dose
• Japanese Encephalitis  – 3rd dose (Sarawak only)
• 4 years old
• Japanese Encephalitis  – 4th dose (Sarawak only)
• 7 years old
• BCG (if no scar)
• DT (booster)
• MMR (2nd dose)
• 13 years old 
• HPV (3 doses within 6 months)

DTaP - Diptheria, Tetanus, accellular Pertussis
IPV - Inactivated poliovirus
Hib - Haemophilus influenzae b
MMR - Mumps, Measles, Rubella
DT - Diptheria, Tetanus
Source: http://kempas.malaysia.gov.my/citizen?articleId=266541&subCatId=293775&categoryId=126085

Additional vaccination (available from private clinic or private hospital)

• Rotavirus (between 6 weeks to 6 months) - 2 or 3 doses given 4 weeks apart
• Pneumococcal (2 months and older) - 2 to 4 doses
• Influenza (6 months and older) - 1 dose every year
• Hepatitis A (10 months and older) - 2 doses given 6 months apart
• Chicken pox (Varicella) (12 months and older) - 2 doses given at least 8 weeks apart

The year each vaccine was introduced into the Malaysian vaccination schedule.
1958 - Diptheria, Pertussis, Tetanus (DPT)
1961 - Tuberculosis (BCG)
1972 - Oral polio (OPV)
1981 - Measles
1988 - Rubella
1989 - Hepatitis B (Hep B)
2002 - Haemophilus influenzae type B (Hib)
2002 - Combined MMR (mumps, measles, rubella) introduced to replace the monovalent measles and rubella
2010 - Human Papilloma Virus (HPV)

References:
http://apps.who.int/immunization_delivery/systems_policy/Malaysia-school-immunization.pdf
http://www.acadmed.org.my/index.cfm?&menuid=67http://www.e-mjm.org/2005/v60n3/Rubella_Immunization.pdf

HPV vaccine in school during Form 1 - 13 years old (3 doses)
1st dose - 0 month
2nd dose - 1 month after the 1st dose
3rd dose - 6 months after the 1st dose
Source: http://nutp.org/new/sites/default/files/Bil.62010%20.pdf

"Upon first school enrolment, each child is provided with a school health record (Rekod Kesihatan Murid, see Annex 3), which contains personal data, history (birth, diseases, and previous immunizations), parental consent and health data (growth and development status, vision and hearing, physical examination, school immunization, interventions carried out at school and referrals). General parental consent in writing is only obtained at the beginning, and based on the Education Act 1996, it is mandatory for parents to allow physical examinations. The act is also binding for schools. However, if a student or parent refuses immunization, this is accepted."
Source: http://apps.who.int/immunization_delivery/systems_policy/Malaysia-school-immunization.pdf

Malaysian Vaccination Schedule: Do You Know What Your Child is Getting?

http://healthbitesonline.blogspot.com/2012/10/malaysian-vaccination-schedule-do-you.html

Adverse Reactions to HPV Vaccine in Malaysia in 2011

According to Malaysian Adverse Drug Reactions (MADRAC) Newletter, a total of 3183 AEFI reports were received in year 2011, the highest record since  year 2000. This figure is a 32.6% increase from year 2010 and projected to INCREASE. Out of this total, 3,031 reports (95%) were Human Papillomavirus (HPV) vaccine and 152 reports (5%) involved other than HPV vaccine.Wow, that's a lot of cases and most likely there are a lot more cases that aren't reported since people are unaware of vaccine reactions and how to report it.

Where did this sudden spike of reports come from? The HPV vaccine that was launched in year 2010 for Malaysian girls around 13 years old (Form 1). "In year 2011, 3,026 reports were received for Cervarix and 5 (five) for Gardasil. The large number of reports received for Cervarix commensurate with its use as the sole HPV vaccine supplied under the National HPV Vaccination Program."

Sadly, nothing will be done to halt the increase in cases since the report assures us the vaccine adverse effects are relatively mild, the benefits outweighs the risks and the vaccine has no quality issues. Looks like the National HPV Vaccination Program needs to take a cue from Japan, at least Japan suspended its recommendation for the HPV vaccine!

Garis Panduan Farmakovigilans - Keselamatan Vaksin di Malaysia A guide on how to report adverse vaccine effects. The following vaccine information should be collected whenever a vaccine is administered: i) Product registration number ii) Batch number iii) Dose number iv) Date administered

Download from http://www.moh.gov.my/images/gallery/Garispanduan/Garispanduan_Farmakovigilans.pdf

Reference:

1. MADRAC ADR 2012 - April http://portal.bpfk.gov.my/view_file.cfm?fileid=1268

BCG Incidence & Mortality Rate in Malaysia 2013

Let's talk about the effectiveness of the BCG vaccine for Tuberculosis disease. It is administered to newborns & a 2nd dose is administered at 7 years old (if no scar) based on the current vaccine schedule.

Below are 3 tables taken from the Health Facts 2013 file released by the Ministry of Health, Malaysia. I was searching for the Tuberculosis incidence rate in Malaysia, and surprisingly it isn't listed inside the vaccine preventable diseases table. I found it inside the Other Infectious Diseases table.

Table 1: Vaccine Preventable Diseases - no mention of Tuberculosis [1]

Table 2: Other Infectious Diseases[1]

Table 3: Childhood Immunisation Coverage, 2012 [1]

The highest incidence rate in Table 2 is 117.66 (per 100,000 population) for Hand, Foot & Mouth Disease - there is no vaccine available at the moment for this disease. This is followed by Tuberculosis with 77.41 (per 100,000 population).
.
BCG Immunisation Coverage of Infants: 98.72%
Incidence rate (per 100,000 population): 77.41
Mortality rate (per 100,000 population): 4.82

Hmm, this BCG vaccine doesn't seem too effective? Perhaps because the tuberculosis strain in the vaccine is sourced from a cow and might not provide immunity for human-to-human transmission?

BCG Vaccine for percutaneous use, is an attenuated, live culture preparation of the Bacillus of Calmette and Guerin (BCG) strain of Mycobacterium bovis. [2]

What is Mycobacterium bovis?

Mycobacterium bovis is spread from cow-to-cow by inhalation of the organism in aerosolized droplets. When people are infected by inhalation of the organism shed from the airways of infected cattle, they can develop classic pulmonary Tuberculosis similar to Mycobacterium tuberculosis infection.
People can then shed the organism from their airways back to other cattle. However, person-to-person transmission of Mycobacterium bovis is considered to be quite rare. [3, 4]

Possible BCG vaccine side effects: “Flu-like” syndrome, fever, anorexia, myalgia, and neuralgia, disseminated BCG infection, moderate axillary or cervical lymphadenopathy and induration and subsequent pustule formation at the injection site; ulceration at the vaccination site, regional suppurative lymphadenitis with draining sinuses, and caseous lesions or purulent draining at the puncture site.[6]

One of the reasons that is often mentioned for BCG vaccination is due to the number of foreigners in Malaysia. Example of countries that:

• DO NOT have BCG vaccine on their schedule: Australia, Finland, Germany, Netherlands, USA, UK.
• DO have BCG vaccine on their schedule: China, Indonesia, Vietnam, Thailand, Myanmar, Philippines [5]

Food for thought: Which foreigner are we worried about and is it worth the risk of vaccine side effect along with the ineffectiveness of this vaccine?



References

1. Health Facts 2013 from Ministry of Health, Malaysia http://moh.gov.my/images/gallery/publications/HEALTH%20FACTS%202013.pdf
2. BCG vaccine http://www.drugs.com/pro/bcg-vaccine.html
3. Mycobacterium bovis http://www.vetmed.wisc.edu/pbs/zoonoses/Tuberculosis/mbovis.html
4. Low risk of infection with Mycobacterium bovis in the UK – 1 July 2013 https://www.gov.uk/government/news/low-risk-of-infection-with-mycobacterium-bovis-in-the-uk-1-july-2013
5. The BCG World Atlas http://www.bcgatlas.org/
6. BCG vaccine insert (Merck) http://www.merck.com/product/usa/pi_circulars/b/bcg/bcg_pi.pdf