Pathogenic microorganisms like bacteria, viruses, parasites or fungi are the causes of infectious diseases.
These diseases can spread to humans through a number of ways, e.g. person to person through direct touch, water, food or airborne particles, and through insects such as mosquitoes.
The National Immunisation Programme (NIP) is a government initiative to curb the spread of infectious diseases.
The Health Ministry introduced the NIP in the 1950s by providing free vaccination services to children in Malaysia.
Currently, the programme targets 12 vaccine-preventable diseases, i.e. tuberculosis, hepatitis B, diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b, measles, mumps, rubella, Japanese encephalitis (only in Sarawak), and cancer caused by the human papilloma virus (HPV).
Children receive all these vaccines within the first two years of life, except for the HPV vaccine, which is given to girls at the age of 13.
Booster doses for some of the vaccines are also given during the ages of seven and 15.
Since the start of the NIP, improvements have been made from time to time, including the introduction of the combined measles-mumps-rubella (MMR) vaccine in 2002 and the five-in-one combination vaccine, which covers diphtheria, tetanus, pertussis, polio and H. influenzae type b, in 2008.
This year, the Health Ministry has introduced a six-in-one (hexavalent) vaccine, which has also led a change in the immunisation schedule.
Less jabs needed
According to the ministry’s Disease Control Division senior principal assistant director Dr Jamiatul Aida Md Sani, this new combination vaccine, which adds on hepatitis B to those covered by the previous five-in-one vaccine, has been adopted by 49 countries worldwide.
She explains that the five-in-one vaccine is currently given to children at the ages of two, three, five and 18 months respectively.
Meanwhile, the hepatitis B vaccine is given to children directly after birth and at the ages of one and six months.
This means that each child needs to be jabbed seven times in order to prevent these six diseases.
The six-in-one vaccine, she says, needs to be given to children at the ages of two, three, five and 18 months.
A separate hepatitis B vaccine also needs to be given as one injection after birth.
She points out: “This means that the number of injections is reduced to five injections to prevent six diseases.”
Her colleague from the Family Health Development Division’s immunisation unit, senior principal assistant director Dr Rozita Ab Rahman notes that the reduction in the number of vaccination injections required also means less immunisation visits to the Klinik Kesihatan (Health Clinics) needed.
She adds: “The second advantage is from the point of view of the comfort of the baby.
“Injections are painful for babies, even for a moment. Less injections means less episodes of pain and crying.
“Thirdly, healthcare personnel will have more time during clinic appointments to conduct assessments of the babies’ health and development such as their growth and their sensory and intellectual development.”
Safe to use
National Pharmaceutical Regulatory Agency (NPRA) Centre of Compliance and Quality Control Pharmacovigilance Section senior principal assistant director Norleen Mohamad Ali notes that the six-in-one vaccine is safe to use.
She says: “Just like other vaccines, this vaccine will go through a few clinical trial phases, including a large-scale trial, before it can be used commercially.
“This is to ensure the effectiveness and safety of the vaccine for the recipients.”
She adds: “In Malaysia, a vaccine goes through a strict and thorough registration process by the Drug Control Authority under the Health Ministry.
“After the approval for registration is granted, only then can the vaccine be used and marketed in Malaysia, including being introduced in the NIP.”
Norleen also points out that hexavalent vaccines are not new in Malaysia.
“As of October (2020), there are two such vaccines registered in Malaysia and the usage is increasing every year.
“Both vaccines have been used in private health facilities since 2006 and 2013 respectively,” she says.
She adds that the majority of reported adverse effects following immunisation (AEFI) with these vaccines in Malaysia were mild and resolved within a few days, with or without treatment.
“The pattern of the reported AEFI is similar with other vaccines.
“However, serious AEFI can still occur, but the frequency is rare.
“Parents are encouraged to report the AEFI experienced by their babies, even if it is a mild reaction such as fever, swelling or itching at the injection site.”
“The NPRA constantly and actively monitors all the vaccines in Malaysia, including the six-in-one vaccines.
“AEFI, either mild or serious, needs to be reported,” she says.
Such adverse effects can be reported through the child’s healthcare provider or directly to the NPRA.
Norleen stresses, however, that: “The benefit of the vaccination to prevent the disease is higher compared to the risk of AEFI, which is mostly mild and harmless.”
Consultant paediatric cardiologist Datuk Dr Zulkifli Ismail, who has been administering the hexavalent vaccines in private practice for many years, notes that no AEFI have been reported by the parents of his patients to date.
“Babies may cry for a while after receiving a vaccine injection, but this is normal.
“They will stop crying after being persuaded or breastfed, and this is not something to worry about,” says the Immunise4Life programme chairman.
He adds: “Other mild side effects include irritation, pain and redness at the injection site.
“But most babies do not show any reaction at all.”
Health director-general Tan Sri Dr Noor Hisham Abdullah said in a recent statement that the implementation of the new schedule would be conducted in stages, beginning last month (November 2020) and depending on the availability of vaccine supplies at public health facilities.
This article is courtesy of the Immunise4Life programme by the Health Ministry, Malaysian Paediatric Association and Malaysian Society of Infectious Diseases and Chemotherapy, supported by the Vaccination is Protection for Kids initiative.