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Fulltext Current issues facing the introduction of human papillomavirus vaccine in China and future prospects

Wong LP, Han L, Li H, Zhao J, Zhao Q, Zimet GD

Hum Vaccin Immunother, 2019;15(7-8):1533-1540.
PMID: 31017500 DOI: 10.1080/21645515.2019.1611157

The introduction of human papillomavirus (HPV) vaccination in China aims to prevent HPV infection in all women. The issues that China might face include high cost of vaccines made in other countries, shortage in HPV vaccine supply, negative events attributed to vaccination (whether justified or not) that jeopardizes the general public's confidence in the HPV vaccine, cultural and literacy barriers, and sensitivity to receiving a vaccine for a sexually transmitted disease. Ensuring the effective delivery of the HPV vaccine in China, a country with vast economic, geographical, and cultural complexities, will require a commitment of significant resources. In light of the high price of imported vaccines, the availability of locally manufactured HPV vaccines would greatly facilitate the national HPV vaccination program. New evidence supporting the efficacy of a two-dose regime in younger adolescents would also be advantageous in terms of affordability and logistical simplicity of vaccine administration. Furthermore, it would potentially enhance the compliance and uptake, especially for hard to reach women in remote regions.

Matched MeSH terms: Immunization Programs/economics; Immunization Programs/organization & administration*
Fulltext Issues in vaccine hesitancy in Malaysia: a countering approach

Wan Taib W.R., Tengku M.A., Aryati A., Yusoff N.A.M.

Journal of Biomedical and Clinical Sciences, 2017;2(1):42-46.
MyJurnal

Immunization has been introduced for decades to eradicate fatal infectious diseases by inoculating attenuated, killed or toxoid of microorganisms such as bacteria and virus. The triggering action to the immune system would not harm the host; despite can boost the immune responses to any infection. However, several cases of the eradicated infectious disease have re-emerged due to the existence of vaccine hesitancy group. Vaccine hesitancy has been observed emerging worldwide due to rejection in receiving vaccine. The main obstacle in vaccination program was identified according to the misconception that they received from internet or any mass media without boundaries. Various actions from the government have met the needs to enforce and educate the public especially the hesitant group towards better disease prevention with vaccination. The strategy would cover any interaction activities or programs with the public in transferring the information about the vaccination and its benefit to the health of herd community.

Matched MeSH terms: Immunization Programs
Dengue vaccine--time to act now

Pang T, Thiam DGY, Tantawichien T, Ismail Z, Yoksan S

Lancet, 2015 May 02;385(9979):1725-1726.
PMID: 25943934 DOI: 10.1016/S0140-6736(15)60888-1
Matched MeSH terms: Immunization Programs*
Fulltext The feasibility and acceptability of self-sampling and HPV testing using Cepheid Xpert® HPV in a busy primary care facility

Woo YL

Journal of virus eradication, 2019 Mar 04;5(Suppl 1):10-11.
PMID: 30997147

Malaysia's approach to reducing the burden of HPV-related disease has centred on adolescent vaccination and cervical screening with Pap smears. While the vaccination programme has been broadly successful, Pap smear screening has been less successful. In an effort to improve screening uptake, the ROSE 1.0 pilot aimed to create more efficient screening, with improved quality and lower total cost.

Matched MeSH terms: Immunization Programs
Role of men in promoting the uptake of HPV vaccinations: focus groups' finding from a developing country

Wong LP

Int J Public Health, 2010 Feb;55(1):35-42.
PMID: 19771393 DOI: 10.1007/s00038-009-0072-4

OBJECTIVES: Better outcomes of human papillomavirus (HPV) vaccination would be expected if men become full partners and advocates in vaccination initiative. Men involvement has important implication especially within the context that they are equally responsible for spreading the virus.

METHODS: Twenty-seven men took part in four focus group discussions carried out to assess men's attitudes toward the HPV vaccine between October and November 2007.

RESULTS: The results revealed that men have low awareness about the newly release vaccine and minimal knowledge of HPV and its association with cervical cancer. When provided with information, most men were in favor of protecting their spouses, partners, or daughters from cervical cancer using the vaccine. They were aware of the effects of men's risk behavioral patterns on women's risk for acquiring HPV infections. Many needed assurance about the vaccine's long-term safety and efficacy. They also expressed concern over the high cost of the vaccine. Men in this study played an influential role in the vaccination decision of their child and sexual partners. Many were in favor of male vaccination for cervical cancer prevention of their spouse or partner.

CONCLUSIONS: Vaccine advocacy should put special emphasis on men as sexual partners, husbands, and fathers from a gender equality and partnership perspective. The findings are useful in facilitating the development of strategies for effective immunization initiatives.

Matched MeSH terms: Immunization Programs/utilization*
Fulltext Cost analysis of measles in refugees arriving at Los Angeles International Airport from Malaysia

Coleman MS, Burke HM, Welstead BL, Mitchell T, Taylor EM, Shapovalov D, et al.

Hum Vaccin Immunother, 2017 05 04;13(5):1084-1090.
PMID: 28068211 DOI: 10.1080/21645515.2016.1271518

Background On August 24, 2011, 31 US-bound refugees from Kuala Lumpur, Malaysia (KL) arrived in Los Angeles. One of them was diagnosed with measles post-arrival. He exposed others during a flight, and persons in the community while disembarking and seeking medical care. As a result, 9 cases of measles were identified. Methods We estimated costs of response to this outbreak and conducted a comparative cost analysis examining what might have happened had all US-bound refugees been vaccinated before leaving Malaysia. Results State-by-state costs differed and variously included vaccination, hospitalization, medical visits, and contact tracing with costs ranging from $621 to $35,115. The total of domestic and IOM Malaysia reported costs for US-bound refugees were $137,505 [range: $134,531 - $142,777 from a sensitivity analysis]. Had all US-bound refugees been vaccinated while in Malaysia, it would have cost approximately $19,646 and could have prevented 8 measles cases. Conclusion A vaccination program for US-bound refugees, supporting a complete vaccination for US-bound refugees, could improve refugees' health, reduce importations of vaccine-preventable diseases in the United States, and avert measles response activities and costs.

Matched MeSH terms: Immunization Programs/economics
Fulltext Cost-effectiveness of HPV vaccination regime: comparing twice versus thrice vaccinations dose regime among adolescent girls in Malaysia

Aljunid S, Maimaiti N, Nur AM, Noor MRM, Wan Puteh SE

BMC Public Health, 2016 Jan 23;16:71.
PMID: 26803814 DOI: 10.1186/s12889-016-2754-1

BACKGROUND: The HPV vaccine was introduced to Malaysian national immunization programme in 2010. The current implementation age of HPV vaccination in Malaysian is at the age of 13 years school girls, given according to a 3 doses protocol which may complicate implementation and compliance. Aim of the study is to determine the cost-effectiveness of HPV vaccination regime comparing twice versus thrice HPV vaccinations dose regime among adolescent girls in Malaysia.
METHODS: A Markov cohort model reflecting the natural history of HPV infection accounting for oncogenic and low-risk HPV was adapted for 13 year old Malaysian girls cohort (n = 274,050). Transition probabilities, utilities values, epidemiological and cost data were sourced from published literature and local data. Vaccine effectiveness was based on overall efficacy reported from 3-doses clinical trials, with the assumption that the 2-doses is non-inferior to the 3-doses allowing overall efficacy to be inferred from the 3-doses immunogenicity data. Price parity and life-long protection were assumed. The payer perspective was adopted, with appropriate discounting for costs (3 %) and outcomes (3 %). One way sensitivity analysis was conducted. The sensitivity analysis on cost of vaccine, vaccine coverage and discount rate with a 2-doses protocol was performed.
RESULT: The 3-doses and 2-doses regimes showed same number of Cervical Cancers averted (361 cases); QALYs saved at 7,732,266. However, the lifetime protection under the 2-doses regime, showed a significant cost-savings of RM 36, 722,700 compared to the 3-doses scheme. The MOH Malaysia could vaccinate 137,025 more girls in this country using saving 2-doses regime vaccination programme. The model predicted that 2-doses HPV vaccination schemes can avoid additional 180 Cervical Cancers and 63 deaths compare to 3-doses.
CONCLUSION: A 2-doses HPV vaccination scheme may enable Malaysian women to be protected at a lower cost than that achievable under a 3-doses scheme, while avoiding the same number of Cervical Cancer cases and deaths. Using the saving money with 2-doses, more Cervical Cancers and deaths can be avoided.

Matched MeSH terms: Immunization Programs/economics
Fulltext Primum Non Nocere

Van Rostenberghe H

Malays J Med Sci, 2021 Feb;28(1):122-124.
PMID: 33679230 DOI: 10.21315/mjms2021.28.1.17

The coronavirus disease 2019 (COVID-19) pandemic is severe and has not shown any signs of warning up to today. Biotech companies around the world have raced to come up with an acceptable vaccine and recently two mRNA vaccines have received emergency usage authorisation from regulatory bodies in several countries. mRNA vaccines, which consist of a new and revolutionary technology have not been previously tested widely on humans. Medium- and long-term safety data are not available. While many experts seem to support the start of a mass vaccination campaign, others feel there are too many unknowns to embark on a mass vaccination campaign. Concerns include uncertainties about the long-term effects of foreign mRNA on human cellular physiology and the possibility of vaccine-enhanced disease severity, which may not be unlikely with the current disease presentation of COVID-19.

Matched MeSH terms: Immunization Programs
Optimizing national immunization program supply chain management in Thailand: an economic analysis

Riewpaiboon A, Sooksriwong C, Chaiyakunapruk N, Tharmaphornpilas P, Techathawat S, Rookkapan K, et al.

Public Health, 2015 Jul;129(7):899-906.
PMID: 26027451 DOI: 10.1016/j.puhe.2015.04.016

This study aimed to conduct an economic analysis of the transition of the conventional vaccine supply and logistics systems to the vendor managed inventory (VMI) system in Thailand.

Matched MeSH terms: Immunization Programs/organization & administration*
Fulltext Adult immunization--a neglected issue in Southeast Asia

Isahak I, Steering Committee for Prevention and Control of Infectious Diseases in Asia

Southeast Asian J. Trop. Med. Public Health, 2000 Mar;31(1):173-84.
PMID: 11023089

Adult immunization is a neglected and underpublicised issue in Southeast Asia. Vaccine-preventable diseases cause unnecessary morbidity and mortality among adults in the region, while inadequate immunization results in unnecessary costs, including those associated with hospitalization, treatment, and loss of income. Childhood vaccination coverage is high for the EPI diseases of diphtheria, tetanus and pertussis; however, unvaccinated, undervaccinated, and aging adults with waning immunity remain at risk from infection and may benefit from vaccination. Catch-up immunization is advisable for adults seronegative for hepatitis B virus, while immunization against the hepatitis A and varicella viruses may benefit those who remain susceptible. Among older adults, immunization against influenza and pneumococcal infections is likely to be beneficial in reducing morbidity and mortality. Certain vaccinations are also recommended for specific groups, such as rubella for women of child-bearing age, typhoid for those travelling to high-endemicity areas, and several vaccines for high-risk occupational groups such as health care workers. This paper presents an overview of a number of vaccine-preventable diseases which occur in adults, and highlights the importance of immunization to protect those at risk of infection.

Matched MeSH terms: Immunization Programs
HPV Vaccination Recommendation Practices among Adolescent Health Care Providers in 5 Countries

Topazian HM, Kundu D, Peebles K, Ramos S, Morgan K, Kim CJ, et al.

J Pediatr Adolesc Gynecol, 2018 Dec;31(6):575-582.e2.
PMID: 30017958 DOI: 10.1016/j.jpag.2018.06.010

STUDY OBJECTIVE: To assess adolescent health care providers' recommendations for, and attitudes towards human papillomavirus (HPV) vaccination in 5 countries.
DESIGN: In-depth interviews of adolescent health care providers, 2013-2014.
SETTING: Five countries where HPV vaccination is at various stages of implementation into national programs: Argentina, Malaysia, South Africa, South Korea, and Spain.
PARTICIPANTS: Adolescent health care providers (N = 151) who had administered or overseen provision of adolescent vaccinations (N = Argentina: 30, Malaysia: 30, South Africa: 31, South Korea: 30, Spain: 30).
MAIN OUTCOME MEASURES: Frequency of HPV vaccination recommendation, reasons providers do not always recommend the vaccine and facilitators to doing so, comfort level with recommending the vaccine, reasons for any discomfort, and positive and negative aspects of HPV vaccination.
RESULTS: Over half of providers 82/151 (54%) recommend HPV vaccination always or most of the time (range: 20% in Malaysia to 90% in Argentina). Most providers 112/151 (74%) said they were comfortable recommending HPV vaccination, although South Korea was an outlier 10/30 (33%). Providers cited protection against cervical cancer 124/151 (83%) and genital warts 56/151 (37%) as benefits of HPV vaccination. When asked about the problems with HPV vaccination, providers mentioned high cost 75/151 (50% overall; range: 26% in South Africa to 77% in South Korea) and vaccination safety 28/151 (19%; range: 7% in South Africa to 33% in Spain). Free, low-cost, or publicly available vaccination 59/151 (39%), and additional data on vaccination safety 52/151 (34%) and efficacy 43/151 (28%) were the most commonly cited facilitators of health provider vaccination recommendation.
CONCLUSION: Interventions to increase HPV vaccination should consider a country's specific provider concerns, such as reducing cost and providing information on vaccination safety and efficacy.

Matched MeSH terms: Immunization Programs/statistics & numerical data
Fulltext Prevalence and risk factors of Hepatitis B in first-time blood donors at National Blood Centre after implementation of National Vaccination Programme

Sow, Emmy, Noorsuzana Mohd Shariff, Chong, Soon Eu, Tun Maizura Mohd. Fathullah, Siti Salmah Noordin

Malaysian Journal of Medicine and Health Sciences, 2018;14(201):1-6.
MyJurnal

Hepatitis B virus (HBV) infection is one of the major public health problems in Malaysia. It remains the most common permanent deferral among blood donors. In Malaysia, the national vaccination programme has been introduced since 1989 to prevent HBV transmission. The objective of this study is to determine the prevalence and associated risk factors of HBV infection among first-time blood donors after the implementation of the national hepatitis B vaccination programme. Methods: This is a retrospective cohort study involving tracing of the database of National Blood Centre Malaysia. The record of first-time blood donors who had donated between 1st January 2010 and 31st December 2015 and were screened HBV positive was reviewed and analysed. Results: There were 376,737 first-time donors who had donated blood and 575 of them screened positive for HBV. The overall prevalence of seropositive for hepatitis B was 0.15%. The prevalence was higher at 0.23% among donors born before the year 1989 (pre-vaccination era) compared to 0.05% among donors born in and after the year 1989 (post-vaccination era). Perinatal transmission was found to have 15 times higher odds of developing HBV infection as compared to those who had the combination of risk factors among those born after the year 1989 (adjusted OR=14.95, 95% CI 1.80=124.01). Conclusion: The implementation of the national vaccination programme reduced the prevalence of hepatitis B among donors who received vaccination at birth compared to those who did not.

Matched MeSH terms: Immunization Programs
Fulltext Laboratory acute flaccid paralysis surveillance in Malaysia: a decade of commitment to the WHO global polio eradication initiative

Saraswathy TS, Khairullah NS, Sinniah M, Fauziah MK, Apandi MY, Shamsuddin M

Southeast Asian J. Trop. Med. Public Health, 2004 Jun;35(2):421-4.
PMID: 15691149

The Institute for Medical Research, Malaysia, was designated the National Reference Laboratory for Poliomyelitis Eradication (NRLPE) in 1992. Since then, our Polio Laboratory has collaborated actively with the Disease Control Division, Ministry of Health (MOH), Malaysia and WHO towards achieving polio eradication. Since 1992, the NRLPE has investigated 1,063 stool specimens from 641 acute flaccidparalysis (AFP) cases. One hundred and one enteroviruses were isolated from these specimens. Positive cell cultures were confirmed by microneutralization assay using standard WHO antisera. All enterovirus isolates were sent to the Victorian Infectious Disease Reference Laboratory in Melbourne, Australia, for further identification and poliovirus intratypic differentiation. Thirty-one out of these 101 virus isolates (30%) were polioviruses (PV) and the remaining 70 (70%) were non-polio enteroviruses (NPEV) which included coxsackie B viruses, echoviruses and enterovirus 71. Three of the poliovirus isolates were wild-type polioviruses isolated in 1992 which were the last wild-type polioviruses isolated in Malaysia. The rest were vaccine-related Sabin-like strains. Monthly reports of the virological investigation of AFP cases are sent to WHO and to the MOH, AFP control committee. The NRLPE continues to play an integral role in AFP surveillance and is committed to the WHO's goal of global polio eradication by the year 2005.

Matched MeSH terms: Immunization Programs
Complete immunization coverage and its determinants among children in Malaysia: findings from the National Health and Morbidity Survey (NHMS) 2016

Lim KK, Chan YY, Noor Ani A, Rohani J, Siti Norfadhilah ZA, Santhi MR

Public Health, 2017 Dec;153:52-57.
PMID: 28915402 DOI: 10.1016/j.puhe.2017.08.001

OBJECTIVES: The success of the Expanded Program on Immunization among children will greatly reduce the burden of illness and disability from vaccine preventable diseases. The aim of the study was to evaluate the complete immunization coverage and its determinants among children aged 12-23 months in Malaysia.
STUDY DESIGN: Cross-sectional study.
METHODS: Data on immunization were extracted from the 2016 National Health and Morbidity Survey. Complete immunization coverage was classified as received all recommended primary vaccine doses by the age of 12 months and verified by vaccination cards, and incompletely immunized if they received partially recommended vaccine dose or not received any recommended vaccine dose or had no vaccination card. The multiple logistic regression analyses were conducted to determine the sociodemographic factors associated with complete immunization coverage.
RESULTS: The overall complete immunization coverage among children (verified by cards) was 86.4% (n = 8920, 95% confidence interval: 85.4-87.4). Multivariable logistic regression analyses model revealed that factors significantly associated with complete immunization coverage were ethnicity, occupation of the mother, head of household's education level, and head of household's occupation. While sex, citizenship, household income, mother's age, and marital status were not significantly associated with complete immunization coverage.
CONCLUSIONS: According to the World Health Organization criteria, the present study demonstrated that the immunization coverage of 86.4% is still unsatisfactory. Thus, the current intervention program should be enhanced in order to achieve the 95% coverage for all antigens in the national vaccination program.
Study name: National Health and Morbidity Survey (NHMS-2016)

Matched MeSH terms: Immunization Programs
Challenges to health workers and their opinions about parents' refusal of oral polio vaccination in the Khyber Pakhtoon Khawa (KPK) province, Pakistan

Khan TM, Sahibzada MU

Vaccine, 2016 Apr 19;34(18):2074-81.
PMID: 26993330 DOI: 10.1016/j.vaccine.2016.03.008

A qualitative study design was adapted to explore the challenges faced by health workers (HWs) during the polio health campaign. In addition, HWs' opinions about the factors causing parents to refuse oral polio vaccination (OPV) were also explored. Four focus group discussions (FGDs) were held (from 1st January 2015-31st March 2015) with the HWs who participated in the OPV campaigns in the polio red zones of Khyber Pakhtoon Khawa (KPK) province of Pakistan, namely Kohat (FG 1), Domel and Bannu (FG 2), Hangoo (FG 3), and Peshawar (FG 4). A total of N=42 HWs (10-11 in each FG) agreed to participate in this study. Overall, HWs disclosed that public attitude and harsh behaviour towards the HWs and security threats are the two main challenges they face. Common issues hindering parents' willingness to vaccinate their children against OPV are: OPV is seen as haram and not permitted in Islam, it is said to contain the blood of pigs (Khinzir) and monkeys, and parents are afraid that it is done to induce sterility among their children. HWs also shared that parents have a strong belief in the conspiracies that are associated with OPV, i.e. the USA and CIA, are spying on us and our government is helping them to achieve their agenda. Furthermore, HWs revealed that frequent visits may further strengthen parents' perceptions and make them more resistant to OPV. The common side effects of OPV reported by parents were mainly gastro-intestinal problems and in some cases mild to moderate fever with some respiratory symptoms. There is a great need to improve the logistics and facilities for HWs assisting in vaccination programmes. Furthermore, it is necessary to improve education, so people understand the basic concept of revaccination and booster doses, thereby assisting in creating a basic understanding of vaccinations, which may trigger changes in attitudes and make people believe in the benefits of OPV rather than following the conspiracies that lead them to refuse it.

Matched MeSH terms: Immunization Programs
Fulltext Impact of a measles elimination strategy on measles incidence in Malaysia

Saraswathy TS, Zahrin HN, Norhashmimi H, Az-Ulhusna A, Zainah S, Rohani J

Southeast Asian J. Trop. Med. Public Health, 2009 Jul;40(4):742-7.
PMID: 19842408

In Malaysia, the two dose measles - mumps - rubella (MMR) vaccine was introduced in the Expanded Program on Immunization in 2002. The Ministry of Health then initiated a measles elimination strategy which included enhanced case-based surveillance with laboratory testing of all suspected cases. The objective of our study was to analyse national measles laboratory data from 2004 to 2008 to study the impact of the nationwide strategy on measles case incidence. Blood samples collected from suspected measles cases during the acute stage of the illness were investigated for measles specific IgM. The estimated incidence of measles ranged from 22.3 cases (in 2004) to 2.27 cases (in 2006) per 100,000 population. During this time, the measles vaccination coverage was above 85%. Laboratory confirmed measles cases dropped from 42.2% in 2004, when sporadic outbreaks were reported, to 3.9% in 2007. Screening for measles IgG levels in 2008 showed that 82.8% of those > 7 years old had adequate immunity. The measles control strategy appears to have been successful in reducing the incidence of measles. Continuing high vaccination coverage rates and ongoing measles surveillance are necessary to achieve our goal of measles elimination.

Matched MeSH terms: Immunization Programs*
Fulltext COVID-19 vaccination campaign in Nepal, emerging UK variant and futuristic vaccination strategies to combat the ongoing pandemic

Sah R, Khatiwada AP, Shrestha S, Bhuvan KC, Tiwari R, Mohapatra RK, et al.

Travel Med Infect Dis, 2021;41:102037.
PMID: 33781945 DOI: 10.1016/j.tmaid.2021.102037

With the emergence of the new variants of concern (VOC) of the SARS-CoV-2, the efficacy of certain vaccines against them requires further research and considerations for future scenarios of COVID-19 vaccination. The vaccines' lack of efficacy against VOC will pose at risk to the vaccinated population and is a public health threat. In this commentary, we discuss Nepal's recent experiences and expectations regarding the confirmation of VOC B.1.1.7 from the United Kingdom in the country.

Matched MeSH terms: Immunization Programs/methods*
Fulltext Sociodemographic determinants of knowledge and attitude in the primary prevention of cervical cancer among University Tunku Abdul Rahman (UTAR) students in Malaysia: preliminary study of HPV vaccination

Tusimin M, Yee CL, Razak NZSA, Zainol MI, Minhat HS, Rejali Z

BMC Public Health, 2019 Nov 05;19(1):1454.
PMID: 31690296 DOI: 10.1186/s12889-019-7764-3

BACKGROUND: Cervical cancer is the third most common cancer affecting women around the world in which the Human Papillomavirus (HPV) is the one of the recognized causative agent affecting women health. In response to this health issue, the Malaysian government had officially implemented the HPV immunisation programme for secondary schoolchildren in 2010 at the age of 13 years old and above. The purpose of this study is to investigate the sociodemographic determinants of knowledge and attitude among students of Universiti Tunku Abdul Rahman (UTAR) towards the HPV vaccination programme.
METHODS: A cross-sectional study was conducted using self-administered questionnaires, recruiting 374 UTAR's students as the respondents by using convenience sampling method. Respondents were categorized as having good/poor level of knowledge and positive/negative attitude towards HPV vaccination.
RESULTS: Over half of the respondents were females (64.5%) and the majority were aged 20 years old and below (55.8%). Generally, 54.7% of the total respondents had a high level of knowledge towards HPV vaccine while 57.5% of the total respondents showed a negative attitude towards HPV vaccine. Female respondents aged 20 years old and below showed good knowledge (56.4%) and a more positive attitude (55.8%) towards HPV vaccine. Students from the Faculty of Medicine and Health Sciences (FMHS) exhibited higher knowledge (67.3%) and positive attitude (62.4%) as compared to the Faculty of Accountancy and Management (FAM) which showed only 32.7% of knowledge and 37.6% of positive attitude towards the HPV vaccination.
CONCLUSION: The majority of UTAR students possess good knowledge regarding HPV vaccination. Nonetheless, they demonstrated a negative attitude towards HPV vaccination, depicting the necessity to impart and further intensify the sense of health awareness among all students, especially among male students. The judicious use of social media apart from the conventional mass media should be an advantage as to enhance the practice of HPV vaccination among them and thereafter minimize the health and economic burdens of cervical cancer.

Matched MeSH terms: Immunization Programs
Fulltext Using TelePrimary Care to monitor immunization status in Sarikei Health Clinic, Sarikei, Sarawak

Lai BF, Safii R, Nyulang L, Dunggau C, Riffin MA, Khu FM, et al.

Int J Public Health Res, 2011;1(2):237-241.
MyJurnal

Introduction The purpose of this paper is to demonstrate the effectiveness of using TelePrimary Care (TPC) to monitor immunization programmed in a clinic. Japanese Encephalitis (JE) vaccination was selected as an example because its coverage has not been satisfactory when compared to that of other vaccinations, which generally exceed 90%.
Methods Data for all children who were eligible for JE vaccination (age range from 9 months to 30 months) who attended Sarikei Health Clinic between 1 January 2007 till 31 June 2008, was extracted from the TPC database and analyzed for completeness and timeliness of JE vaccination.
Results The analysis showed that although 1,243 children were eligible to receive their first dose of J vaccine at 9 months of age, only 560 (45%) received it. 15 (3%) received on time, and 545 (97%) received it late (age range from 10 months to 20 months). Out of the 560 who were scheduled to receive their second dose of JE vaccine four weeks after the first, 382 (88%) received it on time, and 55 (12%) received it late. Only 78 (18%) out of 429 children aged between 18 months to 24 months received their booster dose; 52 (67%) received it on time and 26 (33%) received it late.TPC not only enables health staff to monitor immunization coverage and timeliness accurately, but it also helps them to identify defaulters quickly so that these children can be traced and immunized. Doing these tasks manually is time-consuming and tedious, leading to delays in tracing defaulters.
Conclusions TPC provides an effective system for staff to easily access real time child health data to monitor and audit their immunization programme and take remedial action where necessary.
Study site: Klinik Kesihatan Sarikei, Sarawak, Malaysia

Matched MeSH terms: Immunization Programs
Fulltext Economic impact of switching from partially combined vaccine "Pentaxim® and hepatitis B" to fully combined vaccine "Hexaxim®" in the Malaysian National Immunization Program

Aljunid SM, Al Bashir L, Ismail AB, Aizuddin AN, Rashid SAZA, Nur AM

BMC Health Serv Res, 2022 Jan 05;22(1):34.
PMID: 34986870 DOI: 10.1186/s12913-021-07428-7

BACKGROUND: The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)' and parents'/caregivers' perceptions.
METHODS: In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas the alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents'/caregivers' questionnaire. Also, HCPs' and parent's/caregivers' perceptions were investigated using structured questionnaires.
RESULTS: The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® for the baseline scheme was Malaysian ringgit (RM) 31.90 (7.7 United States dollar [USD]) vs. 17.10 (4.1 USD) for direct medical cost, RM 54.40 (13.1 USD) vs. RM 27.20 (6.6 USD) for direct non-medical cost, RM 221.33 (53.3 USD) vs. RM 110.66 (26.7 USD) for indirect cost, and RM 307.63 (74.2 USD) vs. RM 155.00 (37.4 USD) for societal (total) cost. A similar trend was observed for the alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 (33.1 USD) and RM 104.70 (25.2 USD) in the baseline and alternative scheme, respectively. Eighty-four percent of physicians and 95% of nurses supported the use of Hexaxim® in the NIP. The majority of parents/caregivers had a positive perception regarding Hexaxim® vaccine in various aspects.
CONCLUSIONS: Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with a high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B.
TRIAL REGISTRATION: Not applicable.

Matched MeSH terms: Immunization Programs

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