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Fulltext Social expectations and government incentives in Malaysia's COVID-19 vaccine uptake

Abdul Aziz NI, Flanders S, Nungsari M

PLoS One, 2022;17(9):e0275010.
PMID: 36156604 DOI: 10.1371/journal.pone.0275010

High vaccination rates are integral to reducing infection and severity rates of COVID-19 infections within a community. We examine the role of social expectations in COVID-19 vaccination take-ups and its interaction with potential government actions in Malaysia. We find that individuals' expectations of others in their social groups towards vaccination predicts those individuals' vaccination registrations. Using a vignette experiment, we examine the extent of normative expectations in normalizing pro-vaccination behavior beyond an individual's reference group. We find that unless moderated by a high level of public trust, individuals prefer punitive policies as a way to increase vaccination rates in their communities.

Matched MeSH terms: Diphtheria-Tetanus-Pertussis Vaccine
Fulltext Parents' and healthcare professionals' perception toward the introduction of a new fully liquid hexavalent vaccine in the Malaysian national immunization program: a cross-sectional study instrument development and its application

Al Bashir L, Ismail A, Aljunid SM

Front Immunol, 2023;14:1052450.
PMID: 37180162 DOI: 10.3389/fimmu.2023.1052450

A newly developed fully liquid hexavalent vaccine that comprises six antigens for Diphtheria, Tetanus, acellular Pertussis, Inactivated Poliomyelitis, Haemophilus Influenza type b., and Hepatitis B, is proposed to be introduced in the Malaysian national immunization program, instead of the non-fully liquid pentavalent vaccine and monovalent Hepatitis B vaccine that is currently employed in the immunization schedule. Although the introduction of new vaccines is a necessary intervention, it still needs to be accepted by parents and healthcare professionals. Hence, this study aimed to develop three structured questionnaires and to investigate the participants' perception and acceptability toward the incorporation of the new fully liquid hexavalent vaccine. A cross-sectional study was conducted among a sample of 346 parents, 100 nurses, and 50 physicians attending twenty-two primary health care centers in the states of Selangor and the Federal Territory of Kuala Lumpur and Putrajaya during 2019-2020. The study found that Cronbach's alpha coefficients for the study instruments ranged from 0.825 to 0.918. Principal components analysis produced a good fit with KMO>0.6. For the parents' perception questionnaire, the only extracted factor explained 73.9 % of the total variance; for the nurses' perception toward a non-fully and fully liquid combined vaccine, there was a sole extracted factor that explained 65.2 % and 79.2% of the total variance, respectively. Whereas for the physicians' perception, there was one factor extracted that explains 71.8 % of the total variance. The median score for all the questionnaire items ranged from 4 to 5 (Q1 and Q3 vary between 3-5). Parents' ethnicity was significantly associated (P-value ≤ 0.05) with the perception that the new hexavalent vaccine would reduce their transportation expenses. Moreover, a significant association (P-value ≤ 0.05) was found between physicians' age and the perception of the hexavalent vaccine's ability to decrease patient overcrowding in primary healthcare centers. The instruments used in this study were valid and reliable. Parents of Malay ethnicity were the most concerned about transportation expenses since they have the lowest income and are more concentrated in rural areas compared to other races. Younger physicians were concerned about reducing patient crowding and hence reducing their workload and burnout.

Matched MeSH terms: Diphtheria-Tetanus-Pertussis Vaccine*
Total paralysis regime in severe tetanus

Alhady SMA, Bowler DP, Reid HA, Scott LT

Br Med J, 1960;1:540-545.

Tetanus may be mild, moderate, severe, or inevitably fatal. Our clinical experience suggests it may be classified as severe (or, maybe, inevitably fatal) when a tetanic spasm stops respiration. Ten patients with severe tetanus were treated by the total paralysis regime (T.P.R.), consisting of tracheostomy, curarization, and intermittent positiveor positive/negative-pressure respiration. Two of the patients were saved by T.P.R. and therefore only limited effectiveness can be claimed for the regime. In inevitably fatal cases survival can be prolonged by T.P.R. so that further effects of tetanus toxin emerge. Of these, the most important appears to be direct damage to the myocardium.

Matched MeSH terms: Tetanus
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: Diphtheria-Tetanus-Pertussis Vaccine*
Fulltext Neonatal tetanus in Malaysia

Amar-Singh HS

Med J Malaysia, 2009 Mar;64(1):1-2.
PMID: 19852312 MyJurnal

Neonatal Tetanus is a severe disease with high fatality. It should no longer be present in a country with the development status of Malaysia. However, sporadic cases still occur and the disease has not been eradicated. This editorial summarises the disease pattern, incidence and suggests reasons for the continued persistence of the condition locally.

Matched MeSH terms: Tetanus/epidemiology*; Tetanus/prevention & control; Tetanus Toxoid/immunology
Fulltext Tetanus in adults--a continuing problem: an analysis of 217 patients over 3 years from Delhi, India, with special emphasis on predictors of mortality

Anuradha S

Med J Malaysia, 2006 Mar;61(1):7-14.
PMID: 16708728

Tetanus is still widely prevalent in many parts of the world especially in the developing countries. This study was conducted to assess the demographic and clinical features, treatment and outcome of tetanus in adults with a special emphasis on identification of predictors of mortality. This was a retrospective study of all adult patients admitted with tetanus over a three-year period from 1998 to 2000 at Lok Nayak Hospital, New Delhi, India. The demography, clinical features, treatment and complications of the patients were assessed and were evaluated against two possible outcomes- survival or death, to identify the predictors of mortality. There were 217 adults (148 males, 69 females) admitted with generalized tetanus during the study period. The mean age of the patients was 36.08 +/- 18.84 years. In most instances (63.5%), wounds / injuries served as the source of infection. Overall 31.8% had mild, 21.7% had moderate and 46.5% had severe disease at presentation. Respiratory failure and dysautonomia were the frequently observed complications. Of the 217 patients, 82 died - a mortality rate of 37.78%. Parameters that were significantly associated with increased mortality were: age (especially > 60 years); shorter duration of symptoms - trismus, rigidity and dysphagia; severe disease at presentation and shorter period of onset. Tetanus is a preventable disease associated with a high fatality rate. Universal coverage of immunization programme and appropriate wound prophylaxis is the corner stone of tetanus eradication. The treatment of tetanus is difficult and requires specialized and intensive care. The presence of parameters indicating an adverse outcome at the beginning in the patients will help identify the subset of patients that need more intensive management especially in resource poor nations.

Matched MeSH terms: Tetanus/complications; Tetanus/diagnosis*; Tetanus/mortality*; Tetanus/therapy
Fulltext Re-Emergence of Tetanus in a District Referral Hospital

Ariff HH, Verghese A, Brian CMK

International Medical Journal Malaysia, 2017;16(1):127-130.
MyJurnal

Tetanus is an acute, potentially fatal disease caused by Clostridium tetani. It is characterized by generalized, painful spasms and rigidity of skeletal muscles. We present two fatal cases and discuss the potential causes that lead to mortality in cases of tetanus infection

Matched MeSH terms: Tetanus
The traditional birth attendant and neonatal tetanus: the Malaysian experience

Chen PC

J Trop Pediatr Environ Child Health, 1976 Dec;22(6):263-4.
PMID: 1051832
Matched MeSH terms: Tetanus/etiology*
Influence of immunization schedule on immunization coverage

Chen ST

J Trop Med Hyg, 1989 Dec;92(6):386-90.
PMID: 2607571

The infant immunization coverage for triple antigen (DPT) from 1968 and trivalent oral polio vaccine (TOPV) from 1972 to 1985 for Peninsular Malaysia are presented. It shows that immunization coverage improved when the recommended age for first dose of DPT was changed from the fourth to the second month of life in 1972 and declined when the recommended age for the first dose of DPT and TOPV was revised again from the second to the third month of life in 1980. The advantages of immunizing children early in life are discussed.

Matched MeSH terms: Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage*
Fulltext Timing of antenatal tetanus immunization for effective protection of the neonate

Chen ST, Edsall G, Peel MM, Sinnathuray TA

Bull World Health Organ, 1983;61(1):159-65.
PMID: 6601539

The relationship between the timing of maternal tetanus toxoid immunization and the presence of protective antitoxin in placental cord blood was investigated among women admitted to the obstetrical service of the University Hospital in Kuala Lumpur, Malaysia. The 1st dose was given between 13-39 weeks of gestation, with a median of 29 weeks. The 2nd dose was given an average of 4 weeks later. Protection was conferred on 80% or more of newborns whose mothers received their 1st tetanus toxoid injection 60 days or more before delivery. Protective levels were seen in all cord blood samples from infants whose mothers had received their 1st injection 90 days before delivery. Similarly,protective titers were found in 100% of cord blood samples when the 2nd maternal injection was give 60 days or more before delivery. There was no significant degree of protection when immunization was carried out less than 20 days before delivery. A single-dose schedule provided no protection when less than 70 days before delivery. Cord and maternal antiotoxin titers differed by no more than 1 2-fold dilution for almost all of the individual paired sera. A cord: maternal antitoxin ratio of 2 was more likely to occur with increasing time between the 2nd injection and delivery. Overall, these findings indicate that the 1st injection of a 2-dose maternal tetanus toxoid schedule should be given at least 60 days and preferably 90 days before delivery.

Matched MeSH terms: Tetanus/prevention & control*; Tetanus Antitoxin/analysis; Tetanus Toxoid/administration & dosage*
Tetanus neonatorum in West Malaysia

Chen ST

J Trop Med Hyg, 1974 Sep;77(9):204-7.
PMID: 4416077
Matched MeSH terms: Tetanus/mortality; Tetanus/epidemiology*; Tetanus Toxoid/administration & dosage
Morbidity pattern amongst some primary school entrants in Malaysia

Chen ST, Dugdale AE

Trop Geogr Med, 1972 Sep;24(3):269-74.
PMID: 4636102
Matched MeSH terms: Tetanus/prevention & control
Oxygen therapy and pulmonary fibroplasia: a review and case reports

Chew DT, Yin AL

Med J Malaya, 1971 Dec;26(2):122-8.
PMID: 4260858
Matched MeSH terms: Tetanus/therapy
Effect of Spirulina (Arthrospira) supplementation on the immune response to tetanus toxoid vaccination in a mouse model

Chu WL, Quynh le V, Radhakrishnan AK

J Diet Suppl, 2013 Sep;10(3):229-40.
PMID: 23927690 DOI: 10.3109/19390211.2013.822452

The aim of this study was to investigate whether Spirulina (Arthrospira) supplementation could enhance the immune response to tetanus toxoid (TT) vaccine in a mouse model. Vaccination of TT was performed on day 7 and 21 in mice fed daily with Spirulina (50 and 150 mg/kg body weight). Both Spirulina supplementation and TT vaccination did not significantly affect body weight gain of the mice. Supplementation of Spirulina significantly enhanced IgG level (p = .01) after the first but not after the second TT vaccination. The anti-TT IgG levels of the groups that received low dose and high dose of Spirulina were not significantly different. Spirulina supplementation did not show significant effects on in vitro splenocyte proliferation and cytokine (IFN-γ and IL-4) production induced by Con A and TT. This study showed that Spirulina supplementation could enhance primary immune response in terms of antibody production, but not secondary immune response following TT vaccination in a mouse model.

Matched MeSH terms: Tetanus Toxoid/immunology; Tetanus Toxoid/pharmacology*
Record of interesting cases

Davies EC

Malayan Medical Journal, 1927;2:80.

Matched MeSH terms: Tetanus
The "built-in failure-rate" of immunisation at infant-health clinics

Dugdale AE

Lancet, 1969 Feb 22;1(7591):409-11.
PMID: 4179241 DOI: 10.1016/S0140-6736(69)91371-3
Matched MeSH terms: Tetanus/prevention & control
Intensive therapy in neonatal tetanus

Ganendran A

Anaesthesia, 1974 May;29(3):356-62.
PMID: 4599155
Matched MeSH terms: Tetanus/drug therapy; Tetanus/etiology; Tetanus/epidemiology; Tetanus/therapy*; Tetanus Antitoxin/therapeutic use
Notes on a case of tetanus

Gupta M

Malayan Medical Journal, 1927;2:164-5.

Matched MeSH terms: Tetanus
The management of tetanus

HARPER J

Med J Malaya, 1961 Sep;16:32-45.
PMID: 13904778
Matched MeSH terms: Tetanus/therapy*; Tetanus Toxoid*
Fulltext Diphtheria anti-toxoid antibody levels among pre-clinical students and staff in an institute of higher learning in Malaysia: are they protected?

Hamat, R.A., Malina, O., Chua, Y.J., Seng, K.L., Zubaidah, M., Norhanim, K., et al.

Malaysian Journal of Medicine and Health Sciences, 2011;7(1):-.
MyJurnal

Little is known about the sero-prevalence of diphtheria anti-toxoid antibody levels among medical students in Malaysia. They too, just like other health care workers (HCWs) are at risk of contracting and transmitting diphtheria. Fortunately, this can be prevented by giving a specific vaccine: the diphtheria, tetanus and pertussis (DTP) vaccine. Nonetheless, data from local or regional surveys are needed before any decision is made by the respective authorities. General objective: We studied the epidemiology of diphtheria anti-toxoid antibody levels and vaccination history amongst medical students and staff in Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. Specific objectives: We determined the level of diphtheria anti-toxoid antibodies amongst pre-clinical students and staff. Methodology: A total of 152 sera were collected from subjects aged 19 to 63, and diphtheria anti-toxoid levels were measured by an enzyme-linked immunosorbent assay. Results: One hundred and fifty-two (94.4%) blood samples out of 161 participants were successfully withdrawn, which comprised 105 (69.1%) and 47 (30.9%) medical students and staff, respectively. A total of 77.6% and the other 22.4% of the subjects had full and basic protection, respectively. Higher levels were predominant amongst males and they were 1.3 times more protected than females in 20-29 year-old group (85.1% vs 66.2%; odd ratios 1.25 [95% CI 1.03-1.50]; P=0.03). No significant difference in the levels of immunity among subjects for ethnicity and academic position (P>0.05). Recommendations: Level of full protection against diphtheria toxin should be clearly defined by broad population based studies using several comparable detection methods. Medical students and staff with basic protection should be closely monitored or should be given a booster dose for those who are at high risk of acquiring the disease. Thus, a standard degree of coverage should be clearly determined for health workers to prevent a potential outbreak. Conclusion: Students and staff possess immunity towards diptheria toxin however the level of full protective antibody is yet to be determined in future.

Matched MeSH terms: Tetanus; Tetanus Toxoid

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