Vaccine hesitant parents are linked with re-emergence of vaccine preventable diseases, but evidence is scarce locally. The Parent Attitudes about Childhood Vaccines (PACV) questionnaire was validated and used in the USA to identify vaccine hesitant parents. This study aimed to adapt and translate the 15-item PACV questionnaire from English into the Malay language, and to examine its validity and reliability. The sample population was parents of children aged 0-24 months, recruited at an urban government health clinic between November 2016-June 2017. During content validation, two items from the "Behavior" subdomain were identified as items with formative scale and excluded from exploratory factor analysis (EFA) but retained as part of demography. A total of 151 parents completed the questionnaire with response rate of 93.3%. Test-retest reliability was tested in 25 respondents four weeks later and the intra-class correlation was between 0.53 and 1.00. EFA of the 13 items showed possibility of two to four factor domains, but three domains were most conceptually equivalent. Two of the domains were similar to the original and one factor was identified de novo. One item was deleted due to poor factor loading of < 0.3. Therefore, the validated final PACV-Malay consisted of 12 items framed within three-factor domains. The PACV-Malay was reliable with total Cronbach alpha of 0.77. In conclusion, the PACV-Malay is a valid and reliable tool which can be used to identify vaccine hesitant parents in Malaysia. Confirmatory factor analysis and predictive validity are recommended for future studies.
BACKGROUND Primary cutaneous lymphomas (PCL) are a multifaceted spectrum of cutaneous T cell lymphoma (CTCL) and cutaneous B cell lymphomas (CBCL). Mycosis fungoides (MF) is a rare subset of CTCL that primarily affects adults, and its occurrence in children is exceedingly rare. Most pediatric MF manifests as hypopigmented patches resembling other benign dermatoses, causing diagnostic challenges. This report outlines a case of pediatric MF in a 7-year-old Malaysian boy. CASE REPORT A 7-year-old boy exhibited progressing skin lesions characterized initially by erythematous, papular rashes over the face and upper limbs, then to the whole body, becoming hypopigmented, with pruritus and scaling for 1 year. Multiple clinics treated him for eczema and pityriasis alba but he responded poorly to courses of various topical steroids and emollient treatment. Due to the refractory nature of the lesions, he was subsequently referred to a dermatology clinic, where 2 skin biopsies were performed. The first biopsy revealed epidermotropism of atypical lymphocytes, consistent with MF. Immunohistochemical analysis revealed positive CD3+ expression with slightly reduced CD4+, CD7+, and CD8+ expression, and normal CD2+ and CD5+ expression at the epidermis level. Nevertheless, due to the rarity of MF in children, a second biopsy was performed, validating the diagnosis. CONCLUSIONS Pediatric MF is a rare and challenging diagnosis. This case report highlights the importance of close monitoring of unresolved hypopigmented lesions and increased vigilance on lesions not responding to standard treatment. Timely diagnosis with support of skin biopsy is crucial to avoid potentially serious disease progression and helps provide appropriate management leading to improved outcomes.