VACCINE PREVENTABLE DISEASES CONTROL PROGRAM IN …

Ministry of Health Malaysia 4th NCCR 2010, 2nd June 2010 Ministry of Health Malaysia

VACCINE PREVENTABLE

DISEASES CONTROL PROGRAM

IN MALAYSIA

DR HASBULLAH AB RAHMAN

KETUA UNIT KESIHATAN KELUARGA


Immunity – body reaction toward

antigen to produce antibody

Immunization – development of

immunity in the body after vaccine

injection

Vaccination – process introducing of

vaccine into body regardless to the

development of immunity


Natural Immunity – at birth

(skin, mucosa, phagocytes, lymphocyte and eosinophils)

Specific Immunity – expose to

microorganism

Active immunity – response of natural and

specific

immunity after vaccine

injection

Passive immunity – injection of

immunoglobulin

(snake vernom)

Ministry of Health Malaysia

Immunisation

One of the most powerful and cost-

effective of all public health interventions.

Prevents

Debilitating illnesses

Disability

Morbidity and mortality

Transform lives

Maintains quality health

Improves life prospects

Protects children, adolescents and adults.


Programme Objectives

1. To protect individual from the targeted diseases,

2. To reduce the occurrence of outbreaks of the targeted diseases by creating adequate herd immunity,

3. To reduce the morbidity and mortality due to vaccine preventable diseases,

4. To maintain surveillance on identified vaccine-preventable diseases,

5. To eradicate poliomyelitis, eliminate measles & MNTE, and to reduce hepatitis B by a certain time frame based on WPRO’s Plan of Action.


1.As a concern of “children” (Family Health Development Division as part of

MCH)

2.As an intervention against “communicable disease”

(Disease Control Division)

Have been working synergistically with close cooperation, very minimal overlap


Immunisation Year Introduced

Small Pox Early 1950s

DT Mid 1950‟s

DPT 1958

BCG 1961

OPV 1972

ATT 1974

MEASLES 1982

RUBELLA 1987

HEPATITIS B 1989

Hib, MMR 2002

DTwP-Hep B + Hib 2006

DTaP-IPV/Hib 2008

HPV 2010


Vaccine Preventable Disease

Diseases

Tb

DTP

Hib

MMR

Polio

Yellow fever

Meningococcal

etc

Cancer

Hepatoma

Ca cervix


Strategising immunisation

Saving lives, protection against life-threatening diseases

Integrated services/improved coverage

More vaccine being developed/more productive. More creative and new initiatives

Public-Private Partnerships

Reaching vulnerable groups (equitable) Poorly served remote rural areas

Deprived urban setting

Unsafe areas


Meeting the goal

Sustainable

Strengthening of health system/immunization

programmes

Financing Mechanism

Innovative and sustainable delivery strategies

Improved advocacy and communication

strategies

Long Term Progress Vs Short Term Gains

Continued investments

Research and New vaccines (Tb, Malaria and HIV)


Putting Vaccine to good use

(optimizing)

Introducing new vaccines/technologies, more vaccines.

Protecting more people, reaching more people

Better coverage at district level

Integrating immunization services

Reaching and covering difficult to reach children.


Available vaccines in Malaysia

Government funded:

Tuberculosis

Diphteria

Pertussis

Tetanus

Polio

Hepatitis B

Measles

Rubella

Mumps

H. influenza b

Seasonal flu

Yellow fever

JE

Meningococcal meningitis for hajj

HPV

Own pocket: Rotavirus

Varicella

HPV

Pneumococcal

Hepatitis A

Typhoid

Seasonal flu

Meningococcal meningitis for umrah

Ministry of Health Malaysia 13

VACC. AGE ( Month ) AGE (year)

0 1 2 3 4 5 6 12 18 7 13 15

BCG

Hepatitis B

DTaP

Hib

Polio (IPV)

Measles

MMR

DT

Polio (OPV)

HPV

ATT

Primer dose Booster dose 2nd dose Sabah only

National Immunisation Schedule


Summary Of Injection Site

Vaccine Route of administration

Injection site

BCG intradermal Upper left arm

Hep B intramuscular Upper anterolateral side of the thigh

DTP intramuscular Upper anterolateral side of the thigh

OPV oral mouth

Hib intramuscular Upper anterolateral side of the thigh (older children : upper arm)

MMR subcutaneous Upper left arm

TT/DT intramuscular Upper left arm


Needle position in various type of injection


MONITORING AND EVALUATION Targets For Children Immunisation Coverage (UCI)

Immunisation Coverage (%)

BCG 100

DPT (3rd dose) ≥ 95

OPV (3rd dose) ≥ 95

Hepatitis (3rd Does) ≥ 95

MMR ≥ 95

Hib (3rd Does) ≥ 95


IMMUNISATION COVERAGE 2009 AND 2010

Year

DPT (Dos 3)

Hib (Dos 3)

Polio (Dos 3)

Hep B (Dos

3)

MMR

Deno TBIS ELB TBIS ELB TBIS ELB TBIS ELB 1- < 2

years

old

2009 97.45 100 97.3 99.85 98.4 100.98 85.38 87.61 96.88

2010 100.35 93.55 100.32 93.52 100.36 93.56 85.75 79.93 96.19


IMMUNISATION COVERAGE , 2010

Sataes

DENOMINATOR DPT (DOS 3) HIB (DOS 3)

No.

% No

%

TBIS 2010 ELB 2010 TBIS ELB TBIS ELB

Perlis 3970 4439 3702 93.25 83.40 3702 93.25 83.40

Kedah 35229 36055 32286 91.65 89.55 32286 91.65 89.55

Pulau Pinang 22213 23443 23464 105.63 100.09 23466 105.64 100.10

Perak 37104 37434 36287 97.80 96.94 36213 97.60 96.74

Selangor 74186 100650 95657 128.94 95.04 95657 128.94 95.04

W.P. KL 23539 27209 21580 91.68 79.31 21580 91.68 79.31

W.P.(Putrajaya) 5477 1389 2589 47.27 186.39 2589 47.27 186.39

N. Sembilan 16659 18169 16807 100.89 92.50 16791 100.79 92.42

Melaka 13890 14421 12530 90.21 86.89 12530 90.21 86.89

Johor 54574 59167 52502 96.20 88.74 52502 96.20 88.74

Pahang 28052 26714 26596 94.81 99.56 26595 94.81 99.55

Terengganu 21507 23930 21942 102.02 91.69 21935 101.99 91.66

Kelantan 35498 37345 29495 83.09 78.98 29495 83.09 78.98

WP(Lab) 1649 1715 1909 115.77 111.31 1909 115.77 111.31

Sabah 61693 53655 59027 95.68 110.01 58990 95.62 109.94

Sarawak 40989 45118 41540 101.34 92.07 41515 101.28 92.01

MALAYSIA 476229 510853 477913 100.35 93.55 477755 100.32 93.52


NEGERI DENOMINATOR

POLIO (DOS 3) MMR

BIL %

BIL % TBIS 2010 ELB 2010 1- < 2 TAHUN TBIS ELB

Perlis 3970 4439 4200 3702 93.25 83.40 3516 83.71

Kedah 35229 36055 35400 32289 91.65 89.55 31302 88.42

Pulau Pinang 22213 23443 22600 23475 105.68 100.14 23577 104.32

Perak 37104 37434 36700 36286 97.80 96.93 35659 97.16

Selangor 74186 100650 99500 95657 128.94 95.04 66989 67.33

W.P. KL 23539 27209 26400 21580 91.68 79.31 19519 73.94

W.P.(Putrajaya) 5477 1389 2590 47.29 186.47 masuk dlm Selangor

N. Sembilan 16659 18169 17100 16797 100.83 92.45 17076 99.86

Melaka 13890 14421 13200 12530 90.21 86.89 12506 94.74

Johor 54574 59167 56700 52516 96.23 88.76 54389 95.92

Pahang 28052 26714 25600 26595 94.81 99.55 26564 103.77

Terengganu 21507 23930 23500 21942 102.02 91.69 20825 88.62

Kelantan 35498 37345 35100 29495 83.09 78.98 28102 80.06

WP(Lab) 1649 1715 1700 1909 115.77 111.31 1824 107.29

Sabah 61693 53655 50600 59060 95.73 110.07 58245 115.11

Sarawak 40989 45118 42600 41540 101.34 92.07 40642 95.40

MALAYSIA 476229 510853 490900 477963 100.36 93.56 472177 96.19

IMMUNISATION COVERAGE , 2010


IMMUNISATION COVERAGE DTP DOS 3 NEGERI KELANTAN

JAN-DIS 2010


IMMUNISATION COVERAGE DTP DOS 3 NEGERI KELANTAN

JAN-JUN 2011


IMMUNISATION COVERAGE HEP B DOS 3 NEGERI KELANTAN

JAN-DIS 2010


IMMUNISATION COVERSGE HEP B DOS 3 NEGERI KELANTAN

JAN-JUN 2011


IMMUNISATION COVERAGE MMR NEGERI KELANTAN JAN-DIS 2010


IMMUNISATION COVERAGE MMR NEGERI KELANTAN JAN-JUN 2011


IMMUNISATION COVERAGE DA , OP DAN MMR YEAR 1 2010

NEGERI JUMLAH ENROLMEN

DA SEMULA POLIO SEMULA MMR

BIL % BIL % BIL %

PERLIS 3970 3969 99.97 3969 99.97 3968 99.95

KEDAH 33805 33240 98.33 33240 98.33 33224 98.28

PULAU PINANG 23294 22957 98.55 22957 98.55 22770 97.75

PERAK 36695 36391 99.17 36418 99.25 36391 99.17

SELANGOR 87752 85550 97.49 85550 97.49 85329 97.24

WPKL 22626 19535 86.34 19535 86.34 19327 85.42

WP PUTRAJAYA 1439 1423 98.89 1423 98.89 1421 98.75

NEGERI SEMBILAN 17646 17599 99.73 17598 99.73 17600 99.74

MELAKA 13623 13613 99.93 13613 99.93 13613 99.93

JOHOR 56,550 56,499 99.91 56,499 99.91 56,437 99.80

PAHANG 24730 24510 99.11 24510 99.11 24506 99.09

TERENGGANU 20515 20472 99.79 20472 99.79 20472 99.79

KELANTAN 30441 30102 98.89 30102 98.89 30100 98.88

SABAH 44858 44490 99.18 44490 99.18 44490 99.18

WP LABUAN 1371 1365 99.56 1363 99.42 1334 97.30

SARAWAK 34840 33115 95.05 32834 94.24 32279 92.65

MALAYSIA 454155 444830 97.95 444573 97.89 443261 97.60


IMMNUSATION COVERAGE ATT FORM 3 - 2010


PANDUAN SOAL SELIDIK SEBELUM IMMUNISASI

Tandakan (√) pada jawapan „Ya”, (X) pada jawapan „Tidak” dan (TH) kepada jawapan „Tidak Tahu

Bil.

Perkara

Tarikh

Catatan

1. Suhu badan: (ºC)

2 Keadaan Am:

i. Sakit

ii. Sihat

3. Riwayat penyakit yang lalu (nyatakan)

4. Riwayat penyakit semasa

(nyatakan)

5. Alahan/Reaksi yang teruk tehadap imunisasi

masa lalu:

6. Adakah pernah mengalami keadaan berikut:

• Sawan

• Cirit-birit/Muntah

• Alahan kepada ubat/vaksin

• Mendapat Imunoglobulin dalam

tempoh 3 bulan yang lalu

• Mengidap penyakit trombocytopania

• Mendapat rawatan kemoterapi/kanser

• Jangkitan HIV


Surveillance and Monitoring

Planning

Priority setting

Mobilization of resources

Monitoring trends in disease burden(coverage/disease incidence)

Assessing the impact of disease control programme & progress toward the set target

Early warning of impending or ongoing outbreaks of diseases


DO‟S Use checklist before immunisation

Refer if any h/o AEFI in previous

injection

Protect vaccine from light and heat

Use specific diluent for specific

vaccine

Apply specific injection technique

Always close the fridge properly

Plan before opening fridge

Monitor and chart temp 2x/day

Check the power supply

Place fridge at appropriate distance

to the wall

Arrange and label your vaccine

stock properly (first in, first out)

DON’TS Freeze the vaccines and

diluents (BCG and measles

must not be frozen after reconstitution)

Use expired vaccine

Use vaccine if any changes

in color/appearance

Mix with food/medicine

Open the fridge frequently

Leave a needle in the vial

Keep frost in the freezer


BERI DATA YANG TEPAT

AMBIL DATA DARIPADA HOSPITAL

AMBIL DATA DARIPADA SWASTA

TINJAU DALAM PETI SEJUK

TENGOK PENGEKALAN RANGKAIAN SEJUK

JENGOK- JENGOK UNIT KESIHATAN

SEKOLAH/OPD/KLINIK DESA

Ministry of Health Malaysia 33

VPD as mandatory notification

Under Prevention and Control Infectious Diseases Act, 1988

VPDs

Hepatitis B, Tb, Diphtheria, Pertussis, Tetanus, Polio, measles

Syndromic: viral encephalitis (JE),

Typhoid, yellow fever

Notification within 24 hours vs 7 days

Rubella: administrative notification


Success story: Poliomyelitis Cases Vs Polio

Vaccination Coverage, Malaysia; 1980 - 2010

0

10

20

30

40

50

60

70

80

90

100

110

120

130

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

Year

No. of cases

0

20

40

60

80

100

120% coverage

Poliomyelitis case Immunisation Coverage

OPV started in 1972


Success story: Measles incidence Vs MCV Vaccination

Coverage, Malaysia; 1970 - 2010

Measles containing vaccine (MCV) started in 1982


Incidence of neonatal tetanus

(per 1,000 LB); 1975 – 2010


Number of diphtheria cases, 1975 – 2010


Number of Pertussis cases; 1975 – 2010

0

50

100

150

200

250

300

1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

Year

2 pos cases


EPI vaccination coverage in Malaysia,

1980 – 2010

50

60

70

80

90

100

110

1990 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

imm. coverage

year

BCG DPT (3) POLIO (3) Hep B (3) Measles Hib


Introducing new vaccines

1. Vaccine are safe, effective and of good quality

2. Disease burden assessment; control and prevention plan/goals, efficacy,

3. Develop strategy for service delivery: advocacy, effectiveness and sustainability of program, procurement / supply, logistic / cold chain, training and supervision

4. Monitoring and surveillance: coverage, disease, AEFI

5. Regulatory: registration, vaccine safety, quality control.

6. WHO-Vaccines of assured quality.


The Future

1. Strategies to be in place; reduce morbidity and mortality to all time low levels.

2. Diseases targeted to be either eliminated or eradicated.

3. Vaccine against malaria, tuberculosis, dengue and HIV.

4. School-based immunization

5. New vaccine delivery system (needles replaced, aerosol formulation, heat stable vaccine)

6. Developing countries able to make their own vaccine- tailor made to their own specific needs, affordable

7. New challenges (economic crisis and climate changes)


Critical Barriers

1. Underlying weakness of the health system.

2. Overloaded system

3. Infrastructure and logistical support.

4. Lack of understanding the importance of vaccination

5. Integration of immunization activities with other services

6. Active Community participation required in improving immunization coverage.


Summary

1. Cost effective health intervention.

2. Eliminate and eradicate diseases

3. Transform lives, healthy and life prospects

4. More vaccine/accessible/equity

5. New vaccine, Tb, Dengue, Malaria, HIV.

6. New technology, heat stable, aerosol, oral, skin patches.

7. Implementing strategies, improve coverage, prioritizing, remove barrier to access, effective and sustainable Management.


Healthy children,

healthy nation.

Thank you

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