‘Necessary to vaccinate’

BY LOH FOON FONG

PETALING JAYA: Parents are increasingly giving vaccination a miss for their kids. Doctors, however, are far from pleased with the trend. They point to the rising risk of children getting stricken with preventable diseases.

Some feel that this risk has been heightened by the presence of many migrant workers in the country whose vaccination status is not known.

Malaysian Paediatric Association subcommittee chairman for immunisation Datuk Dr Zulkifli Ismail said there was increasing refusal and hesitancy to accept childhood vaccination, especially among the more educated parents.

He said these children did not only face the risk of suffering diseases but could face complications and other long term consequences from them.

Dr Zulkifli cited the case of an eight-month-old baby who had 250ml of fluid drained out from the left of his chest and was warded in intensive care unit for two weeks because his parents did not want the pneumococcal conjugate vaccine (PCV).

The infant had suffered from cough for one month and fever and breathlessness for a few days when admitted to hospital. Chest X-rays showed pneumonia with fluid in his chest, he said.

“The hospital bill was 18 times the cost of the total course of the vaccine, not including the risk of hospital-acquired infection, pain of IV drips and the chest drain and psychological trauma,” he said.

In another case, a one-year-old boy was never given the primary vaccines because his grandmother was against it.

He had been coughing for three months and did not get well despite being given traditional remedies.

Dr Zulkifli said tests found the bacteria which causes pertussis or whooping cough present.

He said the boy need not have coughed for so long if he had taken the DTaP vaccine given at ages two, three and five months with a booster at 18 months.

Health director-general Datuk Dr Noor Hisham Abdullah said the number of parents refusing vaccination was rising with families with children aged below two, increasing from 470 cases in 2013 to 1,292 cases last year. However, the numbers should be more because statistics collected did not include private health clinics, he said.

Among reasons for vaccination refusal were doubts over the safety of vaccine content, the belief that homeopathy medication and traditional remedies should not be mixed with modern medicine, and the halal concern.

Hospital Kuala Lumpur consultant neonatologist Dr Irene Cheah said in the process of avoiding vaccination, some parents also reject vitamin K injections. As a result, one baby died from bleeding in the brain and another suffered brain damage a few months ago, she said.

The injection is given at birth to prevent bleeding in the brain or gut which could be life threatening or lead to delayed development such as cerebral palsy, she said.

Bad experience a reason some avoid inoculation

PETALING JAYA: A previous bad experience is one reason some parents have chosen not to vaccinate.

Bessie, 34, who did not want her real name published, saw her first child, now aged six, fully vaccinated according to the government recommended schedule.

However, it was her experience with her second child, now aged four, that altered her thinking.

The child seemed to have an adverse reaction to the Hepatitis B vaccine when given the jab at one-month-old.

“She was vaccinated in the morning and the swelling and discomfort started not long after and the following night.

“She cried persistently for three hours and gave one very loud, high-pitched scream,” she said.

Bessie said her daughter continued to have fever for a few days, along with a swollen thigh for more than a week.

“Later, I found out she had brain inflammation and after that, I noticed behavioural change and loss of eye-contact,” she said.

As her daughter grew older, she had speech delay, she said.

She said there was no fever or illness prior to the vaccination and the baby was a healthy, fully breastfed baby.

A father of fraternal twin daughters from Subang Jaya, Dan, 36, spoke of the trauma his children went through 10 days after their second and third month shots, which were the first and second doses of DTP, polio and Hib vaccines.

He said both his twins had fever.

However, the older twin suffered a seizure twice: on Nov 19, 2009 and Dec 19, 2009.

When she had the second seizure, she had to be rushed to the hospital and admitted into the intensive care unit for two days.

“The older twin also gave out a sudden ‘weird’ high-pitched scream and it sometimes happened in the middle of the night. She’d also suddenly throw her head backwards,” he said.

The doctor said the seizures were due to E. coli infection but at the sixth month, Dan decided to stop all vaccines for the twins until he researched further.

“I later learned that this was a sign of encephalitis (swelling of the brain), which can be triggered by vaccines,” he said.

Report if children suffer ill effects, parents advised

PETALING JAYA: Parents are encouraged to notify the National Pharmaceutical Control Bureau of any symptoms they think might be linked with vaccination.

Health director-general Datuk Dr Noor Hisham Abdullah said a committee would investigate the incidence.

“If there is a safety issue with the implicated vaccine, a warning shall be given to all health facilities and the community,” he said in an email reply.

He said that the bureau had received 102 reports or 0.0025% of adverse events following immunisation (AEFI) in 4.1 million doses of vaccination given to children aged below two in Malaysia last year.

“Most AEFI cases reported involve minor reaction at injection site, mild fever and rash which were resolved uneventfully,” he said.

Dr Hisham said AEFI reports received for all age groups showed a decreasing trend, 1,068 cases reported last year compared with 1,777 in 2013.

While most cases of AEFI had been mild, in severe cases, children would need to be hospitalised, such as in cases of anaphylactic shock or Acute Demyelinating Encepha­lomyelitis or death following immunisation, he said.

“The suspected severe AEFI cases will be thoroughly investigated and if found related to the vaccination, the child will not be subjected to the same vaccine type,” he said.

Parents could lodge reports of AEFI to any government or private health facilities that administer vaccines or fill up the form – “Consumer Complaints Relating To Medicine” – which could be downloaded from the bureau website http://portal.bpfk.gov.my/ or fax to 03-7956 7151 or mail it to the bureau.

Asked why Malaysians still get infected with certain diseases that they had been immunised from, he said certain districts had lower coverage.

“This is contributed by a highly mobile population, working parents and to some extent the vaccine hesitancy group.

“At the same time, we have influx of immigrants of unknown vaccination status,” he said.

Dr Hisham pointed out that with immunisation, smallpox had been eradicated and the world was declared free of smallpox in 1980.

The last reported case was in 1978 (laboratory acquired) and 1977 was the last case in community.

Health Minister Datuk Seri Dr S. Subramaniam said when the Government introduced the use of the various vaccines, it would weigh the pros and cons and would only use it when they were convinced that the advantages far outweigh the disadvantages.

Solve garbage problem within a month, Selangor authorities told

PETALING JAYA: The Selangor state and local authorities have been asked to solve the garbage management problem in the Petaling and Hulu Langat districts within a month.

They are to present updates on the garbage management situation to the national task force meeting on dengue next month, said Health director-general Datuk Seri Dr Noor Hisham Abdullah.

“From Health Minister Datuk Seri Dr S. Subramaniam’s visits to Kampung Sungai Kayu Ara and Taman Taming Jaya flats, the issue of garbage in Selangor was not managed well.

“Too many piles of garbage were uncollected while the surroundings are dirty,” he said in a press statement posted on www.kpkesihatan.com yesterday.

Dr Noor Hisham said the services provided were not enough for the community – for instance, only three garbage bins were provided for four blocks of flats.

The garbage management was still being implemented in stages in Petaling and Hulu Langat districts, he said.

Local authorities were also asked to take dengue preventive measures in view of ­traders selling their food and wares into the night during Ramadan.

“They must carry out larvaciding and preventive fogging in public places. They must also ensure that rubbish are collected and the surrounding area cleaned up,” he said.

From June 28 to July 4, a total of 2,832 dengue cases were reported nationwide compared with 2,710 cases the week before, which is a 5% increase.

From January to July 4, a total of 59,365 cases had been reported compared with 44,518 cases for the same period last year, an increase of 14,847 or 4%.

There were 165 dengue deaths in total, almost double the number (85) in the same period last year. The top three states with the highest number of dengue cases were Selangor (726), followed by Johor (217) and Perak (52).

Local authorities to be penalised in anti-dengue op

the star

BY LOH FOON FONG

PETALING JAYA: In an unprecedented move to battle the dengue scourge, the Health Ministry will fine local authorities if they fail to clean up areas under their care.

Health Minister Datuk Seri Dr S. Subra­maniam said that the ministry would penalise the local authorities under the Destruction of Disease Bearing Insect Act 1975 if their areas were found to be breeding mosquitoes.

“If we find the absence of action by the local authorities contributed to breeding of mosquitoes, our ­ministry will take action against them,” he said during a spot check in Kampung Sungai Kayu Ara here yesterday.

Dr Subramaniam said the ministry would not hesitate to act against the local authorities if they conti­nued to turn a blind eye to cleanliness issues.

Deputy health director-general Datuk Dr Lokman Hakim Sulaiman said no fines had been imposed against errant government departments until now.

From January to June 20, Kampung Sungai Kayu Ara, which covers a 162ha area, made up of mainly flats, condominiums, residential areas and squatter areas, had reported 288 dengue cases with two deaths.

Pointing to the sites where people had dumped rubbish, including the river, Dr Subramaniam said the local authorities had not done well in garbage collection.

“Whatever measures we take will not succeed if the local authorities and residents do not take this seriously and change their attitude,” he said.

A resident in Jalan Cempaka, Husin Chea, 56, said garbage bins provided by the Petaling Jaya City Council (MBPJ) were not enough and garbage collection was not frequent enough although it was done regularly.

He said the presence of many foreigners in the area also added to the bulk of the garbage, adding that outsiders were also throwing rubbish into their neighbourhood.

More needs to be done in Kayu Ara

PETALING JAYA: The Petaling Jaya City Council (MBPJ) has admitted that work needs to be done in Kampung Sungai Kayu Ara although the garbage situation has improved in the last two years following efforts to clean up the area.

MBPJ Solid Waste Manage­ment Department director Lee Lih Shyan said they had placed six huge garbage bins along Jalan Cempaka for the community there.

Although it was adequate according to the number of residents, he said illegal dumping of waste by outsiders posed a challenge.

“We are in the midst of solving the problem as we discovered it last year and we are doing our best to solve the issue,” he said, adding that the contractor had been collecting the bulk garbage three times a week.

Lee said this following Health Minister Datuk Seri Dr S. Subra­maniam’s comment that the local authorities had failed to address the garbage problem in Kampung Sungai Kayu Ara.

Dr Subramaniam said he would do spot checks once every two weeks in areas with high dengue cases in the country.

Lee also said that vacant idle land and illegal recycling activities also posed a challenge to the garbage issue there.

He said traders tended to leave their garbage indiscriminately after sorting out and taking only things they wanted.

Health Ministry to penalise local authorities indifferent to dengue menace

the star
BY LOH FOON FONG

PETALING JAYA: In an unprecedented move to battle the dengue scourge, the Health Ministry has warned local authorities that it would fine them if they fail to buck up and clean up areas under their care.

Health Minister Datuk Seri Dr S. Subramaniam said the Ministry would not hesitate to fine them under the Destruction of Disease Bearing Insect Act 1975 if their localities were found to be breeding mosquitoes.

"If we find that the absence of action on the part of the local authorities has contributed to breeding of mosquitoes, our Ministry, if we have evidence, we will take action against them," he said.

Dr Subramaniam said this during a spot check at Kampung Sungai Kayu Ara here Friday morning.

Under the Act, owners of premises found breeding mosquitoes could be issued a compound of up to RM500 or charged in court, said deputy health director-general Datuk Dr Lokman Hakim Sulaiman.

First-time offenders can be fine not more than RM10,000 or jailed for not more than two years while repeat offenders can be fined RM50,000, jailed two years or both.

He said such action had never been taken against other Government departments, including schools, until now.

Dr Subramaniam said the Ministry would not hesitate to move in this direction due to the severity of the situation.

He said this when asked the action that the Ministry would take if local authorities do not clean up their backyard, as many such instances had been highlighted by the press.

"For now, I am asking the state health director to give updates and show pictures of problematic sites to state authorities and asked them what action the authorities will take," he said.

Don: Rope in university students to tackle dengue

PETALING JAYA: With the dengue threat continuing unabated, a health expert has suggested that the brains of university students be picked on how best to counter the menace.

Universiti Malaya virologist Prof Dr Sazaly Abu Bakar wants a competition held in universities to come up with ideas on how to reduce dengue infections.

Backing the decision of the national dengue task force in getting universities to “adopt” nearby dengue hotspots, Dr Sazaly said such a competition would help in the search for a solution.

“But there must be clear targets on what is needed,” he added.

On Wednesday, the taskforce, made up of several ministries and agencies, announced that it would work with the Education Ministry to get 27 public and private higher education institutions involved in the fight against dengue.

Dr Sazaly said university students and staff should be guided on how to protect themselves from the Aedes mosquitoes.

He also said many Malaysians were still “uneducated” on rubbish disposal and that the students could help overcome this.

“Malaysians often think that it’s the Government’s job to keep places clean. This mindset has to go,” he added.

Dr Sazaly said getting local councils to fumigate areas was not enough. “We must do more.”

Varsities to help fight dengue

PETALING JAYA: Universities will be roped in to “adopt” nearby dengue hotspots to fight the menace.

The national dengue task force, made up of multiple ministries and agencies, has decided this and will collaborate with the Education Ministry. The move will involve 27 public and private higher education institutions.

“The universities will be guided by state health offices. This is to create awareness and bring about change in health-seeking behaviours,” Health director-general Datuk Seri Dr Noor Hisham Abdullah said yesterday.

The task force’s latest move was posted on his Facebook page after its meeting yesterday.

The universities would also organise “Dengue Free Campus” programmes involving staff and students, he said.

Dr Noor Hisham said private hospitals were also asked to ensure that their physicians updated themselves with the latest guidelines on clinical management of dengue as 20% of dengue deaths nationwide occurred in their facilities.

“We will work together with the Association of Private Hospitals of Malaysia in making this happen,” he said.

According to ministry data, another four dengue patients died during the week June 21 to 27, putting the country’s total dengue deaths this year at 162.

From January to June 27, the ministry reported 56,533 dengue cases with 162 deaths compared with 42,229 cases and 82 deaths during the same period last year.

The ministry expected the increasing trend in dengue cases to continue until the end of the year.

Healthcare industry urged to improve services

PETALING JAYA: Malaysian healthcare industry members have been challenged to improve services.

In giving the thumbs up to medical tourism, Malaysian Medical Association president Dr Ashok Philip said the healthcare sector should keep improving its services to meet patients’ needs.

He said more private medical centres were being accredited by the Malaysian Society for Quality in Healthcare and the Joint Commission International.

“Because of that, foreign patients have a fair amount of confidence,” he said in a telephone interview.

He was responding to Prime Minister Datuk Seri Najib Tun Razak’s announcement on Tuesday that medical tourism would be made a priority for Malaysia.

Malaysia had 770,000 medical tourists last year, bringing in around RM700mil in revenue.

The number is expected to rise to 930,000, with an estimated revenue of RM1bil, he said.

Dr Ashok said the country was attracting medical tourists in a big way and had many repeat customers, especially from Indonesia.

Asked if medical tourism might worsen the brain drain in public healthcare, Dr Ashok agreed that private hospitals generally roped in more specialists from the public sector.

And for this reason, the Health Ministry encouraged more doctors to go for alternative ways of getting their Master’s degrees.

However, Fomca secretary-general Datuk Paul Selvaraj is worried that with increasing demands from medical tourism, the private sector would keep taking specialists from the public sector and this would cause a longer waiting period for patients there.

“The focus should be on improving healthcare for Malaysians first,” he said.