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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
Ministry of Health Malaysia 4th NCCR 2010, 2nd June 2010 Ministry of Health Malaysia
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
Ministry of Health Malaysia 4th NCCR 2010, 2nd June 2010 Ministry of Health Malaysia
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.
Ministry of Health Malaysia
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.
Ministry of Health Malaysia 4th NCCR 2010, 2nd June 2010 Ministry of Health Malaysia
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
Ministry of Health Malaysia 4th NCCR 2010, 2nd June 2010 Ministry of Health Malaysia
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
Ministry of Health Malaysia
Vaccine Preventable Disease
Diseases
Tb
DTP
Hib
MMR
Polio
Yellow fever
Meningococcal
etc
Cancer
Hepatoma
Ca cervix
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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)
Ministry of Health Malaysia
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.
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia
Needle position in various type of injection
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia
IMMUNISATION COVERAGE DTP DOS 3 NEGERI KELANTAN
JAN-DIS 2010
Ministry of Health Malaysia
IMMUNISATION COVERAGE DTP DOS 3 NEGERI KELANTAN
JAN-JUN 2011
Ministry of Health Malaysia
IMMUNISATION COVERAGE HEP B DOS 3 NEGERI KELANTAN
JAN-DIS 2010
Ministry of Health Malaysia
IMMUNISATION COVERSGE HEP B DOS 3 NEGERI KELANTAN
JAN-JUN 2011
Ministry of Health Malaysia
IMMUNISATION COVERAGE MMR NEGERI KELANTAN JAN-DIS 2010
Ministry of Health Malaysia
IMMUNISATION COVERAGE MMR NEGERI KELANTAN JAN-JUN 2011
Ministry of Health Malaysia
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
Ministry of Health Malaysia
IMMNUSATION COVERAGE ATT FORM 3 - 2010
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia 4th NCCR 2010, 2nd June 2010 Ministry of Health Malaysia
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 4th NCCR 2010, 2nd June 2010 Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia
Success story: Measles incidence Vs MCV Vaccination
Coverage, Malaysia; 1970 - 2010
Measles containing vaccine (MCV) started in 1982
Ministry of Health Malaysia
Incidence of neonatal tetanus
(per 1,000 LB); 1975 – 2010
Ministry of Health Malaysia
Number of diphtheria cases, 1975 – 2010
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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
Ministry of Health Malaysia
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.
Ministry of Health Malaysia
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)
Ministry of Health Malaysia
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.
Ministry of Health Malaysia
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.
Ministry of Health Malaysia
Healthy children,
healthy nation.
Thank you