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
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

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 4th NCCR 2010, 2nd June 2010
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
1.As a concern of “children”
(Family Health Development Division as part of
MCH)

2.Asan 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

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 4th NCCR 2010, 2nd June 2010
 Vaccine Preventable Disease

 Diseases  Cancer
 Tb  Hepatoma
 DTP  Ca cervix
 Hib
 MMR
 Polio
 Yellow fever
 Meningococcal
 etc

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:  Mumps
 Tuberculosis  H. influenza b
 Diphteria Seasonal flu
Own pocket: 

 Pertussis  Rotavirus  Yellow fever

 Tetanus  Varicella  JE
 Polio  HPV  Meningococcal
 Hepatitis B  Pneumococcal meningitis for hajj
 Hepatitis A HPV
 Measles 
 Typhoid
 Rubella  Seasonal flu
 Meningococcal meningitis for
umrah

Ministry of Health Malaysia

 National Immunisation Schedule
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

Ministry of Health Malaysia 13
 Summary Of Injection Site

Vaccine Route of Injection site

administration
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
Hep B (Dos
Year DPT (Dos 3) Hib (Dos 3) Polio (Dos 3)
3) MMR

1- < 2
Deno TBIS ELB TBIS ELB TBIS ELB TBIS ELB 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
DPT (DOS 3) HIB (DOS 3)
DENOMINATOR
% %
Sataes 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

 IMMUNISATION COVERAGE , 2010
POLIO (DOS 3) MMR
DENOMINATOR
NEGERI %
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

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 DA SEMULA POLIO SEMULA MMR
ENROLMEN 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
Catatan
Bil. Perkara Tarikh
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  DON’TS
Use checklist before immunisation  Freeze the vaccines and
Refer if any h/o AEFI in previous diluents (BCG and measles
injection must not be frozen after
Protect vaccine from light and heat reconstitution)
Use specific diluent for specific  Use expired vaccine
vaccine
 Use vaccine if any changes
Apply specific injection technique
in color/appearance
Always close the fridge properly
 Mix with food/medicine
Plan before opening fridge
 Open the fridge frequently
Monitor and chart temp 2x/day
Check the power supply
 Leave a needle in the vial
Place fridge at appropriate distance  Keep frost in the freezer
to the wall
Arrange and label your vaccine
stock properly (first in, first out)

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 4th NCCR 2010, 2nd June 2010
 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 33

 Success story: Poliomyelitis Cases Vs Polio
Vaccination Coverage, Malaysia; 1980 - 2010
No. of cases % coverage
130 120
120
110 100
100
90
80
80
70
60
60
50
40
40
30
20 20

10
0 0
74

76

78

80

82

84

86

88

90

92

94

96

98

00

02

04

06

08

10
19

19

19

19

19

19

19

19

19

19

19

19

19

20

20

20

20

20

20
OPV started in 1972
Year
Poliomyelitis case Immunisation Coverage
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
300

250

200

150

100

2 pos cases
50

0
1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

Year

Ministry of Health Malaysia

 EPI vaccination coverage in Malaysia,
1980 – 2010
imm. coverage

110

100

90

80

70

60

50
1990 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
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

Ministry of Health Malaysia