THE shocking news that a three-month-old infant is critically ill and on life support after being diagnosed with poliomyelitis in Tuaran, Sabah, is indeed devastating.
This is the first reported polio case in 27 years in Malaysia. The last documented case of polio was in 1992 whilst the last major outbreak was in 1977 with 121 cases due to wild poliovirus. In 2000, the World Health Organization (WHO) declared Malaysia polio-free as part of the Western Pacific region.
Malaysia introduced and incorporated the oral polio vaccine into the national immunisation programme (NIP) in 1972. In 2008, the oral polio vaccine was replaced with the combined five-in-one diphtheria, tetanus, pertussis, injectable inactivated polio and haemophilus influenzae b (DTaP-IPV-Hib) vaccine.
At the national level, the vaccine coverage rate for completing the three primary doses of the combined vaccine at two, three and five months of age is more than 95% which would confer herd immunity. However, there exists pockets of communities where the vaccine coverage rate is lower and in Tuaran, where the infant was diagnosed, the vaccine coverage rate was only 88%.
In healthcare, vaccination is the most efficient and effective way to remain healthy and free from disease. For parents, vaccination is an act of love and a gift of life free from death and disabilities from vaccine preventable diseases (VPD).
Parents should ensure that their children are protected from VPD such as polio, diphtheria and measles. At the community level, herd immunity can be achieved only if the vaccination coverage rate is high.
Healthcare providers, teachers, parents, community leaders and all individuals in the neighbourhood should take responsibility to ensure that children, the elderly and vulnerable populations receive their due vaccinations.
Remote and marginalised communities including refugees, stateless, undocumented and migrant populations must be similarly accessed to defuse a potential VPD time bomb.
In recent years, social media has opened the doors to highly vocal anti-vaccine groups and individuals who have refused any form of immunisation and are trying to influence others. WHO has described vaccine hesitancy as one of the ten threats to global health in 2019.
In December, WHO described the global measles epidemic as “an outrage” because most deaths were of children under five who had not been vaccinated. WHO director-general Tedros Adhanom Ghebreysus when commenting on the 70 deaths due to measles in Samoa said, “The fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world’s most vulnerable children.”
In 2013, there were 195 cases of measles in Malaysia and from 2013 to 2017 there were six measles deaths. In 2018 alone, there was a 10-fold increase of measles cases (1,934) and six measles deaths. Coverage for the measles-mumps-rubella (MMR) vaccines had dropped from 94.4% in 2016 to 88.8% in 2017.
From 2016 to 2018 we saw the re-emergence of diphtheria with 80 cases which caused 16 deaths. We had 892 cases of whooping cough in 2018, resulting in 22 deaths.
Local data is similar to the global scenario where with declining vaccine uptake rates, the world is witnessing the resurgence of previously eliminated VPD.
Like many other countries, Malaysia should seriously consider mandatory vaccination for our children to prevent the spread of these deadly and debilitating VCDs, to protect our vulnerable children and the wider community.
The Malaysian Paediatric Association is confident that the two eminent doctors helming our nation would approve of this initiative to work in tandem with the Health Ministry’s (MOH) public awareness campaigns, debunking the anti-vaccine rhetoric.
As a group of paediatric specialists, nurses and allied healthcare professionals, we have since our inception in 1979 been at the front line, advocating child healthcare and welfare.
Among others, alongside our MOH colleagues we have strived for the inclusion of the hepatitis B vaccine in 1989, MMR and Hib vaccines in 2002 and more recently the pneumococcal conjugate vaccine in 2020.
We urge all parents and guardians to ensure that the immunisation status of their children are up-to-date. Do visit government health centres to enquire about your child’s immunisation and/or to get the missing vaccine shots which are free.
More than 70% of vaccine websites on the Internet and social media are actually toxic anti-vaccine propaganda. Do not fall prey to the widespread disinformation by the few but noisy anti-vaxxers in cyberspace.
Reliable websites on vaccines in 10 languages can be found on www.who.int/vaccine_safety/initiative/communication/network/vaccine_safety_websites/en/
For local information on vaccination, we have the Immunise4Life website (www.ifl.my) and Facebook account.
We pray and hope that the baby in Tuaran recovers from this crippling disease and that the epidemic is rapidly contained with vigilant surveillance and prompt and comprehensive outbreak response by MOH.
DR HUNG LIANG CHOO, President, Malaysian Paediatric Association
DATUK DR ZULKIFLI ISMAIL, Secretary-general, Asia Pacific Pediatric Association
DR THONG MEOW KEONG,President, College of Paediatrics Academy of Medicine of Malaysia
Source: The Star, 14 Dec, 2019