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Malaysian immunization

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Ramesh Ramachundran
Ramesh Ramachundran

Immunization is the process of giving vaccines to protect against diseases like tuberculosis, diphtheria, pertussis, tetanus, polio, measles, rubella and hepatitis B. Vaccines provide active immunity by exposing the immune system to antigens without causing the full disease. Passive immunity is provided through immunoglobulin injections which provide immediate but temporary protection. Children should be immunized according to the Ministry of Health's schedule to ensure full protection from vaccine-preventable diseases.

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What isimmunization? Immunizationorvaccinationis thevaccinegiven to someone toprotect them from somespecificdiseases.Antibodies from the motherwill givetemporary shelterfor aboutsixmonths, thebabyshould beprotected fromimmunetothe disease. Immunizationsgiven tochildrenand infantsis the mosteffective andcost-effectiveto protect themfrom thediseasetuberculosis (TB), diphtheria,pertussis(whooping cough), tetanus(tetanus),poliomyelitis, measles,rubellaand hepatitisB. Howeverthere are stillchildren who arenotimmunizedbecause oflack of knowledge aboutvaccinesandimmunization schedules,misconceptionsabout the contraindications,concernsaboutvaccineside effectsandcomplications.
What isactive immunity? Acquiredactiveimmunityby givingthe vaccineby injectionorby mouth.Examples of vaccineconsists of the following:- (i)"Live-attenuatedvaccines"(liveattenuatedvaccine), such aspoliomyelitis vaccine(OPV), measles,rubellaandBCG. (ii)"Killedvaccines"(deadvaccine), such aspertussisandinactivatedpoliomyelitis vaccine(IPV). (iii)'sub-unitvaccine'(subunitvaccine), such asPneumococcusvaccine, hepatitisB,influenza. (iv)"Toxoid"(toksoid)such astetanusdiphtheriavaccine. Most vaccinesprotect againstdiseaseby stimulatingthe immune systemto produce antibodies.BCG vaccineprovides protectionbyimmunecells (cellmediated immunity). OPValsoprovidelocalimmunity(localimmunity)in the intestinal tract.
What ispassiveimmunity? Passiveimmunityis obtainedby injectionofhumanimmunoglobulin.Although the protection givenis immediate,butit isonlyeffectivefora few weeks.There aretwo types ofimmunoglobulins, namely: (i)"NormalHumanImmunoglobulin"(HNIG)obtained fromplasmadonorsand contains antibodiesagainst the viruswhich is now inthe general population.Example ofuse isHNIGgrantto childrenlackedimmune(immunosuppressedchildren)exposed tomeaslesif theyhave not beeninfected. (ii)immunoglobulinspecific fortetanus, hepatitisB,rabiesandvaricella/zoster(chicken pox).Thisimmunoglobulin isderivedfrom blooddonorswho arerecovering fromthese diseases, blooddonorsimmunizednewlaws andthosefound to havehigh antibodylevels.Thuseachspecificimmunoglobulincontainingantibodiesto higher levelsthanHNIG.Instances wherespecificimmunoglobulinusedis the administration of"HepatitisBimmunoglobulin"(HBIG)to thenewbornifthe mother isHbsAg positive.
Wheninfantsand childrenshould beimmunized? They wereimmunizedaccording tothe Ministry of Healthimmunization schedule. (i)Baby
(ii)Children aged1-4years 1½-2years ofadditionaldoses ofDPTandOPVfirst
(iii)School children Standard 1-DTandtwoadditionaldoses ofOPV BCG(if noscar) Rubella(for girlsonly) Standard 6-BCG Form III-TetanusToxoid (iv)mothers Beginning ofthe firstdose oftetanusToksoidduring pregnancy24-28weeks (Kementerian Kesihatanpromotestoksoidtetanusgiven whenpregnancyconfirmed)TetanusToxoidseconddose6-8weeks afterthe firstdose oftetanustoxoid ExtensionOnedoseof eachpregnancy.
What are thecontraindicationstoimmunization? 1) Feverdue toseriousillness.Delayedimmunizationonly 2) Immunodeficiencyconditionsarecontraindicationsto the&quot;live-attenuatedvaccines&quot; only.&quot;Killedvaccines&quot;can be given. Immunodeficiencyconditions, including: (i)illness, inheritedimmunodeficiency (ii)leukemia,lymphoma,Hodgkin'sdiseaseand others.Immunizationbe deferred until6months aftertreatmentfinished. (iii)immunosuppressivetreatmentand radiation.Immunizationbe deferred until6months aftertreatmentfinished. (iv)treatment withcorticosteroids such asprednisone2mg/kg/ dayfor>7days orlow dose/moderateevery dayfor>2 weeks.Immunizationbe deferred until3months aftertreatmentfinished.Childrenaregivena lowdose/moderatefor<2 weeksand thosegivena lowdoseevery other dayforlonger periods of timecanbe&quot;live-attenuatedvaccines.“ Inhaledsteroidsarenotcontraindicated.
3.Pregnancy&quot;live-attenuatedvaccines&quot;should not be granted 4.Specificcontraindications: (i)BCG-HIV infection isabersimptomatik (ii)HepatitisB-There are nocontraindications (iii)Pertussis- (a)a progressiveneurologicaldiseasesuch asinfantilespasms (b)in response toearlierdoses, such as -anaphylaxis -The&quot;shock&quot; -Convulsionsand feverin72 hours -Fever>40.5Cwithin48 hours -Encephalopathyin 7 days
(iv)Diphtheria-nocontraindications (v)Tetanus-nocontraindications (vi)Polio-diarrhea(vaccinegiven, butthis doseis not counted.The doseshould be repeatedlater) (vii)Rubella-Pregnancy (viii)Measles(measles)-anaphylaxistoeggprotein
The followingis not acontraindicationtoimmunization - Lowor moderatefever<38.5Cdue tocommonillnesssuch as coughs, coldsand diarrhea - Skindiseaseslikeeczema,boils andringworm - Low birth weight - Malnutrition - Progressiveneurologicaldiseasethat is notascerebralpalsy,laterdevelopments,a seizurebecause of f ever,seizuresunder controlanddown syndrome. - Neonatal jaundice,G6PDdeficiency - History ofmeaslesdiseasewithoutserologicevidence - Pregnant women(unless therubellavaccine)--- - Historyof miscarriageinpregnantmothers(ATT) - HIV (refer to theBCG) - History ofepilepsyin the family - Congenitalheartdisease *Reference to thedoctorsto makedecisions aboutimmunizationis recommended
What are thecomplications ofvaccination? Immunisationis safe, butsometimesthere may besomecomplications.Localcomplicationssuch as swelling,inflammation,boils orulcersat the injection siteshould be referred toa doctor ifserious. Lowfevercan be treated withparacetamol, buthigh fever,cryingnon-stopfor more thantwo hoursor any otherneurologicalsymptomsshould be referredto the hospital. Ifthe occurrence ofseizuresoranaphylacticreactions,emergency treatmentshould bereferred to the hospitalbefore.
How does anurseor doctorcan make sureallchildrenarefullyimmunized? Each timea child isbeing treated ata clinic orhospitalimmunizationstatusshould be reviewed.Ifthere are anythat have not beengrantedimmunity, he must beimmunized prior toleaving theclinic or hospital. Anydecision to postponeor notimmunizeshould be madeaftercarefullyconsidering theconsequencesof our actionsonthe child.In this case,a doctormustprovide a writtencomprehensiveimmunization scheduleforchildren.

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Malaysian immunization

  • 1.
  • 2. What isimmunization? Immunizationorvaccinationis thevaccinegiven to someone toprotect them from somespecificdiseases.Antibodies from the motherwill givetemporary shelterfor aboutsixmonths, thebabyshould beprotected fromimmunetothe disease. Immunizationsgiven tochildrenand infantsis the mosteffective andcost-effectiveto protect themfrom thediseasetuberculosis (TB), diphtheria,pertussis(whooping cough), tetanus(tetanus),poliomyelitis, measles,rubellaand hepatitisB. Howeverthere are stillchildren who arenotimmunizedbecause oflack of knowledge aboutvaccinesandimmunization schedules,misconceptionsabout the contraindications,concernsaboutvaccineside effectsandcomplications.
  • 3. What isactive immunity? Acquiredactiveimmunityby givingthe vaccineby injectionorby mouth.Examples of vaccineconsists of the following:- (i)&quot;Live-attenuatedvaccines&quot;(liveattenuatedvaccine), such aspoliomyelitis vaccine(OPV), measles,rubellaandBCG. (ii)&quot;Killedvaccines&quot;(deadvaccine), such aspertussisandinactivatedpoliomyelitis vaccine(IPV). (iii)'sub-unitvaccine'(subunitvaccine), such asPneumococcusvaccine, hepatitisB,influenza. (iv)&quot;Toxoid&quot;(toksoid)such astetanusdiphtheriavaccine. Most vaccinesprotect againstdiseaseby stimulatingthe immune systemto produce antibodies.BCG vaccineprovides protectionbyimmunecells (cellmediated immunity). OPValsoprovidelocalimmunity(localimmunity)in the intestinal tract.
  • 4. What ispassiveimmunity? Passiveimmunityis obtainedby injectionofhumanimmunoglobulin.Although the protection givenis immediate,butit isonlyeffectivefora few weeks.There aretwo types ofimmunoglobulins, namely: (i)&quot;NormalHumanImmunoglobulin&quot;(HNIG)obtained fromplasmadonorsand contains antibodiesagainst the viruswhich is now inthe general population.Example ofuse isHNIGgrantto childrenlackedimmune(immunosuppressedchildren)exposed tomeaslesif theyhave not beeninfected. (ii)immunoglobulinspecific fortetanus, hepatitisB,rabiesandvaricella/zoster(chicken pox).Thisimmunoglobulin isderivedfrom blooddonorswho arerecovering fromthese diseases, blooddonorsimmunizednewlaws andthosefound to havehigh antibodylevels.Thuseachspecificimmunoglobulincontainingantibodiesto higher levelsthanHNIG.Instances wherespecificimmunoglobulinusedis the administration of&quot;HepatitisBimmunoglobulin&quot;(HBIG)to thenewbornifthe mother isHbsAg positive.
  • 5. Wheninfantsand childrenshould beimmunized? They wereimmunizedaccording tothe Ministry of Healthimmunization schedule. (i)Baby
  • 6. (ii)Children aged1-4years 1½-2years ofadditionaldoses ofDPTandOPVfirst
  • 7. (iii)School children Standard 1-DTandtwoadditionaldoses ofOPV BCG(if noscar) Rubella(for girlsonly) Standard 6-BCG Form III-TetanusToxoid (iv)mothers Beginning ofthe firstdose oftetanusToksoidduring pregnancy24-28weeks (Kementerian Kesihatanpromotestoksoidtetanusgiven whenpregnancyconfirmed)TetanusToxoidseconddose6-8weeks afterthe firstdose oftetanustoxoid ExtensionOnedoseof eachpregnancy.
  • 8. What are thecontraindicationstoimmunization? 1) Feverdue toseriousillness.Delayedimmunizationonly 2) Immunodeficiencyconditionsarecontraindicationsto the&quot;live-attenuatedvaccines&quot; only.&quot;Killedvaccines&quot;can be given. Immunodeficiencyconditions, including: (i)illness, inheritedimmunodeficiency (ii)leukemia,lymphoma,Hodgkin'sdiseaseand others.Immunizationbe deferred until6months aftertreatmentfinished. (iii)immunosuppressivetreatmentand radiation.Immunizationbe deferred until6months aftertreatmentfinished. (iv)treatment withcorticosteroids such asprednisone2mg/kg/ dayfor>7days orlow dose/moderateevery dayfor>2 weeks.Immunizationbe deferred until3months aftertreatmentfinished.Childrenaregivena lowdose/moderatefor<2 weeksand thosegivena lowdoseevery other dayforlonger periods of timecanbe&quot;live-attenuatedvaccines.“ Inhaledsteroidsarenotcontraindicated.
  • 9. 3.Pregnancy&quot;live-attenuatedvaccines&quot;should not be granted 4.Specificcontraindications: (i)BCG-HIV infection isabersimptomatik (ii)HepatitisB-There are nocontraindications (iii)Pertussis- (a)a progressiveneurologicaldiseasesuch asinfantilespasms (b)in response toearlierdoses, such as -anaphylaxis -The&quot;shock&quot; -Convulsionsand feverin72 hours -Fever>40.5Cwithin48 hours -Encephalopathyin 7 days
  • 10. (iv)Diphtheria-nocontraindications (v)Tetanus-nocontraindications (vi)Polio-diarrhea(vaccinegiven, butthis doseis not counted.The doseshould be repeatedlater) (vii)Rubella-Pregnancy (viii)Measles(measles)-anaphylaxistoeggprotein
  • 11. The followingis not acontraindicationtoimmunization - Lowor moderatefever<38.5Cdue tocommonillnesssuch as coughs, coldsand diarrhea - Skindiseaseslikeeczema,boils andringworm - Low birth weight - Malnutrition - Progressiveneurologicaldiseasethat is notascerebralpalsy,laterdevelopments,a seizurebecause of f ever,seizuresunder controlanddown syndrome. - Neonatal jaundice,G6PDdeficiency - History ofmeaslesdiseasewithoutserologicevidence - Pregnant women(unless therubellavaccine)--- - Historyof miscarriageinpregnantmothers(ATT) - HIV (refer to theBCG) - History ofepilepsyin the family - Congenitalheartdisease *Reference to thedoctorsto makedecisions aboutimmunizationis recommended
  • 12. What are thecomplications ofvaccination? Immunisationis safe, butsometimesthere may besomecomplications.Localcomplicationssuch as swelling,inflammation,boils orulcersat the injection siteshould be referred toa doctor ifserious. Lowfevercan be treated withparacetamol, buthigh fever,cryingnon-stopfor more thantwo hoursor any otherneurologicalsymptomsshould be referredto the hospital. Ifthe occurrence ofseizuresoranaphylacticreactions,emergency treatmentshould bereferred to the hospitalbefore.
  • 13. How does anurseor doctorcan make sureallchildrenarefullyimmunized? Each timea child isbeing treated ata clinic orhospitalimmunizationstatusshould be reviewed.Ifthere are anythat have not beengrantedimmunity, he must beimmunized prior toleaving theclinic or hospital. Anydecision to postponeor notimmunizeshould be madeaftercarefullyconsidering theconsequencesof our actionsonthe child.In this case,a doctormustprovide a writtencomprehensiveimmunization scheduleforchildren.
  • 14.