Health Experts Highlight Protection of both Pregnant Mum and Child from Infectious Diseases

A recent online survey conducted by the Immunise4Life (IFL) has identified several gaps in childhood and maternal immunisation knowledge and practices among mums and mums-to-be.

To highlight and help address these gaps, IFL, under the purview of the Ministry of Health (MOH) Malaysia, the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases and Chemotherapy Malaysia (MSIDC), organised a media forum called ‘Doses of Love for Mom & Child’ in conjunction with World Immunisation Week. The session was officiated by YB Khairy Jamaluddin Abu Bakar, Minister of Health, Malaysia.

The media forum will be followed by a public education video series, released on IFL social media platforms between May and June 2022. Both initiatives are the result of collaborations with the Malaysian Medical Association (MMA), Medical Mythbusters Malaysia (M3), MedTweetMy (MTM) and Perinatal Society of Malaysia (PSM).

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Prioritising Protection of Pregnant Mums and Children Against Infections
YB Khairy Jamaluddin, in his officiation speech, emphasised that as a result of mother-and-child health being one of the Malaysian government’s key priority areas for decades, Malaysia’s maternal mortality ratio was 23.8 per 100,000 live births in 2018 compared with 280 per 100,000 live births in 1957. “Under-five mortality was also markedly reduced, by 90.2%, in 2020 (6.9 per 1,000 live births) from 70.2 per live births in 1965, putting Malaysia on par with advanced nations”.

In recent decades, childhood and maternal immunisation initiatives have been among the key factors contributing to lower mortality rates. He added that the MOH began its childhood National Immunisation Programme in the 1950s, with only a handful of vaccines being provided for free at MOH clinics. However, “Now, the childhood NIP protects Malaysian children from thirteen vaccine preventable diseases” he said.

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He also highlighted that the MOH began its maternal immunisation programme in 1976 by providing anti tetanus (ATT) vaccination for free to all pregnant women. Aimed at protecting mums and newborns from tetanus infection and complications, the programme continues to this day. However, the MOH is now planning to enhance it with the introduction of Tdap vaccination, which will protect mums and children from not only tetanus but also diphtheria and pertussis.

The COVID-19 vaccination programmes for pregnant women and children between the ages of five and eleven (PICKids) and twelve and seventeen (PICK-R) also showcase the MOH’s consistent and continuous efforts to protect mums, newborns and children from infections. YB stressed the importance of getting pregnant women and children vaccinated on time.

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Mothers Lack Awareness of Maternal Immunisation
Datuk Dr Zulkifli Ismail, Chairman of IFL Technical Committee said that, based on the survey, very few respondents are aware that Tdap (21.8%) and influenza (26.9%) vaccinations are recommended during pregnancy. However, awareness is higher for the need for COVID-19 (72.8%) and ATT (63.7%) vaccinations. These results reflect that the latter two vaccines are given for free by the MOH while Tdap and influenza are not. He also highlighted that most respondents are aware that maternal immunisation protects mums (78.7%), but only 64.2% know that it can also protect newborns, while 11.9% are not sure of its benefits.

Dr Mohd Hanif Zailani, public health medicine specialist and Head of Vaccine Preventable Diseases & Food/Waterborne Diseases Sector, MOH, pointed out that some maternal and childhood vaccines may not be among the eleven vaccines listed in the NIP and, which are available in only private clinics or private hospitals, but are just as important. “I would like to urge parents to get all the recommended maternal and childhood vaccinations, especially if they can afford to do so,” he said.

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Prof Dr Jamiyah Hassan, Consultant Obstetrician & Gynaecologist and Maternal-Fetal Medicine Specialist at University Technology Mara (UiTM) highlighted that many countries have introduced Tdap vaccine to replace ATT to counter the rise of pertussis cases among young children. She added that Malaysia is seeing an increase in pertussis cases with 70% of these involving babies under six months who are either too young to be vaccinated or have not completed their vaccination schedule. These infants often acquire pertussis infection from infected mothers and close family members. “Newborns and infants are more likely to suffer from serious pertussis complications that can lead to death,” she said.

Thus, vaccinating pregnant mothers against pertussis is crucial in two ways: It will 1) transfer antibodies from mum to fetus through the placenta and provide the child with protection from birth until the child is eligible to be vaccinated; 2) reduce the likelihood of mum spreading pertussis to the child. Prof Dr Jamiyah remarked, “I applaud the MOH’s intention to include Tdap to its maternal immunisation programme. I hope it will come to fruition soon.”

She also emphasised the importance of getting vaccinated against influenza during pregnancy because, just as pregnant women have been known to have more severe Covid-19 symptoms, they are also at risk of more serious flu complications. She said, “Most of us might have forgotten that, during the influenza H1N1 pandemic, many of the mortalities were pregnant mothers. We cannot afford to be complacent — vaccinating pregnant mothers against this preventable infectious disease is the right thing to do.”

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Stick to Your Childhood and Maternal Immunisation Schedules
Datuk Dr Zulkifli Ismail highlighted that while most respondents (92.9%) agree or strongly agree that vaccinating children on schedule is important, some are unable to put their convictions into practice. Among survey respondents, 15.5% have missed or delayed their child’s immunisation and 0.5% did not vaccinate their child at all. Most commonly cited reasons for preventable delayed or missed childhood immunisation appointments are “forgot” or “too busy”, followed by logistic/transportation and safety issues.

Dato’ Dr Musa Mohd Nordin, Consultant Paediatrician & Neonatologist, urged parents to stick to their child’s immunisation schedule. He stressed that the longer parents delay their child’s immunisation, the more chance of exposing their child to life threatening vaccine-preventable diseases. “You would not wait thirty minutes into a road trip before putting your infant in a car seat, would you? Accidents can happen at any time,” he said. He added that if parents accidentally miss their child’s immunisation appointment, they should call the clinic to reschedule as soon as possible.

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He said, “Some parents have asked what they should do if their child is two years late for a particular immunisation appointment. In most cases, for example pneumococcal, diphtheria, pertussis and polio, the vaccinations can and should be given even if the child has reached the ages of three or four. Do talk to your child’s doctor or paediatrician to determine what is best for your child.”

Prof Jamiyah emphasises that it is also important to follow the recommended maternal immunisation schedule. She emphasised that maternal immunisation, at the appropriate stage of pregnancy, aims to provide optimal protection to both mum and baby through optimal placental transfer of vaccine specific antibodies.

Pn Iman Abdul Rahim, a well-known blogger and mother of two shared her experience, “I try my best not to miss any immunisation schedule be it during my pregnancy or for my child. I set reminders on my phone and make sure the dates of the vaccinations are free of any work or other commitments. It also helps if my husband is aware of our child’s schedule so he can take over if there’s a need.”

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Childhood and Maternal Immunisations Are Safe
Datuk Dr Zulkifli highlighted that safety is less of an issue among respondents when it comes to childhood immunisation when compared with maternal immunisation. Among respondents, 81.5% agree or strongly agree that vaccines given to children are safe while only 62.8% agree or strongly agree that vaccinations given to pregnant women are safe.

Prof Jamiyah said that this could be due to the general lack of awareness among mothers about maternal immunisation. She assured parents and mums-to-be that the MOH does not approve the use of any drugs, including vaccines, on pregnant women in Malaysia unless there is significant research to prove their safety. Therefore, mums should not hesitate to get vaccinated and should ask their doctors about any worries they might have.

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