The real threats of diseases

The real threats of diseases

Vaccines have helped combat common diseases which have claimed thousands of lives in the past. However, it is crucial to keep immunisation programmes going to prevent these diseases from coming back.

Since its wide scale implementation in 1950s, Malaysia’s immunisation programme has been key in saving the lives of scores of children from infectious disease such as measles and hepatitis B. However, these diseases have been rising steadily in recent years, which experts say are partly attributed to a growing number of parents who are refusing to vaccinate their children.

Measles

Some adults may remember getting measles, and may not see it as a big deal as they recovered from the infection. This has been among the excuses given by parents who refrain from getting their children vaccinated. After all, what is a bout of fever and a little bit of rash?

However, measles is a highly contagious disease that still remains as a leading cause of death and disability among young children globally.

The measles virus spreads via water droplets from the nose or mouth, and those who are not vaccinated from the disease risk developing more serious health complications. While it may start with a high fever or a runny nose, measles can lead to pneumonia, encephalitis (inflammation of the brain), and even blindness. In more severe cases, it can lead to death.

In the 1980s, before the existence of immunisation programmes, the diseases caused an estimated 2.6 million deaths annually. Even with the availability of a safe and effective vaccine, the disease still causes a significant number of fatalities. According to the World Health Organisation (WHO), there were 134,200 measles deaths in 2015 – many of these were children under the age of five. However, the WHO adds that the availability of vaccines meant that 20.3 million lives were still saved.

It is disturbing then that the number of measles cases increased dramatically from 2015 to 2016. While there were only 197 recorded cases of measles in first half of 2015, there 873 cases of the disease in the same period last year. Meanwhile in 2014, there were only 11 reported measles outbreaks and outbreak rose to 57 in 2015.

Under the national immunisation programme in Malaysia, children should receive two doses of the measles, mumps, and Rubella (MMR) vaccine. According to the Health Ministry’s research, it found that the MMR vaccine has an 85% success rate at preventing measles, and a 99% success rate when delivered in two doses.

Previously, the first shot was administered to 12-month-old babies, followed by a booster shot when the child is of pre-school age. In 2016, the Health Ministry updated its immunisation schedule to deliver the first dose of the MMR vaccine at a younger age of nine months. The second dose is then given at 12-months old. When announcing the new schedule last year, the ministry stated that the changes were due to its research on the incidence of measles among children in the country. “In the past five years, we found that most cases of measles occurred in children under the age of one, and these children are the ones at the greatest risk of contracting the disease,” it said in a press statement.

Tuberculosis and migration

While migrant workers tend to be unfairly blamed for many social ills, undocumented workers who do not undergo mandatory medical screenings do pose a real public health risk. It was widely reported in the media last year that Malaysian authorities expect more cases of tuberculosis (TB) to be reported, due to a rise in undocumented migration.

Health Ministry data shows that TB deaths increased from 1,603 in 2014, to 1,696 deaths in 2015. The number of TB cases in the country also rose to 24,220 cases in 2015 from 10,800 cases in 1990 – a 124% increase in just 25 years. Of the new cases TB recorded, 12.3% involved migrant workers, most of whom had not undergone a medical screening.

Revealing these statistics in Parliament last year, Deputy Health Minister Datuk Seri Dr Hilmi Yahaya said there was the added problem of migrant workers disappearing after they were found to have TB. “When they disappear, they will infect others around them too. This is the problem we are facing,” he said, adding that foreign nationals with TB need to receive treatment for six months to ensure that they were free from the disease.

For adult, a TB infection usually affects just the lungs, causing severe coughing, and sometimes the coughing up of blood. In children aged five and below however, the infection can spread to the brain and other organs, sometimes simultaneously. This can lead to serious implications, including disability and death.

The vaccine which combats TB is called Bacillus Calmette Gurrain (BCG), and is usually given at birth. The BCG vaccine contains a strain of mycobacterium bovis, a germ which causes TB in cattle.

While TB can be successfully treated if detected early, it requires a six to nine period of taking a combination of medicine to cure the infected person fully. Several strains of TB bacteria have developed resistance to one or more medications taken to treat TB making it hard to treat TB. As such, the best way to fight off the disease is preventing it in the first place through vaccination.

A vaccine against cancer

In Malaysia, cervical cancer is said to be the second most common form of cancer among women, with the National Cancer Registry reporting around 2,000 women being diagnosed with it every year. In many of these cases, the human  papillomavirus (HPV) is the main cause of the cancer.

HPV is a common virus that spreads through direct skin contact, and is one of the most commonly sexually-transmitted infection – if a man or woman is sexually-active, chances are they would have been infected with the virus at some point of their lives. Of the 40-odd strains of HPV that are transmitted sexually, most do not lead to any symptoms. Some strains however, such as HPV6 and HPV11, can cause genital warts. More serious strains such as HPV16 and HPV18, have been shown to account for 70% of cervical cancer cases worldwide.

Following the WHO recommendation of including HPV vaccine as part of immunisation programmes, Malaysia recently introduced the vaccination for older children. Since 2010, the Health Ministry has been offering the HPV vaccine for free to all female Form One students. The vaccine is also available without cost to those aged between 18 and 26 at government clinics.

When initially introduced, there were public concerns about not just the safety of the vaccine, but also that delivering it would encourage “sexual promiscuity” among teenagers. In a contrast with the status of other vaccines however, these claims were swiftly refuted by medical professionals and results are impressive – the Health Ministry’s statistics show that some 95% of parents have given consent for their daughters to receive the vaccination.

The vaccine is administered through three injections over a period of six months. While most people only experience some soreness after receiving the injection, the vaccine will not be given to those who develop more severe side effects following the first injection. The vaccine is also not administered to those who have had a history of serious allergic reactions.

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